THE
NEW ORLEANS
i n
JOURNAL
EDITED BY
S. M. REMISS, M. D.,
W. II. WATKINS, M. D, S. S. HERRICK, M l).
PUBLISHED MONTHLY, AT $5 PER ANNUM , IN ADVANCE.
Volume VII. [New Series. | 1879-80.
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NEW ORLEANS:
L. GRAHAM, PUBLISHER, 127 GRAYIER STREET.
lo l
NClfl
NEW ORLEANS
Medical and Surgical Journal.
JULY, 1879.
PAGINAL poyViyVIUNICATIONS.
A Contribution to the Clinical History of Croupous
Pneumonia.
A report of Eleven Cases of Croupous Pneumonia occurring in private practice
between the dates of Feb. .and June, 1878.
By D. WEBSTER PRENTISS, A. M., M. D.,
Professor Mat. Medicaand Therapeutics, National Medical College, of Washington, D. C.
(Read before the Med. Society of Diet, of Columbia, March 25, 1879.)
Croupous pneumonia is an endemic disease belonging to the
class of infectious diseases.
It is only of comparatively recent date that the nature of
this disease has been correctly understood, nor indeed is it
even now admitted by all writers that the above proposition is
true.
To Austin Flint in this country, and Meinyer Jurgensen and
others in Europe, is due especial credit for pointing out with
clearness the natural history of croupous or “lobar” pneumonia,
and showing it to be a self limited disease, of constitutional
character, m which the local inflammation in the lung is but a
symptom of the general disturbance — -just as is the affection of
Peyer’s patches in typhoid fever, or the skin eruptions in the
exanthemata. The onset of croupous pneumonia is almost
always sudden, preceded by a chill, in which it corresponds
with other zymotic diseases. The lung lesion frequently does
not appear until the 2d or 3d day — and then bears no constant
relationship to the severity of the fever. The fever is regular
2
Original Communications.
[July
in its course with morning decline and evening exacerbation.
At the sudden crisis, about the 7th day, the pneumonic inflam¬
mation often continues unabated, as indicated by the physical
signs and quickened respiration — but the fever utterly disap¬
pears — the pulse and temperature becoming normal, and the
appetite returning.
The disease is most prevalent in the presence of its exciting
causes, chief of which is exposure to cold, wet weather; but
we cannot believe, reasoning by analogy, that these conditions
alone are sufficient to produce it.
In the cases reported below, no connection whatever existed
between them, nor with any other case as far as could be ascer¬
tained ; yetthere are instances occurring continually in the
practice of physicians, that look suspiciously as though an
element of contagion was present. Two or three years since I
was called to a case of croupous pneumonia in a child — in a
family of four children, all under the age of eight years. The
parents were wealthy and the children hearty and robust —
well cared for in a warm comfortable house, where they had
the least possible exposure to cold. When the first child had
been sick four or five days, the other three were all taken down
at once with the same disease. All the cases ran the typical
course to recovery.
Again in the winter of 1876 and 1877, 1 noted a case in a child
10 years of age, coming on without any unusual exposure to
cold, and running the regular course to crisis on the 7th
day and prompt recovery. Just at the time of the crisis a
younger brother, aged 6 years, was attacked with the same
sequence of symptoms and result.
These latter two cases made the greater impression, that my
interest in them was closer than a merely professional one, and
l was watching them night and day. Such cases create the
suspicion that the disease is contagious, though only to a faint
degree, and indicate that the period of incubation is a short
one — from 4 to 7 days. If it is contagious, analogy would sug¬
gest the sputa from the diseased lungs as the principal source
of contagion, just as are the enteric discharges of typhoid fever
and cholera.
It would be inappropriate in an article of this description to
1879] Prentiss — Clinical History of Croupous Pneumonia. 3
enter into a discussion of the diagnosis between croupous and
catarrhal pneumonia, albeit the differences between the two pre¬
sent the strongest argument in favor of the zymotic character
of the former.
Catarrhal pneumonia presents a picture exactly the opposite
of that given above, except only as to physical signs — the in¬
sidious approach, the irregular character of the fever, no defi¬
nite course, and especially the close sympathy between the lung
disease and the general symptoms.
Case I. — Croupous Pneumonia at Base of both Lungs in an Adult.
Mrs. S., Irish, 48 years of age ; stout, healthy woman, who
has had no sickness for many years.
February 28th, 1878. — Chill in evening, followed by fever and
cough, after prolonged exposure to cold.
March 2d. — First saw the patient at 0, P. M., in bed, suffering-
no pain, but feeling sick and distressed. Carefully examined
lungs, but could detect no sign of disease. Has occasional
cough.
DATE.
Day of
Disease.
Pulse.
Tempera¬
ture.
"o8
‘S-
00
&
X
Pulse res¬
piration '
ratio.
TREATMENT AND REMARKS.
March 2, A. M.
3
96
1
3.44
March 3, A. M.
4
96
102
28
Still no crepitant rale.
March 4, A. M.
5
96
105
28
1
3 44
Abundant crepitus at base of right
lung; slight crepitus at base of
left lung. Ordered quin. sul. grs.
xx at one dose; caib. ammon.
mixt.; milk and beef tea.
March 5, A. M.
6
100
104
32
3.13
Repeat quinine. Continue treat¬
ment. Oiled silk shirt.
March 6, A. M.
7
108
105
28
1
3.86
Repeat quinine. Continue treat¬
ment.
March 7, A. M.
8
100
103 5
32
1
3.13
Repeat quinine.
March 8, A. M.
9
80
100.3
22
1
3.64
Quin. grs. ij. ter die ordered in place
of dose of grs. xx.
March 9, A. M.
10
80
98.5
16
1
5
Treatment continued. Profuse
sweating.
March 11, A. M.
12
80
99
15
1
5.33
Lung disease nearly disappeared.
4 Original Communications. [July
This patient was only seen once daily, and the record is
therefore only for the morning, and does not show the antipy¬
retic effect of the quinine ; but according to the report of the
nurses, each dose was followed by relief to the patient and
reduction of fever, the latter rising again in the early morning
hours. On the night preceding the 4th of March she was
extremely ill ; so much so that she insisted she was dying,
and had the priest summoned to administer the last sacrament.
There was no return of this extreme illness after the adminis¬
tration of the first dose of quinine, although the temperature
arose equally high subsequently. The whole twenty grains of
quinine were given between three and four o’clock, P. M., each
day, and their effect in reducing fever lasted twelve or fourteen
hours.
The 5th, 6th and 7th days of the disease were the worst.
Defervescence began on the 8th day from the initiatory chill
occupying 48 hours, but was not complete until the 10th day,
ending in profuse sweating. There was no sudden crisis.
Sweating still continued when attendance was closed, March
11th. The local disease was principally in the lower lobe of the
right lung, posteriorly ; the lower lower lobe of the left lung
was slightly affected. There was no stage of complete hepati¬
zation, the crepitant rale being abundant during the whole
course of the attack. Cough, expectoration and pain were insig¬
nificant. The pain complained of was in the right side, in front.
Recovery was prompt. Average pulse respiration ratio 1_.
3.87
Case II. — Croupous Pneumonia of both Lungs in an adult.
James M., Irish, 37 years of age, stone polisher; is a drinking
man ; drinking by sprees, but sober in the interval ; good con¬
stitution.
Was taken sick March 5th, 1878, with chill followed by pain
in the left side in front, and sweating. Painful cough. Con¬
tinued to work until March 9th. March 10th, first seen. Severe
pain in cardiac region, causing dyspnoea and suppressed cough.
Profuse sweating. Auscultation shows pneumonia in lower
segment of left lung. Respiration in right side normal.
1879] Prentiss — Clinical History of Croupous Pneumonia.
5
DATK.
March 10, A. M.
March 11, A. M
March 11, P. M.
March 12, A. M.
March 12, P. M.
March 13, A. M.
M’ch 13,3 P. M.
M’ch 13, 9 P. M.
March 14, A. M.
M’ch 14, 5 P. M.
M’ch 14, 9 P. M.
March 15, A. M.
M’ch 15, 9 P. M.
March 16, A. M.
M’ch 16, 9 P. M.
March 17, A. M.
March 18, A. M.
March 19, A. M.
March 20, A. M.
1
Tempera- j
ture.
c
j-s
ST
X
X
Pulse res¬
piration,
ratio.
SYMPTOMS, ETC.
116
105
48
1
Rusty sputa; carb. ammon. gr. v
2.42
every 4 hours.
116
105.7
36
1
Pain and dyspnoea very distressing.
3.22
Quinine grs. xx at one dose.
100
102
>8
1
General condition greatly improv-
3.57
ed ; cough and pain continue.
104
104
28
i
Quinine grs. xx repeated ; crepita-
3.71
tion in lower lobe, right lung.
100
102.7
32
1
Chloral grs. xx; morphia gr. J, to
3.12
relieve pain and produce sleep.
112
105
44
1
Pain not relieved. Ordered bath
2.54
at 88° for 10 minutes in wash tub,
in place of quinine.
108
101.5
30
Great relief.
3.60
92
100.3
28
1
Repeated chloral and morphia.
3.28
108
105
44
1
Fever rose again at 2, A. M.— 14 hrs.
2.45
after bath. Repeat bath and in
addition quinine grs. xx.
96
103
44
j
Middle and lower lobes of right
2.i8
lung hepatized ; returning crepi-
tation in left lung.
88
10(1.5
32
1
Whiskey f.^ss every 2 hours.
2.75
84
102
36
'2.33
Repeat quinine grs. xx.
72
100 .2
40
1
1.80
68
99 5
36
1
Left lung improving ; eondit.ion of
1.88 .
right lung unchanged.
76
100.3
32
1
2.37
Profuse sweating.
64
99
36
1
Profuse sweating.
1.50
78
99
32
l
Profuse sweating.
2.43
76
100
28
1
Profuse sweating.
2.78
68
98
28
1
Ordered cit. quinine and iron gr. v.
2.43
and cod liver oil f.?ss 3 times a
day.
0
< Original Communications.
[July
(Continued.)
DATE.
Day of
Disease.
Pulse.
Tempera¬
ture.
a
u
'5.
X
s
33
Pulse res¬
piration,
ratio.
SYMPTOMS, ETC.
March 21, A. M.
17
68
24
1
2.83
March 22, A. M.
18
68
99
24
1
Appetite returning.
2.83
March 29, A. M .
25
76
Severe headache. Ordered brom.
potas. grs. xxx ter die.
Returning rales in right lung ; left
lung normal; convalescing, but
still very weak.
April 1st.
28
80
This case is a type of the severer form of croupous pneu¬
monia. Defervescence did not begin until the 10th day from
the initiatory chill, and cannot be said to have been completed
until the Kith day, a period of six days, so that the termination
of the febrile symptoms was by lysis rather than crisis. It is to
be noticed, as bearing on the question of diagnosis between
croupous and catarrhal pneumonia, that on the twelfth day, when
the pulse had returned to 68, and the temperature to 99.5°, the
diseased process in two-thirds of the right lung continued una¬
bated. The record of the case shows most conclusively the
antipyretic effect of quinine in gr. xx. doses, as well as of the
tepid bath.
On the morning of the 7th day the thermometer indicated a
temperature of 105.7°; gr. xx. of quinine was administered, and
in the evening the pulse had fallen to 100 from 116, and the tem¬
perature to 102°, a decline of 3.7° in seven hours. So on the
following day there was a similar fall of 1.3°.
On the morning of the 9th day the pulse was 112, and tem¬
perature 105°. Quinine having been given two consecutive
days, it was deemed advisable to substitute the warm bath. In
nine hours the pulse had fallen twenty beats, and the tempera¬
ture four and seven-tenths degrees. This could not be attrib¬
uted to the crisis — for on the morning of the 10th day, the
fever again arose to 105°. On this day, the bath and quinine
were both given, and devervescence set in. Carbonate of am¬
monia was given all through the attack, and beef tea and milk
relied upon for nourishment — both being taken freely.
1879] Prentiss — Clinical History of Croupous Pneumonia. 7
The pleuritic pain in this case was very distressing and was
complained of in front, although the pneumonic inflammation
was mostly posterior. Average pulse respiration ratio _L
Case 111. — Croupous Pneumonia in the Lower Lobe of Right
Lung, in a Young Child.
Alvin M., male, aged 8 years ; plump, healthy child. Taken
sick March 28, 1878. First seen March 29th, when* pnemnonia
was developed in the lower lobe of light lung. Dyspnoea
marked.
DATE.
.
o ©
CD
©
©
0Q
.
© ©
a!
a
‘5.
© a
© 5 •
c, © 0
© 3
® 2 *
SYMPTOMS AND REMARKS.
03 CD
q3
a
Ph
S *
©
M
a 3 *
£ *
1878.
March 29, A. M.
2
128
104
80
1
loo
Warm bath ordered every 4 hours.
March 30, A. M.
3
128
101.7
40
1
3.20
March 30, P. M.
3
140
104
56
1
2.50
Quin. gr. v. at one dose.
March 31, A. M.
4
148
103
40
1
3.70
do1 do. do.
April 1, A. M.
5
120
100.3
40
1
£00
do. do. do.
April 2.
April 3.
April 4.
6
7
8
101.5
28
Great improvement. Poise, etc.
not recorded.
Convalescent. Visits discontin¬
ued.
The antipyretic effect of the quinine was very decided, but
does not show in the chart, for the reason that but one visit was
made daily after its administration was commenced. The ter¬
mination was by lysis — the period of defervescence extending
over seventy-two hours, from the 5th to the 8th day.
Average pulse respiration ratio _L
Case IV. — Croupous Pneumonia in an Adult, Right Lung,
Asthenic Form — Death on the 9th Day.
I). A. B., aged 56 years, American, rather slender built,
weight, about 140 lbs ; conductor on street cars.
8 Original Communications. [July
March 9th, 1878. — Had slight chill, followed by fever, cough
and dyspcena. Continued to work until evening of March 10th,
but “ laid oft ” and went to bed March 11th.
March 12, A. M.
■M
© 0 C
05
%
M’ch 13, 2 P. M.
March 14, 12 M.
March 15, 12 M.
March 16, A. M.
M’ch 16, 10 P.M.
March 17, A. M.
108
104
108
96
100
104
120
5 -2
<V j*
« ^
104.8
103.5
104
102.5
103
30
28
32
34
103
103
js £ '
n . ^
l
3.60
1
3.71
1
3.37
1
2.94
36
40
1
2.88
1
3.00
TREATMENT AND REMARKS.
Crepitant rale with marked dullness
over middle lobe of right lung.
“ Prune juice ” expectoration —
harassing cough; dyspnoea mark¬
ed; anxious countenance. Ordered
quin. grs. xx. at one dose. Carb.
ammon. and milk punch freely.
Repeat quinine grs. xx. Beef tea
and stimulants ad. lid.; dusky flesh
on cheeks, oiled silk shirt aiound
chest.
Upper and middle lobe right lung
solid, and crepitant rale heard in
lower lobe. Dyspnoea greatly in¬
creased. Expectoration of same
character and more in quantity.
Condition about the same ; expec-
toration same ; cough very
troublesome, preventing sleep.
Ordered tepid bath to be followed
by quinine grs. xx.; morphia and
chloral mixture to control irrita¬
ble cough. Beef tea and milk
punch continued.
Expectoration less in quantity and
not so bloody; cough in a mea¬
sure relieved by anodyne mix¬
ture. Quantity of whiskey in¬
creased to oz. ss every two hours.
Passed a bad night. Watcher*
went to sleep, so that he got
neither medicine nor nourish¬
ment during the night. Got out
of bed himself to get water.
Right lung entirely hepatized ;
dyspnoea very distressing ; oyan-
osis marked ; larynx rises and
falls during respiration ; supra¬
clavicular spaces sink in. Or¬
dered camphor grs. iij. in emulsion
every two hours, and to push
whiskey and beef tea. Dyspnma
still greater and cyanosis more
marked. Treatment continued.
Dying.
Died at 2 P. M.
r
1879] Prentiss — Clinical History of Croupous Pneumonia. 9
In this case there were prodromal symptoms for two weeks
before the onset of the disease. The patient’s habits of life
had formerly been irregular, but for the past several years had
been correct.
The record of pulse, temperature and respiration would not
indicate a severe attack of the disease, but the accompanying
symptoms of distress, cyanosis and u prune juice” expectora¬
tions pointed clearly to a severe case. The pulse, three hours
before death, was but 120, and temperature 103°.
It is a matter of great regret that just at the most critical
period of the disease — the night between the 7th and 8th day —
he should have been neglected by the sleepiness of those in
charge of him. Had the stimulants and nourishment been kept
up regularly during this time, and the patient been prevented
from getting up out of bed, a different result might reasonably
have been expected.
The record of pulse and temperature shows a remarkably low
average for a fatal case.
Average pulse respiration ratio _L
Case Y. — Croupous Pneumonia , Lower Lobe of Right Lung , in
an Infant.
Ed. O’C., healthy infant, aged 22 months. Taken with chill
followed by fever, March 29th, 1878. Supposed by family to
have intermittent fever. Was not seen until 4th day, when
pneumonia was found developed in lower lobe of right lung,
crepitant rale being distinct, with dullness on percussion.
DATE.
Day of
Disease.
Pulse.
| Tempera-
j ture.
a
c
•s.
X
*
Pulse res¬
piration
ratio.
REMARKS.
April 1, A.
4
192
106
48
1
4.00
Warm bath and quin. grs. iv. at
once.
April 1, P.
M.
4
160
102,5
52
1
3.07
April 2, A.
M.
5
160
103
56
1
2.85
Repeat bath and quinine.
April 3, A.
M.
6
112
98
40
1
2.80
Attendance discontinued.
2
10
Original Commv/n ications.
[July
Average pultee-respiration ratio _i_
Termination by crisis on the 6th day.
The violence of the symptoms on the 4th day, as indicated
by pulse of 192 and temperature of 106°, were such as to create
serious doubts as to the result ; but the pronrpt effect of the
warm bath and quinine in alleviating the alarming condition
was altogether satisfactory.
The temperature fell 3.5° and the pulse 32 beats per minute
in six hours, which was not due to the crisis of the disease, the
temperature rising to 103° the following morning.
CASE VI. — Croupous Pneumonia* , affecting whole of Right Lung,
in a Young Child.
Louisa H., German parentage, 3£ years old; robust, healthy
child. Taken sick with chill, followed by fever on the 1st of
April. Was sent for on the morning of April 2d, on account
of violent convulsion which had been preceded by vomiting.
DATE.
Day of
Disease.
6
02
"3
Ph
Tempera- J
ture.
'oj
’5.
3D
©
Pulse res¬
piration
ratio.
TREATMENT AND REMARKS.
April 2, A. M.
2
160
104
■■
....
Convulsion and vomiting. Calomel
grs. i. every 4 hours; also brom.
potas. grs. v., co. spt. aeth. gttxv.
April 2, P. M.
148
105.5
-•
....
every 4 hours alternately with
calomel.
April 3, A. M.
3
148
105.?
Diarrhcea. Stop calomel. Warm
bath and quin. grs. v.
April 3, P. M.
132
103.5
Have been examining lungs at each
visit, but found no sign of disease
until now, when pneumonia is
discovered in the base of right
lung. Carb. amtnon. grs. iv. every
4 hours.
April 4, A. M.
4
140
105
56
2.00
1
2.00
Dr. S. C. Busey in consultation.
Quin grs. v. repeated. Syr. sen-
egae added to carb. amnion, mixt..
April 4, P. M.
128
103.5
44
Beef tea and milk punch for nour¬
ishment.
April 5, A. M.
5
144
105.8
76
1
i.89
1
Dr. Busey in consultation. Nearly
whole of right lung liepatized.
Quin, repeated.
April 5, P. M.
132
103
56
2.35
Orders left to repeat quin . if fever in¬
creased, and it was done at 2 A. M
18 79] Prentiss — Clinical History of Croupous Pneumonia. 11
(Continued.)
DAT6.
Day of
Disease.
Pulse.
3 rT3
S'g
C rt *
® .£ ®
H 04
Pulse res¬
piration
ratio.
\
TREATMENT AND REMARKS.
April 6, A. M.
6
136
105.364
1
2.12
Dr. Busey in consultation.
5 o’lock, P. M.
--
132
103.564
1
2.06
1
An attack of syncope, apparently
from cough and dyspnoea. Whis¬
key administered freely.
9 o’clock P. M.
--
128
104 60
2H3
Has revived.
April 7, A. M.
7
132
103.556
1
2.35
Dr. Busey in consultation.
April 7, P. M.
136
105 60
1
2326
Repeat quinine.
April 8, A. M.
April 8, P. M.
8
110
92
98 ..
98 32
1
2.87
Dr. Busey in consultation.
April 9, A. M.
9
120
101.556
1
2.14
Headache.
April 10, A. M.
10
116
98.5..
«
1
Returning rales in right lung.
April 11, A. M.
11
92
. 28
3.64
Average pulse-respiration ratio -L
The bowels were loose from the start, sufficiently so to re¬
quire use of starch water and laudanum enemas and bismuth
powders to check the frequency of the loose watery discharges.
The pneumonic inflammation did not develop so as to be recog¬
nized until the evening of the 3d day, although the lungs were
carefully examined each visit in consequence of the doubt as
to the diagnosis. The local disease was confined to the right
lung, but so crippled the entire lung that death was imminent
from suffocation from the 5th to the 7th day of the attack.
The crisis occurred suddenly ou the 8th day, with relief of
all the symptoms except the frequent respiration, which was
governed by the local disease in the lung. The effect of the
quinine was very regular in reducing the temperature from 1.5°
to 2.8° after each administration, this effect lasting about
twelve hours. In this case the administration of the quinine
was followed each time by quiet sleep of three or four hours —
with a fall in pulse and temperature indicated.
Original Communications.
12
[July
Case VII. — Croupous Pneumonia at Base of Left Lung , in a
Young Child.
Louis II., aged 5 years, strong, hearty child. Taken sick on
the night of April 9th with chill. First seen evening of April
10th, when the crepitant rale was abundant at the base of the
left lung.
DATE.
Day of
I Disease.
Pulse.
Temper¬
ature.
a
’P*
OD
Pulse-res¬
piral ion
ratio.
TREATMENT AND REMARKS.
April 10, P. M.
2
140
103.5
44
1
3.18
Flaxseed poultice to chest. Fever
mixture of sweet spirits of nitre
and spirits raindererus.
April 11, A. M.
3
132
103
44
1
3L00
April 12, A. M.
4
132
100.3
40
1
3.30
April 13, A. M.
5
100
98.5
32
1
3.12
Resolution of the lung disease
commenced.
This case is interesting as illustrating the mild or abortive
form of croupous pneumonia. The diagnosis was clear, but the
diseased action in the lung was hardly set up, before it began
to decline ; and, on the 5th day, when the crisis occurred, he
was to all appearance well.
1 had an exactly similar case in the child of Mr. J. H. S.,
aged 4 years, the notes of which 1 have unfortunately lost.
The initiatory fever in this latter case however rose to 105.5°,
but the local disease aborted just as above, and the patient
was well suddenly. 1 believe that many of the eases of so-
called u ephemeral fever v referred to by the older writers, belong
to this form of croupous pneumonia.
Tetminatiou by crisis on 4th day.
Average pulse respiration ratio 2_
CASE VIII. — Croupous Pneumonia in Adult in Lower Lobe of
Left Lung.
D. P. M., aged 58 years, cabinet maker by trade, slender
build and rather delicate in appearance. Was taken with chill
1879] Prentiss — Clinical History of Croupous Pneumonia. 13
April lotli, 1878. Had been troubled with a cough for two
weeks previously.
DATE.
Day of
Disease.
Pulse. 1
Tempera¬
ture.
a
*c8
"ft.
to
Xi
X
Pulse res¬
piration,
ratio.
REMARKS AND TREATMENT.
April 18, A.
M.
4
104
104
20
1
5320
Pneum. of lower lobe of left lung.
Quinine grs. xv.
April 19, A.
M.
5
88
102.5
18
1
4.88
Cough troublesome with pain, left
side. No rusty sputa.
April 20, A.
M.
6
104
10‘3
18
1
5.77
Repeat quinine. Carb. ammon., grs.
v. every 4 hours.
April 21, A.
April 22, A.
M
7
84
68
100.5
Quinine ordered grs. iij 3 times a
M.
8
98.7
16
1
4.25
day.
Profuse sweating.
April 25, A.
M.
11
52
98
12
1
4.33
Average pulse respiration ratio, _L
This patient was very weak and recovered strength slowly.
The previous history, as indicated by the symptoms of bron¬
chial catarrh preceding the onset of pneumonic inflammation,
would seem to point to catarrhal pneumonia, but rapid course
of fever, terminating in crisis, between the 7th and 8th day,
clearly establish the diagnosis of croupous pneumonia. As in
Case IV, there were present prodromal symptoms for two weeks
before the iniatitory chili. Defervescence carried the pulse and
respiration below the normal.
Case IX. — Croupous Pneumonia in an Adult in Lower Lobe
of Left Lung.
John D., 45 years of age. Never sick, but not robust. Was
taken with a chill April 18th, 1878. First saw him April 20th,
when he was sufering with acute pain in left side, in front ,
painful cough with rusty sputa. Auscultation discovers pneu¬
monia in the lower lobe of the left lung.
14
Original Co m m union, Horn.
[July
DATE.
O CO
<5
U .
p-25
P
“ cT • ;
£ o.o
i’-g-g TREATMENT AND REMARKS.
3
P4
as
H 55
CO
< V
«
£. g 2
April 20, A. M.
3
120
103.2
18
1 'Fever mixt. of sweet spirits nitre
6.66 and liq- am- acet. Ckroral and
morphia to relieve pain.
4.3 Quin. gr. xv. at one dose.
April 21, A. M.
4
120
104.5
28
April 22, A. M.
5
116
103.2
28
1 Quin, gr. xv. repeated. Left lobe
4.14 of left lung hepatized.
April 23, A. M.
6
120
102
30
1 Quin. gr. xv. repeated. Carb. am-
4.00 mon. gr. v. every 4 hours.
April 24, A. M.
7
92
99
24
1 Diarrhoea. Profuse sweating. Carb.
3.83 ammon. stopped. Quinine gr. iij.
3 times a day. Beef-tea and milk
punch.
5.66 Returning crepitation in lung.
April 25, A. M.
8
68
95.5
12
April 28, A. M.
11
.
Patient down-stairs sitting, but
very weak. Crepitation rale still
distinct in lower portion of left
lung.
Average pulse, respiration, ratio _1_
Termination by crisis on the 7th day. On the 8th day the
temperature fell to 1)5.5°, with respirations only twelve per min¬
ute. There is a very great similarity between this case and the
preceding one, the recovery from the lung disease being pro¬
tracted. Defervescence below the normal, both as to tempera¬
ture and respiration.
Case X. — Croupous Pneumonia in Upper Lobe of Right Lung
in a Young Child.
Samuel S., aged 3 years, robust, healthy child. Had attack
of spasmodic croup May 24th. Was taken with chill, followed
by fever, quick breathing and flushed face May 26th, 1878.
1879] Prentiss — Clinical History of Croupous Pneumonia. 15
DATE.
Day of
Disease.
Pulse.
Tempera¬
ture.
p
U
X
Pulse res¬
piration
ratio.
REMARKS.
May 27, A. M.
2
148
103.8
44
1
3.36
Warm bath ordered.
May 27, P. M.
132
101.5
44
1
3.00
Pneumonia of upper lobe right
lung.
May 28, A. M.
3
148
102
52
1
2.84
May 29, A. M.
4
152
104.5
72
1
2.10
Wet towel around chest renewed
every two hours ; carb. ammonia
mixture.
May 29, 9 P. M.
132
102
56
1
235
May 30, A. M.
5
120
101.7
40
1
3.00
May 31, A. M.
6
120
101.7
40
1
3A»(T
June 1.
7
104
99
40
1
2.60
Resolution of lung disease prompt
and complete.
Average pulse respiration ratio _I_
Termination by crisis on the Ttli day.
Attention is called to the application of the vet towel in in¬
fants as a substitute for bathing. This child struggled and fought
so against the bath that it was deemed unwise to persevere in its
use, the excitement attending its administration antagonizing
its good effects. A large towel was folded lengthwise, dipped
in water at temperature of 80° and wrapped around, the chest
being covered with dry flannel. This was changed every two
hours, with the most satisfactory effect. The child does not
rebel against this treatment, it is quickly done, and in my ex¬
perience, is a most valuable aid in reducing temperature in
infants.
When we bear in mind that in early life the limbs bear a
much smaller proportion to the body than in adults, and that in
children the intensity of fever is greatest in the body and head,
the value of this mode of application becomes apparent, and
when conjoined with cold applications to the head, fulfills the
whole indication of the antipyretic use of water. 1 am speaking
16
Original Communications.
[July
only of young children, and in them this has been a favorite
method of controlling fever for several years. Of course, where
the fever is the more intense, the wet towel must be changed
the more frequently.
Case XI. — Croupous Pneumonia, occurring during the incubation
of Measles and followed '• immediately by that disease. — Pneu¬
monia in middle lobe of righ t Lung.
W., aged 3 years, girl, healthy child. Has been exposed to
contagion of measles for a week, another child being down sick
with it in the same house. Has had fever every other day for
several days, and a teasing cough.
Was taken June 1st, in the morning, with a chill, and about
noon had a violent convulsion.
DATE.
Day of
Disease.
Pulse.
Tempera¬
ture.
Respira’n
Pulse res¬
piration
ratio.
treatment and remarks.
June 1, 1878. . .
1
....
Convulsion (following chill. —
June 2, 12 M.
June 2, 4 P. M.
2
224
200
104
Brom. potas. grs. vi., elix. val.
ammon. £ 3i. every 3 hours for 3
doses. Rested well all night.
Capillary congestion almost as dark
as scarlatina. CiDcho. quin. grs.
iij. every 6 hours; spts. aeth. nit.
and liq. ammon. acet. for febri-
June 3, 9 A. M.
'3
180
105
fuge ; occasional doses of bromide
with tr. opium gtt. iij.
June 3, 12 M.
103.3
June 4, 2 A. M.
4
180
104.3
, .
....
Quinine grs. iij.
June 4, 8 A. M.
..
144
101.4
....
Irritating cough of most distressing
June 4, 10 A. M.
160
100
character and almost continual ;
child greatly exhausted ; percus¬
sion dull over middle lobe of right
June 4, 5 P. M.
154
105
lung, which also gives crepital
rale on auscultation. Ordered tr.
opii deod. gtt. iv. every 4 hours
until spasmodic cough is relieved.
Cincho quin. grs. iij.; carb. ammon.
June 5, 5 A. M.
5
140
99*5
....
andsyr. senegaein emulsion; soap
liniment freely to chest.
Cough still distressing, no appetite.
June 5, 12 M.
136
98.3
30
Occasional doses of opium as re-
June 5, 5 P. M.
99.8
36
4.53
quired; beef tea and milk punch
ad libitum.
Dr. C. E. Hayner in consultation.
June G, 8 A. M.
6
134
98.4
40
1
Dr. H. in consultation. Treatment
June 6, 8 P. M.
150
103
44
3.35
1
continued.
Eruption of measles beginning to ap-
3.40
pear. Resolution taking place in
lung.
1879] Prentiss — Clinical History of Croupous Pneumonia. 17
(Continued.)
DATE.
Day of
Disease.
Pulse.
&
fi
S ®
t-
0 5
®
c
"cS
u
X
0.
M
Pulse res¬
piration
ratio.
TREATMENT AND REMARKS.
June 7, 6 A. M.
7
120
100
30
1
4.00
Dr. H. in consultation.
June 7, 10 P. M.
--
160
103.2
60
1
2-66
Warm bath.
June 8, 1 A. M.
8
160
103.2
70
1
2.28
Quinine grs. iij.
June 8, 8 A. M.
144
102
66
1
2 18
June 8, 5 P. M*
164
104
72
1
2-25
Collapse in middle lobe of right
lung.
June 8, 8 P. M.
--
170
105.2
70
1
2.42
Quinine grs. v ; carb. ammon. mixt.
and stimulants freely.
June 9, 2 A. M.
9
144
102.4
60
1
2.40
June 9, 6 A. M.
--
128
99.6
54
1
2.37
Oiled silk shirt.
June 9, 8 P. M.
144
101
36
1
4.00
1
Sulph. quin. grs. v.
Eruption fading; appetite return-
June 10.......
10
120
98.2
36
3J53
ing. Phosphat. emulsion of cod-
liver oil.
Pulse-respiration ratio _L
* 2.83
Crisis occurred on the oth day of the pneumonia. On the 8th
day from the initiatory chill the eruption of measles began to
appear, with an increase of temperature to 103°. On the 8th
day collapse of that portion of the lung affected by the pneu¬
monia occurred, with sudden aggravation of all the symptoms.
The most noticeable effect of the rubeola poison in the system
was the intense irritative cough — the regular measles cough —
so greatly aggravated that the father, who is a physician and
watched the case most carefully, thought several times that she
must die from exhaustion. This cough was relieved by full
doses of opium and gradually disappeared as the eruption
faded. The collapse of the lung was the only other symptom
which could be ascribed to the complication of the two diseases,
each disease with these two exceptions — of the intense irrita¬
tive cough and the collapse — running a normal course as though
the patient had but the one at a time. I must confess that I
watched the development of the measles with great anxiety,
18
Original Communications.
[July
fearing and expecting the occurrence of an acute catarrhal
pneumonia which would have proved quickly fatal in the weak¬
ened condition of the little patient.
The collapse of the lung rapidly disappeared under the free
administration of tonics and stimulants.
The subsequent progress of this case was entirely favorable,
and at this date (July, 1878), no trace of the severe illness re¬
mains, except a slight roughness of voice.
The following tables present in a condensed form an analysis
of the more prominent symptoms occurring in the foregoing
cases :
03
S£
◄
*
OQ
Average
Pulse. *
Average
Temp. *
Average
Pulse
Resp’n
| Ratio.
ONSET OF DISEASE.
PORTION OF LUNGS
AFFECTED.
4H
F
99
103 .3
1
3.87
1
Sudden ; ushered
iu by chill.
Lower lobe right lung
principally; left lobe
of lei t lung slightly.
37
M
105
103.4
2^80”
1
2.80
Not sudden ; chill,
after which
worked 4 days
before taking tc
bed.
Lower lobe of left lung
and middle and low¬
er lobe of right lung.
3
M
133
102 6
Sudden ; if chill
did i.ot know.
Lower lobe right lung.
56
M
106
103.4
1
3.25
i
Prodromal symp¬
toms for 2 weeks;
slight chill at
onset.
Whole of right lung.
■m
M
170
103.8 t
3.18
Suddm ; chill.
Lower lobe right lung.
H
F
123
104.3
1
2.43
1
3.12
Sudden; chill ush¬
ered in by con¬
vulsions.
Whole of right lung.
5
M
135
102.3
Sudden ; chill.
Lower lobe left lung.
58
M
95
102.5
1
4.e8
Chill ; prodomata
for 2 weeks.
Lower lobe left lung.
45
M
119
103.2 1
1
TrT
Sudden; chill.
Lower lobe left lung.
3
M
136
102.4
l
2.78
Sudden ; chill, pre¬
ceded by spas¬
modic croup.
Upper lobe right lung.
3
F
178
103.3
‘X83
Chill; convulsions,
preceded by a
remittent fever ;
sudden.
Middle lobe of right
lung.
CASE.
II
III
IV
IX
X
Months. ....
f On the 4th day of case V the temperature arose to 106°, the highest observed in any
of the cases.
| In case IX, on the 8th day, the temperature fell to 95.5°.
1S79J Prentiss — Clinical History of Croupous Pneumonia. 19
CASE.
PAIN.
COUGH.
SPUTA.
TERMINATION.
I
Right side in
front. Not
severe.
Neither f r e -
qnent nor
distressing.
Not significant
By crisis on 8th day,
defervescence last-
ing 48 hours. Profuse
sweating. Recovery
prompt.
II
Very severe in
cardiac re¬
gion.
Very frequent
and suppres¬
sed on ac-
count of
pain.
Rusty, abun¬
dant.
By lysis; defervescence
began on 10th day,
and was not complete
until 16th day, a pe¬
riod of 6 days. Pro¬
fuse sweating.
III
Unable to lo¬
cate it on ac¬
count of age.
Insignificant.
Not seen.
By lysis from 5th to 8th
day, occupying 72
hours.
IV
Severe, but
marked b y
dyspnoea.
Very haras¬
sing, of irri¬
table char¬
acter.
“Prune juice”
in character.
Very abun¬
dant.
Death on 9th day from
asphyxia.
v
Not noticed.
Insignificant.
Not seen.
By crisis on 6th day.
Defervescence less
than 24 hours.
VI
Not noticed.
Troublesome.
Not seen.
By crisis od 7th day.
Defervescence less
than 24 hours.
VII
None.
Insignificant.
Not seen.
By crisis on 4th day.
Defervescence less
than 24 hours.
VIII
Paininleft
side anter¬
iorly.
Trouble some
from giving
pain.
Not rusty.
By crisis on 7th day.
Defervescence less
than 24 hours. Pro¬
fuse sweating.
IX
Pain severe in
left side an¬
teriorly.
Painful cough
Rusty.
By crisis on 7 th day,
Defervescense less
than 24 hours. Pro¬
fuse sweating.
X
Not noticed
Insignificant.
Not seen.
By crisis on 7th day.
Defervescence less
than 24 hours.
XI
Not noticed.
Cough parox¬
ysmal, irri¬
tative, most
bar as s i n g
and exhaust¬
ing. Consti¬
tuted a dan¬
gerous ele¬
ment in the
disease.
Not seen.
By crisis on 5th day.
Defervescence less
than 24 hours.
An examination of these tables of summary of symptoms
shows :
1st. As to age , that six of these cases were between the ages
of one and five years. Five cases were adults between ages of
thirty-seven and fifty-eight years. There was no case between
the age of five and thirty-seven years.
20 Original Communications. [July
2<1. As to sex , eight were males and three females, or a per¬
centage of males of 72.7 to 27.3 of females.
3d. Pulse. — The average pulse during the febrile stage for
the adults was 105, while the same for the children was 145
beats per minute.
Nothing peculiar was noticed as to pulse, except that in the
asthenic cases it was slower than in the sthenic cases, whereas
it might naturally have been expected to be more rapid from
the enfeebled state of the patient. The pulse kept pace very
regularly with the temperature curve.
4th. Temperature. — The average temperature for the eleven
cases to the commencement of defervescence was 103.1°, the
highest recorded being 10(5° in an infant of twenty-two months,
and the lowest 95.5° in Case IX, where the crisis oscillated the
temperature to three degrees below the normal without appar¬
ent detriment to the patient. The typical morning depression
and evening rise in temperature were interfered with by the anti¬
pyretic treatment and hence do not show in the record.
5tli. Pulse-Respiration Ratio. — In the normal state of health
the relation between the pulse and respiration is that of 1 to 4£,
the pulse being taken at 72 per minute and respiration at 1G,
for an adult. About the same proportion exists in children,
both being increased in the same ratio according to age.
The same thing is true in regard to febrile diseases which
quicken the heart beats and breathing. The relative proportion
is maintained as long as there is found at the same time no
morbid condition of the thoracic viscera, but as soon as heart or
lungs become implicated by diseased processes, the normal
pulse-respiration ratio of one to four and a half is destroyed, and
in the case of lung disease, other things being equal, the degree
of variation becomes an accurate measure of extent to which the
lung tissue is implicated.
It is, therefore, a most valuable factor in the early diagnosis
of the form of lung inflammation at present under considera¬
tion, especially because, being an infectious fever, ab initio , the
local lesion does not become apparent in many cases for two or
three days (as in Case VI of this report) and the symptoms may
all be referable with equal propriety to any of several of the
zymotic fevers.
1879] Prentiss — Clinical History of Croupous Pneumonia. 21
While, however, other symptoms fail to furnish any differen¬
tial clue as to the precise nature of the fever, which we are
about to be called upon to battle with, if the ratio between the
pulse and respiration is augmented to any marked degree, we
may be sure that in a very short time there will be found the
crepitant rale, and dullness on percussion over some portion of
the chest.
We have above an average pulse respiration ratio in the
whole number of cases of ' but it would be more exact as ex-
3.33'
expressing the true ratio existing between the pulse and respi¬
ration, in typical cases running a regular course, if we exclude
cases VI 11 and IX, which are exceptional in presenting a pulse-
respiration ratio less than normal, being rerpectively -Land -I_
Leaving out of account these two cases, we have from those
remaining an average _L, which probably expresses very nearly
the true ratio existing between these prominent symptoms in
croupous pneumonia.
6th. The onset of the disease. — An examination of the above
table will show that the attack was ushered in suddenly by a
chill in eight of the cases, and in two (VI and XI) in children,
the succeeding fever was accompanied by convulsions.
In three cases, the commencement was gradual, in two of
which (IV and VIII) there were decided prodromal symptoms
for two weeks.
A chill was present in all the cases, except the third, and in
that it was not observed, although from the age (3 years) of the
child, it might easily have been overlooked.
7th. The lung or part of lung affected. — The whole of the
right lung was involved in two cases, one of which proved
fatal.
Upper lobe of right lung attacked . 3 times.
Middle lobe of right lung attacked . 4 “
Lower lobe of right lung attacked . 6 “
Total . 13 “
Upper lobe of left lung attacked . 0 times.
Lower lobe of left lung attacked . 5 u
Total . 5 “
22 Original Communications. [July
In several instances more than one lobe was inflamed in indi¬
vidual cases, so that the whole number of lobes attacked in the
eleven cases was eighteen. Marked preference is shown for
the lower lobes, they being singled out in eleven out of the
eighteen times.
Both lungs were affected in two cases. The right lung was
involved eight times, and the left lung five times, giving a pro¬
portion between the two of eight to five, which corresponds
very nearly with the statistics of the latest authorities.
8th. Pain . — In none of the cases occurring in children, was
pain in the chest observed, and if present in any degree was
certainly not severe, and could not be located.
In all the severe cases in adults, pain was a prominent symp¬
tom, and a cause of much suffering.
In every case where present, it was felt in front to one side or
the other of the median line, according to the lung affected, while
the pneumonic inflammation invariably approached nearer the
surface — posteriorly.
9th. Cough. — Nothing peculiar to the disease under consid¬
eration appeared in the cough. It was present in all the cases,
but iu those unattended by severe pain from the pleuritic com¬
plication, it was insignificant. Where pain was marked, the
cough became the most distressing, by aggravating a torment,
which was quiescent as long as the patient remained undis¬
turbed. In the fatal case, the cough was peculiarly harrassing,
being almost constant, of a hacking character, and only absent
from the influence of narcotics.
In the 11th case, the character of the cough was evidently
influenced by the measles complication, and was of so serious
a nature, that dangerous exhaustion resulted.
10th. Sputa. — Children under tin* age of five years very rarely
expectorate, and in the six infantile cases no sputum was seen,
although in some it was evidently abundant from the loose
cough, and was swallowed. Of the five adults it was colored
by blood in three cases, and not so in two.
In case IY, it was abundant, like “prune juice,” and in the
result verified the unfavorable prognosis of older writers from
the presence of this symptom.
11th. Termination. — Termination was by crisis in eight cases ;
1879] Prentiss — Clinical History of Croupous Pneumonia. 23
by lysis in two, and death one. The crisis occurred in the first
set as follows :
In 1 case on the fourth day.
In 1 case on the fifth day.
In 1 case on the sixth day.
In 4 cases on the seventh day.
In 1 case on the eighth day.
In the second set of two cases, terminating by lysis, the
defervescence began in one on the 5th day and was complete
on the 8th ; and iu the other case did not commence until the
10th day and was not complete until the 10th.
The exact time occupied by defervescence, where less than
twenty-four hours, could not be determined, on account of suffi¬
ciently frequent daily visits not being made ; nor, for the same
reason, could the hour of the day when defervescence began
be definitely fixed, but according to the reports of the nurses
the improvement began shortly after the morning visit (11,
A. M.), and continued through the night, taking the place of
the usual evening exacerbation.
In seven cases, the time occupied in the reduction of temper¬
ature to the normal degree was less than twenty-four hours ; in
one case it was forty-eight hours ; in one, seventy-two hours,
and in one six days.
Profuse sweating accompanied the defervescence in four
cases, which were also the most severe.
It will appear from the above record that the crisis may occur
anywhere from the 4th to the 10th day, the 7th day being the
one on which it most frequently takes place ; also that the time
of defervescence in a particular case is infiuenced by its severity,
being earlier in mild cases and retarded in the graver forms.
Jiirgensen (Ziemsen’s Cyclop., vol. v., p. 54) gives a table of
721 cases, terminating all the way from the 2d day (eight
cases) to the 18th day (two cases), of which 105 came to an end
on the 7th day.
The cases above reported are susceptible of division into
two groups, viz : sthenic and asthenic. In the former group
are eight cases, including all the infants, which present no pecu¬
liarities, but are typical cases of croupous pneumonia.
In the latter group, the asthenic, are three cases (IV, VIII, IX)
24
Original Communicatio ns.
[July
which differ from the former in several important respects
worthy of especial notice. Two cases (IV and VIII) were pre¬
ceded for two weeks by prodromata of bronchial catarrh and
malaise , which statistics show to be not common in this form of
pneumonia.
In all three the pulse, temperature and respiration were very
low, considering’ the gravity of the cases. In Case IV the
pulse ranged from 96 to 120, the latter rate being but a few
hours previous to death, when the the temperature was but
1 03° and respiration 40.
In Cases VIII and IX, the average pulse respiration ratio is
_L and 2L respectively, being in both less than that of health.
In Case VIII, defervescence carried the pulse down to 52
and respiration down to 12 per minute, and in Case IX the
temperature fell to 95.5° and respiration to 12 — all below
normal.
A report of this character does not allow space for a full
discussion of the question of diagnosis which might be opened
by the consideration of these latter three cases, but it is clearly
suggested, from a clinical point of view, that cases do con¬
tinually occur where the diagnosis between croupous and
catarrhal pneumonia will hinge upon the termination by crisis
or lysis — about the usual time for such termination in the
natural history of the former disease.
In Cases VIII and IX the termination was by crisis on the
7th day. In case IV death on the 9th day, but the history and
symptoms so closely parallel the other cases that the diagnosis
is not in doubt, aud could life have been prolonged a day or
two longer, there was every reasonable hope that the crisis
would have taken place.
As to the preceding bronchial catarrh, whether that was a
true prodroma or merely an ante hoc, is an open question — for
there is no reason why croupous pneumonia should not be
developed during the existence of a bronchitis, the same as
though the latter did not exist, or just as in case XI it made its
attack during the forming stage of measles.
Treatment. — It is of the utmost importance in connection with
the treatment of croupous pneumonia, to take into considera¬
tion its natural history. It is an intensely febrile disease, self-
1879] Prentiss — Clinical History of Croupous Pneumonia. 25
limited — running its course more rapidly perhaps than any
other zymotic disease, and terminating with abrupt suddenness
about the seventh day.
This order of sequence in the symptoms we may confidently
predict under any plan of treatment not absolutely injurious,
for the prognosis is in healthy subjects most favorable, being
even more so in children than in adults.
It is a disease in which the physician can well afford to bide
his time, and bear out the old rule, which I had firmly impres¬
sed upon me, when a student, by my venerable preceptor, the
late Dr. Joshua Riley, — “ To be sure if you can do no good, at
least to do no harm.”
There is no malady in the catagory of medicine, which yields
to the medical attendant so much honor from the patient and
his friends as the one under consideration, because in the very
height of severe illness, the fever often reaching its maximum
just before the crisis, the sick man is suddenly well, and of
course the doctor and his last remedy get the credit for the
(jure.
Nor is it unfrequently the case that the physician himself is
deceived, taking the post hoc for the propter hoc , and thinking
that he has found a specific remedy. Happily this multiplica¬
tion of specific remedies has received a check by the attention
now given to the study of the natural history of disease, and
tendency is to reduce rather than add to the already cumber¬
some materia medica by interposing a more correct knowedge
of what would be the symptoms, course and termination in
typical cases uninfluenced by drugs.
With regard to the disease which is the subject of this paper,
this has of late years been very clearly set forth, and the duty
of the medical attendant in the premises is very much simplified.
It is to guide the case, guard against excessive fever, support
the strength and watch for complications, in other words anti¬
pyretic and supporting. The danger to be apprehended is prin¬
cipally two fold, indirectly from cardiac debility due to intense
fever and lung obstruction, and directly from the extent of the
lung disease.
The high temperature is to be combatted by baths and qui¬
nine. A reference to the temperature record of the above cases
4
Original Communications.
26
[July
shows characteristically the effect of this treatment upon the
fever heat, but it does not and cannot express the great relief
accompanying it to the patient, of distressing symptoms. 1
have never used cold baths in this disease, but have prepared
water at a temperature of 00° and reduced it ten degrees during
the fifteen minutes occupied in administering it.
Not that I believe any risk would be run by making the bath
cold, but experience goes to show that quite as great reduction
of temperature is obtained from the above graduated bath, with
certainly greater comfort to the patient, and less violence to the
prejudices of friends.
If we consider for a moment the modus operandi by which
the bath is an effective measure in reducing temperature, I
think we will be disposed to admit that the warm bath should
have the preference.
The skin is the organ by which the balance of temperature is
preserved between the internal structures and external surface,
and through the agency of the blood. A very great extent of
surface in the capillary vessels of the skin, is exposed to the
cooling influence of the external air with every pulsation of
the heart, and the extent to which the surplus heat of body
combustion is got rid of, is exactly in proportion to the amount
of blood so exposed to the air in the skin, and the condition of
the skin at the time.
The application of cold contracts the capillaries of the skin,
and drives the blood away from the surface towards the inter¬
nal organs.
This is the effect of a cold bath, and although the reduction
of temperature in the blood still remaining in the skin is
greater than from a tepid bath, still the aggregate effect will
be less.
The warm bath relaxes the skin and invites blood to the sur¬
face, while the difference in temperature between water at 90°
and fever heat (104° or upwards) is quite sufficient to give a
decided clinical result.
In addition, the absence of shock and greater feeling of com¬
fort to the patient is an advantage of the warm bath not to be
overlooked.
In some of these cases, where the convenience of a bath tub
1879] Prentiss — Clinical History of Croupous Pneumonia . 27
was not to be had, a common washing tub was used, the patient
sitting in it, covered over the shoulders with a blanket, and
this was found to be an efficient substitute.
Whenever the patient became prostrated from the fever, or
oppressed by the dyspnoea, the baths were discontinued and
quinine relied on as an antipyretic. In children, if the baths
were the occasion of struggling and screaming, they were not
insisted on, the wet towel* and quinine being resorted to.
The dose of quinine given to adults was from grs. xv to grs.
xx, and was found to be sufficient.
The reduction in temperature varied in different cases from
1.5° to 4.7°, and lasted about fourteen hours from the time of
administration. A dose, given at mid-day would show decided
effect in three hours, reach its maximum at 9 o’clock, P. M.,
and the temperature would begin to rise about 2 o’clock, A. M.
In the severer cases the temperature would be again the
following morning as high as before its administration. In the
milder cases the fever did not appear to rise as high any more
after the first dose of quinine.
In some of the cases, especially marked in Case YI, it pro¬
duced a decided hypnotic effect, every full dose being fol¬
lowed by quiet sleep.
Dr. S. C. Bussey, who was in consultation in this case, said
he had frequently noticed the same effect. He had had his
attention first called to it by Dr. Jas. C. Hall, of this city, a
most acute observer, who had been in the habit for years of giv¬
ing quinine at bedtime, with the double purpose of promoting
sleep and at the same time avoiding the annoyance of noises
in head occasioned by this agent.
Stimulants were administered as required. Carbonate of
ammonia as a special cardiac stimulant where the respiration
was embarrassed.
Milk and beef tea were relied on for nourishment.
Season of the Year. All the cases here reported occurred
between the months of February and June inclusive, and eight
out of the eleven were attended in March and April, four for
each month.
See Case X.
28
Original Co?nmmication8.
[July
One case was noted in February, one in May, and one in
June, the latter having its onset on the first day of the month.
From the occurrence of the last case to the present date
(September 10th) I have seen but one case, a child three years
of age, who was taken sick August 28th.
By courtesy of the Health Officer of the District of Columbia,
I)r. Smith Townshend, I am enabled to append a report of 1915
deaths from pneumonia during a period of six years and
eight months, from January 1st, 1872, to July 31st, 1878.
DISTRICT OF COLUMBIA, BOARD OF HEALTH.
OFFICE OF HEALTH OFFICER.
Washington, August 10th, 1878.
Dr. D. W. Prentiss , 1224 Ninth Street N. TF.
Sir — In reply to your letter of the 2d inst., I transmit here¬
with table showing number of deaths from pneumonia in the
District of Columbia from January 1, 1872, to August 1, 1878.
Prior to August, 1874, there was no law requiring physicians
to furnish certificates of deaths to the Health Department, and
no permits for burials were required, hence the “table” is not
reliable prior to that date, although it contains every case
reported to the Health department to that date. Regretting
my inability to furnish more complete information,
I remain, very respectfully,
Smith Townshend, M.D.,
Health Officer.
Statement of Deaths from, Pneumonia in the District of Columbia, January 1st,
1872, to July 31 st, 1878.
TEARS
January.
February.
March.
April.
May.
June.
July.
August.
September.
October.
November.
December.
TOTAL.
1872 .
12
21
20
22
17
11
1
9
3
10
9
16
151
1873 .
27
14
13
13
6
6
2
4
5
7
13
110
1874 .
22
14
26
19
19
2
6
*18
9
20)
18!
40
213
1875 .
81
69
87
47
19
17
4
14
14
24
28!
42
446
1876 .
51
52
78
66
41
8
7
11
14
16
22!
31
397
1877 .
58
61
54
33
25
18
6
7
5
13
21;
26
327
1H78
48
40
45
3d
49
35
20
|
271
Totals.
299
271
323
234
176
91
50
61
49
88
105
168
1915
♦Absolutely correct from August 1874, to and including July, 1878. Prior to August,
74, the records were yery incomplete. Physicians not being required to make returns
We have no records prior to 1872.
1879]
Jones — Treatment of Yellow Fever.
29
This statement would appear at first sight to indicate an
extraordinary mortality for this disease in the District of Co¬
lumbia; and such would be the fact, were they all cases of
croupous pneumonia. It includes, however, all the forms of
pneumonia — catarrhal pneumonia especially of old persons and
young children, of invalids and consumptives, and not unlikely
many cases of capillary bronchitis and pulmonary collapse. The
statistical value therefore, in a mortuary sense, is lost, but the
relative value as to frequency of occurrence at certain seasons
of the year remains but little impaired.
Thus during the four months from January to April, inclu¬
sive, there are 1127 deaths to 788 for the remaining eight
months, and for the six months from December to May, inclu¬
sive, there are 1471 cases against but 444 for the other six
months, showing it to be a disease of winter and spring months.
Treatment of Yellow Fever.
BY JOSEPH JONES, M.D.,
Professor of Chemistry and Clinical Medicine. Medical Department University of Lonis-
iana ; Visiting Physician of Charity Hospital, New Orleans.
(Extracts from Clinical Lecture, Delivered in the Amphitheatre of the Charity
Hospital, January 29th, 1879. Reported for the New Orleans Medical and
Surgical Journal.)
LECTURE IV.
Gentlemen :
In the preceding lectures, we have brought to your notice
various subjects connected with the natural history of yellow
fever, and we have detailed many cases illustrating, by actual
observations, the symptoms, pathological chemistry, microscopy,
and pathological anatomy of this disease,* and we desire to
conclude the clinical lectures on this subject by some practical
observations on the principles of treatment.
OUTLINE OF PRINCIPLES OF TREATMENT OF YELLOW FEVER.
1. Although yellow fever is a self-limited disease, which in
uncomplicated cases runs a definite course, at the same time it
* The details of these cases have been necessarily omitted from the reports of these
lectures, for want of space.
30
Original Communications.
[July
can be if not arrested, at least modified and controlled and
brought to a favorable issue, by judicious treatment, careful
nursing, and the proper use in certain stages of certain drugs.
2. The treatment should be instituted at the earliest possible
moment after the onset of the disease. If the stomach is loaded
with food, it should be immediately relieved by the administra¬
tion of an efficient emetic; and to accomplish this indication, I
have found a drachm of pulverized ipecac, mixed with one pint
of warm water, and administered in small quantities at regular
intervals, the mildest and best emetic, promoting free sweating-
in the first few hours of the disease.
The next step should be to unload the bowels by an efficient
purgative. To accomplish this end, it has been my custom to
administer in the first twelve hours of the fever, to an adult,
ten grains each of calomel and quinine, and to follow with from
one fluid ounce to a fluid ounce and a half of castor oil in three
or four hours. In most cases, by these means the bowels were
relieved of large quantities of dark, foul, stinking fcecal matters.
In no instance have 1 ever regretted the early and prompt
administration of efficient purgatives in yellow fever; on the
contrary, whenever from any cause the purgative was rejected
and failed to act, the subsequent progress of the disease was
unfavorable and unsatisfactory.
3. The poison of yellow fever, as well as the deleterious pro¬
ducts resulting from the chemical changes which it excites, are
eliminated mainly by the skin and kidneys. Black vomit is the
result of this action of the yellow fever poison upon the blood,
and certain organs. It should neither be regarded as the active
cause nor be treated as the disease. Black vomit must be viewed
as a result and not as the cause of diseased action. Therefore
the functions of the skin and kidneys should be promoted by
suitable means during the progress of the disease, and at the
same time due regard must be paid to the irritated and irritable
condition of the gastric mucous membrane. During the early
stages the physician should employ those measures which are
best adapted to equalize the circulation and promote the regu¬
lar and free exercise of the functions of the skin and kidneys.
Stimulating diuretics should as a general rule be avoided, as
they tend to increase the irritation and congestion of the kid¬
neys.
Such a stimulating diuretic as the oil of turpentine, whether
used externally or administered internally, may be productive
of permanent injury in increasing the congestion and promoting
the destructive changes in the kidneys. For a similar reason
blisters should be employed with great caution in this disease.
A favorable impression may be made upon the circulation,
and upon the skin, by the free use of the hot mustard foot
bath. The action of the skin and kidneys may be promoted
by draughts of lemonade, and of warm decoctions of mild
diuretics, as orange leaf and sage tea, and water charged with
carbonic acid. . ,
1879J
JONES— Treatment of Yellow Fever.
31
The thirst due to the chemical changes of the blood, and to
the elevated temperature should be relieved at stated and short
intervals by moderate draughts of cold water, and by fragments
of ice in the mouth.
I have used during the epidemic yellow fever of 1878, with
much benefit the natural alkaline gaseous Apollinaris water of
the Apollinaris Spring, near Neuenahr. Its pleasant taste;
its richness in pure carbonic acid ; its slight alkaline properties
and its gentle diruetie effects, render it peculiarly grateful to
the yellow fever patient. A careful examination of the reports
of Professor Virchow, Dr. Oscar Liebreich, professor of chem¬
istry at the Berlin University, Dr. Carl Bischof, of Wiesbaden,
Professor G. Bischof, of Bonn, Dr. Frederick Mohr, of Bonn,
Professor A. W. Hofman, Vice President of the Chemical
Society of Germany, Professor Aug. Kekule, Privy Councillor
of State and Director of the Chemical Institute of the Univer¬
sity of Bonn, and of Professor W. Odling, professor of chem¬
istry at the University of Oxford, has established the belief,
that by reason of the skill and pains employed at the spring to
present and maintain the water in its natural condition, the
bottled Apollinaris water, fulfills the condition of a natural
mineral water, which retains its charge of carbonic acid, and is
actually presented to the public with its different constituents
in all essential respects for table use and for therapeutic applica¬
tion unaltered. As a mean of eight analysis made by Professor
Carl Bischof, in the year 1877, the total amount of saline matter
was found to be 22 parts in 10,000 parts of the water, 10 of
these 22 parts being constituted of alkaline carbonates, the
carbonate of soda amounting to over 9£ parts, the carbonate
of magnesia to over 3f parts, and the carbonate of lime to over
2£ parts.
According to Dr. Friedrich Mohr, the analysis per 10,000
parts of Apollinaris water yielded: carbonate of soda 9.431,
chloride of sodium 3.5016, sulphate of soda 2.0949, carbonate of
lime 2.5004, carbonate of magnesia 4.0983, oxydul of iron 0.0380,
silicates, etc., 0.1850; total saline ingredients 21.9092.
By a series of analyses made at different times, the water of
the springs is shown to belong to the class of so-called acidnlons-
alkaliue waters ; acidulous by reason of the large excess of car¬
bonic acid gas with which it is charged, and alkaline by reason
of the proportions of the carbonates of magnesia and lime, and
more especially of soda, which form its principal saline constit¬
uents, and together with the excess of carbonic acid, give to
the water its characteristic taste and properties.
I was led by the results of numerous trials of the Apollinaris
water as a drink in the active febrile stage of yellow fever, to
refer its beneficial effects to the carbonic acid, as well as to the
alkaline salts.
It is well known that carbonic acid gas applied to the eye,
relieves the pain and photophobia of scrofulous opthalmia, and
that injected up the vagina, it eases the pain of ulceration of
32
Original Communications.
[July
the os uteri and of cancer and neuralgia of the uterus, and
according to Sir J. Simpson, the inhalation of this gas is service¬
able in chronic bronchitis, asthma and irritable cough.
Carbonic acid water has long been employed in painful and
irritable conditions of the stomach, it eases pain and checks
vomiting. These are precisely the effects which we desire to
accomplish in many cases of yellow fever attended with great
irritability of the stomach. Carbonic acid water is an excellent
addition to milk, which will then be generally retained though
previously rejected. Experience has proven that obstinate
vomiting can be alleviated by liquids containing carbonic acid,
provided there is no serious organic disease of the stomach.
They slightly reduce the temperature, and the frequency of the
pulse, and during their use the urine often contains an abnor¬
mal quantity of oxalic acid, a product of imperfect combustion.
These effects must also be due to the property which carbonic
acid has of diminishing the alkalinity of the animal juices, for
the blood can be rendered acid by saturation with this gas,
after withdrawal from the body. It is also possible that the
transitory fall of temperature which it produces depends on a
reflex stimulus imparted to the nervous centres, similar to that
produced by irritation applied to the skin. Its effect on the
pulse and temperature persists as long as the urine, a product
of tissue changes which are controlled by carbonic acid, con¬
tains an abnormal amount of this gas ; hence it increases for
from half to two hours after tolerable strong doses of the latter,
and can possibly be prolonged by its continued administration
in small doses (Kerner, Binz).
The small proportion of alkaline carbonates existing in the
Apollinaris water, tended 'at once to neutralize an excess of
acid in the stomach and at the same time to promote a free and
continuous excretion of urine, and thus tended to relieve the
congestion of the kidneys and prevent the accumulation of des¬
quamated cells, oil and granular matter in thetubuli uriuiferi.
In the treatment of yellow fever, I administered the Apolli¬
naris water in the following manner:
The cork of the bottle was perforated by the tube provided
with a stop cock now employed so extensively for the discharge
of champagne in limited quantities. Fragments of ice were
placed in the sick cup, and the Apollinaris water allowed to
flow upon them by turning the cock, and the cool water was
immediately administered to the patient. And here I must
state a rule which was invariably followed during the different
stages of yellow fever, namely, the retention at all times of the
recumbent position by the patient, even when drinking or tak¬
ing nourishment. This precaution is preeminently necessary
in yellow fever, on account of the action of the poison on the
ganglia and muscular structures of the heart, and the acute
fatty degeneration which this organ undergoes in this disease.
4. The diet .should he light hut nutritious , and administered in
small quantities and with great caution during the first four or
Jones — Treatment of Yellow Fever.
33
1879 1
five days of the disease. Without doubt the stomach is often
irritated, and even black vomit induced, by the injudicious
administration of food during the active stages of yellow fever.
Aside from the fact that in the hot stage of all fevers, the
secretions of the stomach are so altered and its powers are so
impaired that it is incapable of properly digesting and assimi
lating food, in yellow fever there is an especial irritation and
enfeeblement of this organ ; and withal in many cases there is
a morbid appetite and craving for food. The sensation of
hunger on the part of the patient in this disease should not be
gratified, except in the most cautious manner, and by the
lightest, blandest and most easily assimilated forms of nourish¬
ment. Barley water, beef tea, chicken tea, corn and rice gruel,
milk charged with carbonic acid gas, and milk and lime water,
are the best forms of nourishment, and should be continued at
regular intervals throughout the active stages of the disease.
In many cases, I confined the patients to simple barley water
during the active stages. The barley water was prepared thus :
four ounces of barley were boiled in a pint and a half of water
down to one pint. Solid food and even bread should be
avoided.
Alcoholic stimulants should be used with caution, and their
effects noted. They have proved beneficial in certain cases
attended with great prostration, in the stage of febrile excite¬
ment. Champagne, when pure, is perhaps one of the best forms
of alcoholic stimulants, from the presence of carbonic acid with
which it is charged. The champagne should be delivered from
the bottle in small quantities by means of the tube and stop¬
cock, and should be poured upon fragments of ice in the sick
cup, and thus administered to the patient at regular inter¬
vals. When champagne of good quality cannot be obtained
(the dry champagne should always be used in preference to the
sweet), an excellent substitute may be prepared by diluting
good brandy or whisky with water charged with carbonic
acid gas.
It must be admitted that many cases of yellow-fever, may be
successfully treated without stimulants. In some cases milk-
punch has proved beneficial, but this combination of alcohol
and milk should be given with caution, and in small quantities
at regular intervals.
PURGATIVES.
5. Efficient but gentle purgation in the early part of the first
stage of active febrile excitement, may prove beneficial in
relieving in a measure the congestion of the kidney and liver
and gastro intestinal mucous membrane, and in removing foul
and offending foe cal matters from the bowels. If mercurials
are employed, they should be used in the early part of the first
stage, not later than the second day of the disease. For an
adult from eight to twelve grains of calomel or blue-mass will
be sufficient. Purgatives should not be administered in the
5
34
Original Communications.
[July
second stage of depression. As a general rule, I commenced
the treatment of the disease, with a combination of quinine and
calomel ; ten grains of each being administered at once to an
adult. The effects of the. quinine thus administered will be
considered hereafter ; with reference to the calomel, 1 have pre¬
ferred it as a purgative on account of the following well known
facts :
(a.) Calomel is insoluble m the hydrochloric acid of the gas¬
tric juice, but if brought in contact with a solution of albumen
for a little while at the temperature of the body, a portion of
the metal always becomes dissolved in the latter ; and in the
same way the urine always contains mercury after calomel has
been repeatedly dusted in the eye.
All the salts of mercury which are absorbed into the system
are converted by the chloride of sodium, and the carbonic acid
into soluble combinations.
(b.) In adults doses of from eight to ten grains of calomel
excite active peristaltic movements of the bowels, cause the
expulsion of their contents, and often produce profuse diar¬
rhoea. In yellow fever and in malarial fever, especially in the
first stage of the fever, calomel rarely produces excessive or
troubleson le pu rgati on .
(c.) According to recent researches the quantity of bile,
secreted by the liver is not absolutely increased by the action
of calomel, but on the contrary is somewhat diminished by its
prolonged administration. The dark green color of the abun¬
dant motions which it produces is due to the rapid descent of
the bile from the upper part of the intestinal canal. Calomel,
on the other hand, stimulates the functions of the pancreas,
large quantities of leucine, tyrosin, and indol, being found in
the faeces after its use, whereas they are absent in diarrhoea
caused by other drastic purgatives. Calomel also powerfully
excites the secretion of the intestinal glands. If SchiflPs
researches, be accepted, which show that the liver not only
secretes bile, but also excretes that which has already been
secreted and absorbed in the intestine, it may be possible to
explain the fact, that less bile enters the duodenum after
diarrhoea induced by calomel; and this diminution will also be
explicable by the neeessarily more rapid removal of the chyme,
for with impaired nutrition less bile is secreted ; in this sense
therefore, calomel relieves the animal juices of any excess of
biliary principles which they may contain, and hence it still
may be called a cholagogue.
(d). The experience of generations strongly protests against
the results of experiments on dogs and other lower animals, and
supports the conviction that in some diseases mercury does in¬
crease the bile. It is now not difficult to conceive that in a given
disease mercury may set aside some condition hindering the
formation of bile, and thus act as a cholagogue, though possibly
in health it may check the secretion.
►Jones — Treatment of Yellow Fever.
35
1879]
But we have satisfactory evidence to show that in man the
green stools induced by calomel contain bile.
Simon performed an analysis upon the fifth stool after the
administration of a large dose of calomel : the passage was fluid,
perfectly green, had no foecal odor, exhibited a mild acid reac¬
tion, and showed under the microscope a great number of mucous
corpuscles and epithelium cells. Ether extracted from the
solid residue (obtained by evaporation) a considerable amount
of fat, which had an acid reaction, contained eholesterine and
was colored by biliverdin. All the other substances which were
separated from the stool by water and alcohol, were more or
less colored by bile-pigment ; bilin, bilifelliuic acid, and biliver¬
din were found in large quantity.
Micliea ( Lancet , 1849, vol. i, p. 15) examined chemically the
fieces under four different conditions. First — the spontaneous
dejections of six healthy individuals: no bile was detected.
Second — green stools of three persons suffering from gastro¬
intestinal derangement : bile pigment was found in one case
only, and in this could not be detected after persistent vomit¬
ing had ceased. Third — calomel having been given to eight
healthy persons, five men and three women, bile was readily
demonstrated in the green passages produced in all of the sub¬
jects. Fourth — saline and resinous purgatives were given to
five persons, but no bile could be detected in the liquid stools.
Professor II. 0. Wood, Jr., M.D., in his valuable “ Treatise
on Therapeutics f Philadelphia, 1877, p. 435, gives the following
summary of our knowledge with reference to the action of calo¬
mel on the biliary secretion : “ To the evidence brought forward
in favor of the proposition that calomel given to healthy men
causes an increased escape of bile from the alimentary canal,
may be added the conclusive fact that in some persons, whose
idiosyncrasies render them very susceptible to the action of
calomel, it produces not merely purging, but also vomiting of
bile, which is scarcely at all altered.
“ From the facts wliich have just been passed in review, the
conclusion seems inevitable that mercurial purgatives given to
healthy persons cause the escape of large quantities of bile
from the alimentary canal. As is well known, when from any
cause bile does not pass into the duodenum, the stools become
very pale, of a peculiar potter’s-clay, or even white color. Very
frequently under these circumstances, which may co-exist either
with diarrhoea or with constipation, mercurials will modify the
color of the passages and alleviate or cure any symptoms
present. In many cases the mercurials are, of course, power¬
less to effect the desired result; but this depends upon the
cause being organic, or of some other nature not to be over¬
come by a mere stimulant to secretion.
“ As mercurials in health increase the flow of bile from the
intestine, and as they will sometimes reestablish it in diseases
when the secretion has altogether ceased or has been materially
diminished, the conclusion seems to me inevitable that mercu-
36 Original \ Communications. [July
rials have the power of directly or indirectly increasing the
secretion of bile. The only objection, if any, found to be urged
against this deduction, is founded upon the idea that the drug
simply increases peristalsis in such a way as to cause the bile
naturally in the duodenum to be swept out instead of being
absorbed. The answer to this is embraced in the following
facts : mercurials restore the color of the passages when pale
from arrested secretion, often without producing diarrhoea;
other even more active purgatives fail to induce the same
bilious passages. When diarrhoea exists with clayey stools, the
change in the color of the passages caused by a mercurial may
coincide with a not increased or even a lessened amount of
liquidity; diarrhoea ordinarily does not cause bile to appear in
the passages.”
I have, therefore, uniformly commenced the treatment oi
yellow fever with a purgative dose of calomel, varied in amount
according to the age of the patient, with the design of cleaning
out all fcecal matter from the alimentary canal, relieving the
portal and general circulations, influencing the liver, the organ
most uniformly affected in yellow fever, increasing the flow
of bile, and indirectly reducing the temperature. Calomel thus
administered in the very onset of the disease, tends to render
the subsequent course of the disease milder, and in relieving
the congestion of the gastro intestinal membrane, liver and
portal circulation, to prevent black vomit and urinary suppres¬
sion.
6. In many cases the preceding measures, with careful atten¬
tion to good ventilation, accompanied by absolute rest in bed,
and the careful and continuous attention of experienced nurses
will be all that is required to secure the best results. It is
important however that these propositions should be illustrated
by the actual detail of cases. I select the following from the
records which I preserved in my private practice during the
epidemic of 1878, in New Orleans. It is worthy of note that
the first five cases of the hundred here given occurred in the
beginning of the epidemic and in the very centre , the original
focus of the pestilence.
(Cases omitted, as the details would occupy more space than
is at present available.)
7. OBSERVATIONS ON THE VALUE OF QUININE IN THE TREAT¬
MENT AND PREVENTION OF YELLOW FEVER, WITH OBSERVA¬
TIONS UPON OTHER PROPHYLACTICS.
Quinine may prove beneficial in the earliest stages of the dis¬
ease by its effects upon the nervous system and by its power of
diminishing the temperature and equalizing the circulation ;
but this drug has no such curative effects in yellow fever as it
has in paroxysmal malarial fever. Yellow fever will run a defi¬
nite course and pass through a definite series of changes
1879J
Jones — Treatment of Yellow Fever.
37
whether quinine be administered or withheld. The great fact
has been forced upon my attention, not merely by the observa¬
tion of cases, by also but my personal experience during my
recent protracted, painful and dangerous (all but fatal) illness,
that the actions of the yellow fever and malarial (marsh palu¬
dal, paroxysmal) poisons, are often closely related, the one pre¬
ceding, the other superceding, and then the first following.
Thus after an attack of malignant fever, attended with jaun¬
dice, and a large carbuncle at the back of the head, strangury,
and rectal fissure, 1 suffered with a remittent fever of (50 days’
duration, which necessitated for its relief, the administration of
600 (six hundred) grains of quinine. In a large number of cases
of yellow fever during the epidemic of 1878 m New Orleans, 1
observed the association of the two diseases, or rather the prev¬
alence of malarial paroxysmal fever before and after the yellow
fever had performed its known effects.
In the year 1873, I called the attention of the American
Medical profession to the use of quinine as a prophylactic in
yellow fever; having accomplished a similar work in I860, with
reference to the use of the same agent in the prevention of
malarial or paroxysmal fevers.
Writing in 1873 (at my private expense I printed and circu¬
lated gratuitously, to the profession chiefly in the Southern
States, a large edition of my Observation* on Yellow Fever), I
used the following language :
u The power of quinine not only to arrest, but also to ward
off' paroxysmal malarial fever is undoubted ; and it has been
used extensively, not only in the treatment of yellow fever (as
by the physicians of New Orleans, and Daniel Blair, of British
Guiana, from 1839 to the present time) but more recently as a
prophylatic.
uDr. Newkirk, who was at Assuncion during the recent
severe epidemic of yellow fever, assured Dr. Win. Nathaniel
Hiron, of Buenos Ayres, that the mortality was small, and
that quinine was very generally and extensively used ; and he
expressed his belief that quinine was prophylatic, and that its
continuous use in a healthy person during an epidemic caused
any disease that showed itself to be mild and tractable.
u Dr. Hiron, in his account of the recent severe epidemic of
yellow fever in which Buenos Ay^es, with a population not
larger than that of New Orleans, lost, according to the most
accurate estimates, near twenty thousand of her citizens, re¬
cords the additional fact, illustrating the prophylactic proper-
erties of quinine, that of eleven praeticantes , (dressers) of the
Hospital de Hoinbres, eight took quinine in doses of three
grains daily. All of these had fever in a benign form. Three
took no quinine ; three had the fever very severely, and one
died.
While the facts relating to this important subject are too few
to warrant any decided conclusion as to the propriety and neces¬
sity of using quinine as a prophylactic by those exposed to the
38
Original Communications.
[July
yellow fever atmosphere, at the same time there art1, facts that
indicate that quinine acts not so much as an u antidote ” to the
poison, but as an antidote to the effects of the poison in the sys¬
tem by preserving the integrity of the blood, regulating and
promoting excretion, equalizing the circulation and fortifying
the nervous system against the action of the poison. According
to Binz, quinine has the power of arresting putrefaction and fer¬
mentation, and is an acti ve poison for all low organisms, animal
and vegetable, and Dr. Grace Calvert hafi confirmed the obser¬
vations of Binz, and announced the power of quinine to prevent
the development of fungi.*
* Sir John Pringle, in his "Experiments upon Septic and Antiseptic Substances, with
remarks rela'ing to their use in the Theory of Medicine," read before the Royal Society
in 1750, after detailing various experiments illustrating the power of Peruvian bark to
arrest putrefaction, makes the following practical application. “Now, since the bark
parts with so much virtue in water, is it not reasonable to suppose that it may yield
still more in the body, when opened by the saliva and the bile, and therefore iii some
measure it operates by its antiseptic virtue? From this principle we may perhaps
account for its success in gangrene, and in the low state of malignant fevers when
the humors are apparently corrupted. And as to intermitting fevers, in which the bark
is most specific, were we to judge of their nature from circumstances attending them, in
climates and in seasons most liable to the distemper, we would assign putrefaction as one
of the principle causes. They are the great epidemic of marshy countries, and prevail
most after hot summers, with a close and moist state of the air.' They begin about the
end of summer, and continue throughout autumn, being at the worst when the atmos¬
phere is most loaded with the effluvia of stagnating water, rendered more putrid by vege¬
tables and animals dying and rotting in it. At such times all meats are quickly tainted,
and dysenteries, with othpr putrid disorders, coincide with these fevers. The heat dis¬
poses the blood to acrimony, the putrid effluvia as a ferment, and the fogs and dews, so
common in such situations, stopping perspiration, shut up the corrupted humors and
bring on a fever.’’
Dr. Pringle reproduced his views with reference to the antiseptic properties of cinchona
bark in decoction and powder, in his Observations on Diseases of the Army, London, 1765.
Surgeon David McBride published, in 1765, his five Experimental Essays on the Fer¬
mentation of the Alimentary Mixtures, Fixed Air, Antiseptics, Scurvy, and the Dis¬
solvent Power of Quicklime, and repeated and extended the experiments of Pringle, and
confirmed his conclusions that certain combinations, as the mineral acids, gums and
Peruvian bark, possess powerful antiseptic virtues, resisting and correcting putrefaction.
This subject has been more recently studied by other observers, as Hallier, Pavis6,
Mayer, Polli Herbest. and more especially by Dr. C. Binz, Professor of Pharmacology in
the University of Bonn. The experiments of these authorities have demonstrated that
quinia in proportion ot one part to three hundred will preserve for a long time flesh,
meal, milk, butter, albumen, urine, etc., and will check very markedly the alco¬
holic fermentation in honey or in syrup ; that the salts of quinia are protoplasmic
poisons, arresting amoeboid and the allied movements of the white corpuscles : even
weak solutions are highly poisonous to protozoa and infusoria, more so even than
salts of strychnia or morphia. Small quantities destroy septic germs, and arrest putre¬
faction more thoroughly than most antiseptics, including even arsenic and creosote ;
and with the exception of strychnia, quinia moreover hinders alcoholic and butyric fer
mentations more than other bitters. Professor C. Binz has demonstrated that this anti¬
septic action is due to a poisonous influence exerted by the quinia upon the fungi which
are the immediate cause of the changes. The larger infusoria, as Paramecia and Col-
poda, are killed by a solution of quinia of the strength of one in eight hundred immedi¬
ately, of one in the thousand after some minutes, of one in twenty thousand after some
hours. Upon the ordinary mould Penicillium, upon vibrios and bacteria, as well as upon
the higher infusoria, quinia acts with a similar fatality. In the case of the vibrios and
bacteria, a decidedly stronger solution than the one mentioned is required to quiet move¬
ments. Solutions of albumen are converted into peptones, if shaken up in an atmosphere
of nascent oxygen, but according to Bossbach, this change is prevented if quinia is
present. Even in relatively small quantities it prevents the putrefaction of nitrogenous
substances, as well as several simpler fermentation processes. Other amorphous ferments,
such as ptyaliu and pepsin, have their properties very slightly, or not at all, arrested by
quinia, and there are small protoplasmic organisms on which it has no poisonous effect
whatever, whereas it reacts on others with unexpected vigor! The poisonous action of
many putrid fluids upon warm-blooded animals may be neutralized either completely or
as far as certain symptoms are concerned, by the simultaneous administration of quinia.
On account of its power of arresting or preventing putrefactive fermentation by killing
the microscopic organisms which produce such putrefactive changes, Professor Binz
has recommended if in the so-called septic diseases.
39
1879] Jones — Treatment of Yellow Fever.
These facts have been applied to the explanation of the effects
of quinine upon the process of inflammation. Thus according
to Conheim’s views, pus being’ mainly a collection of white blood-
globules which have passed through the walls of the blood-ves¬
sels, the alkaloid arrests, or at all events diminishes, the forma¬
tion of pus during the course of inflammation.*
The well-established effect of quinine in producing a decre¬
ment of temperature in fever\ has been referred to its power of
* According to Binz, owing to the energy with which it paralyses certain kinds of
protoplasm, quinia diminishes the absolute number of white blood-corpuscles in the body.
The lymphatic glands become small and are found on section to be abnormally dry, while
splenic enlargements, due to hyperplasia of the lymphatic follicles, and to the increased
tissue change within the organ by which it is accompanied, are reduced or prevented.
The escape of white bl od-corpuscles from the vessels, aud the suppuration which ensues,
can be distinctly limited in animals by quinia. Professor Binz announced (Archiv. fur
Mikroscop. Anatomie, iii., 1867) the fact that quinia added to human blood, in the pro¬
portion of one part to four thousand, immediately checks and in a short time arrests the
amoeboid movements of the blood cells. This observation has been confirmed by Schar-
renbwich, Kerner, > nd Geltowsky. In order to determine whether quinia acts in the
living organism as on the stage of the microscope, Professor Binz experimented according
to the method of (Jonheim. Thus when the mesentery of curarized frogs to which quinia
had been given was exposed upon the stage of the microscope, no accumulation of white
cells in the small vessels, or passage of them out into the tissues occurred upon irrita¬
tion ; or if after a time these phenomena commenced, they were at once checked by a
small hypodermic injection of the alkaloid. When the inflammatory process had already
commenced in a Conheim frog an injection of quinia would cause the wandering out of the
corpuscles to cease, and would bring about a gradual change of the white cells from the
choked up vessels. Professor Binz has further found that in the blood of unpoisoned
animals, the white cells are far more abundant than in that of those poisoned by quinia,
and concludes that quinia acts destructively upon the white blood-corpuscles, in the
same way as when they are out of the body. Dr, George R. Culter has experimentally
confirmed the effects of quinia in preventing the extrusion of white cells in the frog's
mesentery; and A. Martin has not only done this, but has also found that the action of
the drug is apparent in the centre of parenchymatous organs, such as the liver.
The limitation by quinia of the escape of white blood-corpuscles from the vessels, and
the suppuration which ensnes, appears in the main to be independent of the condition of
arterial pressure, and is most probably due to a lowering of the affinity of the corpuscles
for the oxygen of the haemoglobin, this oxygen being the stimulus which excites the
independent movements by which emigration from the veins and capillaries is partly
effected. Presh vegetable juices coniaining protoplasm, and also healthy pus, both of
which ordinarily give the reaction of nascent oxygen with tincture ofguiacum or indigo,
lose this pioperty when mixed with relatively weak solutions of quinia. The reason of
this is that the quinia prevents the protoplasm from absorbing oxygen from the atmos¬
phere, and so from undergoing the special alteration to which the above reaction is due.
Phosphorescent infusoria, or those which are continually undergoing powerful oxidation,
completely lose their phosphorescence on the addition ol minute quantities of quinia.—
Binz.
IThe testimony as to the power of quinia to reduce animal temperature Is somewhat
contradictory. Thus according to Binz the fall of temperature which quinia so fre¬
quently produces in fever (0.5° to 4.0° and more, Centigrade) is independent of
the heart, and also of those portions of the nervous system which take origin in the
brain, and pass downward through the spinal cord, for it still takes place after the coni¬
cal portion of the latter has been completely divided. Nor according to Jurgensen and
Lewitzky, does it appear to depend on an increased emission of heat from the skin.
Among other causes it is probable that quinia exerts some inhibitory effect over the
functional activity of the protoplasmatic cells of the heat producing organs. Even the
normal cells become slightly depressed by its action, especially when they are producing
an unusual amount of heat under the stimulus of pyretic substances, and their infective
poisons (whether they be organized or merely in solution) which are capable of self¬
multiplication in the body after a more or less regular period of incubation, and of act¬
ing as irritants to the cells, are either rendered by quinia incapable of further develop¬
ment. as in malaria, or have their energy paralyzed, as happens to some extent in
typhoid fever.— Binz. On the contrary Dr. G. Kerner and Dr. Jurgensen, have noticed
that full doses of quinia appear in a healthy man not to effect sensibly the temperature,
but to prevent that rise which normally occurs from exercise. The numerous experi¬
ments of Dr. C. Leibermeister, have shown that quinia has no constant action on the
bodily heat in health, but he claims for it a decided antipyretic action when given in
continued fevers, or even in phthisis pulmonalis. Dr. Liebermeister gives as a rule, 1 4
to 24 grammes of the sulphate or muriate of quinine, and regards it as essential that
the whole of the dose be given in the course of half an hour, or at the outside, in the course of
a whole hour. If the dose were to be distributed over a length of time the action would
be perceptibly less; even a much larger dose, but given in the course of half a day or a
whole day', has often scarcely any marked influence on the temperature. Accoiding to
40
Original Communications.
[July
destroying the ozonizing power of certain substances ; and as
the red corpuscles have this power, quinine in the blood is sup¬
posed to diminish the oxydation of tissue and thus to lessen the
production of heat.
Thus Ranke* * and Keener found that the tissue changes were
diminished under the action of large doses of quinine. Zuntz
has recorded the observation that quinine in ten grain doses
lessens the daily excretion of urea by one-third or more; and
Unruh has found the same to occur when quinine was adminis¬
tered in fevers. Harley added quinine to blood, and found that
it took up less oxygen and gave off less carbonic acid than blood
which had not been thus treated. Zuntz and Schute have em¬
ployed the changes in the alkalinity Of the blood for the deter¬
mination of the same fact. Thus, if fresh blood be drawn, a
development of acid begins in it, and continues at first rapidly,
then more slowly, till putrefaction sets in ; and as this acidifica¬
tion depends on oxydation, the diminished alkalinity of the
blood thereby produced furnishes a test of the rapidity with
which the oxydation proceeds, and it has been determined by
the experiments of Zuntz, Scliaraenbroich and Schute that qui¬
nine, bebeerine, cinchonine and picrate of sodium lessen, in dif¬
ferent degrees, the production of acid, and consequently prevent
the oxydation of the blood.t
the same author, In one hundred and seventy-eight observations in typhoid fever,
twenty grains of the quinine having been given daring the night, the morning
temperature was lower than that of the previous evening in the average 1.63° C.;
on one hundred and seventy-six different occasions a scruple of quinine was given during
the day ; sixty nine times the temperatnre was lower in the evening than in the morning;
ten times it was the same as in the morning, and ninety-seven times it was higher than
in the morning. Leibermeister asserts that he has given some ten thousand doses of
quinine as an antipyretic, and has almost unbounded confidence in its power of lessening
fever beat. A committee appointed by the London Chemical Society in 1870, after experi¬
menting with the drug in about fifty cases of various diseases, assert that the antipyretic
action of large doses was very decided, appearing within from one to two hours after the
exhibition of the drug, and lasting from a few to many hours. Dr. Sydney Ringer con¬
cludes from the experiments performed by himself and Mr. Gill, that quinia will reduce
the temperature in health, but to effect this in any appreciable degree, large doses, to the
extent of 20 grains, must be given.
* Ranke was the first to notice that quinia produced a great decrease in the elimi¬
nation of uric acid. The experiments of Dr. G. Kerner, have shown that when about nine
grains of quinia were taken in decided doses during the day, the urea was decreased not
quite one-eighth, the uric acid to a little less than one-half, the kreatine was slightly
increased, and the nitrogenous material decreased about one-ninth. When a very large
dose, 38 grains, was taken in the morning, the urea and kreatine were each decreased
about one-fourth, and also the collective nitrogenous material ; the phosphoric acid was
lessened about one-fifth, and the uric acid about four-fifths. Zuntz found that forty-
five grains of quinine reduced his elimination of urea nearly forty per cent.
t The addition of quinia to blood which has been recently drawn, not only diminishes
the physiological production of acid which occurs immediately after its removal from
the body, but also its power of transferring active oxygen to oxidisable bodies. The
latter effect also takes place with pure hromoglobin, without its being possible to detect
any decomposition of the latter spectroscopically during the presence of the quinia.
On the contrary, when blood which contains quinia is heated, the lines which indicate
oxygen disappear at. a higher temperature than the same lines in pure blood used for
comparison— Rossbach.
The penidllium fungus, when mixed with hemoglobin outside the body, withdraws
oxygen from it, and this process is arrested by quinia.— (Preyer.) All things considered,
and taking into consideration the alterations in size which the red blood corpuscles
undergo under its influence, it seems probable that while the quinia renders certain
cells within the human organism still less fitted than before for the absorption of oxygen, it
binds that element more firmly to the haemoglobin. — (Binz).
1879]
Jones — Treatment of Yellow Fever.
41
The experiments of Binz are especially important, in their
bearing upon the question of the direct action of quinine upon
the chemical changes of the blood, or of its indirect action
through the nervous system, which show that when putrefying
liquids are injected into the circulation, the temperature of the
body rises ; but if the fluids be previously mixed with quinine,
whereby the putrefactive processes are arrested or destroyed,
the rise of temperature is either entirely arrested or considera¬
bly diminished. Such experiments not only throw light upon
the therapeutic action of such alkaloids as quinine, but they
also illustrate, as it were, the very nature of the processes of
those diseases, the effects of which they modify or counteract,
by the peculiar chain of chemical actions which they induce in
the blood. u Observations upon the treatment of yellow fever,
by Joseph Jones, M. I).,” American Practitioner, September,
1873.
The preceding facts, as well as an extended clinical expe¬
rience in civil, military and hospital practice, which established
in me an abiding faith in the powers of quinine to reduce the
frequency of the pulse and to diminish and arrest the heat of
fever, have inclined me favorably to the use of the alkaloid as
a prophylactic and as an antipyretic in yellow fever.
To what extent quinine was used as a prophylactic in the
Mississippi Valley during the epidemic yellow fever of 1878, 1
am unable to say, but some of the severest and most fatal cases
of yellow fever in my practice occurred in those who were
daily in the habit of taking small doses of the sulphate of
quinine to ward off the yellow fever. In my own household,
there were eight persons, adults and children, liable to take
yellow fever, and three who had had the disease in former
years ; the latter escaped, every one of the former had the dis¬
ease in a well marked and in some cases severe and dangerous
form, but all recovered. Not one of these eight cases, myself
included, took any prophylatic or exercised any precautionary
measures.
My colleague, Professor John Barnwell Elliott, recommended
the internal use of the sulphite of sodium, the dose being about
ten grains for an adult, three times a day. According to some
accounts the disease was rendered milder by the use of the sul¬
phite of sodium, but 1 have no reliable facts or statistics to
sustain this proposition. Dr. Joseph T. Scott has informed me
that he used with considerable success as a prophylactic meas¬
ure, a plan of treatment, or rather preparatory training, which
consisted in the free use of lemon juice (lemonade), and small
doses of Fowler’s solution of arsenite of sodium, and of quinine
and chlorate of potassa daily.
These measures did not prevent the disease as cases occurred
in my practice who were under this treatment. It was claimed,
6
42
Original Communication x.
[July
however, by Dr. Scott, that these measures prevented the dis¬
ease in many cases, and in others when it appeared modified,
its course rendering it comparatively mild. It is to be hoped
thatDrs. Elliott and Scott, and all others who have experi
merited with prophylatics, will communicate the results to the
profession. 1 shall be pleased to be the medium of such com¬
munications.
However quinine may appear theoretically to be demanded in
the treatment of yellow fever, we can never lose sight of the
fact that it has often proved of no perceptible benefit in some
cases. It is also worthy of note that we are often absolutely
prevented from administering this or any other remedy by the
mouth on account of the irritable condition of the stomach. In
such cases we art* restricted to three modes: absorption by the
surface, subcutaneous injection, and absorption by the rectum
and large intestines. To what extent and with what results
the second method has been employed, 1 cannot say, but with
reference to the first and third, it cau be said that they were
extensively employed. 1 preferred these methods, in that they
allowed the stomach to remain quiet. 1 employed quinine by
liniment externally, using it in this manner in about two hun¬
dred cases, and in no instance did I see any injurious effects.
The patients also expressed great relief of the pain in the back
and limbs from the friction with the quinine liniment, which
was generally composed of from one to two drachms of the sul¬
phate of quinia dissolved in three fluid ounces each of soap lin¬
iment and olive oil. This liniment was well rubbed into the
back and extremeties every three or four hours, and aside from
the direct effects of the quiniue, I found that the olive oil had a
marked effect in reducing the temperature and promoting mois¬
ture or sweating in the skin.
Generally I employed the sulphate of quinia internally
and externally, but in some cases T used the bromide of quinw
with satisfactory results.
8. VERATRUM AND GELSEMIUM.
We possess, for the the treatment of fevers, valuable antipy¬
retics and arterial sedatives, in the American hellebore root
(veratri viridis radix), and in the tincture of the root of the Caro¬
lina jessamine (gelsemium sempervirens). The latter agent is
popular with some physicians, on account of its power to control
nervous irritability in fever. It is well known that veratrum
is a reliable antipyretic if used in sufficient doses, and that it
often effects a complete intermission in cases where it had not
been obtained by quinine.
The root stock of veratrum viride contains two alkaloids,
jervia and veratroidia ; and Mr. Charles Bullock, who in 1867,
was the first distinctly to separate these alkaloids, believed
Jones — Treatment of Yellow Fever.
43
1879]
that they were distinct from all others ; but Mr. Charles T.
Mitchell, in 1874, proved that the viridia of Bullock is chemi¬
cally identical with the jervia of veratrum album.
Professor H. C. Wood, Jr., M.D., from an elaborate series of
experiments (Philadelphia Medical Times, vol. 10 ; also Treatise
on Therapeutics, 1877, pp. 150-156), concludes that veratrum
viride is a powerful spinal and arterial depressant, exerting
little or no direct influence upon the cerebral centres. In full
therapeutic doses it lowers the pulse-rate both by a direct action
on the muscle (jervia) and by stimulating the inhibitory nerves
(veratroidia) ; it diminishes the force of the heart beat by a
direct influence on the cardiac muscle (jervia), and produces a
general vasomotor paralysis (jervia) more or less complete
according to the size of the dose. Under its action the func¬
tional activity of the skin is greatly increased ; but as this is a
necessary result of the profound arterial depression, there is no
reason to believe that the drug has any specific influence upon
the perspiratory glands. In a similar manner the excretion of
bile, is often indirectly increased by veratrum viride, through
the severe vomiting which it induces.
Veratrum viride undoubtedly lowers animal temperature very
decidedly, but whether directly or indirectly has not been deter¬
mined. Professor H. C. WTood has frequently seen it reduce
the bodily heat, and M. Linou states that it does so, but not so
certainly as it lowers the pulse. Oulmont asserts, as the results
of his experiments, that in animals from half an hour to two
hours after the administration of such doses as would produce
violent symptoms without killing, the temperature fell 2°, 3°,
or even 5° C., and remained at this point for twenty-four hoiuvs.
It is evident from the peeceding facts, that with our present
knowledge of the physiological action of veratrum viride, there
are at least three natural indications for its use, namely, to re¬
duce spinal action, to reduce cardiac and arterial action, and to
depress the temperature in fever.
It is well known that this medicine has been used with bene¬
ficial results, in fevers, pneumonia, inflammations, neuralgia
and cardiac troubles. In the inflammations in pneumonia, in
typhoid fever, and in the early stages of yellow fever attended
with cardiac and arterial action and elevated temperature, the
ability of veratrum viride to diminish temperature, to increase
the secretions, to reduce the arterial tension, and slow the heart
are of great value. When employed in the treatment of yellow
fever, its use should be limited to the first stage of active car¬
diac and arterial excitement and elevated temperature. It is
but just to suppose that the most destructive lesions occur in
this stage, and that as a general rule these destructive and
fatal effects will be in proportion to the activity of the circula¬
tion, the spinal excitation and the elevation of temperature.
44
Original Communications.
[July
Administered at the outset of the disease during the first 24,
48 or 72 hours, according to the symptoms of the individual
cases, veratrum viride has accomplished good in my hands.
The mode of administration has been to give from two to four
drops of the tinetura veratri viridis IT. S. P. (^viij. to Oj.), or of
Norwood’s tincture (saturated tincture), to an adult, in orange-
leaf tea, every two or four hours according to the urgency of
the symptoms. The direction was invariably given to stop the
veratrum viride if any decided nausea appeared.
The use of the veratrum viride was rigidly confined to the first
period (stage of active febrile) excitement in yellow fever, on
account of the known tendency of the poison or the product of
its chemical action, to depress the action of the heart and to
reduce the number of beats in many cases below the normal
standard, even when the temperature remained at an elevated
point.
With reference to the yellow jessamine (gelsemium semper-
virens), Dr. Cleveland, of Cincinnati, states that its value in the
treatment of malarial fever was accidentally discovered by a
planter suffering under bilious fever, who took by mistake an
infusion of the root of this plant, and was cured, although for
a time he lost all muscular power. It has been announced more
than twenty years ago as a speedy cure for intermittent fever,
and has been largely used in this disease in the Western and
Southern States.
Dr. Nash, of Norfolk, who has employed it in many cases of
fever, affirms that it has produced the most desirable effects,
neither age nor sex interfering with its exhibition ; and whilst
he does not rely solely upon it, in all cases, especially those of
a high grade, lie thinks that it is entitied to rank as a co¬
efficient with quinine in fevers. It has been chiefly used in the
form of tincture, an excellent preparation being made by Dr.
St. John, an experienced druggist of Alexandria, La. Dr. T.
A. Mayo, who has published a valuable paper upon the gelse¬
mium in the Charleston Medical Journal and Review for March,
1857, affirms that he has never been disappointed in a single
instance in obtaining a direct sedative action from the use of
the gelsemium ; the patient being speedily quieted, although he
may have been excessively agitated previous to its administra¬
tion. Under its influence restlessness is soon succeeded by
calm repose, and the excited, frequent pulse tempers down to
tranquility. These favorable impressions must be secured,
however, by a frequent repetition of the dose, as its effects are
not very durable, wearing off in two or three hours.
(To be continued.)
1879] Report on Intra-Mural Sepulture in New Orleans.
45
Report on Intra-Mural Sepulture in the City of New Orleans.
Adopted by the Nevr Orleans Medical and Surgical Association, at their Meeting Held
on Saturday, May 31, 1879.
To the President and Members of the
New Orleans Medical and Surgical Association ;
Gentlemen —
Your committee, appointed tor the purpose of drafting a
memorial on the subject of intra mural burials in the city of
New Orleans, respectfully report as follows :
The present corporate limits of New Orleans extend from the
upper line of Carrollton to the Slaughter House, include Algiers
on the right bank of the river, and reach as far back as the
Rigolets Station on the water course separating Lake Pont-
chartrain from Lake Borgne. In the length and breadth of
this vast surface their exist 31 graveyards , distributed as fol¬
lows in the order of municipal districts.* (It should be stated
here, that the cemeteries on the Metairie Ridge are classed
separately, for the reason, that they do not come under the
category of graveyards popularly designated as “ intra-mural”.)
First District . 1 graveyard. J
Second District _ 4 graveyards. <
“American,” on Basin street,
near Girod.
^ 1. “ St. Louis, No. 1,” Basin,
between Conti and St.
Louis streets.
2, 3, 4, “St. Louis, Nos. 2, 3, 4,”
Claiborne, from Custom¬
house to St. Louis streets.
1
Third District . 4 graveyards. <
1. “ New St. Louis,” Espla¬
nade, near Bayou St. John.
2. “Hebrew,” Gentilly Road.
3. “ St. Vincent de Paul,”
Louisa and U r q u h a r t
4. “Campo Santo,” Urquhart
near Girod street.
* The committee are indebted to the courtesy of the Board of Health, for the data con¬
tained in this report concerning the number and distribution of the cemeteries.
46
Original Communications.
2.
Fourth District _ 4 graveyards. <
3.
4.
.
Fifth District . 2 graveyards. j
c 1.
Sixth District . 2 graveyards. ^ 2.
Seventh District.. 2 graveyards, j }/
[July
“Lafayette No. l,’r Wash¬
ington and Prytania
“ Lafayette No. 2,” Wash¬
ington and St. Patrick
“St. Joseph No. 1,” Wash¬
ington, near St. Patrick
“ St. Joseph No. 2,” Sixth,
near St. Patrick street.
“ St. Bartholomew,” Alg’s.
“Hughes,” Algiers.
“Valence,” V alence street.
“St. Vincent’s,” St. Denis
street.
“ Catholic,” Carrollton.
“ City,” Carrollton.
Total . 19 graveyards.
Beside the above, there are also 12 cemeteries on the
Metairie Eidge, as follows :
NAMES. DISTRICT.
1. “Holt” . 2d..
LOCATIONS.
Metairie Ridge
“ Metairie” .
1st .
_ do.
do.
3.
“ Odd-Fellows” .
.2d .
.... do.
do.
4.
“ Masonic” .
.2d .
_ do.
do.
5.
“ Ev. Lutheran St. John ”
.2d .
. do.
do.
6.
“Cypress Grove No. 1”. .
.1st .
do.
7.
“ Cypress Grove No. 2” . .
.1st .
. do.
do.
8.
“Greenwood” .
-1st .
. do.
do.
9.
“ Potter’s Field ” .
do.
10.
“ Hebrew No. 1 ” .
.1st .
. do.
do.
11.
“ St. Patrick’s No. 1”. . . .
. do.
do.
12.
“St. Patrick’s No. 2” _
.2d .
do.
Total 12 graveyards on Metairie Ridge ; thus making a grand
total of 31 cemeteries spread out over the whole of the im¬
mense territory included within the corporate limits of the city
of New Orleans. Narrowing the subject, however, within the
boundaries of the portions of that area whioh are regularly in¬
habited^ we find, according to the above list, that of this grand
1879J Report on Tntra- Mural Sepulture in New Orleans. 47
total of 31 cemeteries , twelve are already situated on the Metairie
Ridge, at some distance from the city proper, and these grave¬
yards are not classed in the same category with the others,
which are termed “ intra-mural.” These last are nineteen in num¬
ber ; in size, with but few exceptions, they occupy an ordinary
city square block, and these 19 cemeteries are scattered over
the vast surface of territory extending from Carrollton to the
United States Barracks, and comprising Algiers. Besides, as
the list of cemeteries shows, the Second, Third and Fourth Dis¬
tricts are the only ones in each of which there are four ceme¬
teries. In the First 1 Mstrict there is but one, and the Fifth,
Sixth and Seventh Districts (which are, properly speaking,
rural or suburban), only contain two apiece.
The question of interments and cemeteries is governed by the
following sanitary laws, which are taken from Leovy’s “ Laws
and Ordinances of New Orleans.” In stating these laws and
ordinances, your Committee, for the sake of brevity, intend
mentioning only such articles as have direct reference to the
subject of this report, and therefore pmposely omit others
whose bearing is of a character affecting the matter at issue
more remotely. Under the heading “Cemeteries and inter¬
ments,” the following articles are found:
“ Art. 3. All tombs must be built of the best kind of brick
or stones, laid in mortar, with the proper proportions of the best
cement and sharp sand, and covered with bitumen on the
ground floor of each tomb, with walls not less than nine inches
in thickness, and plastered. All the tombs must be kept in
good order, and it shall be the duty of the sexton to notify the
owners thereof to have them repaired; otherwise it shall be
done by the city, at the expense of the owners, who shall be
fined hi the sum not exceeding fifty dollars.”
“Art. 4. The Mayor and recorders are each authorized to
grant permits for the opening of tombs in the public cemeteries,
to such persons as may make such application to deposit a dead
body therein.”
(At the present time these permits are granted by the Board
of Health.)
“Art. 5. The various churches and associations owning cem¬
eteries are authorized to use them under such regulations made
Original Communications.
48
[July
by them, from time to time, as may not conflict with city
ordinances.”
“Art. 7. All sextons shall inter, within the shortest possible
delay, all deceased persons who may be conveyed to their re¬
spective cemeteries, in graves to be dug not less than four feet
in depth, and to be at a distance of at least three feet from
each other, according to such limitations as shall be described
by the city surveyor, and in pursuance of such directions as
they may receive from the Mayor * * * ”
The remainder of the article is omitted, as it relates to the
duties of the sextons, in connection with the bestowing of
proper care, etc., upon the cemeteries under their charge.
“ Art. 10. It shall be the duty of the surveyor to visit the
cemeteries once a month and oftener, if he deems it necessary,
in order to prescribe the limitations, according to which the
graves and tombs are to be made, care being taken to reserve
all around and along the fences, such places as may be neces¬
sary to build tombs for account of the city ; and it shall be the
duty of the street commissioners to visit the cemeteries once a
month, and see that the ordinances are observed.”
“ Art. 11. No burial shall be permitted in any churchyard
in this city, except the pastor of their churches, under a penalty
of live hundred dollars.”
“ Art. 14. It shall be the duty of every person, at whose
domicile any person shall have died, to cause the same to be
buried within forty-eight hours after his death ; and any person
offending against this section of this ordinance shall pay a fine
not exceeding one hundred dollars for each offence.”
“ Art. 18. Hereafter, no person shall be buried in the ground
of the cemetery on the square comprised within Washington,
Sixth, Prytania and Plaquemine streets, of the Fourth District,
and in future, no interments shall be made therein, except by
persons owning lots, vaults, or tombs ; and further, that the
St. Joseph Asylum, of the Fourth District, may use square No.
271, for burial purposes.”
The graveyard question is one, in which the population of
every locality feels the deepest interest. In this city, to the
best of the knowledge and belief of your Committee, the
influence of intra-mural cemeteries has never as yet been
49
1879] Report on Intra-Mural Sepulture in New Orleans.
studied with the care, the subject deserves. In moments of
panic, the cry has occasionally been raised, that the graveyards
were the cause of yellow fever. Men of science have avoided
any such categorical assertion, for they are well aware of the
gropings of the profession to the present day, with reference to
the cause or causes of yellow fever; but among their number,
some, reasoning upon theoretical grounds, may have con¬
cluded, that because it has been demonstrated that graveyards
have proved injurious elsewhere, therefore they must have
poisoned the health of New Orleans. ^Reflection will, however,
speedily show the unscientific character of such reasoning, and
therefore your committee believe that if the intra mural grave¬
yards are to be condemned at all, it must only be after a most
minute and careful investigation ; one that shall not be con¬
ducted hastily, for the subject should not be slighted, if the
result be expected to meet with that consideration accorded by
thoughtful minds to the dicta of science.
A plan of investigation of the influence of graveyards upon
the surrounding neighborhoods w as suggested some months
ago. This plan, which as your committee learn has very re¬
cently received some attention from the Board of Health, con¬
sists in taking a given graveyard (or more than one, if it be
deemed advisable), in block with a certain number of squares in
its neighborhood, and in comparing these with a corresponding
number of squares situated in another portion of the city where
there is no cemetery, attention being given to the fact that
these two groups of squares should be comparable in point of
population. Then, the comparative mortality of these two
groups of squares should be studied during a number of years —
the greater the better. The records of the Board of Health
would doubtless afford a solution of this interesting question,
but precisely owing to the fact that the labor of going over old
archives in the manner proposed is one of great tediousness,
the result should not be proclaimed too hastily.
With regard to the deleterious influence of cemeteries upon
human beings, two principal classes of effects may be estab¬
lished. 1. In localities where ground or river water is in
general use, burials in the earth are undoubtedly dangerous,
owing to the saturation of the soil and the contamination of
4
50
Original Communications.
[July
the sources of water supply, eveu at great distances. This
class of effects may, for the reasons with which all are ac¬
quainted, be dismissed from consideration as far as New Orleans
is concerned. 2. Under this heading are grouped the putrefac¬
tive changes due to cadaveric decomposition, and the effects
produced by the gases evolved during its continuance. It is
deemed unnecessary, for the purpose of this report, to recite
these changes arid enumerate these gases. It will be sufficient
to state that there is no warrant for asserting that the intra¬
mural graveyards of this city have ever been proved to have
occasioned zymotic or other diseases in the neighborhoods by
which they are surrounded, and therefore their influence upon
the more remote portions of the city is, to say the least, ex¬
tremely problematical. Indeed, it is found that in a country
like France, where a great deal of legislation has been brought
to bear upon cemeteries, the distance at which a graveyard
may, under certain circumstances, be looked upon as danger¬
ous, has been fixed at 100 metres. (The metre is equivalent
to about 30 inches English measure.) That is to say, that the
Freuch law considers it safe for human beings to reside not
further than about 300 feet from a cemetery.
The experience of last summer is yet so fresh in the minds of
all, that it is scarcely necessary to mention that the epidemic
of 1878, in New Orleans, broke out on Constance street, near
Terpsichore, that is to say, at a point fully one mile distant
from the nearest graveyard, and in the First District of the
city, which, unlike all the others , has but one cemetery within its
limits. (The cemeteries on the Metairie Ridge being always
excepted, for the reasons given above.) And it also remains to
be proved, that even in the height of the late epidemic, there
were more cases of yellow fever, or more deaths from that
disease, in the neighborhoods surrounding the various grave¬
yards, than in other parts of the city.
The following extract from an article published some time
since, in the u New Orleans Journal of Medicine,” by Prof. S.
M. Bemiss, M. 1)., is introduced here, as illustrative of the
position taken in this report :
u Sanitary laws, unlike civil and moral laws, are not universal
in their application, but have grown out of the necessities
1879] Report on Intra-Mural Sepulture in New Orleans. 51
of localities differing radically as to tlie circumstances affecting
the health of their respective populations. On this account
very little of what has been legislated or written in regard to
intra-mural sepulture is applicable to the mode of burial in this
city. There is no reason to doubt that ill health to the occu¬
pants of such houses has frequently followed their erection
upon soil that had nearly or quite reached the point of satura¬
tion, or in other words, soil which from repletion of animal
remains no longer retained its powers of disinfection and
deodorization. ' But no such facts can properly apply to the
mode of sepulture practised iu this city. Here the bodies of
the dead undergo such rapid disintegration and volatilization
that within a very few months, only the ashes remain. Some
very few exceptions occur, a portion of which are attributable
to the fact that the burial ^cases are hermetically sealed and
thus the process of decomposition is retarded, in another por¬
tion partial dessicatiou and mummification take place.”
The quotation from the article written by Dr. Bemiss is
interrupted here, for the purpose of stating that, on another
occasion, a member of this committee* called attention to the
danger arising from the use of so-called hermetically sealed
metallic burial cases, which, while they in no maimer prevent
decomposition, still retard the dissemination of the gasses
resulting therefrom.
Dr. Bemiss continues : u But these latter examples are so
few, that the question is mainly in reference to contaminations
of the atmosphere by the volatilized elements of dead bodies
undergoing extremely rapid decomposition, but enclosed with
carefully constructed walls of stoue or brick. The very ele¬
vated temperature, to which the air of these vaults must be
brought by the almost tropical heat of the sun, is not favora¬
ble to the life of the germs of zymotic diseases, so that I pre¬
sume these affections are seldom or never communicated by
emanations from our tombs. Moreover, the process of destruc¬
tion is so rapid and complete, as to resemble combustion
more than ordinary decay ; the period, therefore, must be
brief, when any form of organic effluvia will continue to escape.
Dr. D. C. Holliday.
52
Original Communications.
[July
In the absence, therefore, of all proof or information to the
contrary, 1 conclude that our method of interment is not pre¬
judicial to the health of inhabitants, even living in the imme¬
diate vicinity of cemeteries, in any other manner, than in adding
to the amount of organic matter floating in the atmosphere,
and thus increasing its aggregate impurities.”
For the foregoing reasons, and also from the fact, that owing
to the small size of eacli graveyard considered singly , as well
as owing to the manner in which the cemeteries called “ intra¬
mural ” are scattered over an immense surface of territory, as
has been shown in this report, and the relatively limited num¬
ber of corpses buried in each of these graveyards weekly or
monthly, as the mortuary reports of the Board of Health at¬
test, your committee believe, that under the peculiar circum¬
stances in which the population of this city is at present placed,
and which do not require more than a passing allusion, it
would be a positive injustice and hardship to the greater num¬
ber to close the “intra-mural” cemeteries, when there is no
evidence to prove that the squares in the vicinity of cemeteries
are worse off in the matter of health, than others more
remotely situated.
The graveyard is the resting place of many loved ones, and
precisely because in connection with it, sentiment has sent
forth its roots into every hearth, science should avoid being
unnecessarily dictatorial, and its judgment should only be ren¬
dered, when the proofs of conviction are indisputable.
Your committee in bringing this report to a close, tender,
however, the suggestions formulated below, with reference to
the system of burial as now practiced in New Orleans. They
believe these suggestions will cover the entire ground of con -
troversy, and afford every reasonable assurance of protection
to health and life. .
1st. Prohibit the establishment of any new cemeteries , within
certain limits of the city; said limits to be defined by the
proper authorities.
2d. As to the graveyards now in existence, your Committee
would recommend the adoption of the strictest sanitary measures
in their administration. The foregoing language is selected as
being sufficiently comprehensive to embrace all reforms which
1879]
Correspondence.
53
may be deemed needful. For instance it would include the fol¬
lowing points :
(A.) Do away with the present system of building ovens and
burying in the same, because, as now constructed, one of the
walls of these ovens forms the enclosure of the graveyard,
thereby offering possible sources of danger and offense, from
mosely jointed or imperfectly cemented bricks.
(B.) If any new ovens be constructed, require that they shall
be built independently of the wrall of enclosure, and that they
shall be removed a certain distance from said wall. Thus,
these ovens, in the future, will be assimilable to ordinary tombs,
and for these, as well as for those, observe all possible care in
their construction, with regard to the manner in which they
shall be cemented when in course of erection, inspected at stated
intervals, and sealed when burial takes place.
(C.) Exact from all keepers of graveyards strict compliance
with the laws or ordinances relative to the length of time
which is fixed, before vaults may be opened for the purpose of
allowing fresh interments.
(1).) Maintain a rigid sanitary police surveillance over the
general arrangements for cleanliness and disposal of causes,
which may seem offensive or insalubrious in any given grave¬
yard or graveyards.
(Signed,) THOMAS LAYTON, M. D.
do. DAN’L C. HOLLIDAY, M.
do. L. F. SALOMON, M. I).
, Chairman,
I).
of Commitiee.
F
ORRESPONDENCE.
New Orleans, May 24th, 1879.
Editors New Orleans Medical and Surgical Journal :
Gentlemen — Having been requested by the Louisiana State
Medical Society to further pursue my investigations into the
existence of Leprosy in Louisiana, I would ask you to be kind
54
Obibuary.
[July
enough to insert the following questions in your Journal, with
the request that physicians in this State having any knowledge
of the existence of the disease be good enough to communicate
with me.
Most respectfully, etc.,
L. F. Salomon, M.D.,
515 Baron ne street.
“ QUESTIONS :
u 1st. Are there at present any cases of Leprosy in your
parish ? If so, how many ? What is the race or color of said
cases !
u 2d. State the variety — whether Tubercular or Anaesthetic.
“ 3d. Give the history, as far as can be ascertained, of one
or more cases.
u 4th. In the cases within your knowledge was the disease
hereditary or acquired ?
“ 5th. If possible, give approximate date of the appearance
of the first case of Leprosy in your parish.
' 4
u Otli. Have any cases been treated by you ? If so, please
state treatment and result.’”
OBITUARY.
JOHN MAYNARD WOODWORTH.
The death of the supervising surgeon-general of the marine
hospital service will take the country by surprise. His youth
and vigor, and the prominence in which he has been placed
during the past year, owing to his active labors in behalf of
State medicine, have led many to predict for him a long and hon¬
orable career. It was doubtless the great mental and physical
strain thus imposed that overpowered him, and opened the way
for an erysipelas, which was followed by a fatal pneumonia.
He was born at Big Flats, Chemung County, X. Y., August 15,
1837. He was taken to Illinois by his parents, and was edu¬
cated at the Univereity of Chicago. He first studied phar¬
macy, and attended the lectures on Medicine and Chemistry at
the Rush Medical College. He afterward entered upon the
regular study of medicine in that institution. The winters of
1859, 181)0 and 1801 he spent in the Smithsonian Institution,
Current Medical Literature.
55
1879]
working- under the personal supervision of Prof. Spencer F.
Baird. He graduated in 1862 ot the Chicago Medical College.
He immediately entered active service in the army of the Union
as an assistant post surgeon at Camp 1 )ougiass, Illinois, and
shortly after was appointed assistant surgeon of volunteers,
and joined General Sherman in the field near Corinth, remain¬
ing- with his command until the Union armies were mustered
out in 1865. In 1863 he was promoted to the rank of surgeon,
and assigned to duty as medical inspector of the fifteenth army
corps, and afterward medical inspector and medical director
of the army of the Tennessee. During Sherman’s march to the
sea he was breveted lieutenant-colonel. In 1865 he visited
Europe, and in 1866 he established himself in Chicago. In
1871 he was appointed supervising surgeon-general of the
marine hospital service of the United States, a position wiiich
he held up to the present time.
Dr. Woodworth’s valuable work in promoting the efficiency
of the service he had in charge has been frequently commented
upon by us, and is well known to our readers. The valuable
weekly sanitary reports compiled from all quarters of the
globe savor of an enterprise peculiarly American, and were
highly creditable to himself and the country. He has been in¬
defatigable in his work on the yel.ow fever commission, and in
his efforts to obtain national legislation which would enable us
to prevent a return of the disease. The bill which finally
passed during the last hours of Congress, and the text of which
we give elsewhere, although not in accord with his views, estab¬
lished a board of health to which he, among others, had
already been appointed when death snatched him in the very
height of his career. His loss will be sincerely mourned by
the profession throughout the country. — Bouton Medical and
Surgical Journal.
THE UTERO-O V ARI AN AMPUTATION AS COMP. EMENTARY TO THE
CvESAREAN OPERATION ACCORDING TO THE METHOD OP DR.
PORRO, OF PAVIA.
(From the Chicago Medical Journal and Examiner, .March, 1879.)
The utero-ovarian amputation in a woman subjected to Caesa¬
rean section was first practiced at Pavia, May 21, 1875, by Pro¬
fessor Porro. In this case it was an operation of necessity, being
the only means capable of arresting a haemorrhage which threat¬
ened to be speedily fatal. The circumstances surrounding the
patient were as unfavorable as possible j an epidemic of puer.
Current Medical Literature.
56
[July
peral fever raged in the wards of the maternity at Pavia ; and
yet the experiment of Porro was crowned with complete success.
At the end of six weeks his patient left the hospital, and was
able to bear the fatigue of a journey of several hours. * * *
The beginning of the operation resembles that of ordinary
Caesarean section, up to the moment when, the uterus being
widely open, the surgeon can proceed to the extraction of the
child. This done, instead of separating the placenta imme¬
diately, the uterus is drawn out through the abdominal wound,
and kept there by strong traction. The assistants draw the
edges of the abdominal wound together, compressing them
about the uterine neck. The after birth is not detached and
removed until, by means of these precautions, the penetration
of blood into the peritoneal cavity is prevented. The pedicle
of the tumor formed by the uterus and its appendages, is
clasped by the loop of a linear ecraseur, and tightented suf¬
ficiently to arrest the flow of blood. All the parts are then
removed with the bistoury to within two centimeters of the
chain of the ecraseur, then the stump thus obtained is traversed
by a long needle through its base, which prevents its retrac¬
tion within the abdominal cavity. The lips of the abdominal
wound are united to each other or with the base of the stump
by sutures. All the portion of the stump beyond the chain of
the ecraseur falls at the end of several days, the rest becomes
adherant to the abdominal walls, and the cicatrization is com¬
plete at the end of a month or six weeks.
Since the 21st of May, 1875, the ntero-ovarian operation has
been performed fifteen times. An Italian journal ( Annali uni-
versali di Medidna e Chirurgia , Nov. 1878), gives a statistical
table of these fifteen cases ; we reproduce it, as it is better calcu¬
lated to show the advantages of the new method than any theo¬
retic reasoning.
In 1875, utero-ovarian amputation was performed once only,
May 21, at Pavia, by Prof. Porro ; the patient, as we have said,
got well in six weeks.
In 1876, three operations ; two at Vienna by Prof. Spaeth,
giving one death and one success ; a third, also at Vienna, by
Prof. Braun, followed by death.
In 1877, four operations, all followed by death ; one at Milan
by Prof. Chiara ; a second at Fribourg by Prof. Hegar ; a third
at Bergamo, by Dr. Previtali ; the fourth at Berne, by Prof.
Muller.
In 1878, seven operations; at Milan, by Prof. Chiara, two
cases, one death and one cure; at Turin, Prof. Tibone, one
death; at Liege, Prof. Wasseige, one cure and one death; at
Prague, Prof. Breisky, one death ; at Brescia, Dr. Peroglio,
one cure.
Seven cures and eight deaths ; a result not sufficient to
remove the dread of Caesarean section, but when compared with
the old plan we cannot help recognizing that the process of
1879] Current Medical Literature. 57
Porro constitutes an important progress, one deserving its
adoption in the practice of our hospitals.
Since the publication of the above article in the Chicago
Journal, we have received news from Italy that in the first
quarter of this year three more operations were performed in
Turin, by Professors Tibone, S. Giordano, and G. Beiruti. The
first case died of shock ; the second recovered, perfectly well.
Though we did not hear yet of the final result of the third, we
are able to state that the patient was doing well a few days
after the operation.
For all these cases the women had an extremely viciated
pelvis, so as to render natural labor impossible. The three
fceti came out alive, and healthy. J. 1).
A CASE OF CAESAREAN AND UTERO-OVARIAN AMPUTATION.
[Translated from L' Indipendente of Turin, May 95, 1879.J
On the lhth of May at half-past 5 o’clock, P. M., Doctor G.
Berruti performed the utero-ovarian amputation, assisted
by Professors Giordano and Tibone.
The operation was completed in 35 minutes. The woman
went under the influence of chloroform very easily, so that she
did not feel a single pain during the whole time of the opera¬
tion.
The method was about the same as that recommended by its
bold inventor, Professor Porro of Pavia.
An incision was made on the linea alba down to the pubis,
three centimetres over it, and then the peritoneal cavity was
opened. The womb, which had been firjnly kept fixed to the
abdomen by Prof. Tibone, was next cut to the extent of a
few centimetres. The lips of this wound were seized by the
strong pincer of Tean, and drawn out as externally as possible,
and the placenta was opened.
After having given to the wound of the womb, both above
and below, a larger extension of 10 or 12 centimetres altogether,
the foetus was promptly extracted. The placenta was detached ;
the pincer of Pean approximated, and by their aid the womb and
both ovaries were drawn completely out. A portion of intes¬
tine that had threatened several times to protrude through the
inferior part of the abdominal wound, was kept in situ until
the end of the operation. This portion of intestine was ex¬
tremely red, and injected, a fact observed in other cases. The
womb was then kept up suspended, and the operator intro¬
duced in the inferior portion corresponding to the neck, the ex¬
tremely curved trocar of Prof. Tibone. Through the canula of
this trocar a double strong silk thread was passed, in order to
divide the peduncle in two, and have it tied so as to cause its
8
58
Current Medical Literature.
[July
anaemia. The intention of the operator here was to
substitute for the metallic ligature, of the peduncle,
and constrictors of Gintral , a simple silk ligature, with
its ends to be fixed outside of the abdominal wound,
it ut, as, after the excision of the peduncle with the semilunar
knife, tfie uterine arteries gave way to great quantity of blood,
it was thought prudent to apply around the peduncle a strong
metallic ligature, and to have it crushed by the excraseur of
Kb berle. The haemorrhage stopped immediately. After the
dressing of the peritoneal cavity, the operator proceeded to the
sutures of the abdominal wound. The last point of the inferior
suture was made with a larger needle and a stronger thread,
in order to pass through the lips of the wound and the peduncle,
which was touched by the liquid perchloride of iron.
The whole operation was executed under the carbolic acid
spray, and the farther dressings of the wound were strictly
made according to the antiseptic system of Lister.
The patient hail a very severe but not infectious peritonitis.
8 he is now on the tenth day after the operation, and nearly
approaching convalescence. The temperature never reached
40 degrees (105° F.). Everything is in favor of a rapid recov¬
ery. The tietus of the size of -5750 grammes is in excellent
health.
The pelvis of this woman is extremely defective. The min¬
imum diameter is 4 centimetres. The stature of the woman
is of 1.03 m., and every bone of her skeleton is deformed.
Of the final result of this operation we will let the medical
profession know, whatever it may be. J. D.
TURPENTINE IN WHOOPING-COUGH.
(Wiener Allegem. Med. Zeit., No. 12, 1878.)
l)r. Gerth cured a case of laryngeal catarrh by placing twenty
drops of turpentine on a handkerchief, held before the face and
causing about forty deep inspirations to be taken. Repeating
this thrice daily, the cure was quite rapid. In the same family
he found an infant fifteen months okl iu the convulsive stage of
whooping cough, quite exhausted, and vomiting all ingesta.
There was at the same time slight bronchial catarrh with
slight evening rise of temperature. Gerth decided to experi¬
ment here also with turpentine. He directed the mother to
hold the moistened cloth as above, before it when awake, and
to drop the oil upon its pillow when asleep. The result was
most happy. Within the twenty-four Lours the frequency and
severity of the attacks notably diminished. The child’s strength
was sustained by stimulants, and improvement was very rapid.
Within a year pertussis became epidemic in his vicinity, and he
repeatedly tested the drug in this way. He gave it to children
of all ages, and in any stage of fever. The initial catarrh, the
convulsive, and the final catarrhal stages were all decidedly
benefitted, the spasmodic attacks being in many cases aborted.
Chicago Medical Journal and Examiner,
1879]
Current Medical Literature.
59
A SANITARY PROTECTIVE ASSOCIATION.
An association under the above name lias been formed at
Newport, It. I., for the purpose of securing, at a moderate cost,
sanitary advice and protection to its members. Such associa¬
tions have been in successful existence in Edinburgh, but this
is the first of its kind in this country. The organization includes
an inspecting engineer and a chemist. The members pay an
annual due of six dollars, and for this are entitled to have their
house inspected by the engineer and an analysis of the drinking
water made by the chemist. By a small additional fee they
can obtain similar service for any other houses which they may
own. They can also have a report, without fee, upon the
sanitary condition of any church, school-house, or place of
public resort within the city of Newport, and can have occa¬
sional supplementary inspection and advice concerning the
dwelling or property in respect of which they are subscribers.
The Association is intended to supplement and not conflict
with any public health board. Its object is an excellent one,
for it cheapens the cost of thorough sanitary inspection, and
will therefore tend to diffuse a wider knowledge and encite
greater attention concerning matters of public hygiene. — A. Y.
Med. Rec., April 26.
INEFFICIENCY IN EXPERT TESTIMONY.
In a report upon certain medico-legal cases by Dr. Thad. M.
Stevens, the bad state of affairs that still exists in connection
with expert testimony is very clearly shown. Experts who are
ignorant, experts who lack common sense, and experts who are
dishonest, are referred to in the illustrative cases cited. We
have before commented on this and shown, as is done by l)r.
Stevens, that, while there are many points in toxicology not
yet satisfactorily worked out, yet the present trouble does not
lie in the incompleteness, of the science, but in the present
method of calling experts, some being retained by the prosecu¬
tion and some by the defence.
The first case given, in particular, shows what an ingenious
expert can do when under the stimulus of a tee from the
defence, A woman received a potion from her husband and
a few hours afterward was taken with convulsions and died.
The defendant’s expert admitted at first that the symptoms
covered nearly all those of strychnine poisoning. In addition
he had received privately the glass from which the potion was
given, and found strychnine still in it. He did not mention
this fact, however, but testified that, though the symptoms were
much like those from strychnia poisoning, they might have
been due to morphine — a drug the woman had been in the habit
of using, and one whose effects sometimes resembled those of
strychnine. He asserted that no strychnine wras found in the
stomach, but omitted to mention that morphine might obscure
Current Medical Literature.
[July
60
the test. In fact, the exhibition, from a scientific point of
view, was truly a grotesque one ; but the defendant was ac¬
quitted. Other cases of like character are given, but such
things are too well known to need further illustration here.
The only remedy, and it is a simple one, is to have a commis¬
sion of experts appointed by the court ; they can then work
without bias, and can produce evidence that is not contradic¬
tory, and that does not make themselves ridiculous and their
science inefficient. The existence of much false and stupid tes¬
timony has now become a glaring fact, of which we have had
some very interesting instances in New York, and the present
pamphlet should help to awaken some practical efforts for
reform in the matter. — N. Y. Med. Ree ., April 26.
CEREBRO-SPINAL MENINGITIS.
Dr. J. H. Straugher, of Lexington, Mo., writes that Dr. .Lee
Alexander, of Marshall, Mo., treated cerebro-spinal meningitis
as follows, with great success: Resolved to try something, as
all previous plans had proved unavailing ; the patient’s body
was entirely anointed with oil of turpentine, and then, with the
exception of the head, to which ice was applied, he was immersed
in a barrel of water as hot as could be borne by the hand. The
bath was continued for fifteen minutes, and repeated every hour
until relief came to the patient, which was usually so marked
that for the second bath it became necessary to arouse him.
The tetanic symptoms were usually relieved by the first immer¬
sion, and subsequently the bath was called for by the patient.
The internal treatment consisted of turpentine in 15-25 drop
doses, bromide of potassium 15-20 grain doses, gelsemium, be¬
ginning with doses of 8 to 10 drops, and increasing until double
vision occurred, and blister to the nape of the neck. He claims
twenty-two recoveries out of twenty-three cases. The only
untoward symptom developed during treatment was epistaxis
in a child two years old, which subsided as soon as the gelse¬
mium was discontinued, it having resisted all the usual reme¬
dies. — Medical Record , June 7.
HOW TO MEASURE A SCULL.
The following directions are given by Dr. W. H. Flower, F.
R. S., in a lecture before the Royal College of Surgeons :
The length of the skull is measured from the middle of the
forehead, above the glabella — the ophryon — to the most promi¬
nent part of the occipital region. The breadth is the greatest
lateral breadth in the parietal region. The cranial index, which
is the expression of the relation of the breadth to the length, is
found by a simple calculation, the length being taken at 100.
When the index is over 80, the skull is called brachycephalic ;
when it is below 75, it is said to be dolichocephalic ; those be¬
tween 75 and 80 are memeephalic. The height is the distance
1879]
Current Medical Literature.
(»1
between tbe basion and tbe bregma. The orbital index is the
relation of height to the width of the anterior margin of the orbit
cavity. The average in Australian skulls is 82, in European
88, which gives a fair indication of the difference of. form in this
part in the two races. The nasal index is the relation of the
height of the bony framework of the nose to its breadth. The
height is measured from the nasion to the lower border of
the aperture, or base of the nasal spine. , The breadth is the
greatest breadth of the aperture. This is one of the most use¬
ful of all the cranial indices in distinguising races. The aver¬
age nasal index of all the races is about 50. Races or indi¬
viduals in which the nasal index is from 48 to 52 are called
mesorrhine ; those in which the index is below 48 are leptorrhine ,
or narrow nosed ; those in which the index is above 52 are pla-
tyrrhine , or broad nosed. To this latter category the Austra¬
lians belong, the average index of their nose being 57. The
condition of the frontal suture should always be observed in
examining a skull. In its early stage, the frontal bone is devel¬
oped in two lateral halves, united by a suture. At the age of
two years, this suture is generally obliterated. Sometimes,
however, it remains open ; indeed, if it be not obliterated dur¬
ing the second year, it generally remains open throughout life.
When this suture is permanently open, the skull is said to be
metopic. Among English skulls, it is found to be open in about
one in ten, but in one hundred Australian skulls here and in
other museums in this country there is not one instance where
it is closed. In this respect they resemble the anthropoid apes,
among which metopism is rare, though among many still lower
forms of mammals, as the Ungulata, it is the normal condition.
— Medical and Surgical Reporter , May 24.
A DICEPHALUS MONSTER.
It will be remembered that some months since it was an¬
nounced that a double female monster of the dieephalus type
had been born near Montreal, in Canada. This remarkable
monstrosity has been recently on exhibition in New York, and
excited much interest among the profession. It is known as
the St. Benoit Twins.” The twins are called Rosa and Mary,
and they are now seven months old. They have two perfectly
formed and natural heads, and two bodies also, as far as the
last rib, but below that both are fused into one. They have
four arms, only two legs, and each child has the control of but
one of them. As far as the natural functions of life are con¬
cerned, each is almost separated from the other, and one may
be sleeping while the other is laughing, crying or nursing.
They hav e but one abdomen, one umbilicus, one vagina and one
rectum; although the stomachs, and some, at least, of the
other abdominal viscera seem to be separate. There was no
physician, and not even a professional midwife in attendance ;
only an ordinary female friend, assisted by the mother, were
G2
Current Medical Literature.
[July
present at the conlineinent. One of the heads presented first,
and after that was delivered, the body belonging to it followed.
Next came the body of the second child, with two legs doubled
up alongside of it, and finally the head of the second child.
They are now really fine-looking children, and apparently per¬
fectly healthy, although one of them seems to be somewhat
larger and better developed than the other. — Extract from let¬
ter in Boston Journal. — tit. Louis Medical and Surgical Journal.
A REMARKABLE HOMICIDE.
There is now confined in the city prison of the District of
Columbia a negro whose head would have done splendid service
at the siege of ancient Troy, as in those days battering rams
were called into service in lieu of our modern cannon.
In an affray with another colored man, incited by jealousy of
the affections of a dusky Helen, and moved by the machinations
of the fabled green-eyed monster, this African ram seized his
opponent in such a manner as to butt his head against his own,
breaking in the skull of his rival in as many small pieces as a
boiled egg subjected to repeated strokes with a spoon prepara¬
tory to removing the shell. The fragments of the mashed skull
are so fine that much skill has to be exercised in the process of
mounting the same, which is now being done.
The specimen will be placed on the witness-stand, and cannot
fail, though mute, to prove a most impressive and persuasive
witness at the approaching trial. — National Medical Review.
BRUISES -CHLORINE WATER.
Dr. S. A. Oren writes : A case of bruise causing discoloration
of the skin (black eye) came under my care. 1 used a cloth
saturated with chlorine ivater on the bruised part as an experi¬
ment, depending upon its power as a bleaching agent to bleach
the part. 1 kept the eye closed and greased the edges of the
lids so as to prevent contact and irritation of the eye. The
discoloration was all gone in five days. I had seen the same
party with the same trouble on several prior occasions, and the
part was always 'discolored not less than two weeks. — Med.
Brief.
URTICARIA— BISULPHITE OF SODA.
Dr. Carter, Mt. Jackson, Ind., states that the hypodermic
injection of a saturated solution of bisulpliate of soda, in urti¬
caria, is the most prompt remedy in relieving this troublesome
affection he has yet tried. It appears to act upon the periphery
of the cutaneous nerves as does belladonna, except that the
latter has a heating and the former a cooling effect. — Med. Brief.
1879]
Current Medical Literature.
63
BREECHES.
Malta, O., January 21st, 1879.
Editors Recorder :
On the 12th inst., 1 delivered Mrs. W. B., of her ninth child
— a male, weighing 1 14 pounds. This makes for this lady live
males and four females at nine consecutive labors. All except
the second were breech presentations, and all viable.
How is that for breeches ? Don’t you think she ought to
wear the breeches, until some one is reported to beat it t — The
Ohio Medical Recorder. W. W. W.
HOMOEOPATHIC CONFECTIONERY.
In some parts of Germany physicians are not permitted to
dispense medicines, when there is an apothecary in the place to
do it for them. We learn from the Allg. Horn. Zeit. that three
homoeopathic physicians were practising in Regelsburg, when
an apothecary of the same belief came among them and notified
them to send their prescriptions to him. Two of them refused
and were brought before the court and fined about five dollars.
The case was carried to a higher court, and the medicines (pel¬
lets) sent to the University of Erlangen for chemical analysis.
The chemists of the university failed to find anything in them
of a medicinal or poisonous nature, and so reported; whereupon
the judge reversed the decision of the lower court, and declared
that there was no law that prevented physicians from distrib¬
uting sugar-plums ( Zmkerwaaren ) as freely as they chose. — A.
Y. Med. Rec ., May 3, 1879.
ACTION OF THE BLATTA ORIENTALS.
The blatta orientalis, or common cockroach, is a popular
remedy in Russia. The researches of Bogomolow have given
the following results from its employment: The quantity of
urine is increased; the quantity of albumen diminished ; oedema
and ascites disappear; the weight of the body diminishes ; the
perspiration is generally increased ; digestion is not impaired;
the kidneys are not irritated. The dose employed was four
and a half grains of the powder obtained from the dried insect.
These results were confirmed by TJnterberger, who employed the
drug with great success in scarlatinal albuminuria. M. Koehler
has also employed it in thirteen cases of dropsy of various
origin. His results were sufficiently conclusive, and show that
the blatta orientalis really possesses remarkable diuretic powers.
Its most interesting action however, is its power to cause a
rapid disappearance of tne albumen from the urine. Hence it
is not a simple diuretic, and its true field of action should be
sought in Bright’s disease. It seems to be entirely innocuous. —
Jour, de Med. de Bourdeaux. — A. Y. Med. Rec., March 15.
Current Medical Literature.
| July
64
PHYMOSIS
M. Huet, of Rouen, operates as follows : The prepuce on its
dorsal aspect and opposite the base of the glans is pierced by
a needle carrying a caoutchouc thread : the portion of the
prepuce in front of the puncture is then ligatured, and the
operation is finished. At the end of three or four days the
section is completed. The patients do not suffer, and may, if
necessary, continue their ordinary occupation. M. Huet has
seen the operation succeed in eighty cases, including both old
men and children. — Canadian > Journal of Medical Science..
DYSPEPSIA - CHLOROFORM.
Dr. S. B. Wills writes : In that form of dyspepsia attended
with rapid fermentation of food and evolution of gas soon after
a meal no remedy gives such relief as chloroform — 15 to 20
drops in a little sweetened water. It expels the gases from
the stomach in a few minutes, arrests fermentation promptly
and without any unpleasant effects. — Med. Brief.
POISONING FROM AN OVERDOSE OF SWEET SPIRITS OF NITRE.
Mr. H. Cripps Laurence in the London Lancet records a case.
The patient had been taking an ounce of sweet spirits of nitre
in water at intervals during almost every day for three weeks.
He was drowsy, incoherent, delirious, when roused answered
questions, complained of headache, and said he had found it
difficult to walk straight of late. He could see clearly, irides
dilated, acting feebly ; constipation, no vomiting, urine scanty,
bladder empty. He recovered under diaphoretics and purga¬
tives internally, poultices and dry cupping over kidneys. —
Canadian Journal of Medical Science.
A SUBSTITUTE FOR THE HORSE.
A number of country practioners in England are employing
bicycles or tricycles as a means of locomotion, and the use of
these vehicles is increasing considerably. They do not supply
the place of a horse entirely, but they enable the physicians to
do away with an extra one. The bicycles are made of iron and
steel, the rim of the wheel being covered with rubber. Upon
them one can travel over tolerably rough and icy roads and up
quite steep grades. On good ground the rate of speed is a
mile in five minutes ; racing speed being, however, much greater.
The ordinary rate of travel is eight or ten miles an hour. Tri¬
cycles are also made, which are safer than the bicycles and
nearly as fast. In these the rider sits between two wheels which
he propels by a treading motion ; a third and guiding wheel
is placed in front. There are very likely many places in this
country where this mode of locomotion could be used with
advantage. — A. Y. Med. Record , April 12, 1879.
1879]
Current Medical Literature.
65
SMALLPOX AND GREAT POX.
The occasional similarity of syphilis to variola, which has led
to their bearing a common name, is well illustrated by the
following cases, given by Mr. Jonathan Hutchinson, F.R.C.S.,
in a recent lecture : —
One of the most remarkable examples of this eruption came
under my notice about twelve years ago. A young gentleman
called on me with a conspicuous papular eruption on his face
and other parts. “ I have just had small-pox,” he said ; u and
Mr. - says that I am cured ; but the spots don’t go away.”
He added that Mr. - , a gentleman of large experience, had
kept him in bed a fortnight^ and had since sent him into the
country for a fortnight, and now said that he might return to
his desk at a bank ; u but,” he continued, u the other clerks
won’t sit near me, and declare that I have small pox still.” He
had a chancre, and the eruption was syphilitic. I have seen
several cases which had been treated in the small pox hospital
for eruptions which were undoubtedly syphilitic. Hut I must
not mention the mistakes of others, unless I am prepared to be
candid about my own. I had many a time, in clinical lecture,
mentioned the preceding facts, and enlarged upon the import¬
ance of distinguishing between the syphilitic simular of small¬
pox and the reality, when my own turn came. One day in the
summer of 1877, I was hastily summoned to see a gentleman at
his own house, who had just been landed from a sea voyage,
during the whole of which he had been very ill. He had been
carried from the vessel to his house, and put to bed ; and I
found him covered from head to foot with crusts exactly like
those of variola in the third stage. Some had fallen, and where
this had happened, deep scars were left. The eruption had
begun to come out on the day that he went on board, and he
had been feeling ill a few days before. The stages had been
unusually long, but still had not exceeded possible limits. I
questioned him as to syphilis, and examined his penis and his
throat, but without finding any reason to doubt his denial. In
a word, after a careful and skeptical investigation, 1 thought
that the eruption was variola. The sequel proved that it was
syphilis ; the scabs took months to fall ; and just when he was
recovering from the eruption he had iritis, which I could not
doubt was specific. At this stage, three or four months after 1
had seen him at home, in bed, he came to Moorfields Hospital.
His face was pitted all over, and I had much difficulty in
convincing those who then saw him that he had not really had
small-pox. 1 could not quote an instance more conclusive in sup¬
port of the assertion that one of the forms of syphilitic eruption
is exactly like small-pox in all its stages, and in its resulting
scars. Slow progress is the one difference between the two
exanthems. The similarity is produced, 110 doubt, by the fact
that syphilis in these cases attacks precisely the same anatomi¬
cal structures as those in which the variolous pustule is
9
06
Current Medical Literature.
[July
developed. It is scarcely needful to remark that this form of
eruption always occurs in the secondary stage. — Med. and Surg.
Hep., May 17.
DIET AND LIQUOR DRINKING.
Mr. Charles Napier, in England, has been testing the truth
of Liebeg’s theory that liquor drinking is compatible with ani¬
mal food, but not with a farinaceous diet. The experiment was
tried upon twenty-seven liquor drinking persons, with results
substantiating the Liebig theory* Among the more striking
instances of reform brought about by a change of diet was that
of a gentleman of sixty, who had been addicted to intemperate
habits for thirty-five years, his outbursts averaging once a
week. His constitution was so shattered that he had great
difficulty in insuring his life. After an attack of delirium tre¬
mens, which nearly ended fatally, he was persuaded to enter
upon a farinaceous diet, which, we are assured, cured him com¬
pletely in seven months. He seems to have been very thin at
the beginning of the experiment, but at the close of the period
named had gained twenty-eight pounds, being then of about
the normal weight for a person of his height. Among the
articles of food specified by Napier as preeminent for antago¬
nism to alcohol are macaroni, haricot beans, dried peas and
lentils, all of which should be well boiled and flavored with
plenty of butter or olive oil. The various garden vegetables
are said to be helpful, but a diet mainly composed of them
would not resist the tendency to intemperance so effectually as
one of macaroni and farinaceous food. From this point of view,
high glutinous bread would be of great utility, but it should
not be sour, such acidity being calculated to foster the habit of
alcoholic drinking. A like remark may be applied to the use
of salted food. If we inquire the cause of a vegetarian’s alleged
disinclination to alcoholic liquors, we find that the carbonaceous
starch contained in the macaroni, beans, or oleaginous aliment
appears to render unnecessary, and therefore repulsive, carbon
in an alcoholic form. — Bouton Journal of Chemistry , May, 1879.
THE PERMEABILITY OF A STONE WALL.
We have before referred to the experiments by Pettenkofer
and others, showing the readiness with which gases permeate
walls of stone or brick. A Buffalo paper gives the following
accouut of a recent illustration of the same fact: “Yesterday
Professor Doremus, of the Buffalo Medical College, performed
a very interesting and instructive experiment before his class.
A block of sandstone, such as is usually employed for window-
caps and sills, and about twelve inches square and four or five
inches thick, had a panel one half an inch thick sunk in each
Current Medical Literature.
67
1879]
side. In each panel was fitted a block, which was perforated
by apiece of common gas-pipe, and this was cemented about
the edges. The whole was then coated with an impervious var¬
nish. Air now entering the pipe on either side had access to
the clean surface of the stone beneath the panel, and it was
found that if the mouth be applied to the protruding pipe on
one side, and a caudle be placed in front of the opposite one, it
could very readily be blown out by the air, which, with very
little effort, was forced through the stone. When a rubber
tube was connected with the house gas-pipe on one side of the
stone, and a burner was attached on the opposite side, the sim¬
ple pressure from the gas mains was sufficient to force the gas
through the stone till it was lit at the burner on the opposite
side. WThen by any means the pressure was increased, a very
large flame was thus produced. This shows the permeability
of building stone. Brick walls and the plastering of rooms are
much more porous, and it is readily seen that unglazed tile, or
stone, or brick sewers afford but little security against the es¬
cape of sewer gas. — Bouton Journal of Chemistry , dime, 1879.
THE EXTERNAL USE OF DIGITALIS IN SUPPRESSION OF URINE.
Dr. C. P. Russell says in the British Medical Journal : A
married woman, aged 35, was attacked by acute albuminuria.
The disease resisted the usual remedies. She became extremely
cedematous, with congestion or oedema of both lungs. Respi¬
ration was rapid ; the pulse weak and rapid. She became seini-
comatose, and there was suppression of the urine for thirty-six
hours. The case appeared hopeless ; but having read in the
British medical Journal a case in which the external use of
digitalis was effectual in restoring the secretion of urine, I
determined to try it. I ordered half-an-ounce of the tincture
on a large linseed-meal poultice, to be applied to the abdomen.
Next day I was agreeably surprised to find her vastly improved,
quite conscious and cheerful. The oedema was very much
diminished. Respiration was easy, and the pulse nearly natural.
I was informed that in one hour after the application a copious
flow of urine commenced and continued all night, and, what
was very remarkable, the urine which the day before contained
a large quantity of albumen, was now quite free from it. Con¬
valescence was rapid, and she is now quite well. — South Med.
Rec.. May, 1879.
THE DRY SUTURE.
Dr. John n. Packard recommends this in closing long wounds.
He uses strips of Seabury & Johnson’s porous plaster two and
a half niches wide and the length of the wound. These are
applied on each sibe of the incision, and then the sides laced
together, using the holes in the porous plaster. — Phil. Med. Times.
68
Reviews and Book Notices.
[July
Reviews and Book Notices.
Spermatorrhoea : Its Causes , Symptoms , Results and Treatment.
By Roberts Bartholow, A.M., M.D., Professor of Theory
and Practice of Medicine and of Clinic Medicine, Medical
College of Ohio, etc. Fourth edition, revised. 8vo., pp.
128. New York : Wm. Wood & Co., 1876.
This monograph lias grown from an article published some
years ago m the Cincinnati Journal of Medicine , and its merits
are attested by demands for repeated editions, which have been
enlarged and improved.
It is rather a reproach to the profession, and certainly a cal¬
amity to the public, that this subject has greatly fallen into
the hands of unscrupulous charlatans ; and it is highly com¬
mendable in the author to lend his efforts to rescue it from the
obloquy which- generally attaches to the complaint and to its
treatment.
In the pathology of spermatorrhoea he recognizes three sep.
arate types: (1) the genital, in which u there are excessive sen¬
sibility of the sexual apparatus and greatly increased reflex
excitability of the cord (2) the cerebral form, in which, with
the preceding conditions, we find mental disorders, such as
melancholia, delusional insanity and mania [to which should be
added dementia] ; (3) the spinal form, manifested by functional
derangements or organic lesion.
The volume closes with several well-designed formulae of
remedies. S. S. H.
Potts'1 Disease; its Pathology and Mechanical Treatment , with
Remarks on Rotary Lateral Curvature. By Newton M.
Schaffer, M.D., Surgeon in Charge of the N. Y. Orthopoedic
Dispensary, Orthopoedic Surgeon to the St. Luke’s Hos¬
pital, N. Y. 12mo., pp. 82. New York : G. P. Putnam’s
Sons, 1879.
This essay was originally read before the Medical Society of the
County of New York, and afterwards expanded into its present
shape for publication. Its objects are to point out the defects of the
plaster-of-x>aris jacket in the treatment of spinal caries, and to
advocate the superiority of the author’s mechanical contrivance,
1879J Reviews and Book Notices. 69
which he terms “ anteroposterior support.” The peculiarity of
this latter consists chiefly in two steel supports extending
parallel on either side of the spine from the sacrum to the neck,
which are held fast below by a girdle around the pelvis, mid¬
way by a broad zone of plaster bandage, and attached supe¬
riorly to straps passing under the axilla. The effect is to pro¬
duce extension upward by the shoulder fastenings, while the
counter-extension is effected by the pelvic band ; and thus the
gravity of the upper portion of the body upon the carious ver¬
tebrae is obviated. Great advantages are claimed over the
plaster jacket, in respect of convenience, cleanliness and effi¬
ciency. There can be no doubt about the second consideration,
but the last must be settled by experience, as in the familiar
case of the pudding. The essay is certainly ingenious, and
worthy the attention of orthopaedists and surgeons in general.
S. S. H.
Lectures on Electricity in its Relations to Medicine and Surgery.
By A. D. Rockwell, A.M., M.D., Electro-therapeutist to the
X. Y. State Woman’s Hospital ; Member Am. Neurological
Association, etc. 8vo., pp. 99. New Y ork : Wm, Wood
& Co. 1879.
Ur. Rockwell is one of the authors of a larger work on medi-
ical electricity, in which he was associated with Dr. Geo. M.
Beard, and his little volume consists of a series of lectures orig¬
inally published in the Virginia Medical Monthly. The apology
given for their production in their present shape is the fact
that they present some points not included in the other work
and that their “methods of general faradization and central gal-
nanization” are not adequately presented in other small volumes.
The book is divided into seven chapters on the following sub¬
jects: (1) Electro-physics; (2) Electro-physiology; (3) Electro-
diagnosis; (4) Methods of Application; (5) Apparatus for
Electrotherapeutics; (6) Treatment of Special Diseases; (7)
Electro-surgery. An appendix gives the clinical history of a
case of nervous dysmenorrhcea successfully treated by local
galvanization followed by general faradization.
To those who aim to keep up with the advance of this branch
of therapeutics, the present contribution will be acceptable and
prove instructive and profitable. S. S. H.
70
Reviews and Book Notices.
[July
On Diseases of the Abdomen , comprising those of the Stomach and
other parts of the Alimentary Canal, JEsophagns, Caecum,
Intestines and Peritoneum. By S. (). Habershon, M. D.,
London, F. E. C. I'.; Senior Physician to and late Lecturer
on the Principles and practice of Medicine at Guy’s Hospi¬
tal, etc. With illustrations. Second American from the
Third Enlarged and Revised English Edition. 8vo., pp.
554. Philadelphia: Henry C. Lea, 1870. From Armand
Hawkins, Bookseller, 196£ Canal street.
The usual division into subjects according to the anatomical
structure affected is adopted, in preference to following the
pathological conditions, and strictly surgical affections are not
included. Cholera and Typhoid Fever are also excluded, as
being diseases which impress the general system.
The different subjects are illustrated by 102 clinical records
of cases, which throw light on both the history and morbid
anatomy of fatal cases.
We have not room for an extended notice of this work, which
is indeed too long and favorably known to require it; but we
find the author’s views on the proper treatment of intestinal
obstruction so much at variance with general practice, and yet
withal so rational, that we present a short extract.
u Of the opiate plan of treating intestinal obstruction too
much cannot be said. It has both reason and experience on
its side ; and yet in the reports daily given of such cases, purga¬
tives form generally the early part of the treatment ; and they
are persevered in until the stomach will bear them no longer,
serving only to exhaust the patient and to increase the symp¬
toms. This case also shows the importance of abstaining from
food, which not only distends the bowel, but increases the peri¬
staltic movement and augments the pain.”
The literature of our profession has attained such rankness
of growth that it is out of question to compass the principles
and practice of physic in a single volume. Monographs are
multiplied, and matter is drawn out to the extreme of attenua¬
tion. In this volume we are glad to observe a conservative
tendency, recognizing the inevitable in division into branches,
but preserving enough variety in subjects to admit of some
display of system. We therefore conclude that the book is
legitimate in conception, and can honestly testify to the good
character which it has gained as being well deserved.
71
1879 J Reviews and Bool: Notices.
A full index and a table of coutents render its consultation
easy, and its mechanical execution sustains the reputation of
its publisher. S. S. H.
A Manual of Examination of the Eyes — A Course of Lectures
delivered at the u Ecole Pratique^ By Dr. E. Landolt, L)i-
rectem- Adjoint of the Ophthalmological Laboratory at the
Sorbonne, Paris. Translated by Si rail M. Burnett, M.l).,
Lecturer on Ophthalmology and Otology in the Medical
Department of the University of Georgetown, D. C., etc.
D. G. Brinton, Philadelphia, Publisher.
These lectures deal almost exclusively with the Diagnostic
part of Ophthalmology ; aud in them the student is gradually
led from point to point in the examination of the eye until he
is at last brought face to face with the more difficult subjects of
Refraction and Accommodation, Ophthalmoscopy, lesions of the
Retina, etc.: all of which subjects are explained clearly and
forcibly.
Due respect is paid to the use of the ophthalmoscope, an
instrument which, in the author’s opinion, must at no distant
day stand side by side in importance, from a diagnostic point
of view, with the stethoscope and the clinical thermometer.
The earlier chapters are occupied by a practical account of
all the various modes of forming a diagnosis from external ex¬
amination, and are full of new and interesting material ; and
although the explanations are necessarily concise, the facts are
in nowise crowded together j the language is plain, the illustra¬
tions graphic, and the clinical examples easily understood.
Of these first chapters one of the most interesting is that
which treats of the substitution of the new metrical system for the
old one hi the matter of oculist’s trial glasses, a change which
was decreed by the last International Ophthalmic Congress,
which assembled at Brussels in 1875, and which so greatly sim¬
plifies this hitherto complicated and unsatisfactory subject, and
renders it for the first time uniform for all nations.
The last half of the book is devoted to a variety of subjects,
chief among which are Ojilithalmoseopy, and the sensibility of
the Retina to Colors — a very important matter in various
departments of business. Much that refers to the perception
of colors is new and original, the author laying great stress
Reviews and Book Notices.
72
[July
upon the prognostic, significance of the appreciation or non¬
appreciation of the various colors of the spectrum.
Dr. Landolt concludes from his observations in this direc¬
tion, observations that bear the stamp of originality, and do
credit to his industry and ingenuity, that the sensitiveness to
colors possessed by the peripheral portions of the Retina has a
very great prognostic value in many, if not in all diseases of
the Optic Nerve, no matter what their causes may be. Want
of space, however, forbids our entering more fully into this
most interesting and novel subject of investigation. H.
A Clinical Treatise on Diseases of the Liver. By Dr. Fried Thiod.
Frerichs, Professor of Clinical Medicine in the University
of Berlin, etc. In three volumes. Translated by Charles
Murchison, M.D., F.R.C.P. “Wood’s Library of Standard
American Authors.” Win. Wood & Co., New York. Ar-
mand Hawkins, 196£ Canal street.
The names of Frerichs and Murchison have been so long and
favorably known to the profession in connection with investi¬
gations on diseases of the liver, that the simple announcement
of the republication of the work under consideration will be
enough to insure its finding a place in the library of the physi¬
cian, and we must congratulate the publishers on their choice
in presenting such a work to the medical public in such a cheap
and convenient form. Wood’s Library of Standard Medical
Authors should have the support of the medical profession,
for, judging the future by the past, we feel convinced that when
the twelve volumes are complete, no purchaser will fail to con¬
gratulate himself on the judicious expenditure of twelve dollars.
The Diseases of Live Stock and their Most Efficient Remedies. By
Lloyd V. Tellor, M.D. Philadelphia: I). G. Briuton. 8vo.,
pp. 409. Price $2 50.
A plain untechnical treatise on the diseases of horses, cattle,
sheep and swine — the work of a physician brought up on a
farm. It is thorough enough to meet the wants of the phy¬
sician, yet so simple that the farmer will find it comprehensive
and valuable.
1879J
Reviews and Boole Notices.
73
A Manual of Physical Diagnosis. By Francis Delafleld, M.D.,
and Cliarles F. Stellmau, M.D. New York : Win, Wood
& Co. New Orleans : Armand Hawkins, 1964 Canal street.
Tlie work before us bears evidence of a desire to “ do the
handsome ” towards students and physicians, and the superb
make-up of the book is a credit to artistic skill. The plates,
especially the one with super imposed colored pieces of paper,
certainly exercised the ingenuity of their author.
Unfortunately the work is too bulky to ever become a hand¬
book for students, like the little work of Flint, and for the medi¬
cal teacher it is superfluous.
In definitions of certain normal sounds over the thorax and
abdomen we think laws of acoustics shoidd have been given
and the physiological explanation carried farther. This having-
been done, and synonyms having been more carefully studied,
we would not have had the fact asserted that the quality of
pulmonary resonance is “ pulmonary,” or that the quality of
tympanitic resonance is u tympanitic.”
The work, however, does abound in many good qualities, and
some of the definitions and descriptions are all that can be
desired.
The publishers have done very creditable work, and the print¬
ing, binding and paper illustrate to what degree of success
Messrs. Wood & Co. have carried their art.
A Treatise on Practical Surgery , including Surgical Dressings ,
Bandaging , Ligations and Amputations. By Prof. J. Ewing
Hears, M.D. Containing two hundred and twenty-seven
illustrations. Published by Lindsay & Blakiston, of Phila¬
delphia. Armand Hawkins, No. 1964 Canal street, Agent.
This work is admirably adapted not only as a text-book for
students, but the thorough and systematic consideration of the
subject constitutes it a valuable aid to the general practitioner.
A minute description of the details under each head are
appropriately considered, as for instance:
(1) Surgical Dressings — the materials used.
(2) Bandages — the variety and modes of application.
10
74 Reviews and Book Notices. [July
(3) Ligations — methods of holding instruments; making in¬
incisions ; relation of vessels ; closing wounds.
(4) Amputations — instruments; method of controlling haemor¬
rhage; different methods of amputations ; general rules to be
observed ; special amputations.
The work is thoroughly practical, exceedingly complete, and
will be found of great service to the profession. J. M. W.
Ophthalmic Out-Patient Practice. By Charles Higgens, F.R.O.S.
2d edition. Philadelphia: Lindsay & Blakiston. 1871).
The exact object of this little work it would be difficult to
determine from a scientific point of view.
That it is not a treatise for ophthalmologists is most obvious ;
that it does not fulfill the needs and demands of the general
practitioner is equally obvious.
If written for the general reading public, it fails still more to
meet the object. The most reasonable supposition is that it
has been written for the general practitioner, as there is too
little of anatomy, physiology and hygiene to be profitable to
the general public. In these respects it is in strong contrast
with the work concerning which a tew words succeed this crit¬
icism, and which is one of a series of “ American Health
Primers.”
Hearing and How to Keep it. By Burnett.
This is one of a series entitled “ American Health Primers,”
and is evidently intended to instruct the general reader in some
degree in the Anatomy, Physiology and Hygeine of the Ear.
This object is very well executed, and there is no endeavor to
make “every man his own aurist ;” but the author adheres
strictly to his proper relation to the general public as a teacher
of fundamental facts, a general knowledge of which is greatly
important to all.
For obvious purpose it is in strong contrast with the work
above noticed on the Eye, and, while some may object to it as
being a method of advertisement, yet it is so entirely different
in its methods from those of “irregular practitioners ” in
treating of disease, that we can dismiss this objection without
furth er com m en t.
Reviews and Book Notices.
1879]
Demonstrations of Anatomy : Being a Guide to the Knowledge
of the Human Body by Bis ection. By George Yiner
Ellis, Emeritus Professor of Anatomy in University Col¬
lege, London. From the eighth and revised English edi¬
tion. Illustrated by two hundred and forty-nine engravings
on wood. Philadephia: H. C. Lea. New Orleans : Armand
Hawkins, 196.1 Canal street. 8 vo., pp. 716.
This work on topographical anatomy presents to the student
in the oidy logical manner possible, a full course of anatomical
study, arranged in a most natural plan, taking up structures
as they are met with under the knife ; the routine system of
committing to memory structur es which belong to each order
is replaced by the study of each tissue as it is met with in the
course of dissection, and the relationship of nerves, vessels,
etc., is described with special view to the surgical bearings of
the part.
Regional anatomy is therefore fully taught, but besides all
this, at the conclusion of the study of a portion of the body,
as head and neck, upper extremity, etc., the author has ar¬
ranged a table showing at a glance the origin, branches and
distribution of the arteries and nerves.
We cordially recommend the work.
Hints in Obstetric Procedure. By William B. Atkinson, A.M.,
M.D., Physician to the Department of Obstetrics and
Diseases of Women, Howard Hospital, Philadelphia, etc.
Pp. 121. 12mo. Philadelphia: D. G. Brinton. New Or¬
leans : Armand Hawkins, 196 \ Canal street.
Dr. Atkinson deserves and must have the thanks of the pro¬
fession, for the conscientious manner in which he has taken hold
hold of a subject till now almost neglected. Those “ little
things” that afford the lying-in woman comfort have never
been given the prominence they deserve, and the minute in¬
structions in regard to the child should be carefully studied by
the young practitioner. The little work is heartily recommended.
It naturally takes its place by the work of Andrew Combe on
“ The Management of Infancy,” and the physician’s library is
incomplete without both.
Boohs and Pamphlets Received.
[July
7(5
Books and Pamphlets Received.
Pottos Disease ; Its Pathology and Mechanical Treatment , with
remarks on Rotary Lateral Curvature. By Newton M. Shatter,
M.D., Surgeon in charge of the New York Orthopaedic Dispen¬
sary, Orthopaedic Surgeon to St. Luke’s Hospital, New York :
G. P. Putnam’s Sons, Publishers, 182 Fifth Avenue, N. Y.
Pocket Therapeutics and Dose Book , with classification and
explanation of the action of Medicines ; Index of Diseases , with
appropriate Remedies ; Classification of Symptoms ; Poisons and
their Antidotes / Useful Hints to the Prescriber. By Morse Stew¬
art, Jr., B. A., M.D., Detroit, Mich.
Hinth Annual Report of the Nero York Ophthalmic and Aural
Institute , New York, for the year ending December 31, 1878.
Yelloic Fever ; Its Origin and Relation to other Malarial
Fevers. By J. G. Westmoreland, M. D., Atlanta, Ga. Re¬
print from Transactions of the Medical Association of Georgia.
Chloral Inebriety ; Read before the Kings County Medical So¬
ciety , April 15, 1879. By J. B. Mattison, M.D., Brooklyn, N. Y.
Thirty-third Annual Announcement of Starling Medical College ,
Session of 1879-’80.
How to Elevate the Standard of Medical Education and Medical
Teaching. By A. B. Cook, A.M., M.D. ; Professor of the Science
and the Art of Surgery and Clinical Surgery in the Kentucky
School of Medicine ; Professor of the Science and Art of Sur¬
gery and Clinical Surgery in the Louisville Medical College.
Reprint from the American Medical Bi-Weekly, April 2G, 1879.
Circulars of Information of the Bureau of Education No. 1, 1879/
Training Schools for Nurses. Issued by the Department of the
Interior, Washington, D. C.
Transactions of the Detroit Medical and Library Association ,
April, 1879.
The Therapeutical Society of New York. Reprint from the
New York Medical Journal, March, 1879.
Editorial.
77
1879]
On the Permanent Removal of Hair by Electrolysis. By George
Henry Fox, A. M., M.D., New York. Read before the Medical
Society of the State of New York. Reprint from the Medical
Record. March 22, 1879.
The Difficulties and Dangers of Battey’s Operation. By George
J. Engelmann, M.D., Fellow of the American Gynecological
Society, Fellow of the London Obstetrical Society, Consulting
Surgeon to the St. Louis Female Hospital, etc. Extracted from
the Transactions of the American Medical Association.
Hoic Shall the Degree of Doctor of Medicine be Conferred f
By E. Fletcher Ingals, M.D., Lecturer on Diseases of the Chest
and Physical Diagnosis, and on Laryngology in the Post Grad¬
uate Course, Rush Medical College, etc., etc. Reprint from the
Chicago Medical Journal and Examiner, April, 1879.
Ophthalmia Neonatorum. By Richard H. Lewis, M.D. Re- '
print from the North Carolina Medical Journal, March, 1879.
Constitution and the List of Members of the American Public
Health Association.
An Address upon the Life and Character of Lunsford Piths
Yandell , M.D. , Late President of the State Medical Society.. De¬
livered before the Kentucky State Medical Society, at the meet¬
ing held in Frankfort, April, 1878.
University of the City of Neic York. Medical Department.
Annual Announcement of Lectures and Catalogue , Session of
1879-’80.
The Medicinal Properties of the Healing Springs, Bath County,
Virginia.
Capon Springs and Baths, Hampshire County, Virginia.
This number of the Journal begins the seventh volume
of the new series. We are able to congratulate its friends
t
upon its largely increased, and increasing patronage and
78
Editorial.
[July
prosperity. During the past year we met with an obstruc¬
tion to the circulation of the Journal, of a character and
to a degree previously unheard of in the Mississippi Valley.
We refer to the numerous local obstructions of the mails by in¬
land quarantines, and to the fact that two of our Southern
States established quarantines of such severity, that the
transportation of mails was interrupted. On this account,
the editors were obliged to store away in their room, a large
portion of three consecutive issues.
It is extremely unlikely that such an event will again occur,
certainly not for a long period of time.
In the first place, the health of the whole country for the
first half of 1879 has been unusually good. Some very local
epidemics of scarlatina have occurred, and also some of diph¬
theria; but the aggregate mortality rate of the country will
prove to be as low as that of any preceding half year. In the
second place, it is a subject affording cause of congratulation
to the inhabitants of our Gulf seaboard that yellow fever does
not at present show much tendency to spread in those of the
West India islands which have the most intercourse with this
part of the United States. Undoubtedly it is true, that in¬
creased prevalence of yellow fever in countries south of us in¬
variably intensifies our danger to epidemics, and in truth
almost always precedes their occurrence here. We should
therefore watch for these forebodings of coming storms, just
as the residents of the slopes of a volcano may anxiously watch
those signals which characterize an impending eruption.
The danger to this country seems now to center in Port an
Prince, and principally to threaten New York city. But at that
port great vigilance and care are being exercised to prevent its
finding a foothold among their population. The norrors of
such a calamity can only be conceived by those whose sad
experiences have rendered them familiar with the tragic events
of sweeping and fatal epidemics. The Northern people are
beginning to question and abjure that fallacious teaching
which would lull them to unguarded security by affirming that
they “were outside the yellow fever zone.” Epidemics of a
fatal character have reached localities as far north as Boston,
and as far south as Buenos Ayres. We should thank that
1879 1
Editorial.
79
great politician and astute reasoner, Hon. Mr. Blaine, for rais¬
ing his voice in the halls of Congress in opposition to ideas of
complete security in any part of the United States against
yellow fever.
We have in the third place, much to hope for in the future
from the recent labors of the National Board of Health in
constructing a series of rules for the government of transpor¬
tation in places attacked by yellow fever or exposed to danger
from its existence in contiguous places. We sincerely believe
that the enforcement of these, or similar rules, will so lessen
danger, that in future we may hope to escape such wide-spread
visitations as that of last year.
The convention of railroad and steamboat managers called
for July 2, at Memphis, will determine whether these rules will
be accepted and enforced by them or not.
THE BLANKS OF THE SUPERINTENDENT OF
CENSUS.
We hope that every practitioner of medicine who has not
been provided with the blank forms for returns of deaths just
issued from the census office, will send his address to Gen. F.
A. Walker, Washington City. If every practitioner in the
United States should obtain and carefully till and return these
forms, the next census reports would contain statistics of in¬
estimable value.
In our next issue we will return to this subject and discuss it
more freely.
It will, no doubt, be gratifying to the readers of the
Journal to observe the new dress in which it enters upon
the seventh year of its new series. It is an evidence that
the publisher appreciates the good conduct, which has elicited
such a u reward of merit.”
A little delay in the appearance of this issue is attributable
to the extra matter comprised by the Transactions of the
State Medical Society. Our patrons will not complain, as they
are receiving considerably more than we agreed with them to
provide.
80
Meteorological and Mortality Tables:
[July
Meteorological Table — May, 1879.
Day.
Mean
Barometer
Tempt-ratur
Maximum Minimum.
e. _
Range.
Mean
Humidity.
Rainfall.
1
29.98
83
64
19
67
.00
2
30.05
75
59
16
82
.82
3
29.98
78
58
20
79
.00
4
29 93
80
64
16
73
.00
r>
29.94
82
66
16
78
.00
6
30.00
79
67
12
75
1.78
7
30.04
74
66
8
73
.00
8
30.09
78
64
14
71
.00
9
30.18
80
66
14
68
.00
10
30.15
79
68
11
55
.00
11
30.01
78
64
14
53
.00
12
29.94
81
63
18
65
.00
13
29.83
82
70
12
63
.00
14
29.87
83
69
14
65
.00
15
29.82
80
69
11
54
.00
16
29.85
81
67
14
59
.00
17
29.96
83
68
15
58
•00
18
29.98
86
70
16
62
.07
19
29.95
85
68
17
64
.00
20
29.88
35
69
16
71
.00
21
29.80
86
77
9
67
.00
22
29.89
81
72
9
67
.00
23
30 06
84
71
13
69
.00
24
30.18
81
73
8
68
.00
25
30.13
81
67
14
61
.00
2()
30.10
81
67
14
59
.00
27
30.15
83
68
15
63
.00
28
30.09
85
66
19
66
.00
29
29.99
85
68
17
72
.00
30
29.97
82
72
10
80
1.05
31
30.00
82
74
8
77
.91
Mean..
29.989
81.2
67.8
13.4
67.5
4.63
Mortality in New Orleans from May
22, 1879, INCLUSIVE.
25, 1879 to June
Week Ending.
Yellow
Fever.
Malarial
Fever.
Consump
tion.
Small¬
pox.
Pneu¬
monia.
Total
Mortality.
June
1..
0
2
11
0
7
104
J une
8..
0
0
13
0
3
88
J une
15..
0
4
5
0
4
105
June
22..
0
6
7
0
2
89
Totals.. .
0
12
36
0
16
386
81
1879] Louisiana State Medical Society.
Louisiana State Medical Society, Annual Session of 1879.
Abstract ok Proceedings. — ( Continued.)
NEW PROVISIONS
IN THE INTERESTS OF STATE MEDICINE PROPOSED FOR THE
CONSTITUTION OF LOUISIANA.
On April 11, 1879, a committee of the Orleans Parish Medi¬
cal Society presented to the Louisiana State Medical Society
the following recommendations for adoption by the Louisiana
constitutional convention of 1879 — stating that these recom¬
mendations had been revised by and had received the hearty
approval of every lawyer to whom they had been submitted ;
among these lawyers there were four of the most eminent judges
and jurists in the State. That the only discouraging criticisms
made were :
That these recommendations could be provided for by the
Legislature, and that they were at least fifty years in advance
of public opinion in Louisiana. In reply to these objections it
was urged that the recent constitutions of Texas, North Caro¬
lina, etc., presented precedents justifying the adoption of these
recommendations by Louisiana ; and that if embodied in our
constitution public and legislative opinion would be thereby
solicited to, and so gradually enlightened upon these important
interests of the people. After due consideration these recom¬
mendations were indorsed unanimously and emphatically by
the Louisiana State Medical Society, which further resolved
that an Auxiliary Committee be added to the Standing Com¬
mittee of the Society on State Medicine, for the purpose of
urging these recommendations on the constitutional convention.
Dr. S. E. Chaille, of New Orleans, was appointed chairman
of the Standing Committee, Dr. John P. Davidson, of New
Orleans, chairman of the Auxiliary Committee, and the recom¬
mendations are as follows :
TITLE— STATE MEDICINE.
Art. — . The Legislature shall provide for the interests of
State Medicine in all its departments; for public hygiene or
preventive medicine ; for medical education ; for institutions
for the sick and infirm, and for medical jurisprudence; for the
establishment and maintenance of a State Board of Health
and Vital Statistics for the whole State, with parish or munici¬
pal boards subordinate thereto ; for the protection of the people
from all contagious and infectious diseases, anti from all pre-
11
82
Abstract of Proceedings
[July
rentable causes ot' disease and death ; for the protection of
the people from unqualified practitioners of medicine, surgery,
midwifery, pharmacy and dentistry; for the maintenance of
the University of Louisiana, and its three departments of liter¬
ature, medicine and law ; for the care, education and mainte¬
nance of the destitute, sick and afflicted, of the blind, of mutes,
of idiots and feeble-minded children, of the insane and of ine¬
briates, in hospitals or asylums, constructed with proper regard
to health as well as comfort and the interests of morality, such
institutions being rendered as nearly self-supporting as is con¬
sistent with the purposes of their creation ; for the protection
of confidential communications made by patients to physicians ;
for preventing the advertisement and sale of all foeticidal drugs
or instruments, and of all drugs detrimental to the interests of
health and morality ; for tlie adequate compensation of scien¬
tific experts in all cases ; for the separate trial of criminals
alleged to be insane on each issue — first that of insanity — and
that adequate time and opportunity shall be given to medical
experts to test the question of insanity. No persons shall be
allowed to testify as expert witnesses to matters of scientific
opinion, except those recognized as competent experts in such
matters by their own profession, as organized under the laws
of this State. Only qualified practitioners shall be expert
witnesses in the courts to medical facts ; the Igeal duties of
coroners shall be assigned exclusively to experts in law, and
their medical duties exclusively to experts in medicine.
ADDITIONAL INSTRUCTION TO THK COMMITTEE.
If any article of the Constitution of 1879 provides that priv¬
ileges, to have effect against third persons, must be recorded,
the following proviso should be made :
Provided , That the fees due physicians and surgeons, the
wages of nurses, and the bills of druggists and apothecaries,
for professional services rendered, and medicines furnished
during the last illness, shall enjoy the privilege conferred by
law, even as to third persons, without recordation.
STATE MEDICINE
AND MEDICAL ORGANIZATION.
ADDRESS ON APRIL 10, 1870, BY THE “ANNUAL ORATOR” OF
THE LOUISIANA STATE MEDICAL SOCIETY,
S I ANFORD E. CHAILLfi, A.M., M.D.,
Prof. Physiology au«l Pathological Anatomy, Medical Dept. University of La.
u When lone in woods, the cringing savage crept,” he could
prove how boundless was his liberty, by hands smeared in the
blood even of wife or child ; but men and beasts as savage
and as strong, soon taught the primitive man civilization’s first
Louisiana State Medical Society.
83
1879]
great lesson, that he could barter part of his liberty in exchange
for greater security to property and life, by submitting with
his brothers to the rule of a patriarch. Like causes forced
these patriarchs, combining many families into one tribe, to
yield submission to a common chief; and, progress continuing,
these chiefs were forced, combining many tribes into one nation,
to give allegiance to a king. Wherever social order has been
secured and civilization developed, men have been forced in
larger and larger masses to unite, have overcome obstacles in
proportion to the strength of their union, and this strength has
been proportionate to the intelligence and self-denial of the
units; for, although self-interest has organized every nation,
as well as every union, yet, if these triumph permanently,
the self-interest must be sufficiently enlightened to compre¬
hend that the individual’s welfare depends on the general wel¬
fare, anil sufficiently ennobled to sacrifice the good of one —
even of one’s self — to the good of many.
If the making of a nation thus depends on the union of larger
and larger masses of men, its maintenance and progress are not
less dependent on the redistribution of its united citizens into
new co-operative groups — groups which multiply as civilization
increases ' ae interests of the nation and the occupations of its
citizens. Every nation is forced to distribute its citizens in
many different groups; some must wield the sword, others
carry it purse and others balance its scales of justice ; while
even those citizens left by government undistributed, find their
highest welfare in organizing voluntary associations. Every
great private as well as public enterprise— whether in agricul¬
ture or commerce, in manufactures or mining, in politics or re¬
ligion, in literature or art, in education or science — depends for
success on co-operation, and on the strength of the bonds link¬
ing each unit to the whole. In fine, the history of civilization
proves that man “can only make progress in co-operative
groups,” and that enlightened self-interest is their organizer.
This effort to enforce the trite and briefer lesson, “ in union
there is strength,” would not have been made, except for the
reasons that, while physicians have, with unanimity, constantly
complained of the many and manifest defects in our laws,
relative to medical matters, few have seemed to appreciate that
these defects necessitate, for their correction, an efficient organi¬
zation of the medical profession ; and still fewer have been
willing to make the sacrifices necessary to secure such an
organization. If to complain of evils without an effort to
correct them is childish ; if to know the remedy and not strive
to apply it is folly, then the medical profession is lacking either
in manly enterprise or in an intelligent appreciation of the
importance of associated action and of the means to effect it.
Therefore, the all-important problem to be solved by us,
pioneers in organizing in one societ ill reputable members of
the regular medical profession in Louisiana, is, what can we,
only a small part of the whole, do to ,. ain our first great need,
84 Abstract of Proceeding* | July
which is, to bind in one co-operative group all the physicians of
this State '?
Manifestly we should appreciate the obstacles to success, and
should ourselves not only understand, but should also force
our professional brethren to understand, what good we would
and could accomplish if their indispensable aid were given in
securing union of the medical profession. To some of the
obstacles to be encountered, to some of the benefits to be con¬
ferred, your attention is solicited.
History furnishes an instructive warning. The first “Louisi¬
ana State Medical Society ” was organized in 1841), under
auspices like those which originated its successor, this society ;
for the project was initiated by a country society,* and accom¬
plished by the aid of the physicians of New Orleans. From
birth its life was feeble, and, remaining in spite of its title a
mere city society, it, after six years, died of u absenteeism due
to the indifference and apathy of the country parishes.” Effort
must be made to understand the causes, if we would correct
them, of that professional apathy, indifference and absenteeism,
not only of the country but also of the city, which destroyed
the preceding, and threaten the success of the present State
Medical Society.
The history of the thirty-seven State Medical Societies in the
present thirty-eight States proves that the relative prosperity
of these depend largely on the number of physicians, the
number of miles of railroad, and the density of population
(especially near to the railroad lines) in the State. A fair com¬
parison as to these three particulars shows that Louisiana, out¬
side of New Orleans, stands at greater disadvantage than any
other States except Colorado, Florida, Nebraska, Nevada and
Oregon. The tax on the time and money of the traveler, from
parts of this State to New Orleans, is as great as from this city
to New York, and yet there is no point in the State which
presents for concentrating an assemblage, traveling facilities
comparable with those to New Orleans. City members can do
nothing to diminish the tax on the time, but ought they not to
do all they can to diminish the tax on the money of the country
members ? In any case, the progress of our two railroads to
Texas justifies strong hopes of the greater success of this Society
on their completion.
Comparison further proves that, with few if any exceptions,
the most prosperous State Medical Societies have owed their
permanent success, some of them their origin, to the fostering
aid of their legislatures, by which they have been chartered,
authorized to examine and license, and in various ot her ways
assisted. Experience justifies the belief that, while State
Legislatures heed but little the often dissentient voices of
physicians representing a few scattered localities, important
* In lti49 by the *• Attakapas Menical Society ’’ and lhe ‘ New Orleans* Pliysico-Medi-
cal Society,” iii 1878 by the ‘•Plaquejjwoea Parish Medical Association, ”|and tHe '• Shreve¬
port Medical Society.” *
1879J
Louisiana State Medical Society.
85
privileges ami powers would be granted to even a majority of
the profession if united in a State Medical Society. Every
increase of privilege and power tends inevitably to increase the
membership and influence of a Society.
Another serious obstacle to our success is presented by the
deplorable facts that in this State about one-sixth of the white
and seven-eighths of the colored voters — in fact, more than half
of all the voters — “ cannot write their names.” Ignorance
spreads a pall of indifference and apathy far beyond itself. Men
generally, even intelligent and ambitious physicians, strive
rather for relative than for absolute superiority, and are prone
to become content when manifestly superior to their associates,
even if these “cannot write their names.” Hence the educa¬
tion of every citizen, black as well as white, is of infinite impor¬
tance to the success of this Society, as of every other interest
of the State.
All the facts now enumerated tend to produce that vital
defect — paucity of members — from which ensue too little pro¬
fessional interest in the Society’s action to stimulate the mem¬
bers to such labor as would render their sessions practically
useful and attractive ; too little power to enlist, as power
always does, new adherents; and too little money to discharge
the duty, most essential to the success of every scientific society,
the publication and dissemination of useful knowledge. An
annual income of only $1000, expended in judicious publica¬
tions, would rapidly increase both our membership and the
value of our publications. It, however, must not be forgotten,
that while the dissemination of knowledge is our chief road to
success, revenue and publication are also two rocks on which
many medical societies have been wrecked, and require for
their beneficent disposal the utmost caution and discretion.
But the greatest obstacle to our success, the one to which all
others are subordinate, is the inappreciation by physicians of
the great benefits which would accrue to them, and at the same
time be conferred on the people, by union of the medical pro¬
fession. To illustrate these benefits, and also to prove that an
efficiently organized medical profession could secure them, are
the chief objects of this address.
You will not forget that this society has publicly declared
that “ the inauguration and promotion of State Medicine is a
subject of unequaled importance to the material welfare and
happiness of the people,” and that this great subject was the
most important consideration prompting its organization. Then
surely we ourselves should clearly understand and enable all
others to understand what is State Medicine in general and in
its details.
The adjective-noun being used generieally, as in statecraft
and statesmanship, State. Medicine is the application by the State
of medical knowledge to the common weal , and embraces every sub¬
ject for the comprehension of which medical knowledge , and
for the execution of which the legislative and executive authority
86
Abstract of Proceedings
[July
of the government are indispensable. Its bounds are neces¬
sarily as limited as may be the authority of the government,
so that, in the United States, State Medicine is restricted, as
to our national government, within very narrow bounds, with¬
in even narrower bounds than as to our county and municipal
governments, while our State governments have ample and un¬
disputed authority over each of its four great subdivisions,
viz : Public Institutions for the sick and the infirm, Medical
Education, Medical Jurisprudence, and Preventive Medicine
or Public Hygiene.
Are these vital interests of the people, of whom we are an
integral part, worthy the consideration of our profession, the
only class of the people now able to appreciate tlieir importance ?
Or does it happen that the laws of Louisiana are on these sub¬
jects so enlightened that we can with quiet conscience refrain
from efforts for reform f In truth, many States are far in ad¬
vance of Louisiana, and it is those farthest to the front which
resound the loudest with the incessant cries of our brothers for
additional progress. No physician whose heart vibrates in
response to human suffering and whose brain is sufficiently
enlightened to appreciate State Medicine, can possibly submit
apathetically, indifferently and without effort to the many
remediable evils which beset us. An enumeration of, with
comments on, the various subjects which belong to each one of
the four great branches of State Medicine will suffice to remind
you what are some of these evils and some of the defects of our
laws.
PUBLIC INST TLTIONS FOR THE SICK VND THE INFIRM.
No State >.„s yet perfected its laws for the organization and
suppor* ( i its hospitals, dispensaries, infirmaries and sanitaria ;
of its as^ at ms, which should he educational as well as medical,
for idiots and feeble-minded children; of its asylums for the
blind, for mutes, for the insane and for habitual drunkards.
When will Louisiana have such a General Hospital as has
Massachusetts, so excellent that even the wealthiest and the
worthiest of the State seek its pay wards for their own relief?
When will Louisiana have an asylum, both educational and
medicinal, for its idiots and feeble-minded children, such as has
New York 'l* When will Louisiana make such provision for its
insane that tender hearts will cease to be shocked by the
woful reports of grand juries and boards of administrators ?
And when will this State aid in rescuing thousands of wives
more wretched than widows, thousands of children more
wretched than orphans, from incurable drunkards, by providing
such an inebriate asylum, as New York was the first govern¬
ment in the world to establish in 1854 ? In fine, who in this
State is there who has investigated this branch of State Medi-
*OonD0<!ticut. Illinois, Kentucky, Ohio, Pennsylvania and perhaps other States are
reported to have schools for idiots and feeble-minded childr en, hut I do not know whether
these are or are trot State institutions.
1879J
Louisiana State Medical Society.
87
cine sufficiently to report to the people its needs and its defects,
with the remedies therefor ; and yet, on such reports depend
the difference between the cruel suffering and the welfare of
thousands of the most unfortunate of all our fellow creatures ?
MEDICAL EDUCATION
The bliss of ignorance is proverbial, but what man can be
content who knows how inadequately medical education is pro¬
vided for, how deplorably the practice of medicine, or pharmacy
and of midwifery is regulated, and how inefficiently the people
are protected from the enormous evils to health and life inflicted
by adulterated and patent drugs and by mountebank doctors ?
Louisiana needs, as does every State, better laws, to regulate
the practice of medicine, pharmacy, midwifery and dentistry ;
to establish, organize and govern medical colleges ; to encour¬
age and support medical libraries, museums, laboratories and
botanical and zoological conservatories; to promote original
research ; and to facilitate anatomical and other medical studies
to the utmost. Except in the last particular Louisiana is infe¬
rior to many of the States, none of which can be compared in
these particulars with France, Germany or Great Britian; but
there is no good reason why we should not at least strive to
equal, in all good things, any nation on earth.
Of the various subjects appertaining to medical education,
two are now profiting by professional attention, viz : the regu¬
lation of the practice of medicine, in order to suppress quackery
outside of the profession ; and collegiate education with final
examination, in order to suppress the same great evil inside the
profession. Since these topics, however trite, must be discussed
until disposed of by satisfactory action, you will pardon a brief
allusion to them.
Although medical literature, including the transactions of
State Medical Societies, abounds in discussions, I have searched
in vain for a single article on laws to regulate the practice of
medicine, in any wise exhaustive, or worthy of the subject;
which serves to illustrate what little attention is yet given to
State Medicine. For instance, few of our impatient reformers
seem aware that until about 1840, every State then in the Union,
except Pennsylvania, Virginia and North Carolina, had had the
now much desired Medical Examining Boards appointed in
some cases by the Governor, but in many other cases by the
regular medical profession itself, through State or county medi¬
cal societies ; and that these boards did not prove satisfactory
to the profession, and so unsatisfactory to the sovereign people
that their representatives, in nearly if not quite all the States,
did, from about 1840 to 1852, repeal or annul all the laws estab¬
lishing such boards. Surely, if we would profit by the experi¬
ence of our fathers, it is indespensable for us to know all the
causes of their fai.ure, and yet not one of those advocating re¬
form adequately supply this knowledge. Still farther, North
Carolina since 1859, and a few other States have on this subject
Abstract of Proceedings
88
[.July
old laws still unrepealed ; and since 1873 at least seven States*
have enacted new laws, and yet 1 have searched in vain tor an
instructive report as to the comparative merits of these laws
and as to their operation, whether satisfactory to both profes¬
sion and people, and whether likely to be improved by amend¬
ments or to be repealed. Surely knowledge of this kind is very
requisite to guide us rightly, and to guard us from retarding
instead of promoting, the very progress which we seek — an
evil which often ensues from inconsiderate legislation.
Some study of the legislative history of this subject justifies
the following conclusions and suggestions: It is worse than
idle to seek legislation which would debar from practice homoeo¬
paths, eclectics or other practitioners of any special or exclusive
system of therapeutics, because no such law could be executed,
if enacted. Our fathers, as has been stated, had such laws,
which were all repealed, for the chief reason apparently that it
was attempted to enforce them. Regular physicians enjoy un¬
molested their system of practice and their code of ethics, and
experience proves that the public intend to maintain an equal
right to test the demerits of other systems and codes, and to
leave error free in its combat with truth. This resolve is im¬
planted so deeply in the hearts of our voters that Texas has
enthroned it in her constitution, which solemnly declares that
“ the Legislature may pass laws prescribing the qualifications
of practitioners of medicine in this State, and to punish persons
for malpractice ; but no preference shall be given by law to any
school of medicine.” If therapeutic systems were disregarded,
we could probably induce the people to protect themselves from
unscrupulous medical tramps and ignorant adventurers by
laws prescribing that no person, unless found qualified by educa¬
tion, shall practice medicine ; but then arise these, as yet, un¬
solved questions : By wliat method shall the qualifications
necessary be determined, and by what means shall the penal¬
ties for the violations of the law be enforced ? Having no
confidence in the discharge of laborious official duties by volun¬
tary and unpaid officers, I find no answer to these questions
except in adequately paid officials, whom it is not probable any
legislature will grant for many a day to come.
The ripest civilization, from which we, with like language,
laws and institutions, can gather fruitful lessons, is that of
Great Britain, and 1 believe that our road to progress in this
subject of State Medicine, as in many others, is by the path
“blazed” by the British Parliament. The British Registration
Law of 1858 is reported to have operated admirably. It is
executed bv a “ General Council of Medical Education and
Registration,” composed of twenty-four officers designated by
law, and paid — paid, as 1 infer, by the British Medical As¬
sociation. It is based on the principle u that it is expedient
* Alabama in 1877, California 1876 and 1878, Indiana 1879, New Hampshire 1875,
New York 1874, Texas 1873 and 1876, Vermont 1876 and 1878.
1879]
Louisiana State Medical Society.
89
that persons requiring medical aid should be enabled to dis¬
tinguish qualified from unqualified practitioners.” Those whom
we designate irregulars are, if found qualified by the council,
registered equally with regulars. Fraudulent registration is
liable to severe penalties. No physicians, except those regis¬
tered are recognized by the courts; are exempt from jury and
militia duty ; an (F enjoy the right to practice and collect fees, to
sign legal certificates, to testify in courts as experts, and to
serve as medical officers in the army, navy, and civil service.
Such is the pith of the only law ever yet enacted on this subject
by any English-speaking people, which, tested by experience,
has proved worthy of our imitation.
Louisiana has had, since 1861, a registration law* — poorly
devised, inefficiently executed — but will it not furnish an enter¬
ing wedge to progress, and ought we not to direct our efforts
to amendments of this law ? And ought we not also to seize
some one of the many opportunities presented to test on medi¬
cal impostors the value of that act of 1872 and 1879, t which
declares : u Any physician, or pretending physician, who shall
falsely pretend to have been a professor of any medical college,
or to hold literary or professional titles to which he is not en¬
titled shall be forever barred from the right to practice medi¬
cine in this State, and on failure to supply evidence to sub¬
stantiate any claim to such title by proper diploma or other
documentary or satisfactory evidence, shall, on conviction, be
imprisoned in the State Penitentiary not less than six months
or more than five years.” The fact that out of 270 practition¬
ers of medicine now in New Orleans ninety-three of them are,
as is reported, irregulars or quacks, should stimulate us to
efforts for reform.
As to the subject of collegiate instruction with final examina¬
tion, it is unnecessary to detail the numerous expedients which
have been adopted or are now under discussion to promote pro¬
gress in this direction, nor will it be denied that some of these
are calculated to palliate present evils ; but the only effectual
remedy, in my opinion, is the total divorce of medical instruc¬
tion from the right to confer a diploma, which of itself confers
the legal right to practice medicine. The professors of a medi¬
cal college should not constitute a legalized Board of Medical
Examiners; but it must not be forgotten that to annul this
power in one State might now destroy any unendowed medical
institution of such State, so that action seems dangerous until
at least a majority of those States which have prosperous
medical colleges can be induced to cooperate.
MEDICAL JURISPRUDENCE. OR FORENSIC MEDICINE.
Neither Louisiana nor any other State can challenge intelli¬
gent approval of their laws on the following subjects :
*See sections 2677, 2678, 2679 Revised Statutes of Louisiana, 1870.
tSee the ftaal olause of the seventeenth paragraph of Act No. 14, page 51, Acts of 1872,
rep3ated on pag> 41, Acts of 1879, sixteenth paragraph of section 1, Act No. 27,
12
Abstract of Proceedings
90
[July
Medical Witnesses. — In at least three particulars the laws
generally are defective; for they fail to adequately provide
competent physicians to act as ordinary witnesses to medical
facts, such as are derived from professional examinations ; they
fail most grossly to provide that expert witnesses to medical
opinions shall be furnished solely by veritable medical experts ;
and they fail to provide adequate compensation for medical
experts. Further, the laws are defective as to the insane, to
inebriates, to poisoning, to infanticide and criminal abortion,*
to the viability of the new-born infant, to protection of confi¬
dential communications by a patient to his physician, and to
malpractice. A brief consideration will be given such of these
subjects as are now exciting medical discussion.
In some of the oldest and most densely inhabited States,
where are invariably developed evils unknown in States sparsely
populated, malicious suits, professedly tor malpractice, but
really for blackmail, have grown to such an evil, that in 1878
the Maine Medical Association resolved u that, with the exist¬
ing laws on civil malpractice, it is unsafe to practice surgery
among the poor.” Apparently, out of <>00 physicians in the
State, 125 have been prosecuted. The legal remedy sought for
is, “ bonds compelling the plaintiff, in case of defeat, to pay
the taxable costs.”! Other societies have recommended that
all suits for malpractice should be tried by a special jury of
physicians.
From the same class of States the report is often repeated
that criminal abortion is constantly and alarmingly increasing.
A member reported to the Maine Medical Association that the
cases annually were not less than two thousand, while a mem¬
ber of the Wisconsin State Medical Society reported in 1870
that no physician would dispute that, “ where one living child
was born into the world, two are done away with by means of
criminal abortion.” Most medical societies demand better laws,
but others report that the evil in their States is due, not to the
laws, but to their inefficient execution ; and, in confirmation of
this, the report from Maine is that u it is impossible to get an
attorney to prosecute, or a jury to convict, an abortionist.”
Defects of the laws as to the insane are to be found in every
State. Though numerous and grave, allusion will be limited
to two of these defects. In some of the States, while the
alleged insanity of a criminal, and of a dead man who has left
a will, must be decided by a jury, yet one or more of such doc¬
tors, as the laws so loosely recognize, can issue a certificate
which will consign an innocent living man to an insane asylum,
which to him is virtually a penitentiary. It is believed that as
* The laws of some States still hear the impress of barbarous origin, in regarding
only the “quick child,” (Miss., Mo., and no doubt others), as a living human being;
and in selecting a jury of old women to determine any question as to the pregnancy
of a criminal.
t Me. Med. Assn. Trans. 1878 and specially the excellent article of Dr. Sanger.
Louisiana State Medical Society.
1879]
91
yet Maine, New York and Wisconsin* are the only States which
have provided wisely for the trial of criminals alleged to be
insane.
The question, whether a court can force a medical expert to
testify without securing him adequate compensation, has in
recent years excited so much interest that medical societies
have even resolved to raise the issue and force the courts to a
decision. This was done in Indiana, and the following facts
are pertinent to this question. English courts have decided
that a scientific expert need not attend a subpoena, that his
testimony cannot be forced, and that he must be compensated.
In 1877 the Supreme Court of Alabama decided to the contrary;
but, also in 1877, a circuit court of West Virginia concurred in
the English view; in 1878, Judge Clark, in the case of the
“State of Texas vs. Jasper Weathers,” decided that he “ knew
of no law to force a physician to attend court, and testify as
an expert, without compensation;” and, also in 1878, the Su¬
preme Court of Indiana, reversing the decision of a lower court,
maintained the expert’s right to compensation.! The Iowa
Code of 1873 (and probably the laws of some other States)
wisely provides that “ witnesses called to testily only to an
opinion, founded on special study or experience in any branch
of science, or to make scientific or professional examinations,
and to state the results thereof, shall receive additional com¬
pensation, to be fixed by the court, with reference to the value
of the time employed, and the degree of learning or skill
required.” This law grants all the medical profession demands.
Questions, however, referring to expert medical evidence, far
more important than this to justice and to the interests of the
people, are — whom should the law recognize as experts, how
should these be selected, and how should their evidence or
decision be rendered? In this matter the laws which, when
first enacted, may have been justifiable or excusable, have now,
in consequence of the vast progress of medical science, become
a mere mockery of justice. In proof of this I will repeat} here
that which 1 intend to repeat on every appropriate occasion —
that, “as a general rule,” it has been adjudged by the State
courts of this country that any practitioher of medicine (that
is, any man who dubs himself doctor) has sufficient knowledge
of medical science to furnish justice with its “ best attainable
evidence ;” and that, as results of our laws, “ the power of
medical science, crippled at the coroner’s inquest, is prostituted
by the partisan opinion of incompetent experts, then perverted
by advocates, and at last, wheu emasculated of all vigor, is sub¬
mitted for decision to those unable to estimate its weight.”
* See Chapter 191, Revised Statutes of Wisconsin, 1878.
t See two excellent articles on “The Medical Witness," by Dr. W. Hobbs, Trans. 1877
and 1878, Indiana State Medical Society.
J See Author's Address on Medical Jurisprudence, “Trans. International Medical
Congress,” Philadelphia. 1876.
92
Abstract of Proceedings
[July
I cannot leave this subject of medical witnesses, without
recording the greatest triumph yet accomplished by American
Medical Jurisprudence, a triumph which, on this subject, places
Massachusetts in advance of every English-speaking people.
For, of these, all others still maintain that insult to medical, as
it is to legal science, the medico-legal office of coroner ; who,
common sense dictates, should be both a- medical and legal ex¬
pert, but whom our medieval laws encourage to be neither.
Louisiana, makes herself, in this matter, exceptionally ridicu¬
lous by enacting the superfluous negation, “that it shall not be
necessary that he (the coroner) shall have had a medical or
surgical education, or have been a regular practitioner of either
branch of science.”* ( )n the other hand, Louisiana has wisely
required from every coroner an annual statistical report to the
General Assembly, but though such a consolidated report would
prove extremely instructive, and tend, as it has done in Eng¬
land, to destroy all respect for the coroner’s office, who ever
saw such a consolidated report, or ever heard of the execution
of this law ! t But, returning to the instructive example of tri¬
umphant progress, permit me to report, that on October 4, 1870,
at a stated meeting of the councillors (delegates) of the Massa¬
chusetts Medical Society, it was “voted that a committee of
five be appointed, to take into consideration the defects of the
present laws relative to the appointment and practices of coro¬
ners, so far as these defects involve the medical profession, and
to report at the next meeting what action, if any, is desirable.”
At the next meeting, February 7, 1877, this action was strength¬
ened; and at the annual meeting, June 12, 1877, the committee
reported that it had “met with speedy and remarkable suc¬
cess.” In fact on May 9, 1877, the Governor had approved “an
act to abolish the office of coroner, and to provide for medical
examinations and inquests in cases of death by violence.” The
pith of this law is as follows: While coroners have been re¬
quired in Massachusetts — as they now are elsewhere — to dis¬
charge the incompatible duties of medical examiner and
judge — that is, of an expert medical witness and of an expert
judge of law — Massachusetts has now divorced this ill-assorted
union of centuries ; has created the “Medical Examiner” for
the performance of one duty, and has transferred the other to
the judges of the courts, and has specially enacted that
“ whether a homicide has been committed or not is a medical
question, and whether that homicide be the result of accident,
or be justifiable homicide, or manslaughter, or murder, is a le¬
gal question.
Thus, laws sanctified by centuries of hereditary prejudice and
of barbarous precedent, have in Massachusetts, been at last
beheaded by the slaughtering axe of common sense, which
emphatically claims that the coroner’s medical duties should
* Section 650, Revised Statutes of Louisiana, 1870.
t Section 67*2, Revised Statutes of Louisiana, 1*70
Louisiana State Medical Society.
93
1879J
be assigned exclusively to a competent medical expert, and his
legal duties as exclusively to a competent legal expert. Hail !
to Massachusetts, which heads the cheerful funeral procession
to the coroner’s grave ; the tombstone should have engraved
on one face “ Monstrum horrendum informe, ingens, cui lumen
ademptum” — and on the other, “ God hath numbered thy king¬
dom and finished it; thou art weighed in the balance and
found wanting; thy kingdom is divided and given to” the doc¬
tors and the judges. The results of this novel law, not yet
perfected by experience and already once amended, are more
harmonious, successful and economical than the results of the
antiquated laws repealed, and an active Massachusetts Medico-
Legal Society has been stimulated into existence.
As no science is more progressive than medicine, so on no
men, more than on physicians, is it oftener and more incumbent
to “ honor him to whom honor is due.” Theo. II. Tyndale, Esq.,
of Boston, is, I am assured, the enlightened operator who, sub¬
jecting his patient, the Massachusetts Legislature, to judicious
preparatory treatment, met with “ speedy and remarkable suc¬
cess ” in the unprecedented operation of excising this foul tu¬
mor from the body politic. If a surgeon, by accident or skill,
succeeds in a hitherto unsuccessful operation, the plaudits of
the profession reward him, even though the operation be not
calculated to confer a fraction of the benefit which will ensue
from that operation, which by the advice and aid of the Massa¬
chusetts Medical Society, was performed by Mr. Tyndale. That
both operation and operator are so little known to and honored
by the profession, proves again how little real interest is taken
in State Medicine. That both may be better appreciated, it
should be known that since 1875, if not longer, the British
Parliament, prompted by the British Medical Association, has
fully recognized the disease and has agreed to operate, but has
not yet been able to decide upon the mode of operation. Mr.
Tvndale’s method is, however, as eminent for its simplicity as
for its success. Yet a Louisiana legislature could not appar¬
ently now adopt it, since Article 93 of the Constitution of 1868
requires that coroners u shall be elected,” etc.
PREVENTIVE MEDICINE OR PUBLIC HYGIENE.
No one of tlie four branches of State medicine involves the
public welfare to so enormous an extent as preventive medi¬
cine ; a birth of this century, generated by the conviction,
forced on us by centuries of experience, that the bounds of
curative medicine are very restricted, and that the faith of our
fathers in the discovery of an elixir vitae , or of a panacea , was
the baseless fabric of their imaginations. So important is public
hygiene that there is in our profession a strong tendency,
against which this address is an earnest protest, to consider it
synonymous with State medicine, of which it is only a most essen¬
tial branch . So paramount in importance is public hygiene to th e
public good, that Dr. Bowditch estimates this country’s annual
94
Abstract of Proceedings
[July
deaths by preventable diseases to be not less than one-fifth of
our million total deaths; while many authorities will concur
with me, that an estimate of from one-fourth to one-half would
more nearly approximate the frightful truth. Accepting the
lowest estimate, experience seems to prove that there are many
whose imaginations are too sluggish to respond by action to
the dry statistical fact that 200,000 people (lie annually in the
United States by avoidable diseases. It may aid some to
realize all that this dry fact implies, if “the mind’s eye” con¬
jures up a vast array, the more horrible because avoidable,
of unnecessary doctors, nurses, druggists, undertakers, anguished
parents, homeless widows and destitute orphans. It implies
a great reduction in the normal duration of life, and thereby
the loss of inestimable benefits ; such benefits as a community
would now be deprived of if a large proportion of the men, at
present from forty-five to sixty years of age, had been swept
into their graves prior to this period of their greatest useful¬
ness. It implies far greater public injury than would result from
the diminution of immigration to the extent of 200,000 annual
foreign immigrants. And, if the average value of a freeman’s
life equals $500, or the value of a slave’s, and if the time of
those sick and attending on the sick has an average value to
the community of fifty cents a day, then my dry statistical fact
no longer implies but proves an annual national loss by pre¬
ventable disease and death exceeding $200,000,000 ! This com¬
munity painfully realizes its loss by one year’s epidemic, but
like other communities, it suffers every year as great a loss,
which from ignorance and habit it cannot realize. Were our
cotton crop destroyed, exchange, forum, press and even the
pulpit would resound with lamentations and with active expe¬
dients to prevent the recurrence of such a disaster, and yet
preventable disease and death annually inflict a damage, which,
though unrealized, is very real, greatly exceeding in money
value the profits on the whole of our annual cotton crop. Why,
in this case, is there neither public lamentation nor action I
Because, public teachers have, for many generations, been in
the habit of insulting our Creator by attributing to His malev¬
olence evils really due to our own ignorance and to our own
filth. Charity cries : “ Lord, forgive them ; they know not
what they do !”
What should the public be incessantly taught f First, the
inalienable right of every human being to be supplied with un-
contaminated air, water, food, soil and personal surroundings;
and the duty of tin? State to allow no trespass on this right
from negligence, ignorance or greed of gain. Secondly, that
the causes of many diseases and of many deaths can be as suc¬
cessfully fenced out from their human crop, as domestic animals
can be fenced out from a grain crop ; and that, as powder and
other explosives are by law stored away and guarded, so, as
one instance only, a small-pox pustule, potent with greater
mischief than a magazine of dynamite should be, for greater
/
1879]
Louisiana State Medical Society .
95
reason, stored away and guarded. And last, but not least, that
u public health is public wealth f and therefore, the public
which organizes vigorously and spends money lavishly to van¬
quish Indian and other marauders, should make as efficient war
against conquerable morbific foes, which, though invisible, are
more disastrous to both life and property.
After many years of special study each additional year has
increased my conviction that wherever social order has been
firmly secured by law, there the supreme subject of importance
is : The avoidable causes of disease and death , their extent , cost and
influence on morality and human progress. This subject is so
exhaustless, so varied in detail, so fruitful to study and dis¬
covery and so little understood by the public that I confess my
impatience whenever a physician discourses to a public audience
on any other subject ; for it has been wisely taught that u the
art of politics (an art essential to the progress of State medi¬
cine) is to try to get ideas stamped as deeply as possible
into, and spread as widely as possible among, the masses.”
Germane to these views are the glad tidings that on March 31,
1879, the Citizens’ Auxiliary Sanitary Association of New
Orleans was organized — auxiliary in matters of public health to
our public officials. This evidence of non-professional interest
in public hygiene is very encouraging, but experience warns us
not to be too sanguine, and that it will require at least one year
without an epidemic of yellow fever, to test the earnestness and
the enlightenment of this association. For, ten years ago, I
ventured to warn the public that u every year without a yellow
fever epidemic was a year nearer to it,” and added that u em¬
press seems now to wait with inactive silence like its patron
the public, for another overwhelming pestilence, such as the
great epidemic of 1853, which galvanized them into a few
spasmodic efforts resulting in some ill-digested and worse exe¬
cuted laws, a quarantine satisfactory to neither contagionists
nor anti-contagionists, and an impotent board of health utterly
powerless to enforce those things needful for the public health.”
The overwhelming pestilence of 1878 has come and gone ; it has
galvanized the public into efforts which, it is to be hoped, even
the coming year may serve to prove are not merely spasmodic ,
for four of our greatest epidemic years (1839, 1847, 1858, 1807),
during the past forty years have not been followed by an
immediate successor. Persistence in sanitary reform, in spite
of the absence of epidemics, is the only test of the enlighten¬
ment of the reformer. In addition to the organization in New
Orleans of a Citizens’ Sanitary Association, another cause for
great exultation is presented in a fact which inspires the hope
that the disastrous epidemic of 1878 may yet prove to be an
infinite “ blessing in disguise.” This fact is the recent appro¬
priation (on March 4, 1879), of $50,000 by Congress to establish
at last a “ National Board of Health.” But 1 have wandered
somewhat from my theme, which strictly is, what are the
various subjects which belong to public hygiene and require
9G Abstract of Proceedings [July
better laws. The needs of this State and of others will now be
indicated.
An efficient State Board, strengthened by auxiliary local
Boards of Health and the Registration of Vital Statistics,
which includes the registration not only of marriages, births
and deaths, but also of prevailing diseases, are fundamental
necessities, with which not a single State is as yet adequately
provided ; and yet some States* have laws on these and other
subjects to be mentioned, much superior to those of Louisiana.
Health is preeminently essential to happiness and usefulness,
and to guard it some special knowledge is requisite; yet a
knowledge of the elements of hygiene — a knowledge much more
important and more easily acquired than geography — is so far
from being taught in the public schools of the State, that even
the teachers know nothing about it.
Purity of air is man’s prime requisite, and purity of water
is only second in importance ; yet not a State has laws ade¬
quately providing these, nor to repress the increasing evils of
adulterated foods. Insanitary occupations, offensive and un¬
wholesome disposal of the dead, and many other sanitary nui¬
sances receive little attention from either the people or their
lawmakers. Every large city has tenement or other crowded
houses for the poor, so constructed that it is not possible for
the occupants to be either healthy or chaste, and in which
children from their birth are seized in the remorseless arms of
this age’s Three Furies — tilth, disease and crime— yet so far are
our laws from regulating the healthy construction of dwelling-
houses that this is not done even for public edifices; no, not
even for the public schools of our children, thus educating
them in anti-hygiene.
Hot a State has laws encouraging, for sanitary purposes,
either drainage or irrigation. Massachusetts in 1849 effected
a sanitary topographical survey, which proved of great value,
and a second one was in 1875 instituted by New York; but
other States have neglected this important matter; and, in¬
stead of guiding the immigrants, whom they seek to entice
with trustworthy health maps ; they supply him with the
seductive but false certificates of ignorant residents, who base
their worthless convictions on such facts as that they are not
dead yet, and that several of them, who, however, never happen
to have about them a legal record of the date of their birth,
are one hundred and more years old !
Some States have laws to protect property and life from ex¬
plosive illuminating oils, but, in most of these States as in this,
the greed of gain lias so emasculated these laws, that property
is still endangered, while health and life are sacrificed.
* Some cities have an efficient registration of vital statistics, except of prevailing dis¬
eases ; of the States, Massachusetts and Rhode Island have the best.
1879]
Louisiana State Medical Society.
97
Bowditch* reports that while eleven States have laws which
served to protect one species of four-footed beasts from the
u Texas cattle disease,” only twelve States have laws to protect
the human species of biped from yellow fever, sixteen from
cholera, and twenty-one from small pox. All know how defec¬
tive, both in the letter and in execution, these laws are as to
the preceding and all other contagious and infectious dis¬
eases. Thus tar, medieval prejudice lias defeated all efforts to
stamp out syphilis. This dire disease, which afflicts the inno¬
cent and the unborn as well as the guilty, is reported to have
increased to such extent that its victims are computed to now
number as many as one in every twenty of the population.
What can be done ? 1 have for years advocated (in my profes¬
sorial lectures) one measure which should be, and I doubt not
will be eventually adopted — a measure which received in 1878
the advocacy both of the President! and of an able essayist!
of the Maine Medical Association. The measure thus advo¬
cated is the castration, or spaying, not only of the syphilitic,
the leper, the idiot, and the habitual criminal — when found
guilty of indulging in sexual intercourse — but also of all other
persons who would with certainty transmit to their progeny
the irreparable curse of a corrupted organization. There is no
debt to posterity more obligatory than is this. The laws of
our pious grandfathers used this penalty to punish evil-doers
who inflicted on society far less evil than do those for whom
the resuscitation of this penalty is now advocated.
Such is a brief and partial record of the various subjects
appertaining to Public Hygiene, subjects illustrative of the
needs of the people, and therefore demanding the advo¬
cacy of an organized medical profession. But common
sense, discouraged by innumerable evidences of popular
ignorance, rudely awakens us from dreams of a sani¬
tary Utopia, and commands us to concentrate our strength on the
reforms most practicable and necessary. The reform now most
necessary is the establishment of an efficient State Board of
Health, having control of an efficient system for the Registra¬
tion of Vital Statistics. On these two topics some additional
information and suggestions will now be submitted.
The value of vital statistics is so little appreciated that the
medical profession should familiarize itself with arguments to
convince the public of their value, not only in reference to the
rights of property and other judicial requirements, but also in
reference to their infinitely greater value for sanitary purposes.
Public Hygiene derived its birth from and depends for its
future progress on vital statistics, and every argument which
favors the establishment of boards of health is an argument
in behalf of vital statistics, for, while a board of health without
‘“Hygiene in America, 1877,’' a vade mecuni of the American sanitarian,
tDr. Gerrish and Or. G. F. French. Trans. 1878. Me. Medl. Assn.
13
98
Abstract of Proceedings
[July
them is as helpless as is a man without eyes to guide him, so,
without vital statistics the public is destitute of the only valid
test of the value of a board of health. If a human being is
much more valuable to the State thau is a bale of cotton, then
statistics of the human crop would prove much more valuable
than statistics of the cotton crop, and yet every newspaper can and
does furnish statistics as to the cotton crop, such as no man can
now anywhere procure as to our human crop. Vital Statistics
furnish unerring lessons as to the health, prosperity and morals
of the people ; they teach the influence of marriage on illegiti¬
macy and morality ; the fecundity of the whole people and of
the races thereof; the vital force of the children ; the duration
of life, with its expectation and value, for all ages and races ;
the influence of meteorology, occupation, locality, in generating
disease and improving healtn, and thereby the removal of un¬
favorable conditions, always found, even where least suspected' ;
and the approach of morbific storms, by ignorance of which
negligent cities and even nations have been destroyed. The only
foundation of life insurance, vital statistics serve alike to
guide the resident and the immigrant, the capitalist and the
laborer, the politician and the statesman, the moralist and the
scientist. Ignored or disparaged by the average American
State-legislator, they have been advocated and supported by
Napoleon and Thiers, by Bismarck and Cavour, by Gladstone
and Disraeli ; and their establishment has become a test of the
degree of civilization reached by a people and their rulers.
Louisiana needs the warning that the experience of other
States, has abundantly proved, that trustworthy reports of vital
statistics cannot be obtained from the voluntary action even of
medical men; that an adequate penalty must, in case of negli¬
gence, be enforced on all from whom the law may require re¬
ports ; aud that a competent, paid, medical official, to receive
and compile the reports, is indispensable.
In regard to State Boards of Health, the following facts de¬
serve to be better known : after thirty years of effort by the
medical profession, Massachusetts, in 1809, legislated into ex¬
istence the first State Board of Health and Vital Statistics
organized in the United States. This prolonged effort was no
doubt used in conciliating that legal maxim, which declares
that “ no law can successfully precede its public sanction,” and
serves to explain, at least in part, the pre-eminent success
of this Board. However, the Governor did exercise, in the
choice of members of the Board, an amount of discretion very
unusual to politicians, when acting in medical matters; and
the legislature, beginning with an experimental appropriation
of $3000, for the first year, has rapidly trebled it. The acknowl¬
edged superiority of this Board is sufficiently proved by this
fact, among many others, that it did at once recognize that the
greatest obstacle to sanitary progress was popular ignorance,
and therefore that its primary duty was to teach the people.
Hence, it at once organized a corps of reliable correspondents
1879] Louisiana State Medical Society. 99
throughout the State ; it solicits reports from, and issues circu¬
lars of information to, all the doctors, preachers, teachers,
county and State officials, newspapers and journals in Massa¬
chusetts; and, in addition, it issues and freely distributes more
than 10,000 copies of the most valuable Annual Health Report
ever published in this country. Thus by enlightening the pub¬
lic it has gained its favor, and has thereby increased its own
power, and the bounty of the legislature. So great is this
power, that it triumphed over a financial combination of fifty
slaughterhouses, and converted these health and life destroying
nuisances into sanitary blessings ; it made war in Boston on
the pestilence-breeding “ houses of the poor,” and thus so
alarmed the politicians, who loving their country much, love
votes, even of the sick pauper, more, that the Board summoned
to its support a mass meeting of the people and was sustained.
Some few of the other eighteen State Boards of Health —
notably that of Michigan — increase the hopes inspired by Mas¬
sachusetts’ example ; but it is a sad truth that a majority of
these boards are, through legislative or gubernatorial action,
mere burlesques on sanitary science. Louisiana has legislated
on paper a State Board of Health and Vital Statistics ; but in
reality we have no State, merely a city, board of health, organ¬
ized under laws which nobody except politicians (and a design¬
ing or ignorant class of these) can possibly approve. The eftbrts
of the ‘‘legislative committee” of this society to improve these
laws deserve careful consideration, and probably our support.
If consolation is derivable from the superior folly of others, then
Louisiana is consolable ; for some other States have certainly
surpassed her. Georgia, Virginia and, alas! my native State,
Mississippi, have legislated State Boards of Health into exist
ence, have imposed on the officers onerous and expensive duties,
and then have appropriated for the execution of these laws, and
the discharge of these duties — not one cent ! But, in any record
of legislative quackery, North Carolina cannot be omitted, for
her legislature, apparently emulous to humiliate Virginia (1874),
Georgia (1875), and Mississippi (1877), passed a similar law
(1877), requiring the discharge of equally onerous and expen¬
sive duties, and then enacted “section 5,” which deserves a
prominent place in that Sanitary Museum which we some day
will have, as Great Britain now has. It reads : “ For the pur-
pose of defraying the necessary expenses of the board of health
of the State of North Carolina in the discharge of its official
duties, there shall be paid annually out of the treasury of the
State to the treasury of the said board of health, upon the
requisition of the president and secretary thereof, the sum
of ONE hundred DOLLARS ! ! ”* None the less, another legis¬
lature has surpassed all these in ludicrous legislation. For
years the Maine Medical Association has been in vain solicit-
* It is gladly annonnced that on March 14, 1879, North Carolina enacted a much im¬
proved hoard of health law, which is, however, still defective, specially as to an adequate
appropriation.
100
Abstract of Proceedings
[July
mg a board of health, which, however, it will very certainly
soon get, because it is using all such means as public lectures,
newspapers and journals to teach the people. About 1876, the
doctors urged on the legislature, among other things, the argu¬
ment that, inasmuch as the State paid annually $4000 bounty
on wolves and bears to protect its sheep, its human animals
were entitled to similar, even if to less favor, to protect them
from such wolves and bears as variola and scarlatina. The
Solons of Maine, by scratching their perplexed heads, at last
appreciated the logical bait prepared by cunning doctors to
ensnare them, and having concentrated the full force of their
juridical minds on devising a consistent method of escape from
the trap, they triumphantly enacted an immediate rej)eal of
the bounty on wolves and bears ; thus leaving wolves, bears,
voters and sheep unmolested by the equal hand of justice in
their “ struggle for existence.” The four parties interested
were all deprived of farther right to complain of “class legisla¬
tion,” but there can be no doubt that the sheep of Maine have
concluded that “ too much legislation is dangerous.”
Thus far, effort has been made to illustrate the benefits to
the profession, and to the people which this society should seek
to confer ; and now much briefer consideration will be given to
the last portion of my subject — to proofs that these benefits,
which, in a free country, have never been attained by other
means, can be conferred by an organized medical profession.
What has been effected by the 20,000 physicians of Great
Britain will serve, in part, to prove what might be effected by
the 60,000 physicians of these United States ; and because of
like language, laws and institutions, the successive steps by
which Great Britain has made its noted progress in State
Medicine are worthy of our special study, since through like
progressive steps must we advance. In 1882, 310 physicians
founded the British Medical Association, which, extending now
its arms by thirty -one Branch Associations into every part of
the three kingdoms, numbers more than 7000 members; and,
though these pay an annual fee of only $5, the revenue of the
Association amounts to $50,000.* What power has it gained
over, and what benefits has it conferred on the profession and
on the public '?
It has promoted friendly intercourse, and thereby strength¬
ened the links binding the units to the mass ; it has gained
immense control over medical ethics, and thereby established a
high standard of professional conduct, and greatly increased
both its social and its political influence; it has fostered scien¬
tific debate, as also greater accuracy in clinical and all medical
studies ; in addition it appropriates some $2000 yearly for pro¬
moting original researches, which exalting the profession have
*The British Medical Association was incorporated in 1874. Its affairs are managed by
a “ General Council, ” composed of one delegate for every twenty members, and the
authority of this council is in large degree delegated to twenty members, who compose
the “ Committee of Conneil," which meets not less than four times a year.
Louisiana State Medical Society.
101
1879]
blessed humanity, and thereby it has vastly stimulated the pro¬
gress of medical science. It has raised by voluntary subscrip¬
tion a ‘‘benevolent fund,” which yields more than 13000 annu¬
ally, and thereby it constantly contributes “ temporary relief
to distressed medical men, their widows and orphans.” It did
in 1853 establish, and in I860 greatly improve, its weekly offi¬
cial organ, that noted first class periodical the British Medical
Journal , and thereby it has constantly instructed and stimu¬
lated its members — furnishing this valuable journal without
cost — has increased its membership since 18(56 at the rate of
500 annually, and has added a large surplus to tne revenue
derived from the annual fee of its members. But, great as are
these benefits to the profession, they are insignificant when
compared with those conferred on the public.
Pari passu with the progress of the British Medical Associa¬
tion, medical and sanitary measures have been forced upon the
attention of Parliament, and are now receiving lrom this
enlightened body more consideration and wiser action than given
by any other national legislature. Parliament, influenced by
the British Medical Association, has, by law, greatly improved
the status and efficiency of the medical officers of the army,
navy and “ Poor Law Medical Service f has, by the Registra¬
tion Act of 1858, greatly repressed charlatanism, and has nota
bly stimulated medical education, not only by this means, but
also by establishing boards independent of medical teachers to
examine and grant diplomas;* and has by the four different
Acts of 1853, ’(51, ’(57 and ’71 forced “compulsory vaccination”
on all infants over three months old ; thus obviating the popu¬
lar Anglo-American outcry against invasions of the “personal
liberty of the subject.” But, surpassing in importance all
these and other unmentioned laws, are the six public health
Actst enacted from 1848 to 1875, which have established on a
solid foundation an efficient system of public hygiene, with
15.000 sanitary districts and the requisite number of sanitary
officers. These Acts have rendered Great- Britain pre-eminent
in preventive medicine, and have secured to this great nation
the preservation of its power and a constant increase to its
prosperity. But, as science is ever progressing, so the British
Medical Association is constantly finding old structures to
demolish, new edifices to erect. Among these it will soon
demolish the coroner, build up inebriate asylums and other
means to control habitual drunkards; establish compulsory
revaccination at puberty, and erect for our envious admiration
a few stately “ Conjoint Medical Examining Boards,” which
will secure the people not only qualified physicians but also
competent midwives, pharmacists, dentists, and even profes¬
sional nurses.
* See address on “Higher Med. Hd.," etc., by Dr. Wm. Pepper. Philadelphia. 1877.
1 The Public Health Act of 1848, the Nuisances Removal Act of 1855, the Local Gov¬
ernment. Act of 1858, the Satiitary Act of 1866, the Public Health Act of 1872, and the
Public Health Act of August 21, 1875.
102
Abstract of Proceedings
[July
With this imperfect statement of what has been, and will
soon be accomplished by the British Medical Association, atten¬
tion should be directed to the important advantages it enjoys
over our American Medical Association. First, the small
extent of Great Britain, the density of its population, the cheap¬
ness and quickness of travel, all tend greatly to facilitate asso¬
ciated action. Secondly, the British medical profession has
the inestimable advantage as to State Medicine, that it is
able to concentrate its whole influence solely on one supreme
legislative body — Parliament — while our form of government,
since it, for the most part, reserves to the States those powers
on which State Medicine depends, forces the American medi¬
cal profession to fritter away its influence on forty-eight State
and Territorial Legislatures. Hence, this important lesson,
that the American Medical Association is not so important to
the American medical profession as the British Medical Associa¬
tion is to the British medical profession ; and that our thirty-
seven State Medical Societies are of infinitely greater import¬
ance to our medical profession than the thirty-one British
Branch Associations are to their medical profession. However,
there are but few States in which the medical profession seems
to realize these important facts, and even few State Medical
Societies which seem to appreciate what is their chief function.
For, if the promotion of State Medicine be not the paramount
object of a State Medical Society, then what is its chief object,
and to whom else would it transfer the interests of State Medi¬
cine I Although some State Medical Societies seem oblivious
to this duty, none the less the length of this address could be
readily doubled in enumerating all that has been and is being
done by others of them. While the necessities of this occasion
will not permit this, it is incumbent on me to prove that State
Medicine has been and can be promoted in our own as well as
in a foreign land by an organized medical profession.
The first proof will be derived from the Massachusetts Medi¬
cal Society, which numbers in its membership much more than
half the regular medical profession in the State, has one branch
in every county, and more than one branch in several, has prop¬
erty valued at more than $30,000 and an annual income of
about $7000. All that it has done need not be stated, for it will
answer my purpose to recall to you that it is in Massachusetts
that, are found the best State Board of Health, and the best
Registration of Vital Statistics in any State, and the Medical
Examiner occupying the larger part of the coroner’s chair. If
our society, even after many years, should succeed in only this
much, then our society would merit the gratitude of the people,
and would certainly receive the blessings of posterity.
But since foreign and distant examples often cause conviction
to abort, my last proof shall be derived from a State whose
boundaries kiss our own, and whose people are as like to us in
virtues and in faults, and as beloved by us as brothers — the
State of Alabama. That a lesson by comparison may be profit-
1879J
Louisiana State Medical Society.
103
able the comparison should be just. Then what advantage has
Alabama over Louisiana! The former enjoys, 1 believe, none
over the latter except the following: In 1870 the one had 1418
practitioners of medicine, the other 939 ; the one had 19§ inhabi¬
tants to the square mile, the other 17A ; the one neither had nor
has a large proportion of its population crowded into one great
city, thus diminishing the density of population in the coun¬
try — the other had and has New Orleans; the one had 521,000
white population, the other had 362,000; the one had, in 1878,
1802 miles of railroad, the other had only 539 ; the one organ¬
ized its first State Medical Society in 1848 and it lived until
1861, the other in 1849 and it lived only until 1856; and, finally,
the Alabama Society was reorganized in 1868, and the Louisiana
society not until 1878. Of these advantages, only one will be
considered in replies to the question : What good use has
been made by Alabama of the ten years (1868-1878) lost by
Louisiana !
The Alabama Medical Association deliberately considered
for three years the construction of a new constitution, which,
peculiar in several important particulars, specially provided
for the advancement of State Medicine ; and it dates its success
from the adoption of this constitution in 1873. It, at the same
time, adopted, as guiding principles, that it would u never,
under any circumstances, demand legislative action for the
express and exclusive advantage of the medical profession,”
and that it would maintain as a primary object the purification
of the regular profession itself, and as a secondary object, the
suppression of irregulars ; in addition, it seems to have appre¬
ciated the great necessity there is that every scientific society
should use the greatest caution in attempting to influence legis¬
lation on political, or personal, or class matters, and on matters
unsettled in science. The results which have followed are, that
the Alabama society has organized thirty-two county societies,
which have 382 members, and all of these are members of the
State Society; in 1875 it secured from the Legislature an Act,
which constitutes the State Society the State Board of Health
and of Vital Statistics, and its affiliated county societies county
boards of health; and in 1877, the Legislature empowered this
society to appoint a State Board and county boards of Medical
Examiners, and granted to these the extraordinary power to
regulate, exclusively and regardless of all diplomas , the practice
of medicine in Alabama, determining the qualifications neces¬
sary therefor, subject to the sole restriction — that those pro¬
posing “ to practice any irregular system of medicine” should
be authorized to practice, if found qualified in other branches
than therapeutics. Thus, Alabama has formally recognized the
supremacy of the regular medical profession, subjecting irregulars
to its supervision ; and in fact has, by the Acts of 1875 and 1877,
constituted its State Medical Society a veritable medical legis¬
lature, as to both Medical Education and Public Hygiene, in-
104
Abstract of Proceedings
[July
vesting this imperium in imperio with “ great and unprecedented
powers.” It is grievous to add that the legislators who labored
thus well in the right direction failed to make any appropria¬
tion to pay the expenses indispensable to the execution of these
laws ; and it is very .joyful to add to this, that the Legislature
did in 1879 appropriate $8000. Who of you will not gain
courage from Alabama’s example ? Who of you will not earn¬
estly hope for the success of this grand experiment in State
Medicine ; and who of you will deny that I have now fully
proved all I promised? But, if we are to pay “honor to him
to whom honor is due,” then, in connection with the Alabama
State Medical Association, must be mentioned the name of Dr.
Jerome Cochran, of Mobile, to whom is due its constitution,
and to whom is largely attributable the prosperity of the asso¬
ciation and the consequent progress of State Medicine in Ala¬
bama.
In conclusion, permit me, fellow-members, through you to
call the attention of all physicians of our State to the many
recounted evils which are indicted by ignorance and negligence
of State Medicine and to the following considerations. As
this society is not composed of visionary enthusiasts, we can¬
not indulge the extravagant hope that we can remove all these
evils in a day, nor even in a generation. But, none the less,
we can, in all soberness, hold these truths to be self-evident;
that, as surely as this State keeps step with the march of civ¬
ilization, so surely must these evils be eventually corrected ;
that a beginning must be made; that this beginning must
be originated by the medical profession ; and that an organ¬
ized profession is the only agent competent to deal with
these evils — which are relics of professional, as well as of pub¬
lic ignorance.
The only remedy for this ignorance is instruction by lecture
and by publication which necessitate an expenditure of money,
beyond the means of this society as of most others. But, if
the medical profession were organized in county societies, these
condensed into State Societies, and these aggregated into the
American Medical Association ; and if every physician cheer¬
fully paid, as many now do, annual fees of from $10 to $15 to
support all three of these, it would be difficult to exaggerate
the magnitude of the power which medical knowledge would
acquire to combat ignorance. Consider the inliuence on the
sanitary progress of the nation, and of every State, the Ameri¬
can Medical Association could exercise with a revenue of
$200,000, which it would have, if every reputable physician
were a member ; and consider what could be accomplished by
our society it every physician in the State who desired to do no
more, did no more, than support the society by its annual fee,
for, if means to publish and to teach were supplied, able volun-
1879]
Louisiana State Medical Society.
105
teers would gladly do the labor u without money and without
price,” until that early day when publications, more valuable
than, the fee, would be gratuitously distributed to every mem¬
ber, as is now done by the British Medical Association. Hav¬
ing digested these considerations, still farther consider what
can be the degree of enlightenment of the many physicians of
every State who contribute neither money nor presence to
medical organization ; what the enlightenment of some county
societies, which were so dissatisfied with an annual fee to the
State Society of $1, for each member that the Texas State Med¬
ical Association was forced, in 1878, to reduce this fee to a
homoeopathic fifty cents. In face of such examples, for what
reason does the medical profession arrogate to itself the right
to denounce the ignorance of the people ? By what right does
the profession arraign the x>eople’s representatives who, for the
most part, are, as you know, superior to their constituents in
little except in the art to secure and to use their votes ; and
differ from them in little except m the psychological peculiar¬
ity that their judgment will not approve the day after election
the very measures, which, if set on foot the day before, they
would have cheerfully pledged themselves to support ? Before
expecting the support of these we must convert to the u gospel
of health” the preachers, the school teachers, the editors, and
above these the lawyers, especially those of them who honor
the fundamental principles of the law more than its precedents.
But our first and greatest need, like charity, begins at home,
for most of all we need to convert our own profession.
Even we, who are now present and ready for duty, have
sadly lagged behind our professional brothers in other States,
and have incurred reproach. We have the right to urge that
four years of fatricidal war, followed by eleven years of legal¬
ized rapine and anarchy, kept Louisiana as she was left, pov¬
erty-stricken and demoralized, mourning, in ragged garments,
over desolated and impoverished homes, and over the graves of
the best and bravest of her sons ; that not until 1877 did we
secure civilization’s first great need, social order, for, only then
was the protracted experiment — whether political art could by
legal device enable ignorance and vice to permanently rule over
intelligence and virtue — decided in favor of civilization’s and of
nature’s law — the survival of the fittest — a law which, like all
of inexorable nature’s, man, aye, even senators and presidents,
struggle against in vain. For these reasons, Louisiana was,
in the nation’s centennial year, the only one of the thirty-eight
States, except the new-born and sparsely inhabited mining
State of Nevada, which had no State Medical Society, and did
not initiate until 1877 the efforts which the year after organized
this society.
Bom after travail so arduous and protracted, born the
14
100
Abstract of Proceedings
[July
harbinger of social order and prosperity, shall we not join
hands in its support so earnestly and unselfishly that we shall
preserve it from the fate of its predecessor ; make it, in gener¬
ous emulation, the equal of its sister organizations ; and, while
rendering it a blessing to our profession, render it a still greater
blessing to our people f If this effort meets with failure it will
be due, not to the people nor to their representatives, nor to
any other class so much as to the medical profession itself;
and the public will be justified in indorsing this our proclama¬
tion to the medical profession of Louisiana —
“The fault, dear [doctors,] is uot in our stars,
But, iu ourselves, that we are underlings.”
Comparative Pathology of Malarial and Yellow Fevers.
BY JOSEPH JONES, M.JL).,
Professor of Chemistry autl CJinical Medicine. Medical Department University of Louis¬
iana; Visiting Physician of Charity Hospital, New Orleans.
Gentlemen :
The title of the paper which 1 proposed to prepare at the
close of the last session of the Medical Association of Louis¬
iana, was the comparative pathological anatomy of malarial and
yellow fevers ; when the transactions were published, I found
that the title of the proposed voluntary communication, em¬
braced a far wider field. Pathology, in its widest acceptation,
treats of the origin, history, causes, symptoms and effects,
nature and differences of diseases. A discourse on the doc¬
trine of diseases should even embrace the theories of preven¬
tion, prophylaxis and treatment. I am therefore, embarrassed
by the magnitude of the subject ; and my chief difficulty lies
in the selection and presentation of such materials as Mill in
the brief space of time at my command, best advance the
scientific interests of this honorable and learned Association.
The investigation of any specific disease, should embrace,
1st, its origin m time and space; 2d, history ; 3d, relations to
climate, soil and waters ; 4tli, relations to race, food and sani¬
tary conditions, habits and occupations of human beings; 5th,
accurate records of the symptoms at stated periods of the day
and night, exhibiting the changes of temperature, pulse and
respiration, and unfolding accurately the manifestations of the
nervous, muscular, cutaneous, circulatory, alimentary and
urinary systems ; Oth, microscopical examinations of the blood,
associated also .with microscopical .and chemical analysis of the
air and waters ; 7th, chemical analysis of the blood ; 8th, chem¬
ical and microscopical analysis of the urine, sweat, saliva, gas-
1879]
Louisiana State Medical Society.
107
trie and intestinal juices and excretions and morbid products ;
9th, chemical and microscopical examination of the various
organs and secretions as the bile ; 10th, post-mortem observa¬
tions of changes of temperature ; 11th, post-mortem examina¬
tions, embracing accurate details as to the physical, chemical
and microscopical characters of the solids and fluids ; 12th, pre¬
vention ; 13th, prophylaxis ; 14th, treatment ; 15th, relations
of symptoms, pathological chemistry and physics, and patho¬
logical anatomy, to analogous conditions and changes, in related
and diverse diseases.
Even if the investigations as to the nature, causes and treat¬
ment of malarial and yellow fevers, were so far advanced as to
admit of the widest and most positive generalizations, time on
the part of the speaker, and patience on the part of the hearer
would be wanting upon the present occasion ; and we shall
content ourselves chiefly with the presentation of such results
of our investigations as bear upon the following points :
1st. The history of yellow fever, more especially in Louisiana.
2d. Relations of the yellow fever as it prevails in Louisiana
to climate. *
3d. General outline of the symptoms and pathological anat¬
omy of yellow fever.
We shall endeavor to illustrate each division of our subject
by comparative observations on malarial fever, and by actual
demonstrations with pathological specimens, microscopical ob¬
jects, colored drawings, and tabulated statements. We do not
desire to burden this Association with the charge of this mass
of material which will find its proper place in the 2d volume of
my Medical and Surgical Memoirs, which will relate chiefly to
the fevers and diseases of our Southern States. In sanitary
science as well as in political history, we can form a correct
estimate of the future, only by a careful study of the experience
of the past; and hence all that relates to the past history of a
terrible scourge which has upon several memorable occasions,
and more especially during the past year carried terror, suffer¬
ing and death, far into the interior of the North American Con¬
tinent, should command the attention of the medical profession
as the natural guardians of the public health. The early his¬
tory of yellow fever in New Orleans, is of special interest, not
merely to this State and country, but to all other civilized na¬
tions, as she is the grand emporium of all the vast tracts trav¬
ersed by the Mississippi, the Missouri, and their tributary
streams, and enjoys a greater command of internal navigation
than any other city of either the old or new world. The
Mississippi drains the greater part of the territory of the
United States lying between the Alleghany and the Rocky
Mountains ; its basin more than equal in area to the whole
Continent of Europe, exclusive of Kusssia, Norway and Swe¬
den, is greatly diversified in soil, in climate and in produc¬
tions, and opens to commerce more than 20,000 miles of nav¬
igable rivers, all tributary to the great Mississippi.
108
A bstract of Proceedings
[July
No city in the world lias suffered more obloquy than New
Orleans, in relation to health, and more especially in regard to
its oft’ recurring epidemics of yellow fever. It would not be
beyond the bounds of truth to affirm, that but for this American
scourge, New Orleans, even at this day, would have exceeded
every other city of America, as well in the magnitude of its
imports as of its exports. If by the application of all the facts
known to science, the sanitary condition of New Orleans can be
so far improved as to exclude yellow fever, it is not unreason¬
able to believe, when we consider the boundless extent and
extraordinary fertility of the basins of the Mississippi and
Missouri, that New Orleans is destined to become the great
emporium, not of America only, but of the world. Even at the
present day, she holds commercial relations with almost every
maritime nation and large city of the globe ; and as the repre¬
sentative and port of this mighty valley, her health and
prosperity is not merely national but cosmopolitan.
Yellow fever in its origin and spread is governed by fixed
laws, which have their origin in the constitution of the physi¬
cal universe, and the great question of quarantine must be
discussed and its value determined by the adaptation of its
regulations and restrictions to the natural history of the
disease.
MALARIAL FEVER. HISTORY.
It is probable that the v arious forms of paroxysmal, marsh
(paludal), or miasmatic fever, were coeval in their origin and
prevalence with the occupation of tropical, sub tropical and
temperate regions by the human race. The cause of these
fevers appear to have existed from the time of the advent of
the human race on this globe. Accurate descriptions of inter¬
mittent, remittent and pernicious malignant fevers, are found
in the earliest medical writers, from the days of Hippocrates.
And numerous facts recorded in every age, show that countries
are unhealthy in proportion to the quantity of marsh or un¬
drained alluvial soil which they contain. It has been observed
for ages that the mortality of countries is seriously influenced
by the condition of the soil, the elevation and the temperature.
In former times, before the introduction of bark and quinine,
the mortality was in low marshy situations, as high as 1 in 15
of the inhabitants, whilst in more healthy and elevated coun¬
tries, it did not average annually, more than 1 in 40. The
connection of intermittent and remittent fevers with warm
moist climates and marshy, swampy, ill drained and badly cul¬
tivated countries, is well established by the histories of Home,
Italy, France, Germany, Holland and England, and of the
United States. The experience of these countries have estab¬
lished the great fact, that drainage and agriculture sensibly
reduce the number of cases of this disease ; whilst the neglect
of drainage and agriculture sensibly increases the number and
severity of the cases.
Louisiana State Medical Society.
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1879]
In the Southern States, especially in North Carolina, South
Carolina and Georgia, the inhabitants suffered severely from
the gravest forms of malarial fever, during the clearing of the
dense virgin forests. With improved drainage, and the exten¬
sion of agriculture, these forms of malarial fever have to a great
extent disappeared, and been replaced by typhoid fever. During
the recent civil war, 1801, 1805, when immense bodies of Con¬
federate troops were assembled along the low marshy and
swampy borders of the Southern States, malaria produced
destructive and disastrous effects, not only destroying many
lives, but also permanently impairing the constitutions of
the soldiers. At the same time it is well known that yellow
fever was absent from the southern armies, limited epidemics
and sporadic cases occurring only at Charleston, Wilmington
and Norfolk and New Orleans.
The sudden liberation of the slaves, and the subversion of
the political and agricultural system of the South, at the close
of the war, caused the abandonment of many well cultivated
and thoroughly drained estates, and to this cause chiefly, must
be attributed the prevalence since the war of that severe and
fatal form of malarial fever, attended with severe jaundice and
luemorraghes known as Inemorraghic and hsematuric malarial
fever.
Malarial fever is an endemic of all warm climates, it has
its base within the tropics and extends northwards till it is ar¬
rested by decreasing temperature. It is very prevalent in the
West Indies, East Indies, India, China, and along the southern
coast of North America, and within the Mississippi Valley, whilst
it is almost unknown in Nova Scotia and in the New England
States on the Atlantic sea board. In Europe ague is endemic
on the coast of the Gulf of Bothnia, beyond latitude 92° north.
In the interior valley of North America., intermittent fever is
the prevailing malady. From its occurring constantly within
the tropics, but ceasing far south of the Polar circle, it appears
that a high temperature is a condition necessary to its produc¬
tion, but this can only be considered as an exciting cause. It
is found that a summer temperature of 00° is necessary to the
production of the fever, and that it will not prevail as an epi¬
demic when the temperature is below 95°. It therefore occurs
in winter at places where the season has a mean temperature
of G0° or upwards, as at Vera Cruz, Tampico, Havana, and in
certain winters in New Orleans. But at this latter place, and
generally under the 30th parallel, where the mean winter tem¬
perature is under 50° F., the fever is suspended. At New
Orleans the necessary heat exists for 9 months of the year,
March to November ; at St. Louis 5 months, May to Septem¬
ber ; at Montreal 4 and Quebec 3 months. A continuance of
a heat of more than two months, a heat equal to 60°, is neces¬
sary to its development ; here it prevails more in October than
April, though their mean temperatures are nearly the same,
and the greatest prevalence of malarial fever in every latitude
is generally some weeks after hottest months of the year.
10
[July
Abstract of Proceedings
YELLOW FEVER HISTORY.
Yellow fever with syphilis have been regarded as strictly
American diseases, the medical history of which do not ante¬
date the discoveries of Columbus. With reference to the latter
disease, my explorations of the mounds and stone-graves of the
Mississippi Valley have established the important fact that
undoubted marks of syphilis are to be found in the diseased
bones of the aborigines, whose remains antedate the advent of
Europeans on the North American continent.
After a critical examination of the works of Herodotus,
Strabo, Justin, Cornelius, Nepos, Eutropius, Plutarch, Titus
Linus, Thucidides, Homer, Sallust, Virgil, Flores, Vallerius,
Particulus, Caesar, Horace, Cicero, Xenophon, and Tacitus, we
have failed to recognize .the disease now called yellow fever,
in any descriptions of particular plagues or allusions to
any pestilence : and in like manner, whilst in the writings of
the middle ages we have descriptions of wide-spread and mortal
plagues, amongst which may be recognized the oriental glan¬
dular plague, small pox, measles, typhus and typhoid fevers,
the sweating sickness, elephantiasis or leprosy, cholera, dysen¬
tery, and cerebro-spinal meningitis; yellow fever finds no
place in these annals of general history, or of medicine, previous
to the discovery of America by Columbus.
WAS YELLOW FEVER KNOWN TO THE ABORIGINES OF AMERICA
BEFORE ITS DISCOVERY BY COLUMBUS 1
As we have failed to find any history or record of yellow
fever before the voyage of Christopher Columbus, the first
question of importance which presents itself is, whether yellow
fever had ever prevailed among the aboriginal inhabitants of
North and South America and the West Indies previous to the
discovery of America and the explorations of the Spanish
adventurers, and the establishment of the Spanish, French,
Portuguese, Dutch and English colonies ?
The West India Islands and certain portions of North and
South America, as the Valley of the Mississippi, Mexico, Central
America and Peru appear to have been, at the time of their
discovery by Europeans, peopled with a sufficiently dense popu¬
lation for the existence of those conditions upon which the
origin and spread of certain diseases depend. The wholesale
destruction of the native population by cruel wars, and by still
more cruel slavery, and by the introduction of certain diseases,
as the small pox, as well as the wanton destruction of the pic¬
torial works by which the hieroglyphics of the more advanced
nations of America might have been deciphered, and the sudden
and utter subversion of the systems of religion and science
peculiar to these people, and the rapid disappearance of the
royal families and priests who were, as in ancient Egypt, the
custodians of the national science and art, have involved in
1879J
Louisiana State Medical Society.
Ill
obscurity many subjects of great and lasting interest to the
medical historian.
The medical historian has only imperfect and doubtful data
upon which to found any opinion as to the nature of the
epidemic and contagious diseases which afflicted the aborigines
previous to the discovery of the Western hemisphere.
That the more populous nations of America were not exempt
from diseases of an epidemic and pestilential nature, has been
well established.
ANALOGIES BETWEEN THE MEXICAN PESTILENCE MATLAZA-
HUATL AND YELLOW FEVEK.
The pestilence called by the Mexicans u Matlazaliuatl ” deso¬
lated the cities of the Toltecs in the eleventh century, and
forced them to abandon Mexico, and to continue their migra¬
tions southward, and to the west and northwest ; it invaded the
populous cities of Central America, and a similar disease com¬
mitted great ravages amongst the Indian tribes which occupied
the country between the mountains and the Atlantic coast a
few years before the landing of the Pilgrim Fathers.
The Matlazaliuatl, a disease closely resembling yellow fever,
but which is said to be peculiar to the Indian race of America,
has seldom appeared more than once in a century ; it raged in
the eleventh century amongst the Toltecs, it made great ravages
amongst the Mexicans in 1545, 1576, 1736, 1737, 1761 and 1763,
and amongst the Indians of the Atlantic coast in 1618 and
1619.
According to Alexander Humboldt, the Matlazaliuatl,
although pestilential in its nature, and attended with haemor¬
rhage from the nose and stomach, was distinct from the Vomito
Prieto, and was peculiar to the aborigines of America. The
Spanish authors call this disease a plague. The following pas¬
sage from Humboldt’s “ Political Essay on New Spain ” appears
to embody all that is known with reference to the nature of the
Matlazaliuatl of the Mexicans :
“ The Matlazaliuatl, a disease peculiar to the Indian race,
seldom appears more than once in a century. It raged in a
particular manner in 1545, 1576 and 1736. It is called a plague
by the Spanish authors. As the latest epidemic took place at
a time when medicine was not considered as a science, even in
the capital, we have no exact data as to the Matlazaliuatl. It
bears certainly some analogy to the yellow fever or black vomit¬
ing; but it never attacks white people, whether Europeans or
descendants from the natives. The individuals of the race of
Caucasus do not appear subject to this mortal typhus, while, on
the other hand, the yellow fever or black vomiting very seldom
attacks the Mexican Indians. The principal site of the Vomito
Prieto is the maritime region, of which the climate is excessively
warm and humid ; but the Matlazahuatl carries terror and de¬
struction into the very interior of the country, to the central
Abstract of Proceedings
112
[July
table land, and the coldest and the most arid regions of the
kingdom.
u Father Forribio, a Franciscan, better known by his Mexican
name of Motolina, asserts that the small pox at its introduc¬
tion in 1520, by a negro slave of Narvaez, carried off half the
inhabitants of Mexico. Toquemada advances the hazardous
opinion that in the two Matlazabuatl epidemics of 1545 and
1570, 800,000 Indians died in the former, and 2,000,000 in the
latter. But when we reflect on the difficulty with which we
can at this day estimate in the eastern parts of Europe the
number of those who fall victims to the plague, we shall very
reasonably be inclined to doubt if the Viceroys Mendoza and
Almanza, governors of a recently conquered country, were
able to procure an enumeration of the Indians cut off by the
Matlazahuatl. 1 do not accuse the two monkish historians of
want of veracity, but there is very little probability that their
calculation is founded on exact data.
u A very interesting problem remains to be resolved. Was
the pest which is said to have desolated from time to time the
Atlantic regions of the United States before the arrival of the
Europeans, and which the celebrated Kush and his follow ers
look upon as the principle of the yellow fever, identical wi h
the Matlazahuatl of the Mexican Indians ! We may hope that
this last disease, should it ever reappear in New Spain, will be
hereafter carefully observed by the physicians.” — u Political
Essay on the Kingdom of New Spain,” vol. i., pp. 117, 118.
u Long before the arrival of Cortez there has almost periodi¬
cally prevailed in New Spain an epidemical disease called by
the natives Matlazahuatl, which several authors have con¬
founded with the Voinito oryelhnv fever. This plague is prob¬
ably the same as that which in the eleventh century forced the
Toltecs to continue their emigrations southw ards. It made
great ra vages amongst the Mexicans in 1545, 1576, 1736, 1737,
1761, and 1763; but as we have already observed, it differs
essentially from the Vomito of Vera Cruz. It attacked few
except the Indians or copper-colored race, and raged in the in¬
terior of the country on the central table-land, at twelve or
thirten hundred toises above the level of the sea. It is true,
no doubt, that the Indians of the valley of Mexico who per¬
ished by thousand in 1761 of the Matlazahuatl, vomited blood
at the nose and mouth ; but these haematemeses frequently oc¬
cur under the tropics, accompanying bilious ataxical (ataaiques )
fevers ; and they w ere also observed in the epidemical disease
which in 1759 prevailed OA er all South America, from Potosi
and Oraso to Quito and Popazan, and which, from the incom¬
plete description of Ulloa, was a typhus peculiar to th£ ele¬
vated regions of the Cordilleras. The physicians of the United
States who adopt the opinion that yellow fever originated in
the country itself, think they discover the disease in the pests
which prevaled in 1535 and 1612 among the red men of Canada
and New England. From the little which wre know of the
1879]
Louisiana State Medical Society.
113
Matlazahuatl of the Mexicans, we might be inclined to believe
that in both Americas, from the remotest periods, the copper-
colored race has been subject to a disease which in its compli¬
cations resembles in several respects the yellow fever of Yera
Cruz and Philadelphia, but which differs essentially from it by
the facility with which it is propagated in a cold zone, where
the thermometer during the day remains at ten or twelve Centi¬
grade degrees (50° and 58° Fahrenheit).” — u Political Essay on
the Kingdom of New Spain,” vol. iv., pp. 135-137.
During the four centuries in which the monarchy of the Toltecs
lasted, they multiplied considerably, extending their popula¬
tion in every direction and founding numerous and large
cities, and building those great pyramids and monuments which
required the united efforts of multitudes for their completion ;
but the calamities which happened to them in the first year of
the reign of Topillzia — A. D. 1131-52 — gave a fatal shock to
their prosperity and power. For several years their country
was afflicted with such a severe drought that their fields failed
to yield them their necessary fruits; the air, infected with
mortal contagion, filled their graves with the dead, and the
minds of the survivors with consternation ; a great part of the
nation died by famine and sickness, and the wretched remains
of the nation, in order to save themselves from the common
calamity and from utter destruction, deserted Mexico, and
sought relief from their misfortunes in other countries. There
was therefore in this desolating plague of the Toltecs the usual
association of famine and pestilence ; and it is probable, that
as in the history of many other nations, the former was the
cause of the latter, and that the disease probably partook of
the nature of the typhus and typhoid fevers of the present day.
Humboldt, however, does not appear to be fully sustained in
resting his opinion as to the absolute difference between the
Matlazahuatl of the Mexicans and yellow fever ( vomit o prieto J,
upon the fact that the former prevailed at high latitudes and
elevations.
The stereotyped expressions of systematic writers as to the
limitation of yellow fever to certain elevations, must in the
light of certain facts be abandoned. It has been supposed
that yellow fever was confined to the sea shore, either because
persons who bring that disease disembark there, and goods
supposed to be impregnated with deleterious miasms are there
accumulated, or because on the seaside gaseous emanations of
a peculiar nature are formed. It is certain, however, that
yellow fever has prevailed in the elevated table-land of Caracas,
3000 feet above the level of the sea, upon more than one occa¬
sion. In 1696, a bishop of Venezuela, Diego de Banos, dedi¬
cated a church to Santa Rosalia of Palermo, for having deliv¬
ered the capital from the scourge of the black vomit (vomito
nigro J, w hich is said to have raged for the space of sixteen
months. A mass celebrated every year in the Cathedral, in
15
114
Abstract of Proceedings
[July
the beginning of September, perpetuates the remembrance of
this epidemic. The year 1696 was very remarkable for the yel¬
low fever which raged with violence in all the West India
Islands, where it had begun to gain an ascendency in 1688.
This disease also carried off in Caracas a great number of
European soldiers in 1802.
In the remarkable epidemic of yellow fever which prevailed
in Peru in 1855 and 1856, the disease passed even the barrier
of the Andes, committing fearful ra vages in Andine and Trans-
andine regions, at elvations of 14,000 feet above the level of
the sea. Even the ancient capital of the Peruvian empire,
Cuzco, at the elevation of 11,378 feet above the level of the sea,
was not exempt from the ravages of yellow fever. No authentic
records exist, from which maybe gathered any facts illustrating
the nature of the pestilence which, according to the “ Gentle¬
man of Elvas,” desolated certain Indian nations a short time
before the invasion of I)e Soto; it is supposed, however, to
have been similar to the Matlazahuatl of the Mexicans.*
The terrible pestilence which wasted the American Indians
in 1618 and 1619, a short time before the Pilgrim Fathers landed
in Massachusetts, has been supposed by Noah Webster and
others to have been yellow fever. This supposition cannot be
maintained because, the disease prevailed with the greatest
severity during the winter and in extremely cold weather. We
are not justified in adopting the conclusion of Webster simply
because there was a general yellowness of the skin, attended
with haemorrhages from the nose.
About 1750, a malignant epidemic, disease prevailed amongst
the Indians of the Atlantic coast, but did not afflict the whites,
and which, in like manner, Webster considered as the “ infec¬
tious yellow fever.” The patients were said to have first com¬
plained of a severe pain in the head and back, which was fol¬
lowed by fever ; in three or four days the skin turned yellow
as gold, a vomiting of black matter took place, and generally
a bleeding at the nose and mouth, which continued until the
patient died. These symptoms resemble to a certain extent
those of the disease known to the Mexicans as Matlazahuatl ;
and also those which characterize the malarial luematuria,
which, since the recent war for the establishment of the inde¬
pendence of the Southern States, has prevailed to a consider¬
able extent, and has been attended with a high rate of mor¬
tality.
The American Indians, in common with the whites, were sub¬
ject to the various forms of malarial fever (intermittent, remit
tent, and congestive or pernicious, and malarial haematuria),
4 Hutchinson's History of Massachusetts, vol. I, pp. 34, 35.
Belknap’s Biography, vol. 2, p. 20f>.
Grookin s Historical Collections of the Indians in New England.
Prince’s Chronological History of New England, p. 46.
Purcha-i, vol. 4, 1175.
Wintlirop’s Journal, p. 52.
History of Epidemic and Pestilential Diseases, etc., by Noah Webster, vol. 1, pp. 177.
1879]
Louisiana State Medical Society.
115
and it is well-known that in the first settlements of both North
and South America, the Spanish, French and English colonists
suffered terribly from these diseases. Many of the most flour¬
ishing and populous settlements were in a few years almost
depopulated by these fevers, which committed the greatest
ravages in those towns and colonies which were located near
the mouths of large rivers in low marshy regions. Entire
armies were destroyed by these fevers ; and the pioneers who
cleared the forests and drained the low lands, were either sud¬
denly cut off by these u high grades ” of bilious fever, which
were often attended with a yellowness of the skin (jaundice),
incessaut vomiting of bilious matter, which was sometimes
mixed with blood (black vomit), or were slowly poisoned by the
malaria of the swamps and marshes, and dragged out miser-
erable existences, rendered almost intolerable by enlargements
of the spleen and liver, derangements of the blood and nervous
system, neuralgias, and dropsies.
Thus it appears from Purchas, that the emigrants to Vir¬
ginia in 1619, 1620, 1621, amounted to 3570 in 42 sail of ships.
There were 600 souls in that colony before these arrived, making
the whole number 4170. Of these, 349 perished in the Indian
massacre of 1622, which would leave 3821 survivors. But in
1624 no more than 1800 were living. Scant means of sub¬
sistence might have contributed to this mortality ; but most of
it was in consequence of fevers, that were probably the effects
of the climate, soil and atmosphere.
In that form of paroxysmal malarial fever characterized by
complete jaundice, intense vomiting, nausea, and haemorrhage
from the kidneys, which has received different names at dif¬
ferent times and in different countries, and which is no u new
disease,” even in the United States of America, the haemor¬
rhage from the kidneys is preceded by capillary congestion of
these organs, and is attended by desquamation of the excretory
cells and tubuli uriniferi.
Malarial haematuria (hwmogastric malarial fever ), as a general
rule, occurs only in those who have suffered from repeated
attacks of intermittent fever, or who have been enfeebled by
a prolonged attack of remittent fever, or whose constitutions
have been impaired by bad diet, excessive labor, and frequent
exposure to cold and wet and the exhalations of swamps and
marshes. And whilst some of the symptoms — as the nausea,
incessant vomiting (and in extreme cases black vomit), deep
jaundice, and the impeded capillary circulation — resemble those
of yellow fever, yet there are marked differences between this
disease and yellow fever. The presence of albumen in the urine
of this so-called malarial hsematuria is attended also with the
presence of colored blood-corpuscles, excretory cells of the
kidney and of the tubuli uriniferi. The excretory tubes of the
kidney appearing in the urine are often impacted with colored
blood-corpuscles, and deeply stained by the coloring matters of
the blood. As a general rule in yellow fever, the tubuli
110
Abstract of Proceedings
[July
uriniferi are loaded with yellow, granular, albuminoid and
fibroid matter. In some cases immense quantities of green
biliary fluid, or liquid tinged with bile, were vomited, and the
patients died in a state of collapse, with blue mottled and
purplish extremities, and sunken, pinched features. As a
general rule, suppression of the functions of the kidneys was
a fatal sign, and, as in yellow fever, was sometimes attended
with convulsions, coma and delirium. Careful examination
of the blood revealed a marked decrease in the fibrin and
colored blood-corpuscles ; in fact, this change in the blood was
characteristic of all cases of this disease which have come
under my observation. The pathological changes which I have
observed after death from malarial hsematuria are character¬
istic of paroxysmal malarial fever, and not of yellow fever —
viz., enlarged slate-and-bronze-colored liver, loaded with dark
pigment granules, deposited in greatest numbers in the portal
capillary network; gall-bladder distended with thick, ropy
bile, presenting, when seen en masse , a greenish-black color,
and in thin layers a deep yellow. As much as 1000 grains of
bile of high specific gravity has been obtained from the gall¬
bladder, whilst in yellow fever not more than 120 grains of bile
are, as a general rule, contained in the gall-bladder.
As it is well established that malarial hsematuria, and the
severe and most fatal forms of malarial fever, prevail only in
certain years, and appear to be dependent to a large extent
upon the degree of heat and moisture, as well as upon the
amount of organic matter in the soil, and as these epidemics
in the tropical and temperate regions of America are often of
the widest extent and severest character, and as the Indians
suffered from these diseases to an almost equal degree with
the whites, and as they were in North America without the
most important remedies — bark and quinine — it is not unrea¬
sonable to suppose that at certain seasons large numbers
perished by these diseases. And were it not for the free use
of quinine in the treatment of paroxysmal fevers, many of the
cities of the Southern States, surrounded with swamps and
marshes, would have been depopulated ; and even in the more
elevated regions of the country, as in the rich valleys of the
Cumberland and Allegheny mountains, and along the rivers
flowing into the Atlantic and Gulf of Mexico, the mortality
from paroxysmal malarial fever would in certain seasons be
very great but for the free use and powerful antiperiodic vir¬
tues of quinine.
It is evident, therefore, that the origin of the American
plague or typhus ( vomito prieto , fievre jaune , yellow fever) is
involved in doubt, on account of the prevalence in the tropical
and sub-tropical regions and temperate zones, both amongst
the natives and foreigners, of some forms of malarial fever,
often attended with jaundice, passive haemorrhages, and black
vomit. If it could be determined at what time this terrible
disease was clearly recognized by the medical profession and
Louisiana State Medical Society.
117
1879J
historical writers as distinct from paroxysmal malarial fever,
and as dependent upon a specific cause or upon a combination
of causes peculiar to itself, a firm ground for the discussion
of its origin and of its relations to the native population, as
well as to the foreign elements, would be established. Rut it
is well known that many of the descriptions given by various
authors will apply as well to the severe forms of paroxysmal
malarial fever as to yellow fever, and also that the distinction
of the one from the other has been the result of comparatively
recent labors, and even at the present time there are not a
few physicians who hold to the identity of both diseases in
their origin and essential nature.
THE IMPOSSIBILITY OF DETERMINING WITH ACCURACY THE
DATE AND MODE OF ORIGIN OF YELLOW FEVER, ILLUS¬
TRATED BY AN EXAMINATION OF THE THEORIES WHICH
HAVE BEEN ADVANCED AT DIFFERENT TIMES BY VARIOUS
WRITERS AS TO ITS NATURE AND CAUSES.
The opinions in regard to the causes of yellow fever have
been arranged by systematic writers under three heads —
1. That it is a disease induced solely and essentially by con¬
tagion. 2. That it is essentially of endemic origin. 3. That,
being of endemic origin, it afterwards becomes contagious. The
doctrine that not only intermittent, remittent, and congestive
or pernicious paroxysmal malarial fever, but also yellow fever,
assume more or less, according to circumstances, the type of
one another, has been extensively entertained by the medical
profession. Believing them to arise from essentially the same
causes, variously modified, which assail th<* system through
the same avenues, these fevers are regarded by this class of
reasoners as essentially the same, modified by the intensity of
the cause and by the prevailing constitution. And it has
strangely been sought to maintain this position by the fact
that the natives of southern cities, in which yellow fever is
of such frequent occurrence as to be pronounced endemical,
possess in a great measure an exemption from this malady,
and suft'er only from the mild intermittent and remittent,
whilst those lately arrived from northern latitudes so often fall
victims to yellow fever that it has in some cities received the
name of strangers' fever.
To sustain the opinion that yellow fever arises from mias¬
matic effluvia, the following facts have been frequently cited :
1. Yellow fever always appears simultaneously with bilious
remittent. 2. A high range of atmospheric temperature is
essential to the generation of its cause. 3. Its first appearance
is almost always in the lowest and most filthy parts of towns,
and in localities favorable to the production of miasmata.
4. The supervention of storms, heavy rains, or cold weather
puts an immediate check to its progress.
It has been asserted that whilst at New Orleans, Charleston,
118
Abstract of Proceedings
[July
Savannah and Gibraltar the same individual is seldom twice
attacked by yellow fever, in the West Indies and on the coast
of Africa it is said to secure no subsequent immunity. With
some writers it is still even a disputed question whether certain
fevers which have, or are supposed to have, their source in
vegetable miasms or in effluvia from marshes, or from infusoria
or fungi developed and propagated under certain combinations
of heat, moisture, and putrefying vegetable and animal matters,
are subsequently spread by contagion ; whilst some writers con¬
tend that within the tropics yellow fever may at any time, under
certain conditions of moisture and temperature, arise de novo in
the impure atmosphere of the crowded and filthy ship or city.
Others, again, as strenuously uphold the doctrine that it is a
specific contagious pestilential disease, which, like small pox
or measles, may be transported and communicated from one
ship or city to others, thus following the great avenues of
commerce. Whilst a third class adopt and advocate a doctrine
which embraces the main features of both propositions. Some
who hold that yellow fever may be engendered de novo in the
hold or atmosphere of ships navigating in the warm, moist
tropical regions, have coupled with this view the doctrine that
if this poisoned atmosphere be allowed to escape at the wharves
of cities situated beyond the yellow fever zone, those only who
come within the sphere of its influence will be affected ; and its
subsequent spread will depend upon conditions of filth and
crowding of such localities, the disease never spreading endemi-
cally, and falling harmless among the inhabitants of a salubri¬
ous locality.
According to this view, the development of this malignant
fever requires the conjoint operation of both local and general
causes, constituting an endemico-epidemic, which is unsus¬
ceptible of propagation by specific, contagion; and in the sum¬
mer atmosphere of a city lying beyond the yellow fever zone
there must exist some peculiar combination of circumstances,
or some peculiar agency favorable to its development. In these
cases it is affirmed that there is generally found an infected
district, which slowly and regularly extends its boundaries,
rendering all who come within its limits subject to this form of
fever. It has been said that the experience of several centuries
teaches us that the cause of this fever is perennially present in
the tropical and sub tropical cities of America ; that it is indis¬
solubly connected with climate; that it maintains the same
relation towards the human system as the other malarious
emanations of swamps and lowlands ; and that it is liable to
be developed at any time in different degrees of intensity by
the combined operation of heat and other agents.
Amongst the most striking circumstances in the etiology of
yellow fever -are the marked geographical boundaries within
which it is confined and the circumscribed location in which it
prevails, the disease being rarely met with south of the 85th or
north of the 40th degree of latitude, and even between these
119
1879] Louisiana State Medical Society.
limits being more frequent in the Western than in the Eastern
Hemisphere ; its almost universal limitation to commercial sea¬
ports elevated but a few feet above the level of the sea. although
it occasionally spreads to towns and cities in the neighborhood
of the latter, situated in the interior country or on the banks of
navigable rivers ; and the fact that it is very frequently cir¬
cumscribed within certain limited ami well-defined portions of
the locality or city in which it prevails. The shores of the
Western Archipelago, and of the Gulf of Mexico and the
Caribbean Sea, constitute the prolific liot-bed in which has
been geuerated^and propagated toe mysterious poison of this
disease, which has desolated cities, armies, and fleets, and
destroyed the successive swarms of adventurers and invaders
from Europe and the colonies of North America.
GENERAL OUTLINE OF THE HISTORY OF YELLOW FEVER,
ILLUSTRATING THE DIFFERENT VIEWS WHICH HAVE BEEN
HELD AT DIFFERENT TIMES AS TO THE PLACE AND MODE
OF ITS ORIGIN.
If it were possible to determine with accuracy the nature of
the severe and fatal forms of fever which afflicted the first ex¬
plorers and colonists of the tropical and sub tropical regions of
America, and even the very companions of Columbus, the ques¬
tion of the origin of yellow fever would be relieved of much
uncertainty and doubt. If we are to credit the accounts of
some authors, the first trace of yellow fever was observed at
the end of the fifteenth and beginning of the sixteenth century
at San Domingo and Porto Rico, in the Continent of South
America, and in the Gulf of 1 )arien, at which latter place it is
said to have prevented the Spaniards from settling. In Novem¬
ber, 1493, Columbus landed at San Domingo with 1500 Span¬
iards, in order to found the city of Isabella. A severe and
fatal fever carried off the greater part of them within a year
after their arrival, and the disease is described as being “ yel¬
low as saffron or gold.” From 1544 to 1568 there is no record
of the disease having prevailed as an epidemic until 1635, when
it appeared in Guadaloupe, and thenceforward it occurred at
regular intervals. In the seventeenth century it spread along
the Continent of South America to latitude 8° south, and in
North America to latitude 42°, but only on the eastern coast of
both. The first appearance of the disease in the United
States was at Boston in 1693, and in Charleston and
Philadelphia in 1699. It is said first to have appeared
in the Gulf of Mexico, at Biloxi Bay in 1702, and Mobile
in 1705; but Humboldt held that it had prevailed from the
very foundation of Vera Cruz, and was indigenous to this
city. It prevailed at Pensacola and Mobile in 1765.
In the eighteenth century it appeared on the west coast of
South America in latitude 2° south. On the North American
120
A bstract of Proceedings
[July
continent it spread to latitude 42° north; it extended even to
Europe, and reached the Pacific and Madagascar. At the
beginning of the nineteenth century it penetrated deeper into
the North American continent than formerly, reaching as high
as latitude 47° north, and in Europe it extended to latitude 48°,
and prevailed in the Canary Islands and Leghorn.
Ever since yellow fever attracted attention it was recognized
as a distinct disease from the remittent autumnal fevers of the
temperate zone. It lias prevailed as an endemic in Havana,
raging epidemically from April to December, and occurring
sporadically during the rest of the year. From time immem¬
orial it has been endemic at Vera Cruz, in the Gulf of Mexico,
where its chief victims are strangers who come from cold re¬
gions during the hot season, as well as Europeans and those
natives who exchange the more elevated and cool regions of
Mexico for the coast.
At the time when Spain possessed by far the best and
largest portion of the American continent, extending from the
north of California to the Straits of Magellan — a space of
between 6000 and 7000 miles — a system of commerce was estab¬
lished which appeared to be eminently favorable to the origin
and spread of yellow fever. The Spanish galleons were, in
fact, very large men-of-war, built in such a manner as to afford
ample room for the stowage of merchandise, with which they
were commonly so encumbered as to be rendered incapable of
defence. The fleet of galleons consisted of eight such men-of-
war, and generally convoyed fron twelve to sixteen merchant¬
men. During times of peace the galleons sailed once a year
regularly, though at no set time, but according to the pleasure
of the King of Spain and the convenience of the merchants.
They sailed from Cadiz to the Canaries, thence for the An¬
tilles, and after reaching this longitude they bore away for
Cartnagena. As soon as they came in sight before the mouth
of Eio de la Hacha, after having doubled Cape de la Vela,
advice of their arrival was sent to nil parts, that everything
might be prepared for their reception. They remained a month
in the harbor of Carthegena, and landed there whatever was
designed for terra firm a. They then sailed to Puerto Velo,
where having stayed during the fair, which lasted five or six
weeks, they landed the merchandise intended for Peru, and
received the treasures and commodities sent from thence. The
galleons then sailed back to Carthagena, and remained there till
their return to Spain, which usually happened within the space
of two years. When orders for returning home arrived, they
sailed first to the Havana, and having joined the flota, and
what other ships were bound to Europe, they steered north¬
ward as far as Carolina, and then, taking the westerly winds,
they shaped their course to the Azores, when, having watered
and victualed afresh at Terceira, they thence continued their
voyage to Cadiz.
1879]
Louisiana State Medical Society.
121
The Spanish flota consisted, like the galleons, of a certain
number of men-of-war and merchant ships ; there were seldom
more than three of the former and sixteen of the latter in this
fleet. They sailed from the coast of Spain some time in the
month of August in order to obtain the winds that blow in
November for the more easy pursuing their voyage to Vera
Cruz. They called at Puerto Rico on their wray to refresh,
passed in sight of Hispaniola, Jamaica and Cuba, and, accord¬
ing to the winds and season, sailed either to the coast of Yu¬
catan, or higher through the Gulf to Vera Cruz. The Spanish
flotilla being intended to furnish not only Mexico, but the
Philippine Islauds also, with the goods of Europe, was obliged
to remain in VeraCruz for a considerable time, and sometimes
found it necessary to winter in that port. This fleet usually
sailed from Vera Cruz in the month of May, but was sometimes
detained as late as August; it then made for Havana, and
returned to Spain in company with the galleons.
The Spanish towns were generally built in low, unhealthy
localities, surrounded by marshes and swamps, with narrow
streets and high w alls and fortifications, which not only com¬
pressed the towns within certain limits, and induced crowding
and favoured the accumulation of filth, but also prevented to
a certain extent the free circulation of air.
If the history of yellow fever in the Western Hemisphere be
critically examined, it will be found that the accounts and
dates of its origin varied with the extent and character of the
information of the writers in each city, locality, or island ; and
each one in turn was tempted to assign to the disease a
foreign origin. No city or place has been found to claim the
honour of the origin and continuous propagation of yellow
fever. Thus, the French writers, called this disease mal de
Siam , and held the tradition that the disease had been imported
in the ship Orijlame , which sailed with French colonists from
Siam in the latter part of the year 1090. Monsieur Poupee
Desportes, who practised at St. Dominique from 17.32 until
1748, says that this fever was so called from its first being-
taken notice of in the island of Martinique at a time when
some vessels were there from Siam. — (u Hist, des Malad. de St.
Dominique,” vol. i, pp. 191, 192). But it is well known that
the Orijlame touched at Brazil wdiere yellow fever had been
prevailing for several years, and Father Labat, who arrived
at Martinico on January 29, 1694, tells us that the passengers
of this ship caught the disease in Brazil.
Equally incorrect was the account given by Dr. Warren of
its introduction into Barbadoes between the years 1732 and
1738. Dr. Warren concluded that the yellow fever which he
saw at Barbadoes in 1732 and the following years was a con¬
tinuation of the plague which in 1720 and 1721 had been
brought from Palestine to Marseilles, and which he imagined
had been brought from the latter place to Martinico, and
thence to Barbadoes in 1721 by the Lynn ship of war.
16
122.
A bstract of Proceedings
[July
Dr. Towne, who lived and practised as a physician at Bar-
badoes at the time of the alleged introduction of the plague
from Marseilles (1721), and who wrote in 1724 (before the
arrival of Dr. Warren) on yellow fever under the denomina¬
tion of febris ardens biliosa , made no allusion to any such
importation, but considered it as an endemic disease in the
West Indies to which Europeans were subject upon their first
arrival.
Mr. Hughes says, in his “ Natural History of Barbadoes,” that
Dr. Gamble remembers that it was very fatal in 1691, and that
it was then called the “new distemper,” and afterwards, “ Ken¬
dal’s fever,” also the “ pestilential fever,” and “ billious lever.”
This statement is also confirmed by Captain Thomas Phillips,
who was at Barbadoes with a large ship in 1094, and says, in
the account of his voyage to Africa and Barbadoes, that it
was the fate of that island to be then “ violently infected with
the plague.” — (Churchill’s Collect., vol. i., p. 253.)
It appears, however, from the statement of Mr. Richard
Vines, a planter and practitioner of physic in Barbadoes, that
yellow fever prevailed with destructive effect as “ an absolute
plague ” as early as 1647 ; and Dr. Edward Nathaniel Bancroft,
in his essay on yellow fever, suggests that it was called “ a
new distemper ” in 1691-94, because all who had had any accu¬
rate knowledge of it in 1647 were probably dead or removed.
Mr. Richard Ligon in his history of Barbadoes, published in
1657, says that when he arrived there in 1647, in the early part
of September, the inhabitants of the island and shipping too
were so seriously visited by the plague (or as deadly a disease)
that “ before a month was expired after our arrival the living
were hardly able to bury the dead.” In considering the causes
of this disease — whether it was brought thither in shipping, or
was occasioned by the irregularities, debaucheries, and ill diet
of the people, and the unhealthy, low, marshy situation, subject
to overflow — lie inclined to the latter.
A similar fever, and probably from the same causes, prevailed
at the same time at St Christopher, Guadaloupe, and other
islands, and there died at St. Kitts and Barbadoes each five or
six thousand inhabitants.
P. I )u Tertre also mentions this disease, and calls it the plague.
He says that it began at St. Christopher, and in eighteen
months carried off one-third of the inhabitants, and that it was
accompanied with violent pain in the head, great debility of
the limbs, and a constant vomiting ; and that in three days it
sent the patient to the grave.
Dr. Hillary, who enjoyed a high reputation as a successful
practitioner and learned physician in Barbadoes, affirms that
the disease was indigenous and endemic to the West India
1 slands.
The testimony of Alexander Humboldt is similar to that of
Dr. Hillary, and is worthy of the most careful consideration in
the light in which it presents the history of yellow fever. In
1879J Louisiana State Medical Society. 123
his u Political Essay on the Kingdom of New Spain,” this dis¬
tinguished traveler, naturalist, and philosopher says: —
u The typhus, which the Spaniards designate by the name of
1 black vomiting ’ (vomito prieto), lias long prevailed between
the mouth of the Rio Antigua and the present port of Vera
Cruz. The Abbe Clavigero(a) and some other writers affirm
that this disease appeared for the first time in 1725. We know
not on what this assertion, which is so contrary to the tradi¬
tions preserved among the inhabitants of Vera Cruz, is
founded. No ancient document informs us of the first appear¬
ance of this scourge ; for throughout all the warmer parts of
equinoctial America, where the termites and other destructive
insects abound, it is infinitely rare to find papers which go fifty
or sixty years back. It is believed, however, at Mexico, as
well as at Vera Cruz, that the old town, now merely a village,
known by the name of La Antigua, was abandoned towards
the end of the sixteenth century(b) on account of the disease
which then carried off the Europeans.
“ Long before the arrival of Cortez there has almost periodi¬
cally prevailed in New Spain an epidemical disease called by
the natives 4 Matlazahuatl,’ which several authors (c) have con¬
founded with the vomito or yellow fever. * * *
u Lt is certain that the vomito , which is eudemical at Vera
Cruz, Carthagena, and Havana, is the same disease with the
yellow fever, which, since the year 1793 has never ceased to
afflict the people of the United States. This identity, against
which a very small number of physicians in Europe have
started doubts, (d) is generally acknowledged by those of the
Faculty who have visited the Island of Cuba and Vera Cruz,
as well as the coast of the United States, and by those who
have carefully studied the excellent nosological descriptions of
of MM. Makittrick, Rush, Valentin, and Luzuriaga. We shall
not decide whether the yellow fever is perceptible in the causus
of Hippocrates, which is followed, like several remittent bilious
fevers, by a vomiting of black matter ; but we think that the
yellow fever has been sporadical in the two continents since
men born under a cold zone have exposed themselves in the
low regions of the torrid zone to an air infected with miasmata.
Wherever the exciting causes and the irritability of the organs
are the same, the disorders which originate from a disorder in
the vital functions ought to assume the same appearances.
u It is not to be wondered at that at a period when the com¬
munications between the Old and New ( 'continents were far
from numerous, and when the number of Europeans who an¬
nually frequented the West India Islands were still small, a
disease which oidy attacks the individuals who are not sea
(a) *• Storia di Messioo,” t. i., p. 117.
(b) “ New Spain,” vol. ii., p. 253.
(c) Letter of Alzate in the “Voyage de Chappe.”
(d) “ Aretfnta de la Fi&bre Atnarillade Cadiz,” t. i., p. 143.
124 Abstract of Proceedings [July
soned to the climate, should have very little engaged the at¬
tention of the physicians of Europe.
u In the sixteenth and seventeenth century the mortality
must not have been so great. — 1st. Because, at that period the
equinoctial regions of America were only visited by Spaniards
and Portuguese — two nations of the south of Europe less ex¬
posed, from their constitution, to feel the fatal effects of an ex¬
cessively hot climate than the English, Danes, and other in¬
habitants of the north of Europe who now frequent the West
India Islands. 2dly. Because, in the islands of Cuba, Jam¬
aica, and Hayti, the first colonists were not assembled together
in such populous cities as were afterwards built. 3rdly. Be¬
cause, on the discovery of continental America, the Span¬
iards were less attracted by commerce towards the shore, which
is generally warm and humid, and preferred a residence in the
interior of the country, on elevated table-lands, where they
found a temperature analogous to that of their native country.
In fact, at the commencement of the conquest the ports of
Panama and Nombre de Dios (e) were the only ones where there
was a great concourse of strangers ; but from 1535 the resi¬
dence at Panama, (f) was as much dreaded by the Europeans
as in our times a residence at Vera Cruz, Oma, or Porto Cabello.
It cannot be denied from the facts related by Sydenham and
other excellent observers that, under certain circumstances,
germs of new diseases may be developed ; (g) but there is no¬
thing to prove that the yellow fever has not existed for several
centuries in the equinoctial regions. We must not confound
the period at which a disease has been first described, on ac¬
count of its ha ving committed dreadful ravages in a short space
of time, with the period of its first, appearance.
“ The oldest description of the yellow fever is that of the
Portuguese physician Joam Ferreyra Da Rosa, (li) who ob¬
served the epidemic which prevailed at Olinda, in Brazil,
between 1687 and 1694, shortly after a Portuguese army had
made the conquest of Pernambuco. We know in the same
manner witu certainty that in 1691 the yellow fever manifested
itself at the island of Barbadoes, where it went by the name of
4 Kendal’ fever, without the smallest proof appearing that it
was brought there by vessels from Pernambuco. Ulloa (i)
speaking of the chapetonadas, or fevers to which Europeans are
exposed on their arrival in the West Indies, relates that accord¬
ing to the opinion of the people of the country, the vomito
prieto was unknown at Santa Martha and Carthagena before
1729 and 1730, and at Carthagena previous to 1740. The first
(e) Nombre de Dios, situated to the east of Porto Bello, was abandoned in 1584.
(f) Pedro de Cicca, c. ii., p 5.
(g) See “ Respecting an Affection of the Larynx which prevails epidemically at Ota-
heite since the arrival of a Spanish vessel Vancouver ,” t. i., p. 175.
(h) “ Trattado da Constituicam Pestilencial de Pernambuco,” par Joam Ferreyra da
Rosa, era Lisboa, 1694.
(i) “ Voyage, ' t. i., pp. 41 and 149.
1879]
Louisiana State Medical Society.
125
epidemic at Santa Martha was described by Juan Josef de
Gastalbrude, (k) a Spanish physician. Since that period the
yellow fever has several times raged out of the West India
Islands and Spanish America, on the Senegal, in the United
States, (1) at Malaga, Cadiz, (m) Leghorn, and according to the
excellent work of Cleghorn, even in the island of Minorca (n).
We have thought it proper to relate these facts (many of which
are not generally known) because they throw some light on the
nature and cause of this cruel disease. The opinion that the
epidemics which since 1793 have nearly every year afflicted
North America differ essentially from those which for centuries
have prevailed at Vera Cruz, and that the yellow fever was
imported from the coast of Africa into Grenada, and from
thence into Philadelphia, is equally destitute of foundation
with the hypothesis formerly very generally believed — that a
squadron from Siam introduced the vomito into America (o).
“In all climates men appear to find some consolation in the
idea that a disease considered pestilential is of foreign origin.
As malignant fevers easily originate in a numerous crew cooped
up in dirty vessels, the beginning of au epidemic may be fre¬
quently traced to the period of the arrival of a squadron : and
then, instead of attributing the disease to the vitiated air con¬
tained in vessels deprived of ventilation, or to the effects of an
ardent and unhealty climate on sailors newly landed, they affirm
that it was imported from a neighboring port, where a squad¬
ron or convoy touched. at during its navigation from Europe to
America. Thus we frequently hear in Mexico that the ship-of-
war which brought such-or-such a viceroy to Vera Cruz has
introduced the yellow fever which for several years had not
prevailed there ; and in this manner during the season of great¬
est heat the Havana, Vera Cruz, and the ports of the United
States, mutually accuse one another of communicating the
germ of the contagion. It is with the yellow fever as with the
mortal typhus known by the name of ‘Oriental pest,’ which the
inhabitants of Egypt attribute to the arrival of Greek vessels,
while in Greece and Constantinople the same pest is considered
as coming from Rosetta or Alexandria.” (p.) — “Political Essay
on the Kingdom of New Spain,” vol. iv., pp. 135-143).
The preceding facts show the fallacy of attempting to decide
the date of the origin of yellow fever from the statements of
the writers of any one locality ; and they also show the im¬
propriety of confounding the period at which a disease has been
first described, on account of its having committed ravages at
(k) ••Lnzmiaga de la Calenttra Biliosa," t. i.. p. 7.
(l) In 1741, 1747, 1763.
(tn) At Cadiz in 1731, 1733 1734, 1774, 1746, and 1764, and at Malaga in 1741.
(n) In 1744. 1749 ( • Tommasini Febbre de Livorno del 1304,” p 65.)
(o) ,Lobat« ‘Voyage aux Isles, t. i., p. 7.1. Respecting the plague of Bouillam in
Africa, see Chisholm “On Pestilential Fever, ’ p. 61; Miller, “ Histoire de la Fievre de
New York,” p. 61 ; and Volney, “Tableau de Sol de A merit) tie,” t. ii. , p. 334.
(p) Pugnet, Sur les Fieves du Levant et des Antilles,” pp. 97 and 331.
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[July
some particular locality or time, with the period of its first
appearance.
From the preceding facts we conclude :
1st. As destructive and extensive pestilences , resembling yellow
fever, have destroyed the aboriginal inhabitants, in former times,
when they formed a numerous and comparatively dense population ,
we are justified in holding that the A merican Continent has been
in past ages subjected to wide spread terrestial, celestial and clim¬
atic conditions which were hostile to h uman life.
2d. The experience of the past leads to the belief that such
destructive combinations or conditions may occur in the future and
cause wide spread destruction uncontrollable, by human means.
.‘id. Yellow fever has, since the advent of Europeans in the
Antilles, and in North and South America, prevailed at various
periods, separated by no uniform intervals, with great violence and
during such periods its area , has been noddy extended, as in 1878.
4th. However perfect the sanitary arrangements and complete
the quarantine regulations of cities situated within certain parallels
of latitude, it is probable that in seasons of great epidemic in¬
fluence, human agency may fail in the circum vention or arrest of
the American plague.
5th. In insular, tropical and subtropical America, one of the
most essential conditions for the increase of yellow fever, is the
accession and crowding of unacclimated persons , natives of the
colder regions of America and Europe, in cities or on sh ip-board.
Armies and navies are the great fields of its ravages.
YELLOW FEVER COEVAL WITH THE FIRST SETTLEMENT OF THE
GULF COAST OF LOUISIANA BY THE FRENCH. HISTORY
DURING FRENCH DOMINATION 1684—1763.
Father Christian Le Clerq in his “ account of La Salle's at¬
tempt to reach the Mississippi by sea, and of the establishment of
a French colony in St. Louis Bay," states that in September, 1(584,
La Salle suffered with a dangerous malady in the Island of St.
Domingo, which brought him to the verge of the grave, and
the soldiers and most of the crew, bavins' plunged into every
kind of debauchery and intemperance, so common in these
parts, were so ruined, and contracted such dangerous disorders
that some died on the Island and others never recovered. The
disease appears to have been of an infectious and contagious
character, for Father Christian Le Clerq states farther, that
after the construction of the forts in St. Louis Bay, on the
coast of the present State of Texas, u the maladies which the
soldiers had contracted were visibly carrying them off, and a
hundred died in a few days, notwithstanding all the relief
afforded by broths, preserves and wine, which were given them.”
It is evident therefore, that the soldiers, sailors and colonists of
the fleet of the celebrated and unfortunate La Salle, which
sailed from Rochelle, France, on the 15th of August, 1684,
suffered severely from an infectious fever, after reaching the
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island of St. Domingo on the 14tli of September, and this
fever, which came near destroying the commander, was trans¬
ferred to the shores of Louisiana, and continued its ravages
after the foundation of the Fort of St. Louis.
It is probable, therefore, that yellow fever, was coeval with
the settlement of the French on the coast of Louisiana.
According to M. Benard de La Harpe, M. d’Iberville, built
the fort at Biloxi in the month of April 1099, with four bastions,
which he mounted with 12 cannon, and gave the command of
it to his brothers Sauville and Bienville, and set sail for France,
on the 4th of May, 1699. On the 22d of August, 1701, M. de
Sauville died of a fever, supposed to have been yellow fever;
and by the same disease, the garrison lost upwards of sixty
men, leaving only one hundred and fifty persons in the colony.
This circumstance, as well as the poverty of the surrounding
soil at Biloxi led Bienville to commence on the 16th of January,
1702, a settlement on the Mobile river, about eighty leagues
from the sea.
According to La Harpe, on the 24tli of April, 1704, M. Du
Coudray Guimont, arrived at Dauphine Island with the Pelican,
of fifty guns, from France, bearing provisions and other articles
for the colony. lie also brought sixty-five soldiers, four
priests, two grey nuns, twenty-three poor girls, and four fam¬
ilies of artisans. In the month of December a great deal of
sickness prevailed in the colony. M. Du Coudray Guimont,
lost the half of his crew' and was obliged to take twenty men
from the garrison to sail the vessel back to France. MM. de
Tonti, et le Vasseur, Father Donge, a Jesuit, and thirty sol¬
diers of the new troops, who had just arrived at the fort, died
during the month.
On the 19th of October, 1706, M. de Chateau gue arrived
at Mobile from Havana, and reported that M. de Iberville had
fitted up a fleet to seize upon Jamaica, and had taken on board
at Martinique about 2000 buccaneers, but, hearing that the
English had been informed of his intentions, he sailed for
Havana, and took on board one thousand Spaniards to invade
Carolina. The fever or pest (yellow fever) which prevailed at
that time, broke out among his troops, of which Iberville died
and 800 men.
In the spring of 1718, Bienville selected a site for a town on
the banks of the Mississippi, and placed fifty men to clear otf
the grounds, as the location of the future capital of the pro¬
vince. The ground selected was that which is now covered by
the lower portion, or French part, of the present city of New
Orleans. Next spring the river overflowed its banks, the new
settlement was completely inundated, and the site seemed to
present an uncertain location for a city, which remained for
several years little more than a military post remote from the
settlements. For three years Bienville’s headquarters remained
at Mobile.
The historian, M. Le Page Du Pratz, who came over with a
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colony of eight hundred men in 1718, under the auspices of the
West India Company, states that six weeks before the arrival
at Cape Frangois , St. Domingo, fifteen hundred persons died of
an epidemic called the Siam Distemper. Du Pratz gives,
however, no facts to show that any of the body of emigrants
some of whom settled at New Orleans, and others at Natchez,
suffered with yellow fever, for he states that after a passage of
three months, including the six weeks spent at Cape Francois,
they arrived at the Island of Massacre , since called Isle of
Dauphin e , on August 25th, after a prosperous voyage, no one
having died, or having been even dangerously ill. Du Pratz
describes the location of the future capital of Louisiana in 1718,
as being marked out by a hut covered with palmetto leaves.
As early as the year 1718, in which New Orleans was founded,
a company ship had sailed from France with troops and one
hundred convicts, destined for Louisiana, but had never been
heard ot. Toward the close of 1821, there arrived in Louisiana,
a French officer who gave some account of this ill-fated vessel.
It was now discovered that like the fleet of La Salle, she had
missed the Mississippi, and had been driven to the west. .Her
commander had mistaken the island of Cuba for that of St.
Domingo, and had been compelled to pass through the old
channel to get into the Gulf. He made a large bay, in the 29th
degree of latitude, and discovered that he had lost his way.
His misfortune was increased by a contagious disease breaking
out among the convicts. Five of the officers thought it less
dangerous to land, with provisions for eight days, and their
arms, than to continue on board. The first importation of
African slaves numbering 500, was made in 1719, a large por¬
tion of which was sent to New Orleans, and transferred to the
west bank of the river to a plantation owned by a company.
The remainder were sold chiefly to the agricultural settlements
of the lower Mississippi. We have no accounts of any importa¬
tion of yellow fever by these or subsequent cargoes of slaves
under the French reign.
Bemud de la Harpe states that on the 1st of July, 1720, the
king’s ships, Le Comte de Toulouse, sixty-four guns, com¬
manded by M. de Vatel, after the death of M. de Caffiro, on the
17th of June, and the Saint Henri, seventy guns, commanded
by M. Douce, arrived in Louisiana. They brought with them
from the island of St. Domingo, a contagious fever, or malady,
which carried off a great number of persons every day. After
opening several bodies, it was discovered that the disease came
from a corruption which engendered a quantity of worms in the
stomach.
Francois Xavier Martin gives a wholly different account of
the origin and nature of this malady, and classes it with the
Oriental Plague. He says : u Two line-of-battle ships came in
the latter' part of J une, 1720, from Toulon. They were in great
distress ; Caffaro, the commodore, and most of their crews had
fallen victims to the plague, which some sailors in these ships
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who had come from Marseilles, had communicated to the
others ; that city being ravaged by pestilence, brought there
by a ship from Lyde, in the Levant. Father Laval, a Jesuit,
royal professor of hydrography iu the college of Toulon, had by
the king’s order, taken passage on board this fleet, with direc¬
tions to make astronomical observations in Louisiana. The
chaplains of the ship having died, the father, considering
science an object of minor consideration to a minister of the
altar, thought it his duty to bestow all his time in administer¬
ing spiritual relief to the sick, who for a long time were very
numerous, and he sailed back with the ships.
Experiment having shown that Europeans could not stand
the labors of the field, but sickened and died under the burning
suns of Louisiana, and the chilling dews and fogs of night; the
Western Company was therefore compelled to introduce African
negroes to cultivate the plantations scattered on the bayous and
rivers of the delta of the Mississippi and for several years it fur¬
nished the agricultural interests of the colony with several hun¬
dred annually, which was the origin of African slavery in Louisi¬
ana. In 1824, M. de Bienville drew up a code, containing all the
legislation applicable to slaves in Louisiana, which remained in
force until 1803. It appears that during the year 1781, Louisi¬
ana received no less than 1367 negroes from the coast of Africa.
We have failed to discover in the writings of La Harpe, Du
Pratz, Charlevois, Martin, Gayarre and others, any facts sus¬
taining the view advanced by some, that yellow fever was
first imported into Louisiana by the slave ships.
Du Pratz, who visited New Orleans and Biloxi in 1722,
states that at the latter place more than five hundred persons
died of famine. He states that u the great plenty of oysters
found upon the coast saved the lives of some of them, although
obliged to wade up to their thighs for them a gunshot from the
shore. If this food nourished several of them, it threw num¬
bers into sickness, which was still more heightened by the long
time they were obliged to be in the water.”
In the beginning of August, 1723, Bienville removed his
headquarters to New Orleans. A most destructive hurricane
desolated the province on the 11th of September, 1723. The
church, hospital and thirty houses were levelled to the ground
in New Orleans ; three vessels that lay before it were driven on
shore. The crops above and below were totally destroyed, and
many houses of the planters blown down. Famine threatened
the colonists with its horrors, but they were in some degree
relieved by the appearance of an unexpected crop of rice. Dis¬
ease added in the fall , its horrors to those of impending death.
In 1724, the white population of Louisiana, says La Harpe,
amounted to about 1700 souls, and the black population to
3300. If La Harpe’s statement be true, it shows an astonish¬
ing diminution of the white population, which in 1721, was
computed at 5400.
17
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130
During the fall of 1726, Perrier, a lieutenant of the King’s
ships, having been appointed commandant general of Louis¬
iana, shortly after, Bienville sailed for France : one of the
articles of instruction to Governor Perrier ran thus: “ Whereas
it is maintained that the diseases which prevail in New Orleans
during the summer proceed from the want of air and from the city
being smothered by the neighboring woods , which press so close
around it , it shall be the care of M. Perrier to have them cut down ,
as far as Lake Pontchartrain .” These instructions show : That
at that remote time, the summer was the sickly season at New
Orleans, as it has continued ever since up to the present day;
and that to make the city more healthy, the government as far
back as 1726, was struck with the necessity of an improvement
which was only finally executed to fulfill the necessities of the
Federal troops during their hostile occupation in 1863, 1864 and
1865.
In the year 1727, the land on which the city of New Orleans
now stands, not being protected by an adequate levee, was
subject to annual inundations, and was a perfect quagmire,
presenting no better aspect than that of a vast sink or sewer.
The waters of the Mississippi and those of Lake Pontchar¬
train, met at a ridge of high land, which by their common
deposits they had formed between Bayou St. John and New
Orleans, called the highland of the lepers. To drain the city,
a wide ditch was dug on Bourbon street, the third from and
parallel to the river ; each lot was surrounded by a small ditch,
which in the course of time filled up, except the part fronting
the street, so that every square instead of every lot was
ditched in. The wnole city was surrounded by a large ditch,
and fenced in with sharp stakes wedged close together. In
this way a convenient space was drained. In the language of
Gayarre, u musquitoes buzzed, and enormous frogs croaked in¬
cessantly in concert with other indescribable sounds ; tall reeds
and grasses of every variety grew in the streets, and in the
yards, so as to intercept all communication, and ottered a safe
retreat and places of concealment to venomous reptiles, wild
beasts and malefactors, who, protected by these impenetrable
jungles, committed with impunity, all sorts of evil deeds.” Is
it any matter of surprise, therefore, that the hot months of
summer and autumn were even at this early day, dreaded for
their destructive, pestilential fevers.
Governor Perrier signalized the beginning of his administra¬
tion, by the completion on the 15th of November, 1727, in
front of New Orleans, a levee of eighteen hundred yards in
length, and so broad that its summit measured eighteen feet
in width. This same levee, although considerably reduced in
its proportion, he caused to be continued eighteen miles on
both sides of the city above and below. He announced to the
company that he would soon undertake to cut a canal from
New Orleans to Bayou St. John, in order to open a communi¬
cation with the sea., through the lakes, and he mentions the
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arrangements which he had made with the inhabitants in rela¬
tion to the negroes they were to furnish for the execution of
this work, which was actually begun, but to which subsequent
events put a stop. Thus it is seen that the plan of the canal
which now bears the name of Oarondelet, did not originate
with the Spanish governor.
From a dispatch of Diron d’Artaguette, dated April 23, 1733,
we learu that the small pox was then raging in Louisiana, and
that from this cause and famine, the result of the destruction
of the crops by a hurricane, the colony was on the eve of being
depopulated.
Bienville and Salmon, in a joint dispatch pf the 31st of
August, 1735, say : “The mortality of cattle is frightful, the
drought is excessive and the lieat is suffocating. Such hot
weather has never been known since the foundation of the col¬
ony, and it has now lasted four months without any change.”
While the planters were suffering from drought, after having-
suffered from inundations, the inhabitants of New Orleans
were laboring under a strange kind of infection. They could
hardly venture out of their houses without being bit by mad
dogs. These animals had increased to such an extent, that
they had become an intolerable nuisance, and to remedy the
evil, the royal commissary, Salmon, ordered them to be
hunted down, on certain days, from live o’clock to six o’clock in
the morning. He also prohibited negroes and Indians from
having dogs, under the penalty for the offender of being sen¬
tenced to wear an iron collar.
In 1734, Bienville, was re-appointed Governor of Louisiana.
The force which Bienville assembled in 1739, for the subjec¬
tion of the Chickasaw Indians, consisted of upwards of 1200
white, and double that number of Indian and black troops.
This comparatively large army, unaccountably spent six months
in making preparations for its march. In the meanwhile, the
troops lately arrived from France became unhealthy, and many
died, and the climate had an almost equally deleterious influ¬
ence on those from Canada. Early the next fall, the regulars
and militia of Canada and Louisiana, who had escaped the
autumnal disease, were prostrated by fatigue, and Bienville
was compelled to confine his call for service, to his red and
black men. They were his only effective force. In the Chicka¬
saw war peace was purchased at the price of many valuable
lives — estimated at 500, out of 1200 white troops, not slain in
battle, but destroyed by the fevers of the climate.
On the third of November, 1703, a secret treaty was signed
at Paris, between the French and Spanish Kings, by which the
former ceded to the latter, the part of the province of Louisi¬
ana which lies on the western side of the Mississippi, with
the city of New Orleans, and the island on which it stands.
1 have drawn the following conclusions, from data which I
have collected from every available source, and purchased and
preserved in my library , relating chiefly to the Medical History
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of Louisiana, as viewed in connection with its commercial and
agricultural development, during the French rule, extending
from the settlement in Matagorda Bay, by La Salle in 1684 to
‘the treaty of Paris in 1763, when France ceded to Spain and
lb) gland her possessions in North America.
1st. Under the French government, the growth of the popu¬
lation of Louisiana, was very slow. According to a census
of the inhabitants of the province, three years after
the treaty of Paris, it had 1893 men fit to carry arms,
1044 marriageable women, 1375 boys, 1244 girls, in all
5556 white individuals. The blacks were nearly as numer¬
ous. The erftire population at the end of near 80
years, did not exceed 12,000. The growth of the Cap¬
itol, New Orleans, had been very slow, and in 51 years after its
foundation, the population amounted to only 3190 persons of
all colors, sexes and ages.
2d. The commerce of New Orleans, and of the province gen
erally, was exceedingly limited during the French domination.
3d. It is probable that LaSalle and his men suffered with
yellow fever, in the West Indies as early as 1684, and they
appear to have brought the fever with them to the shores of
the Gulf of Mexico. The next visitations of yellow fever were
at Biloxi, in 1701 and 1704. Iberville and 800 of his men died
of yellow fever in the West Indies in 1706. The historian M.
LePage 1 )u Pratz states that six weeks before his arrival at
Cape Francois, St. Domingo, in 1718, fifteen hundred persons
died of an epidemic distemper, called the Siam distemper,
which was one of the French names for yellow fever, ft is
probable that yellow fever caused the great mortality amongst
the troops and convicts in 1718, on board the French ship,
which had lost its reckoning, and missed its destination, and
passed to the west of the mouths of the Mississippi.
4th. The na vigation of the Mississippi, from the Gulf to New
New Orleans, was very tedious before the introduction of steam,
and often occupied one month. The commerce of the city was
very limited during the French domination.
5th. The record of the diseases of New Orleans during the
first half century after its foundation, are very imperfect, and
we are not justified in affirming that during this period yel¬
low fever was unknown. We have seen that as early as 1726,
eight years after its foundation, the severe fevers of the summer
and autumn attracted the attention of the government.
6th. There are no facts to show that during this period, yel¬
low fever was introduced by the slave ships. The mortality on
these ships was often frightful, and was chiefly occasioned by
bad diet, crowding, foul air, scurvy, diarrhoea and dysentery.
7tli. The records of the casualties and diseases and surgery
of the various armies employed by the French at different
times against the Indians, English and Spaniards, are either
entirely wanting, or wholly inaccessible to the American stu-
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dent ; but we have recorded the destruction of the men of the
army of Bienville, by fever, during* the summer and autumn
of 1739.
HISTORY OF YELLOW FEVER IN NEW ORLEANS, LOUISIANA,
DURING THE SPANISH RULE, 1763—1803.
•
In the archives of the Department of Marine in France, is to
be found a memorial, written on the 15th of August, 1763, on
the situation of Louisiana, by one Redon de Rassao, who seems
to have occupied an official position in the colony. Among the
causes which lie gives as having operated as obstacles to the
prosperity of Louisiana, are the following :
“ 1st. Under M. De Yaudreuil, half of the married men sent
to Louisiana had no children, and were between forty and sixty.
“2d. A good many families are located below the English
Turn, in marshy and unwholesome ground requiring incessant
labor to make and keep up embankments. To this must be
added the deleterious influence of poverty, and every variety
of misery, the abjection of the men and the prostitution of the
women.
“3d. The officers, addicted to trading, and converting their
soldiers into slaves ; a shameful system of plunder authorized
by the governors, provided they had their share in it ; the dis¬
solute morals of the military, drunkenness, brawls and duels,
by which half of the population was destroyed.”
Francis Xavier Martin states that the fall of 1765 was extremely
sickly ; D. Abadie died, and tiie supreme command of the pro¬
vince devolved on Aubry, the senior military officer.
We have no record of the diseases of New Orleans during
the year 1765, but yellow fever prevailed in other portions of
the province.
Yellow fever prevailed at Mobile in 1765. The most authen¬
tic and detailed account of the epidemic was given by Captain
Bernard Romans, in his concise Natural History of East and
West Florida, and is as follows : “ This fatal disease has been
followed by the entire ruin of Mobile, and had nearly spoiled
the reputation of Pensacola. * * * In the year 1765, ar¬
rived a regiment (1 think the twenty-first) from Jamaica; with
them they brought a contagious distemper, contracted either in
the island or on their passage; these men, like most soldiers, lived
a life of intemperance, and besides drank the water out of
stagnant pools ; this and other inconveniences of a soldier’s life
joined to their arriving in a bad season, swept them off so as
scarce to leave a living one to bury the dead.” When describ¬
ing the diseases of Florida, Bernard Romans remarks, “ 1 am
persuaded that wherever the yellow fever has made its appear¬
ance in the Floridas, it was imported from Jamaica or Havana, as
was the case in 1765, which (by the way) was almost univer¬
sally an unhealthy era, as well in Europe as elsewhere.” Con¬
cise Natural History of East and West Florida , p.12-13, p. 232.
Abstract of Proceedings
[July
134
I)r. James Lind, in his Essay on Diseases Incidental to Euro¬
peans in Hot Climates , has recorded the prevalence of yellow
fever in 1765, at Pensacola. He says: “At Pensacola, where
the soil is sandy, and quite barren, the English have suffered
much from sickness. Some for want of vegetables, died of
the scurvy ; but a far greater part of fevers. The excessive
heat of the weather, has sometimes produced in this place a
mortal sickness, similar to that which in the West Indies, goes
under the name of the yellow fever; this in the year 1765,
proved very fatal to a regiment of soldiers sent from England,
unseasoned to such climates, from the unfortunate circumstance
of their being landed there in the height of the sickly season;
it raged chiefly in the fort, where the air in the soldier’s bar¬
racks being sheltered from the sea breeze, by the walls of the
fort, was extremely sultry and unhealthy.
It is worthy of remark, that during the fatal rage of this
fever at Pensacola, such as lived on board the ships in the
harbor escaped it.
Pensacola, however, is of late esteemed more healthy than
Mobile, where intermitting fevers prevail in the months of
duly, August and September.” “ Lately, when a mortal sick¬
ness, in the year 1765, prevailed at Pensacola, by which a
regiment newly arrived there lost 120 men, and eleven out of
twelve of the officers’ ladies, who were landed with them, were
said to have died ; the companies of the men-of-war, lying at a
mile’s distance from the shore, enjoyed the most perfect health.
These ships were the Tartar and Prince Edward, of whose
men, three only, who had been on shore, were seized with this
malignant fever, and all of them recovered when they got on
board. It was likewise remarkable that such gentlemen as
were seized with this fever at Pensacola, and carried on board
ships, quickly recovered; or at least, by this change of air, the
fever, being divested of most of its mortal symptoms, soon
assumed the form of an intermittent.”
Dr. James Lind also records the fact, that “ in the year 1766,
sixteen French Protestant families, consisting of sixty persons,
were sent at the expense of the English government to West
Florida. The ground allotted for their residence was on the
side of a hill, surrounded with marshes, at the mouth of the
river Scambia. These new planters arrived in winter, and
continued perfectly healthy until the sickly months, which in
that country are those of July and August. About this time,
eight gentlemen (from one of whom 1 received this account),
went to this new settlement to solicit votes for the election of
a representative to the General Assembly of that province ;
where, by remaining but one night, every one of them was
seized with a violent intermitting fever, of which the candi¬
date, for being the representative, and another of their number
died. The next day seven gentlemen came upon the same bu¬
siness, to this unhealthy spot of ground; but by leaving it be¬
fore night, they had the good fortune to escape this sickness,
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and all continued in perfect health. During the same months,
the annual fever of that climate proved so fatal to these
French settlers on that unwholesome spot, that of sixty per¬
sons, fourteen only survived it ; and even those who remained
alive, in the September and October following, were all in a
very ill state of health, but one of them having escaped the
attack of the fever, and most of them dying within a few
months afterwards, from the injury it had done their consti¬
tutions.”
Some writers have fixed upon 1766, as the tirst visitation of
yellow fever in New Orleans.
Martin says : “ This year, the province was visited by a dis¬
ease, not dissimilar to that known as yellow fever. It was
severely felt in West Florida, where a number of emigrants
had lately arrived. Sixteen families of French Protestants,
transported at the expense of the British government on the
river Escambia, consisting of sixty-four persons, were almost
entirely swept away by the deleterious sickness.” History of
Louisiana, vol. 1, p. 354.
The learned and accomplished historian, Charles ( tayarre,
says that in 1736, Ulloa, “ordered a census to be made of the
white population of Louisiana and the result was found to be
1893 men able to carry arms, 1044 women, married or unmar¬
ried, 1375 male children, and 1240 of the other sex. Total
5562. The blacks were about as numerous. But the popula¬
tion was somewhat reduced by an epidemic which prevailed in
that year (1766), and which, it is said, closely resembled the
disease now so well known here under the name of yellow
fever.” Hist, of Louisiana under French Domination, vol. ii,
pp. 133, 134.
The 17th and 18th of January, 1768, were the two coldest
days that had ever been known in Louisiana. All the orange
trees perished a second time throughout the colony as in 1748.
In front of New Orleans, the river was frozen on both sides to
thirty or forty feet from its banks.
Normau, in his “ New Orleans and its Environs, 1845,” says
that “The first visitation of yellow fever was in 1769. Since
that time it has continued to be almost an annual scourge. It
was introduced into this continent, in the above named year,
by a British vessel , from the coast of Africa, with a cargo of
slaves .”
We have seen that no allusion to the introduction of yellow
fever or any infectious disease by the slave ships is found in the
preceding colonial records. Norman does not cite authority for
his statement, which would place the tirst epidemic of yellow
fever in the year 1769. On the other hand, Dr. Thomas Axes
the first invasion of the fever in New Orleans, in 1796, or about
twenty-seven years later. Essai sur la Fevre Jaune d’Amer-
ique, p. 70.
Dr. Daniel Drake, says, “ This however is a mistake as we
shall presently see. Throughout the whole period, the com-
Abstract' oj Proceeding*
139
[July
lnerce of the city was exceedingly limited and up to the year
1788, seventy -eight years after the first settlement, the popula¬
tion amounted to only 5338, including negroes. On the whole
we may conclude that throughout the period mentioned, the
town suffered but little or at all from that malady. Since the
year 1790, it has become gradually more frequent and formida¬
ble ; but throughout the first twenty-seven years, the accounts
of its invasion are meagre and unsatisfactory.” Principal Dis-
seases of the Valley of North America, 1854, pp. 201, 202.
Louisiana although ceded to Spain in 1703, was not under
the entire control of that power before the 18th of August,
1709, when O’Reilly took formal possession of the country.
One of the first acts of O’Reilly, was an order for a census
of the inhabitants of New ( frleans. If was executed with great
accuracy. It appeared that the aggregate population amounted
to 3190 persons, of every age, sex and color. The number of
free persons were 1902; 31 of whom were black, and 08 of
mixed blood. There were 1225 slaves, and 00 domesticated
Indians. The number of houses were 408; the greater part of
them were in the third and fourth streets from the river, and
principally in the latter.
In 1778, one of the most serious afflictions of the province in
this year, as in the preceding one, Avas the small -pox, which
proved very fatal in NeAv Orleans, and on the plantations above
and below. It appears to have been, for many years, in Louisi¬
ana, the disease most prevalent and most feared. Hurricanes
seem also to have been one of its chief scourges.
The army of 1400 men, assembled by Galvez for an expedi¬
tion against the English, suffered considerable loss, towards
the end of the summer of 1779, from the diseases incident to
the climate; and when the Spaniards came in sight of Fort
Manchac, situated at a distance of about one hundred and
fifteen miles from New Orleans, disease and the fatigues of the
journey had caused a diminution of more than one-tliird of
their number.
The winter of 1784, was of extraordinary severity. On the
13th of February, the whole bed of the river, in front of New
Orleans, was tilled up Avith fragments of ice, the size of most of
which Avas from twelve to thirty feet, with a thickness of two
or three feet.
One of the first measures of Miro’s administration, which
succeeded that of Galvez, in 1785, was of a most remarkable
character, and charitable in its purpose, namely, the founda¬
tion of a Hospital for Lepers. There being a number of persons
in the Province of Louisiana, afflicted with leprosy , the Cabildo
erected an hospital for their reception, in the rear of the city,
on a ridge of high land, between it and Bayou St. John.
There are no facts to show the precise nature of the lep¬
rosy of Louisiana, of those days, but it may Avith reason be
supposed, that several affections were confounded with the true
leprosy of the ancient Egyptians, Hebrews and Greeks, as
1879]
Louisiana IS tale Medical Society.
137 .
constitutional syphilis, elephantiasis and the yaws of the
African race. 1 have upon a former occasion, presented to
the New Orleans Medical and Surgical Association, the results
of my investigations into the History of Leprosy in the South¬
ern States, and the paper has been published in the New Or¬
leans Medical and Surgical Journal.
According to the census taken by order of Galvez, New Or¬
leans contained in 1785, 4980 inhabitants.
Much light would be thrown upon the history of yellow
fever and other diseases, in New Orleans, were it possible to
recover the records of the Royal Hospital of New Orleans, for
which there was expended in 178a, the following sums: a
comptroller $000 ; commissary $300 ; steward $480 ; physician
$000 ; chaplain $480 ; first surgeon $000 ; assistant surgeon
$300; mate $192; two minor surgeons $300 ; apothecary $480;
apothecaries’ attendants and cook $904 ; provisions and medi¬
cines $18,000. The total expenses of the government of Louis¬
iana, were $449,389. Whilst the expenses of North Carolina,
with a population of 377,721, was only $50,930, or fifteen cents
per head; those of Louisiana, with her 27,584 inhabitants
(14,217 whites, 1203 free colored and 10,594 slaves), were six¬
teen dollars and fifty-five cents.
The summer of 1787 was marked by fevers which frequently
and easily assumed a malignant type. There was also an epi¬
demic catarrh, from which few were exempt, and by which
many were seriously incommoded. The small-pox infested the
whole province, and those whom fear prevented from
being inoculated, became the victims of their prejudices. All
those who were attacked by the contagion, either died, or were
dangerously sick. The inoculation was fatal only to very few,
but this wras enough to confirm in their systematic opposition
those w ho declaimed against this wise and humane practice.
After the massacre by the negroes, on the night of the 23d
of August, 1791, of the French of the Island of Hispaniola, a
portion of the white inhabitants fled to Louisiana.
Dr. Daniel Drake, who visited New7 Orleans and instituted
personal inquiries, states, that the first invasion of yellow7
fever in New7 Orleans, of which he had an authentic account, was
in the year 1791. Dr. Drake’s informant, Richard Relf, Esq.,
one of the most venerable citizens of New Orleans, soon after
his arrival experienced an attack, and three of his fellow
lodgers, fell victims to the fever. After his recovery lie saw
many cases, and in subsequent years became so familiar with
it that he could not be mistaken as to the character of the dis¬
ease. The Principal Diseases of the Valley of North America ,
2d series, 1854, p. 201.
On the 9th of May, 1794, Don Francisco Louis Hector, Baron
de Carondelet, gave notice of his intention to dig a canal, which
carrying off the water of the city and its environs into one of
the branches of the Bayou St. John, would rid New Orleans of
18
A bstract oj Proceedings
138
[July
the stagnating ponds which rendered it sickly, and the multi¬
tude of musquitoes, which harrassed the inhabitants.
Baron Carondelet designed the canal to run from the ditches,
that ran along the ramparts, with which the town was encircled,
to Bayou St. John, and thus to drain the putrid waters, stag¬
nating around the city, and producing those epidemics which
were so fatal to its prosperity.
In the month of October, 1705, Baron Carondelet by a publi¬
cation in Le Moniteur de la Louisiane (the only periodical paper
published in the province during its subjection to Spain)
brought to view the future grandeur of New Orleans, and
announced that in five days more the Colonial Government
would complete the canal ; and in another publication on the
23d of November, draws attention of the inhabitants to the
commercial facilities afforded by the canal, and to the marked
diminution of Mortality during the preceding three months.
The great sanitary problem of New Orleans, drainage, en¬
gaged the attention of its governors, for sixty -four years, before
the practical and valuable experiment of Baron Carondelet.
In 1796, the canal behind the city was completed, and a num¬
ber of vessels went through it to a basin, which had been dug
near the ramparts.
THE EPIDEMIC YELLOW FEVER OF NOT THE FIRST VISITA¬
TION OF THIS DISEASE IN NEW ORLEANS.
According to Charles Gayarre, ‘‘New Orleans was visited,
it is said for the first time, with the yellow fever in the fall of
the year 1796. That autumn proved besides very sickly in every
other way. The Intendant Ventura Morales, in a despatch of
the 31st of October, speaks of it in the following terms : An
epidemic which broke out in the latter part of August and
which is prevalent to this day, has terrified and still keeps in a
state of consternation the whole population of this town. Some
of the medical faculty call it a malignant fever , some say that
it is the disease so well known in America under the name of
Black Vomit, and finally others affirm that it is the yellow
fever, which proved so fatal in Philadelphia in the autumn of
1791. Although the number of deaths has not been excessive,
considering that according to the parish registry, it lias not yet
reached two hundred among the whites since the breaking out
of the epidemic, and considering that many died from other
diseases, still it must be admitted, that the loss of lives is very
great, because although those who died out of the precincts of
the town, and the protestants who perished (and they were
numerous), have not been registered, nevertheless the number
of deaths exceeds by two-thirds those which occurred in the
same lapse of time in ordinary years. A peculiarity to be
remarked in this disease is that it attacks foreigners in prefer¬
ence to the natives, and what is singular, it seems to select the
Flemish, the English, and the Americans, who rarely recover,
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Louisiana State Medical Society.
139
and who generally die the second or third day after the inva¬
sion of the disease. Such is not the case with the Spaniards •
and the colored people, with whom the recipe of Dr. Masdevall
has produced marvellous effects.” History of Louisiana, Span¬
ish Domination, p. 375.
A small pamphlet of 48 pages was published in New ( hleans,
in 1790, with the following title: u Medicamens et pree.es de la
Methode de Mr. Masdevall , Docteur Medecin du Roi WEspagne,
Charles IV, pour guein toutes les Maladies Epidemiques, putrides
et Ma-lignes , Jievres de diff events genres, &e., et pour en preserver
divises en paragraphed, et en numeros eorrespondens u V -usage des
families d *' pour dues de Medecins. Prix 4 escalins broche , Chez
Louis Duel ot. Imprimeur a la Nile Orleans, 1 790, area permis¬
sion du Gouvernment .”
This work is dedicated to Francis Louis Hector, Baron de
Carondelet, who was at that time the Governor of Louisiana.
in the preface allusions are made to the efforts of Baron
Carondelet in improving the health and extending the com¬
merce of the city, in causing the construction of a canal. In the
first paragraph it is stated that Doctor Joseph Masdevall, had in
the year 1783, observed the epidemics of putrid and malignant
fevers, which had desolated Catalogue, by direction of Charles
Ill. This account was published in Madrid in 1780. This pam¬
phlet, published in New Orleans in 1790, and which has been
regarded as one of the earliest, if not the earliest medical work
issued in Louisiana, appears to consist chiefly of extracts from
the work of Dr. Masdevall, published ten years before in
Madrid. After careful examination of this small medical tract,
I have discovered no facts relating to the origin, nature and
spread of the yellow fever of 1790 in New Orleans. Tartar
emetic entered largely into the composition of the various
febrifuge remedies recommended by Dr. Masdevall.
Martin makes no allusion to the prevalence of yellow fever
in the summer and fall of 1790, but says : “ the fall of (1797)
this year was very sickly in New Orleans, and the city was vis¬
ited by the yellow fever.” History of Louisiana, vol. ii., p. 147.
Of the origin of the epidemic of 1790, Dr. Thomas (Essai sur
la Fievre Jaune, p. 70), gives the following account :
“ It is said that yellow fever had never been observed in
New Orleans, before 1790. Up to that time the city was of no
great extent, and was surrounded by trees, which, by their
shade, prevented the putrefaction of the water covering the
ground at their roots, and which absorbed to a great degree
(a quality which they are known to possess), the deleterious
miasm. The Spanish Baron Carondelet, then governor of
Louisiana, caused a number of works to be executed about this
time, of which the principal were, 1st, the construction of a
canal two miles long, which still bears his name, and termin¬
ates in New Orleans in a basin (large enough to contain a great
number of small vessels from 25 to 100 tons burden, dug ex¬
actly in the place where the old cemeteries were situated), and
140
Abstract of Proceedings
[July
at the other end in a small river emptying into Lake Pontchar-
train ; 2d, fortifications surrounded by ditches; .‘id, a clearing
away for a considerable distance of the trees which surround
the city. This laid bare a considerable extent of marshy land,
which dangerously influenced by the solar heat, soon disen¬
gaged effluvia in abundance.
These works, and particularly the canal, were finished in
1790, as is shown by the records of the city, from which I have
obtained these details ; and it is exactly, at the time, that the
first epidemic of yellow fever occurred, which carried off at its
inception, all the laborers engaged on the works, as eye-wit¬
nesses testisy. The disastrous results of disturbing the soil,
have been demonstrated anew, in the epidemic of Natchez,
1819. Dr. Prouens, a well-educated physician, who practices
medicine, then wrote on this subject to the Medical Society of
New Orleans (of which he is a correspondent), that the obvious
cause of this epidemic was not an importation of it by the
river, as the eontagionists contend ; for the mortality began to
show itself in a place quite remote from the port, and in the
immediate vicinity of some very considerable excavations,
which had been made a short time before for the purpose of
levelling the streets. The old inhabitants of St. Domingo have
assured me that many analogous examples were known to have
occurred on that island, from the same cause, ft will be seen,
in reading the description of the epidemic of 1822, that excava¬
tion of the earth may be considered as one of the causes which
fixed its limits.” The preceding opinion advanced by Thomas,
that the yellow fever of 179(1, was of local origin, appears at
that time to have been contested, for the late Professor Car¬
penter (Sketches from the History of Yellow Fever, p. 13),
copying from the Louisiana Courier for November, 1820, says
u it was traced to a vessel which had brought it.”
The view held by Thomas, that the (so-called) first e))idemic
of yellow fever in New Orleans, was referable in its origin and
causation to local causes, and especially to an extensive dis¬
turbance of the soil, found an ardent and able advocate in the
late Dr. Edward H. Barton, whose views were fully unfolded
in the Report of the Sanitary Commission of New Orleans , in the
Cpidemic Yellow Fever of 1853. Dr. Barton says, “I wish to
be understood distinctly as stating that since 1790-7, to the
present time , there has been no great epidemic yellow fever in this
city , without an extensive breaking up , disturbance and exposure of
the original soil of the country ; and that the extent and malignancy
of the disease has been pretty much in proportion to the extent of
these exposures .”
In connection with the preceding speculations, it is worthy
of note, that the canal Carondelet was commenced in the
month of June, 1794; that in the autumn of 1795 there was a
navigable canal remote from the city by way of the lakes to
the sea, and that the canal and basin were in successful opera¬
tion in 1796.
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Louisiana State Medical Society.
141
Dr. Bennet Dowler, wlio appears to have endorsed to a cer¬
tain extent the opinions of Thomas and Barton as to the local
origin of the epidemic of 1790, is manifestly in error when he
states that “ the health of New Orleans anterior to the appear¬
ance of yellow fever (in 1790), was unsurpassed by any city in
America for without recapitulating the facts which we have
recorded to show that pestilential fevers had afflicted the city
at various times, as well as small pox and leprosy, the incor¬
rectness of his statement is shown by the following facts:
In 1787, the population of New Orleans was 5284, with a
total mortality of 338 ; one death in 15.04 inhabitants, and a
ratio per thousand of population (Millesimal mortality) of
63.92.
In 1796, the population of New Orleans was 8756, with a
total mortality of 638 ; one death in 13.57 of inhabitants, and a
ratio per 1000 of population (Millesimal mortality) of 72.86.
It will be seen from the preceding statistics, that in 1787,
when we had no record of an epidemic in New Orleans, the
mortality reached the fearful proportion of one in fifteen of the
inhabitants, and in 1796, this heavy mortality was still farther
increased by the yellow fever to one death in 13.57 inhabitants.
The mortality of both these years 1787 and 1796, was in
relation to the actual population, far heavier than that of the
past year 1878, which will be memorable for its epidemic of
yellow fever, which stands as third in the list of great epidemics
in New Orleans, from its foundation in 1718 to 1879.
Thus the total mortality for the year 1878, was 10,318, of
which 8062 were whites, and 2256 colored, making of all colors
one death m about 20 inhabitants ; or 50.17 per 1000 of popu¬
lation; or 55.32 per 1000 of white population, and 39.13 per
1000 of colored population.
The number that died of yellow fever, was 4046, of which
3863 were whites, and 183 were colored; 4056 deducted from
10,318 would give for all other diseases 6272; making of all
colors a ratio of mortality 30.02 per 1000 of population, or 28.81
per 1000 of white population, and 35.95 per 1000 of colored
population. The ratio of mortality per 1000 from yellow fever
was 19.30 per 1000 population; and from malarial fevers 3.77
per 1000 of entire population.
In the light of such facts it is but just to hold the view that
Neve Orleans has been subject to pestilential fevers at various
times from its foundation, and that the opinions as to its won¬
derful healthfulness from its first foundation in 1718 to 1796,
the date of the so-called First ! Epidemic of yellow fever, are
mere opinions without foundation in fact. And we attach little
or no weight to the assertion of Bennet Dowler and many
other writers of less note, that whilst New Orleans from its
foundation had been closely connected by geographical position,
commercial intercourse, language and governments, with both
insular and continental America, where yellow fever had pre¬
vailed for centuries, under Spanish, French and English rule,
Abstract of Proceedings
142
[July
it had yet always remained exempt from yellow fever up to the
year 1796.
We have seen that Martin states that yellow fever prevailed
in 1797. M. Victor Debouchel, in his history of Louisiana,
published in 1 <S4 1 , says that the yellow fever desolated New Or¬
leans in the following years, namely : 1767, 1797, 1802, 1810,
1814, 1818, 1822, 1824, 1827, 1831, 1835, 1837.
Dr. Carpenter states that in 1799, “there was what was
considered as proof of its importation.” Sketches from the
History of Yellow Fever, p. 14. Dr. Carpenter refers to the Lou¬
isiana Courier of November 20th, 1820, as the source of this
surmise. Dr. Dow, of New Orleans, in his visit to Philadelphia
in 1800, informed Dr. Benjamin Kush, that the natives and old
citizens of New Orleans, who retired into the country during
the prevalence of yellow fever in that city the year before 1799,
were often affected by it, whilst all such persons who did not
change their residences escaped it (Rush Inquiry, 10, 126).
In a dispatch of the 25th of July, 1799, Morales informed
his government of the death of Gayoso, in the following terms:
“ On the 18th inst., it pleased God to put an end to the life and
government of Brigadier-General Don Manuel Gayoso de
Lemes. He died of a malignant fever, of the nature of those
which prevail in this country during the summer, and the dan¬
gerous character of which was known only a few hours before
it terminated fatally. He had no time to lose in fulfilling the
last duties of the Christian and in making his testamentary
dispositions.”
In a remarkable memoir submitted on the loth of September,
1800, to the First Consul of the French Republic, by M. Ponta-
bla, he says that, “ Louisiana cannot dispense with the slave
trade. The excessive heat prevailing during the five months in
which the hardest works are to be executed, on the plantations,
does not allow of the use of free and white labor, and renders
the blacks indispensable.”
In March, 1801, Baron de Carondelet, in an official document,
set forth the importance of improving the topography of the city,
so as to drain off in Canal Carondelet, the stagnant waters
which abounded “ near the city,” and which he regarded as
“ the cause of much mortality ,” a measure which he says would
put an end to pestilential fevers (Martin, vol. ii, pp. 176, 177),
in which category he doubtless included yellow fever, which
a few months later occurred as an epidemic.
Dr. Snead, of New Orleans, detailed the mode of treatment
and critised it as inefficient.
In 1802, the government of the United States applied to the
Spanish government for permission to establish a Marine Hos¬
pital at New Orleans, for American seamen, many Inning died
there in a destitute condition.
Dr. Rush represents 1803, as a year exempt from epidemic
yellow fever in the United States, Charleston excepted, it pre¬
vailed however in New Orleans.
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Louisiana tState Medical Society.
143
One of the first acts of the colonial prefect, Laussat, who
arrived at New Orleans on the 26th of March, 1803, was to ex¬
amine the fortifications, which eleven years before, had been
erected by the Baron de Oarondelet, and in his report to Minis¬
ter Deeres, he says : “ It has lately been proposed to the King
of Spain to razee or at least greatly to reduce these works, as
being useless or even mischievous, because the fevers which
every year, carrying off the most valuable portion of the popula¬
tion of this city, date from the time when there were dug round
it those ditches which are always full of stagnating water.”
In a work entitled “ Vue de la Colonie Espagnole du Missis¬
sippi ou des Provinces de Louisiane et Florida Occidental en
L’Ann6, 1802. Par un Observateur Resident sur Les Lieux. B.
Duvallon, Editeur, Paris, 1803, an accurate description of yel¬
low fever is given, and the statement is made that it hail pre¬
vailed during the summer and autumn in New Orleans, during
the preceding six or seven years, pp. 84-98. According to this
writer yellow fever prevailed in 1794, 1795, 1790, 1797, 1798,
1799, 1801. The writer of this work, whilst directing attention
to the peculiar topography of lower Louisiana, with its Hat
depressed surface, and changeable climate, states that the
country was comparatively healthy for both whites and blacks,
whilst on the other hand, New Orleans, was, during the months
of July, August, September and October, ravaged by the yellow
fever. He says : “ The city of New Orleans has for several
years during the months of July, August, September and part
of October, been afflicted with a species of malignant fever of
the gravest form. The symptoms and accidents of this disease,
varied to such an extent, that the physicians of the city, con¬
sisting of eight or ten surgeons, with a few exceptions without
letters, were entirely ignorant of the methods of cure in this
destructive plague.” This malady has during the past six or
seven years, made ravages almost every summer upon New
Orleans ; but has not affected the country to any extent, where
it is known only by or through communications from one point
to another; and as the consequent of such communications.”
After giving an accurate description of the disease, the author
thus discusses its origin: “But why should this disease be en¬
demic in the city and not in the surrounding country ? The causes
which clearly corrupt the air breathed in New Orleans, and dur¬
ing the heat of summer, render it susceptible of being impreg¬
nated from impure and fatal miasms, are the excessive amount of
tilth distributed in the town, along the levee, in the streets, in the
vacant lots, and even in the court yards of many houses, where
evidently the slops are thrown, and from whence they are not
taken away, except partially, and at long intervals ; the accu¬
mulation of pools of stagnant water mixed with ordure (excre¬
ments, both animal and human), within the confines of the
city : the accumulation of large heaps of putrefying infectious
matters in the middle of the unpaved streets, and in many
other places.
144
Abstract of Proceedings
[July
The hit'll brick houses that have been erected during several
years past, preserve and communicate more .dampness, in a
locality that is always damp, and also stop and prevent the
free circulation of the air. The air is thus rendered stagnant,
and the poison is thus accumulated in the lower atmosphere.
The ditches surrounding the fortifications erected several years
ago, are tilled with stagnant water, which, during the heated
term, exhale foetid vapors, which were unknown before the dig¬
ging of these trenches or canals around the town.
To these causes of insalubrity, from which all persons suffer,
and the existence of which no one upon examination will deny,
another may be added, to which the oldest people of the city,
attribute great influence, and even the origin of the disease.
As in a matter so important to the preservation of humanity,
nothing should be neglected, we will therefore cite this cause,
or explanation, without adopting or rejecting it, until expe¬
rience and observation shall have dissipated all uncertainty.
It is held by some, that this disease has only been known in
New Orleans, during the past six or seven years, or the period
at which dates the great extension of American commerce to
New Orleans, and it is inferred that as this disease was already
spread in the North of America, before this period, as is
known from the ravages which it made in Philadelphia and
other places in 1 703, that it has been brought here by the
Americans, who are in fact its principal victims. Without
deciding this question I will say, that it is notorious and
an established fact that this fever has spread during the
past ten years in the different cities of North Amer¬
ica, and especially in Philadelphia and New York, where
it appears to have originated, and even where it received the
name which it bears, and that since its first appearance it makes
annual ravages during July, August, September and part of
October, so as to render these cities almost desolated, and iso¬
lated during the violence of the malady. In these towns the
disease exerts its chief violence upon Americans, rather than
strangers, who are found there in large numbers. I believe
that the yellow fever is endemic in the United States, and I do
not hold that it is only twelve or fifteen years since the disease
was known.”
The same writer states, that the sick in the country, were
most generally brought into New Orleans for treatment, and
this custom converted the city into a vast hospital, and tended
to introduce the germs of disease.
It appears that at this time, the practice of medicine in New
Orleans, was very lucrative.
C. C. Robin, in his valuable work,* records the observa-
* Voyages dans l’interieur de la Louisiane, de laFloride Occidental© et dans les Isles de
la Martinique et de Saint Domingue. pendant les annees 1802, 1803, 1804, 1805 et 1806.
Contenant, de Nouvelles Observations sur 1'Histoi le Naturelle la Geograpbie, les Mocurs,
1‘ Agriculture, le Commerce, l’lndustrioetlesMalades de ces Contrees, particuliement sur
la Fievre Jaune, et les Moyens de les prevenir, etc. Par C. C. Kobin, autre de plusieurs
ouvrages sur la Literature et les Sciences. 3 vols. A Paris, 1807, vol. 1, pp. 145, 200.
1879]
Louisiana /State Medical /Society .
145
tion, that the pulse gives no index of the severity of the attack
of yellow fever. He describes accurately the symptoms of the
disease, and states, “ There is generally repeated vomiting of
black blood. Very often again, as is said by Father Labat, the
people who suiter but little from pain in the head expire sud¬
denly. In New Orleans during the summer of 1805, several
English and Anglo Americans have died in this sudden man¬
ner. fine among them, attacked by this malady, expired at
once on the levee, holding in his hand a piece of melon which
he was eating. His skin was congested, and his countenance
animated. A physician who was asked by a citizen to pass by
his house, and visit his wife, who was dangerously ill, said to
this party, after looking at him, ‘ And you, sir, how do you
feel?’ ‘Very well!’ ‘Very well!’ replied the physician,
‘ let me feel your pulse. You are also sick, and very danger¬
ously so ; go without loss of time to bed ; I will follow you ! ’
A few days after, this man died.”
Robin states that the yellow' fever prevailed with destructive
effects in New Orleans in 1805. He also records the fact that
at this early date calomel in large doses w as employed in the
treatment of this disease.
Whilst alluding to the fact that yellow fever had prevailed
during several years preceding his visit to New Orleans, and
reaffirming the observation that strangers, and especially the
Americans, from their habits of life, and use of strong drinks,
were more subject to the disease than the Spaniards and the
natives (Creoles), French and negroes ; on the other hand he
does not give any specific date as to the first appearance of this
disease in New' Orleans. Robin affirms that yellow' fever was
unknown in the early history of New Orleans, when only a few
small cottages neatly white- washed, occupied the commodious
squares, and whilst the rising town w'as surrounded by forest
trees. He refers the origin of the disease to several causes, as
the clearing of the surrounding forests, the exposure of the
marshy soil, the accumulation of filth in the city, ami the
building of lofty houses, which obstructed the circulation of
the air, and at the same time increased the heat by reflection
of the rays and absorption. Robin quotes Father Labat to
prove that yellow fever had been long known in the West India
Islands.
M. Perrin Du Lac, in his “ Voyage dans les Deux Louisianes ,
et chez les Nations Sauvages du Missouri par les Etats Unis ,
TOhio , et les Provinces qui le bordent , en 1801, 1802, et 1803: A.
Lyon, An. xiii, 1805 alludes to the prevalence of yellow fever
in the American cities as early as 1745, and to its ravages in Phil¬
adelphia and New York in 1794. With reference to the ques¬
tion of contagion and importation, M. Perrin Du Lac appears
to incline to the opinion that the disease originated in those
cities, chiefly in and about the filthy wharves and in low ill-
ventilated tenement houses.
19
146
Abstract of Proceedings
[July
He states that for several years preceding his visit to New
Orleans, yellow fever had prevailed, and he attributes its ori¬
gin to the filthy condition of the streets and houses, and the
putrefying filth and garbage about the markets. He directs
attention, also to the fact that the negroes in New York and
Philadelphia were comparatively exempt from the ravages of
the disease, and also that the Creoles, French and Spaniards
were but infrequently attacked by the disease in New Orleans,
which proved so fatal to Europeans and Americans (pp. 11-19,
392-396).
The following conclusions may be drawn from the preceding
outline of the H istory of Yellow Fever in Louisiana, during the
Spanish rule, 1764-1803:
1st. Whilst New Orleans suffered annually with malignant
malarial fevers, similar in all respects to those known at the
present time as intermittent, remittent, congestive, pernicious,
paroxysmal, paludal, marsh, swamp and malarial fevers, yellow
fever does not appear to have attracted much attention in this
city before the year 1796, and consequently we find but few
allusions to its existence in the works of the earliest travelers
through Louisiana.
2d. During the Spanish rule, as also during the preceding
French dominion, New Orleans and the entire region named
Louisiana, was without medical journals, and produced no
native medical works. When neither medical writers nor books
existed, it would be absurd to affirm that the mere absence of
records, demonstrated the absence of any specific disease as
yellow fever.
3d. The tall of 1765, was very sickly in New Orleans, as well
as that of 1766, when the population of the city was reduced,
by an epidemic, which is said to have closely resembled the
disease.
4th. A careful consideration of all the testimony presented
in the preceding historical sketch, will show that yellow fever
did not appear for the first time in New Orleans in 1796. It
was certainly present in 1791, 1794 and 1795.
5th. Throughout all her past history, up to the present
moment, the grand sanitary problems, of New Orleans, were
effective drainage, efficient police of private premises and pub¬
lic thoroughfares, the daily and rapid removal of all offal
and excrementitious matter, the proper elevation of and con¬
struction of houses, free ventilation ; abundant water supply ;
the proper distribution of the population, so as to avoid over¬
crowding.
6th. Many writers, attributed the origin of yellow fever, to
the stagnant and foul fermenting putrid waters of the ditch,
canal or bayous surrounding the wall of the city, and referred its
first advent to the extensive operations of Baron Carondelet.
7th. Whilst we might regard the reference of the origin of
yellow fever, to the extensive disturbance of the soil, in the
construction of the Canal Carondelet, and the excavation of the
1870]
Louisiana State Medical Society.
147
basin on the borders of the rampart, as an example of special
pleading; on the other hand it would be equally unphilosophi-
cal in the absence of well ascertained facts, and carefully
recorded statistics, to attribute the repeated prevalence of yel¬
low fever in New Orleans, since 1764, solely to the increase of
population and commerce during the Spanish rule.
That the commercial relations of New Orleans, was greatly
extended under the Spanish rule, is evident from the fact, that
in 1802, two hundred and fifty-eight vessels (170 American, 97
Spanish and 1 French) with a tonnage of 23,725 tons, entered
the Mississippi; and in the same year, there sailed from the
Mississippi 205 vessels (158 American, 104 Spanish, 3 French)
with a tonnage of 31,241 registered tons.
As the city during both French and Spanish dominion, was
without quarantine regulations, and without any organized
board of health, without any medical or scientific associations,
or journal, and with only a small gazette, it is impossible either
to affirm or deny, that the statement quoted by Dr. Carpenter,
from a newspaper article published in 1820, to the effect, that
the disease was brought by a vessel, may not have contained the
entire solution of the mode of the origin of the epidemic of
1796. Without doubt, the workmen engaged upon the canal
running through a low marsh and cypress swamp, were sub¬
jected to the destructive effects of malaria; and the inhabitants in
the immediate vicinity suffered from diseases of this class, in
increased numbers and intensity just after the exposure of the
newly drained marshes to the action of the sun ; but so far
from breeding sickness in the city itself, the construction of the
canal, was the first great sanitary measure projected and exe¬
cuted for the improvement of the health of New Orleans, by
draining the stagnant and putrid waters of the moat, surround¬
ing the city and also the neighboring ponds.
8th. The rapid increase of the population of New Orleans,
under the Spa nish rule, and the great influx of strangers from the
United States, and from Spain, Arcadia and the Canary Islands,
formed a most important condition for the spread of yellow
fever when once introduced. In 1760, the total population
of Louisiana amounted to only 13,538; and that of New Orleans
to 3190 ; whilst in 1803, total population 40,473 ; of New ( )rleaus,
8,056. That is, during the short period of 34 years, the popula¬
tion had increased near three fold. As the yellow fever, at¬
tacked chiefly Americans, and as large numbers of American
ships entered this port annually ; and as yellow fever ravaged
during this period, Philadelphia and New York, the contagion-
ists of New Orleans had plausible grounds for accusing the
Americans of introducing the disease.
9th. A plausible and apparently philosophical argument
was advanced for the foreign importation of yellow fever, dur¬
ing the Spanish domination, by increased commerce and in¬
creased immigration; but the older and best substantiated
theory was that the disease was due to climatic and terrestial
148
Abstract of Proceedings
[July
causes, and more especially to heat, moisture, and putrefying
animal and vegetable matters, and stagnant water and air.
According to the latter view commerce and immigration merely
furnished new material for the fever, which was the result of
the horribly filthy condition of the streets and drains and
yards and privies of the city.
OUTLINE OF THE HISTORY OF YELLOW FEVER IN NEW OR¬
LEANS, DURING THE DOMINATION OF THE UNITED STATES,
1803. 1878.
On the 20th of December, 1803, the United States commis¬
sioners and forces entered New Orleans and took possession of
Louisiana, in accordance with the treaty between Napoleon
Bonaparte and the Government of the United States.
In 1803, New Orleans had a military hospital and a charity
hospital, with a few houses, yielding to it a revenue of about
$1500 a year.
1804. The yellow fever had in the autumn of this year, been
very fatal in New Orleans, and in connection with other
remarks on this subject, Governor Claiborne, in a message
to the Legislative Council, on the 14th of December, 1804,
called attention of that body, to a plan devised by Jefferson,
to prevent the recurrence of such a calamity. Referring to the
probable growth of New Orleans, the President said :
“ The position of New Orleans, certainly destines it to be the
greatest city the world has ever seen. There is iio spot on the
globe, to which the produce of so great an extent of fertile
country must necessarily come. It is three times greater than
that on the eastern side of the Alleghanies, which is to be
divided among all the seaport towns of the Atlantic States.
In the middle and northern parts of Europe, where the sun
rarely shines, they may safely build cities in solid blocks, with¬
out generating disease ; but under the cloudless skies of
America, where there is so constant an accumulation of heat,
men cannot be piled one on another with impunity. Accord¬
ingly we find this disease confined to the solid built parts of
our towns, and the parts on the water side, where there is the
most matter for putrefaction, but rarely extending into the thin
built parts of the towns, and never into the country. In these
latter places, it cannot be communicated. In order to catch it,
you must go into the local atmosphere, where it prevails. Is
not this then a strong indication, that we ought not to contend
with the laws of nature, but should decide at once that all our
cities should be thinly built V
After these introductory observations, the President ex¬
pressed the opinion that in building cities, in the United States,
the people should take the checker board for their plan, leav¬
ing the white squares open and unbuilt forever, and planted
with trees. u As it is probable,” he observed to Claiborne,
“ that New Orleans must soon be enlarged, 1 enclose this same
1879]
Louisiana State Medical Society.
149
plan for consideration. 1 have great confidence that however
the yellow fever may prevail in the old part of the town, it
would not be communicated to that part which should be built
on this plan, because this would be like the thin built parts of
our towns, where experience has taught that a person may
carry it after catching it in its local region, but can never
communicate it out of that. Having very sincerely at heart
that the prosperity of New Orleans should be uncheckered and
great faith founded, 1 think on experience, in the effect ot
this mode of building against a disorder which is such a
scourge to our close built cities, 1 could not deny myself the
communication of the plan, leaving it to you to bring it into
real existence, if those more interested should think as favor¬
ably of it as 1 do. For beauty, pleasure and commerce, it would
certainly be eminent.”*
Unfortunately this plan of Jefferson has not met with favor
in the gradual enlargement of New Orleans.
1805. In July, 1805, after James Pitot had resigned his com¬
mission as mayor, and Watkins had been appointed in his place,
the new city council went actively to work and to plan improve¬
ments. It passed resolutions requesting the evacuation of the
forts around the city, which were occupied by the troops of the
United States, their speedy destruction, and the filling up of
the ditches, which surrounded the forts of New Orleans. Clai¬
borne partially complied with their request. In a communica¬
tion of the 2d of August, lie said to them, “ I am so strongly
impressed with the opinion that the stagnant water which
accumulates in the old fortifications must prove injurious to
the health of the city, that 1 cheerfully consent to the levelling
of all of them, except those of Forts St. Charles and St. Louis.
These two forts are garrisoned by troops of the United States,
and cannot be evacuated but in pursuance of orders emanating
from the President. Desirous, however, of cooperating with
the city council in all measures which may conduce to the
health of the city, I have no objection to the draining of the
ditches in the vicinity of St. Charles and St. Louis, under an
impression that it can lx* done without injury to the works.
1806. The population of Louisiana was 52,998 ; slaves 23,-
574 ; free people of color 3355 ; whites 26,069 ; of these, at
least 13,500 were natives of Louisiana, for the most part
descendants of the French ; about 3500 natives of the United
States, and the residue Europeans. In the beginning of July,
Claiborne departed from New Orleans, partly to avoid a resi¬
dence in the city during the sickly season.
1808. In the month of March, the City Council requested
the Governor to consent to the demolishing of Fort St. Louis,
and the filling up of the trenches surrounding it, “in as much
as it impeded the communication between the town and the
* Executive Journal vol I. p. r6 History of Louisiana, The American Domination:
Charles Uayarre, 1866: p. 36-37.
150
Abstract of Proceedings
[July
suburb St. Mary, and the trenches were receptacles of stagnant
water and all manner of filth which engender disease.” Clai¬
borne consented to this request. Executive Journal, p. 181,
vol. 3.
1809. On the 2d of November, 1808, the Secretary of War
directed General Wilkinson to take measures, without delay,
for assembling at New ( )rleans and its vicinity, as large a por¬
tion of the regular troops as circumstances would allow. Gen¬
eral Wilkinson reached New Orleans on the 19th of April, 1809.
The force in the city was a little less than 2000 men, and one-
third of it was on the sick list. In order to promote the health
of the troops, he moved them out of the city to Terre aux
Bumfs.
The troops had hardly been three weeks encamped at Terre
anx Bauds, when General Wilkinson was peremptorily ordered
to embark his whole force, and proceed to the high grounds in
the rear of Fort Adams and Natchez. A difficulty in procuring
boats, and other circumstances, did not allow the troops to
begin ascending the river before the fifteenth of September ;
their progress lasted forty-seven days ; during which, out of
nine hundred and thirty-five men, who embarked, six hundred
and thirty-eight were sick, and two hundred and forty died.
Scarcely one hundred men remained fit for duty, upon their ar¬
rival at Fort Adams and Natchez. The diseases which had so
terribly thinned their ranks, were fevers and a malignant scurvy
and dysentery. The scurvy was a most loathsome and fatal
form of disease, which rendered its victims to a mass of living
putrefaction. Of the 2000 troops, 704 died, and 100 deserted,
giving a total loss of 930. In the month of August 500 had
been on the sick list at one time.* The only authentic account
of the diseases which afflicted the American troops in 1809, at
Terre aux B cents, and during their subsequent progress up the
Mississippi River, with which we are acquainted, is contained
in the u Physical Observations and Medical Tracts and Researches
on the Topography and Diseases of Louisiana, by Jabez W. Heustis,
M. I)., late surgeon in the Army of the United States, etc., etc.
New York, 1817, pp. 89-104.
The committee appointed by Congress to investigate the
causes of the great mortality in the army of General Wilkin¬
son, ascribed the sufferings of the troops and the destruction
of the army to the following causes :
I. The detachment consisting of new levees.
II. The insalubrity of the climate; the summer and autumn
of 1809 being unusually sickly.
HI. To the nature of the ground on which the detachment
was encamped at Terre aux Bceufs, and the detention of it at
that place during the whole of the summer.
IV. To the want of sound and wholesome provisions and
* History of the Discovery ami Settlement of the Valley of the Mississippi, etc., by
John W. Monette, M. D., vol. ii. p. 485-486.
1879] Louisiana State Medical Society. 151
vegetables ; the want of an hospital, and of hospital stores and
medicines.
V. The excessive fatigues to which the troops were subjected
in clearing, ditching and draining the ground on which they
were encamped.
VI. To the want of repose during the night, owing to the
troops not being provided with bars or nets to protect them
from the annoyance of mosquitoes.
VII. The want of cleanliness in the camp, the nature of the
position rendering it almost impossible to preserve it.
VIII. The sick and well being confined to the same tents,
which neither protected them sufficiently from the heat of the
sun, nor kept them dry from dews and rains.
With reference to yellow fever, Dr. Heustis states that “ there
are but few months in the year, in which the inhabitants of
Louisiana are not subject to bilious diseases. These, however,
are principally severe in the summer season, at which time the
fever frequently assumes the symptoms and character of the
bilious yellow fever of tropical climates,” p. 109.
With reference to the causes of yellow fever in Louisiana,
Dr. Heustis observes : u A constitution unaccustomed to the
climate is the predisposing cause; marsh miasmata, the
remote cause, and a tit of intoxication, or exposure, the exciting
cause. But independently of any peculiarity of predisposition
or constitutional susceptibility, and without the aid of inter¬
ference, the miasmata themselves are frequently sufficient to
occasion serious attacks of fever.” Dr. Heustis, with respect
to the nature of this disease, expressed the belief, jbhat it is
only a more aggravated degree of intermitting and remitting
fever ; and that the plague is the grand climax of malignity,
analogous in its origin and nature, and standing at the top of
the same scale. He says : u Briefly my opinion is, that the inter¬
mitting, remitting, yellow fever, and plague, are only grada¬
tions and modifications of the same diseases; that they all
arise from similar causes, differing only in degree of force, and
concentration, and that the proximate cause of each is the
same.”
That yellow fever prevailed in New Orleans, in 1809, is evi¬
dent not only from the work of Dr. Heustis, but also from
the following facts communicated to Professor Hosack, of New
York, by a gentleman of New Orleans:
“ It is well known to nearly all the inhabitants of Lafourche,
that in the year 1809, Captain Edward I). Turner, and his wife,
who resided at Point Houmas Plantation, lost their lives by
opening a trunk of clothes, which had been sent from New
Orleans, during the prevalence of yellow fever; that they im¬
mediately sickened and died with black vomit, as did also the
negro-nurse who attended them.*
'■ An accouut of the yellow fever as it prevailed in the city of New York in the summer
andautnmu of 1822. By PeterS. Townsend. M.D. New York, 1823. Appendix p. 345.
152
Abstract of Proceedings
[July
During this year Louisiana received large accessions of
French from the Island of St. Domingo, and on the 18th of
July, 1809, the refugees from this island amounted to 5754, of
whom, 1798 were white people, 1977 free colored and blacks,
and 1979 slaves.
In consequence of the frequent ravages of the yellow fever,
particularly in the autumn of 1809, Claiborne recommended to
the legislature, the policy of making u some general health
laws, which should enforce cleanliness, and subject the ship¬
ping entering the Mississippi to those quarantine regulations
which at other places have proved salutary.”*
1810. The population of the Territory of Orleans, had been
rapidly augmented by emigration from the United States, and
in seven years (1803-1810) had increased from 49,473, to 76,556 ;
and the city of New Orleans from 8,056, to 24,552.
1812. On the 10th of January, 1812, the inhabitants of New
Orleans, witnessed the approach of the first vessel propelled
by steam, which floated on the Mississippi, the New Orleans
from Pittsburg.
The captain stated he had been but two hundred and fifty-
nine hours, actually on the way. — Martin’s History of Louisiana,
vol. 2, p. 311. This speed seemed at the time to be marvelous,
and the whole population flocked to the river to examine this
wonderful creation of the genius of man, which was destined
not only to revolutionize commerce, but also to influence the
transmission and spread of destructive diseases.
1815. It was only after the year 1815, when Louisiana was
relieved jjom the danger of foreign invasion, and began to reap
the advantages of steam navigation on the river that the State
and New Orleans began to take the proud rank they now enjoy
in population, commerce, agriculture and arts. The entire
population of Louisiana in 1815, did not exceed 90,000 souls, of
whom one-half were black. In 1830 the State had increased to
215,740, including 126,300 blacks. The census of 1840, gave an
aggregate of 352,400 souls, including 168,452 slaves.
1817. The yellow fever committed ravages in New Orleans,
during the summer and fall of 1817, confining itself chiefly to
Europeans and Americans. The epidemic declared itself dur¬
ing the month of July, but in the preceding month of June,
symptoms of the disease had been manifested in various por¬
tions of the town, but chiefly at the Civil Hospital, where it
showed itself before the arrival of the schooner from Havana,
which had lost part of her crew by the vomito. The disease
continued its ravages during July ; assumed a greater degree
of intensity in August, on account of the great number of
Europeans who lauded and Americans who came down the
river. The epidemic diminished after a severe storm, which
took place at the commencement of September. The weather
was changeable until the 20th of that month, then the south
'Executive Journal, vol. 4, p. 219.
1879J
Louisiana Slate Medical Society.
153
wind commenced blowing again ; the heat increased accompa¬
nied with dampness, and the disease attacked several individuals
newly arrived in the city. At length it disappeared in the
month of October, except at the Civil Hospital, where it
reigned for some time.
M. M. Gros and Gerardin in their “ Rapport, Fait a la
Societe Medecale, sur la Fid v re Jaune, qui a regne d’une
maniere epidemique, pendant l’Ette de 1817,” held that “the
disease was caused by the peculiar topography of New Orleans ;
abundant rains tilling the stagnant marshes ; excessive heat of
the summer and influx of strangers. This disease of endemic
nature has become epidemic on account of a concurrence of
circumstances favorable to its progress and development. It
has not been contagious, but it is supposed that under certain
circumstances, it may become contagious.”
1819. The yellow fever of 1819, appeared on the 7th of May,
when one named John Gifford was attacked and died. After
this it manifested itself in another fatal case, continued in a
sporadic form, augmenting progressively, until the commence¬
ment of August, at which time the patients multiplied at such
a rate at the hospital and in the town, that from that time it
was regarded as an epidemic. It continued with great intensity
until the commencement of November, when the number of
patients diminished in a sensible manner, until the middle of
December, which was regarded as its definite termination. The
committee of physicians appointed by the “ Societe Med 'vale de
la Nouvelle- Orleans ” to investigate the origin and nature of this
epidemic, state that the yellow fever of 1819, as well as that of
1817, manifested itself sporadically from the month of May,
but it became at an earlier date an epidemic in 1817, as it was
regarded as such in the month of July, whereas it was not so
pronounced in 1819, until the commencement of August; which
appears to indicate that the cause was more intense in 1817;
however the epidemic of 1819, lasted a longer time, terminating
in December, whilst that of 1817, was considered as having ter¬
minated in October. The greater number of persons affected in
both epidemics were Europeans or Americans, recently arrived.
The Creoles of New Orleans, however, were not entirely exempt
from the ravages of the fever. In 1817, not one negro is said
to have been attacked by the disease, whereas in 1819, several
died with yellow fever. Malarial and intercurrent fevers were
more common in 1817. In 1819, yellow fever superseded all
other diseases.
The committee referred the yellow fever of 1819, to the burn¬
ing heats of July, August and September, frequent rains, and
stagnant water in the marshes. They regarded the yellow
fever of 1819 as constitutional, non-contagious, indigenous (of
spontaneous origin), and non-imported. Individuals contract¬
ing the disease in the city did not communicate it to their fam¬
ilies in the country. Not one of the inhabitants of St. Domingo
20
154
Abstract of Proceedings
[July
were attacked by the yellow fever of 1819. In tine the com¬
mittee* regarded the yellow fever of 1819 as due to heat,
humidity, and local causes.
1820. The deaths from yellow fever for the year numbered
400. Deaths from yellow fever in the hospital 82. First ad¬
mission J uly 21 st, the last December 21st.
ESTABLISHMENT OF THE FIRST QUARANTINE AND BOARD OF
HEALTH IN NEW ORLEANS .
The city and State authorities fully alive to the sanitary
interests of New Orleans, enacted health laws of the most
stringent and extensive character, on the 0th of March, 1816,
and 18th of March, 1817. Although these acts appeared to
exhaust the subject of hygienic legislation, they had no appar¬
ent effect on the march of yellow fever.
Dr. Bennet Dowler, states that quarantine laws were enacted
in the winter or before the hot season (Tableau of the Yellow
Fever of 1853, p. 14), but Dr. W. M. Carpenter quotes the N.
O. Gazette to the effect that u In consequence of the positive
proofs of the importation of the disease in the dreadful year of
1817, the legislature of that winter passed a quarantine law;
which though far from perfect iu its structure, might have
been considered as a pledge of more efficient precaution.’,
Sketches from the History of Yellow Fever, p. 17.
The mortality for August, 1817, was 489 ; September, 304 ;
October, 172; total for the three months, 905. This record
was taken from that of the various cemeteries. Dr. Bennet
Dowler gives the mortality during live months, as white male
adults, 700; white female adults 03; a ratio of more than
twelve times less than the former ; total mortality for five
months, 1142. The Pliysico-Medical Society on the contrary
reported the deaths in August, 304 ; in September, 178 ; in Oc¬
tober, 91; in November, 91 ; in December, 74. From these and
various other data, Dr. Dowler estimated the deaths from yel¬
low fever, this year, at 800.
Governor J. Villere, January 0, 1818, in his annual message
says : “ That during the course of the last summer, the yellow
fever had extended its ravages over the city, chiefly falling on
newcomers, but many of our citizens were its victims.” He
thinks that the disease was imported, and regards quarantine
laws favorably.
The yellow fever reappeared in New Orleans in 1818, and
according to the estimate of some authors, the mortality
amounted to 1151. Dr. Bennet Dowler gives the following
statistics for 1818; deaths, white male adults 324; of female
adults, 81 ; white children, 87 ; black male adults, 219; black
* Rapport Publie au nom de la Societe Medecalede la Nouvelle-Orleaus, sur la Fievre
.Janne qni y a r6gne6pidemiqneraent, durant l’Ete et l’Automme de 1819, Nouvelle-Or-
leans. The members of the committee were Trabuc, “ President de laSociete Medecale,"
Fortin, President da Comite, Marlin, Conuani, Milteuberger, Lacroix, and Thomas, “ Sec¬
retaire Rapporteur."
1879]
Imdsiana State Medical Society.
1 55
female adults, 162; black children, 277. The mortality aug¬
mented in eacli month until September, in which 166 died.
Total whites, 492; total blacks, 658; grand total, 1151. I)r.
Barton does not include 1818, amongst the epidemic years, and
the statistics given by Dr. Dowler, evidently relate to all dis¬
eases.
An Act approved March 6, 1819, repeals the Act establish¬
ing a Board of Health in New Orleans, the health officer and
all laws for the prevention of the introduction of pestilential,
malignant and infectious diseases; directs the sale of the
lazaretto and all its property; investing the Governor with
authority to establish quarantine by proclamation at his sole
discretion.
As we have seen yellow fever prevailed as a destructive
epidemic in 1819. The city proper had whites 18,604; blacks
13,592. The city and suburbs contained 45,958 souls. Mortal¬
ity by months, beginning with .January 70; February 102;
March 97 ; April 78; May 120;. June 130; July 130; August
292; September 594 ; October 513; November 134; December
109; total 2369. It will be observed that the total mortality
for August, September and October was 1199, during the prev¬
alence of the yellow fever, or over one-lialf the entire mortality
for the twelve montas. These figures taken from the reports
of the medical society and cemeteries apply probably only to
the city proper.
Mr. Nuttal, the naturalist, in his travels, estimates the victims
to yellow fever for this year in the city, at from five to six
thousand, an aggregate greatly exceeding probability.
In the official report of the Surgeon-General U. S., it it said :
“ At New Orleans it was estimated that upwards of 3600 died
of yellow fever; and it was not until after the first of Decem¬
ber that it was deemed prudent to return either to this city or
Natchez. The interior of the country, in the Southern States,
seemed to sutler in a corresponding ratio. In the West Indies
the fever exhibited a still greater mortality.”
The grand total mortality, according to the report of the
Medical Society (supposed to include only the incorporated
limits), is but 1‘337 ; the males being 1,142; the females 195;
blacks, male adults 182; females 168. Deaths of blacks dis¬
tributed almost equally among the month’s of the year, and
little if any increased during the three epidemic months, while
the deaths of white adults increased from 64 in .J uly to 485 in
September. Six white men died for one white woman.
According to Dr. Bennet Dowler, the first two cases of
yellow fever in 1849, occurred May 7th and 12th ; the last death
December 9th. And as we have previously shown the Coin-
mitte of the Medical Society, after minute inquiry, failed to
trace the disease to local causes.
Dr. Carpenter, on the other hand, in his special pleading for
importation aud contagion, says :
“In June, several vessels, with crews sickly with yellow
150
Abstract of Proceedings
[Julj
fever, entered from Havana, and about the first of
July, cases began to appear among the shipping in
the harbor. The Governor now proclaimed quarantine,
by a power vested in his hands, by the Act repeal¬
ing the quarantine law. The disease, however, had already
made some progress, and the thing was given up, and the ves¬
sels continued to come in, and some from Martinique, which
were known to have lost some of their men on the voyage, and
even on their way up the river, with the worst type of the
‘vomito prieto,’ and not a voice was heard to prevent their
mooring at the levee. The disease became epidemic before the
middle of August, and assumed a character of the highest
malignity ; medicine lost its effects ; the skill of the physician
was baffled, and multitudes were carried to the grave.” (New
Orleans Gaz., January 7, 1820, Sketches from the History of
Yellow Fever, p. 18.)
It is evident that the disease had originated in the city, be¬
fore its introduction in the way mentioned by Dr. Carpenter,
who appears merely to quote the statements of a newspaper
article.
On the other hand Dr. Dupuy de Chamberry, in his historical
sketch of yellow fever, as it appeared in this city in 1819, says :
“ I formerly believed the yellow fever to be contagious, but
since 1 have been in the midst of it, my numerous practical
observations have never been able to furnish me with one
proof of this much dreaded attribute. Indeed, the result has
been quite the reverse; and, I am now convinced that the dis¬
ease is permanently fixed to the spot, and within the limits of
the place which has created it. Not one case occurred beyond
the limits of the city, during its prevalence in the years 1817
and 1819, that could be traced to our innumerable patients,
although daily intercourse was kept up with the people of the
neighboring estates and plantations. A great number of our
inhabitants who carried the seeds of the disorder abroad, seek¬
ing refuge from the danger at a distance, suffered an attack of
the fever and died, but in no instance was it communicated to
their friends. Fifty times have T had my hands and besmeared
with the putrid blood, black vomit, or fietid slimy matter of
perspiration. Fifty times have I been immersed in the effluvia
issuing from a dead. or living subject, and never been infected
by the disease. From extensive observations I infer that the
yellow fever of this place is a disease, sui generis , the product
of local causes, and neither contagious nor exportable. Flight
from the infected spot is the only preservation, and a distance
of three miles appears to be quite sufficient to inspire the full¬
est confidence.”
The repulsive, mischevous, demoralizing and inhuman doc¬
trine of the direct contagiousness of yellow fever, has been
revived in our day, and during the epidemic of 1878, led to
remorseless quarantines and the shameful neglect of the sick iu
many cases.
1879]
Louisiana State Medical Society.
157
New Orleans was again visited by an epidemic of yellow
fever in 1820. Deaths from yellow fever in the hospitals 82.
First admission July 21st; the last, December 21st. The
deaths for August from all causes were 289, September 402,
October 177, total 868. During the same months, in 1817, the
mortality was 965, and in 1819, 1199. Dr. Carpenter states
that u About the 20th of July, it became known that several
cases of yellow fever had appeared among the shipping, and
some at boarding houses. When the mayor desired Dr. David¬
son to examine all the vessels which had lately entered the
port of New Orleans from the West Indies where the yellow
fever was then prevailing, who made diligent inquiries
into and having investigated the grounds for the rumors which
had prevailed in the city for some days past, that malignant
fever had made its appearance, respectfully reports that :
‘ The schooner Gold Huntress, Martin, rhaster, from Havana,
entered on the 17th of June, having lost two men on her pas¬
sage with yellow fever; also that the brig Charles Fawcett,
Lainon, master, from Matanzas, arrived on the 10th of July,
having lost two men on her passage, and having others sick with
yellow fever.’ ” The yellow fever became epidemic between the
first and middle of August. (Letter of Dr. G. C. Forsyth, ex¬
tract from N. O. Gazette, Nov. 15th, 1820. Sketches from the
History of Yellow Fever, p. 19.)
Governor Villere declared “ that the scourge of war is prefer¬
able to yellow fever ;” “ that the city had been twice ravaged
in three years,” (1817, 1819) and “that it is contagious.” He
urged the legislature to pass quarantine laws, in which lie had
the greatest confidence as a preventative.
Governor Villere, a firm advocate for contagion and quaran¬
tine, in his message of November 22d 1820, in relation to the
then existing epidemic yellow fever, says :
“ All the medical faculty appear definitely to have adopted
the opinion that the yellow fever, which during the last year
lias plunged us once more into mourning and desolation, is not
contagious.” But he argued : u During the months of August,
September and October, there has been almost constantly in
the prison of this city a great number of prisoners, and not a
single one among them has been affected with the disorder.”
“ If the yellow fever were natural to our climate, how has it
happened that among such a number of persons, heaped to¬
gether in so small a space as the prison of this city, not a
single one should have been attacked ”
Dr. Chabert, a physician of New Orleans, opposed the Gov¬
ernor’s argument as to the prison, and maintained that the
creoles never take the yellew fever, though they do not shut
themselves up to avoid it.
Governor Villere reviews the report of the Medical Society
for the current year, dissents from its deductions, which he
regards as those of all the faculty, and denies what he calls
158 Abstract of Proceedings [July
u The constitutionality of the Yellow Fever.” Tableau of the
Yellow Fever of 1853, etc., by Bennet Dowler, M.D., p. 17.
On the 18th of December, 1820, Governor Robertson, in his
inaugural message, urged the legislature to establish quaran¬
tine against yellow fever.
The quarantine laws passed by the legislature, in February,
1821, creating a Board of Health, with plenary powers, legisla¬
tive, judicial, executive, pecuniary and sanitary, modeled after
codes the most rigid, and enforced by the heaviest penalties,
were carried into effect in March of the same year.
The quarantine ground, established at the English Turn,
including incidental expenses, cost over twenty-two thousand
dollars.
The Board of Health commenced its duties on the 0th of
March, and instituted measures for cleansing the city, im¬
proving its salubrity, and providing against the introduction
of infectious diseases. The quarantine was under the direc¬
tion of the Board of Health, and vessels arriving in port were
compelled to contribute to its support. The Board held its
meetings every Tuesday afternoon at the Customhouse, until
the 1st of June, and from that time until the 1st of November
every day excepting Sundays. The mayor, Joseph Roffignac,
was president, ex-officio, of the Board, composed of twelve
members, who received no pecuniary compensation for their
services.
The nature of the ordinances of the Board of Health, may be
gathered from the following extracts from the Code of Public
Health :
u All keepers of inns, taverns, boarding-houses, or other
places, where persons are lodged for hire, shall once in every
week, furnish the Mayor of the city, at his office, a list of the
persons lodging or boarding at their houses respectively, ac¬
cording to the printed forms which the Mayor shall furnish
at the expense of the corporation, which shall contain the
names, apparent age, occupation, place of permanent residence ;
and nativity of such boarders or lodgers, and the time they
have respectively lodged or boarded in such house; and every
person offending against this article, shall forfeit one hundred
dollars; or if knowingly furnishing a false return or list, shall
forfeit a sum of live hundred dollars.
11 If any seafaring man, or sojourner, shall, at any such house
as is described in the foregoing article, fall sick at any time
between the first day of May and the first day of November in
any year, the master of such house shall, vvithiu twelve hours,
report the name of such sick person to the Board of Health,
and describe the place at which lie lies sick, unless such person
is attended by a physician duly admitted to practice, and for
every neglect to make such report, every keeper of such house
shall forfeit twenty dollars.
“ The sexton or keeper of every cemetery in the city of New
Orleans, shall every day during the months of May, June,
1879]
Louisiana State Medical Society.
159
July, August, September and October, and every week during
the rest of the year, make a return to the Board of Health, of
the persons buried in such cemeteries; and for every neglect,
such sexton or keeper, shall forfeit ten dollars.
“ Every person practising physic in the city of New Orleans,
who shall have a patient sick of the yellow, or bilious malignant or
pestilential fever, or infectious fever, between the first day of
May and the first of November in every year, shall within
twenty-four hours make a report in writing to the Board of
Health, at their office, and for neglecting to do so he shall for¬
feit for every offence, three hundred dollars.”
The year 1821 proved salubrious — a result attributed to the
strict quarantine. From the following table it will be seen
that the deaths were only slightly augmented during the
months of July, August, September and October.
Annual Report of Interments in the Cilj / of Atw Orleans , commencing o> the
i st dag of January and ending on the '.list day of December 1821, as made
to the Mayoralty and Board of Health.
1821.
Sh
58
n
"5
| Febr’ary.
March.
April.
l May.
Jure.
July.
August.
Septem’r.
October.
c
*g
it
>
o
Z
a
a,
o
<v
Total.
l Men .
24
18
24
25
24
37
54
60
75
74
49
39
505
Whites.
> Women .
3
4
3
5
6
4
8
7
0
10
10
5
65
S Children .
2
7
4
2
8
10
19
10
14
89
15
5
105
) Men .
13
12
9
6
16
10
18
20
17
12
14
10
157
V Women .
15
12
12
13
14
7
13
18
10
7
16
15
152
) Children .
14
17
15
13
15
23
16
18
6
15
14
15
181
'1 ot als.
71
70
67
65
85
91
128
133
122
126
118
89
1165
Governor Robertson, in January, 1822, congratulated the
Legislature upon the good fortune of New Orleans as being
u the healthiest city ” in the Union ; but at the close of August,
the yellow fever appeared ; it augmented throughout Septem¬
ber, but did not reach its culminating point until October; the
month of greatest mortality having amounted to 005, exceeding
that of the preceding month by 83. The following was the
mortality for three months: August, 165; September, 532 ;
October, 605. Total, 1302.
Total deaths from yellow fever in 1822, 808; or one in 53.28
of the population. The highest number of deaths any one day
of yellow fever, was 00; and of all causes 80. During 1833,
the largest mortality any one day of yellow fever was 53 ; 1841,
highest number from yellow fever 43, and greatest mortality 00.
Of the ten epidemics of yellow fever, with which New Or¬
leans had been visited since the cession to the American Gov¬
ernment in 1803, up to the year 1842, the average loss has been
estimated as not exceeding 800; and during this period the
most fatal epidemic was that of 1822, when the deaths ntim-
160
Abstract oj Proceedings
[July
bered 808, or one in 53.28 of the entire population. The total
mortality from yellow fever in 1841, was 1(>41 ; distributed thus
by cemeteries : Catholic Cemetery, 42 ; Cypress Grove Ceme¬
tery, 77 ; Protestant Cemetery, 63; St. Patrick’s Cemetery, 78;
Lafayette Cemetery, 241 ; Jewish Cemetery, (in Lafayette) 10;
Potter’s Field, 1124. Total, 1041.
Natives of the United States, 288 ; natives of foreign coun¬
tries, 1055; natives of countries unknown, 208. Total, 1641.
The population of New Orleans in 1820 was 41,350, and in
1840,102,101. In 1841, the population of New Orleans, prob¬
ably exceeded 103,000 ; ratio of deaths from yellow fever one
in 02.7 of population.
The value of the labors of the Board of Health in diminish¬
ing the rate of mortality, and by the prevention of yellow
fever, by the so-called efficient and rigid quarantine, will be seen
from the comparative mortality, from all diseases, during the
three months of August, September and October of the years
specified.
Ykars.
Months.
1817
1819
1820
1822
1833
1837
1839
1841
August .
489
292
289
165
41n
483
619
562
September.... ....
304
594
402
532
783
1188
648
1115
Octobt-r .
172
513
177
665
565
568
297
659
Totals. . .
965
1199
868
1362
2758
2239
1554
2231
Ratio to eurire pop- 1
1 in
1 in
l m
1 in
1 iu
1 in
1 in
1 in
ulatiou . 1
37.62
33,09
47.63
31.60
37.27
38.76
61-73
48.15
The message of Governor Robertson, after the epidemic of
1822, breathed sorrow and despair, and he could no longer
exult upon the good fortune of New Orleans, as being “ the
healthiest city in the Union? and his bitter experience might
well be heeded, when so-called sanitary reformers, attribute the
occasional absence of yellow fever from New Orleans, to their
pretentious but superficial efforts and shallow lucubrations.
“ It is.” says Governor Robertson, “ an idle waste of time for
me to inquire into the causes, origin and nature of this dread¬
ful malady.” * * * “ The State resorted to quarantine,
under the expectation that it would add to the chances of
escape from this dreadful visitation. If this hope be fallacious,
if no good effect has been produced, if even a procrastination
of its appearance has not resulted from the measure, then
should it be abandoned, and our commerce relieved from the
expense and inconvenience which it occasions.”
In 1823, the Copimittee of the House of Representatives on
Quarantine Laws, reported, that u duriug the last year (1822)
notwithstanding the strictest compliance with these laws , our ex¬
pectations were frustrated at the very moment when we thought
Louisiana State Medical Society.
161
1879J
we could indulge the hope of the most complete success. The
season was far advanced, and in the month of September this
metropolis enjoyed the most perfect health, when the yellow
fever made its appearance.”
u Notwithstanding the signal and lamentable failure of quar¬
antine in 1822, the committee of the House of Representatives,
of which F. Grima, Esq., was chairman, recommended its con¬
tinuance in the most rigid form, because it had not been tried suffi¬
ciently long, and because other States had similar regulations .”
The Board of Health upon this occasion, as well as upon
many others were not slow in finding an unfortunate vessel and
some miserable individuals to whom they attached the odium
of having introduced the disease. The Board of Health of
1822, set a worthy example to succeeding boards, which has been
frequently exempli lied in the most striking manner, in expressing
sublime faith in its own powers, and in the efficacy of quaran¬
tine to exclude yellow fever from New Orleans. Thus they
held the following language :
“ The Board of Health believe it their duty to do away with
the impression made by interested persons, to induce a belief
in the inutility of the powers which you have so wisely con¬
ferred on the Board, for the establishment of quarantine, which
these persons wish to see destroyed.” * * *
u This opinion is diametrically opposed to that of the Board
of Health, who believe that the yellow fever is contagious, and
that the establishment of quarantines is necessary to prevent
its introduction.”
The citizens however were not convinced by the arguments
of the contagionists, as to the value of their system to prevent
yellow fever, and determined to petition the legislature to
abolish the quarantine laws.
On the 23d of January, 1823, a large public meeting took
place, in which it was moved and carried, “ that the late epidemic
had tested the total inefficiency of the quarantine laics and regula¬
tions ; we consider them not only useless but in the highest
degree oppressive and injurious to the commerce of this city ;
and that application ought to be made to the legislature for the
purpose of having them annulled.” A memorial was addressed
to the legislature accordingly for that purpose. The legisla¬
ture, however, took no decisive action upon the matter. The
quarantine continued in force. The health of the city con¬
tinued good throughout 1823, only two cases of yellow fever
having been recorded in the books of the Charity Hospital.
The Governor, in his message of January, 1824, congratulated
the legislature on the health of New Orleans, and proclaimed
the city free from u all contagious diseases , ” but on the loth of
November of the same year, the Governor in his message says:
u New Orleans has been again subjected to the dreadful
scourge,” and suggests the expediency of closing the business
21
162 Abstract of Proceedings [July
season in midsummer, and recommends a general flight to the
unacclimated.
Mayor J. Rottignac in his message dated September 11,
1824, gives the following exposition of the causes of yellow
fever :
“ The opinion of professional men on the primary cause of the
insalubrity of New Orleans, tends only to confirm the idea which
must occur to the mind of every attentive observer, on looking
at the topographical situation of our city, to- wit: that these
causes are of two kinds ; the one arising within and the other
without the city itself, and that both ought to be counteracted.
“ The internal causes are, 1st the tilth daily created in a
populous city ; 2dly, the low grounds and pools where stagnant
water lies, the wooden gutters, constantly wet and fermenting
under the rays of a torrid sun ; .‘idly, the want of privies in
most of the populous districts, which renders it necessary to
recur to the disgusting and dangerous use of tubs.
“ The external causes are, 1st, the marshes lying north and
west of the city, uncovered but undrained, and deprived, by
the cutting down of trees, of the shelter formerly afforded to
them by the shade of a luxuriant vegetation for which the very
miasms that now spread death and desolation among us, were
a source of life and vigor ; 2dly, to the south and east, the
Mississippi, which in its periodical retreat, at the hottest sea¬
son of the year, leaves on its banks a great portion of the tilth
which has been thrown into the current, but is brought back by
eddies ; 3dly, the winds, which at the moment we feel most se¬
cure, may, as was the case in 1822, convey to us the deadly
effluvia of the dangerous spots, which they sweep in their
course.”
Mayor J . Rottignac does not allude to contagion , nor does he
allude to the quarantine , which had afforded no protection, and
proved a delusion against disease, and a serious obstruction to
commerce.
The quarantine had been tried for three years, and yet two
epidemics had occurred ; the contagionist began to waver and,
the joint committee of both houses of the legislature disagree¬
ing on quarantine, were discharged from the consideration of
the same on the last day of November, 1824.
Experience cominced the public that quarantine was not
only useless but absolutely injurious to a city so exclusively
commercial ; that a free untrammeled trade, with freedom of
ingress, egress and progress, was a social necessity involving
the question of subsistence or starvation. On the 19th of
February, 1825, the legislature repealed the quarantine laws
which it had enacted four years previously, and at the same
time the quarantine grounds were directed to be sold. During
the eight years which followed, yellow fever was never so des¬
tructive as in 1822, under a strict quarantine, when according
to some authorities, as the Rev. Timothy Smith, who visited
New Orleans in 1823, 2000 died of that malady, although the,
1879]
Louisiana State Medical Society.
l 63
records examined by Drs. Barton, Dowler and myself, show
only 808, the whole mortality for the three months ending with
October being 1362. The maximum mortality upon one day
rose to 80, of yellow fever to 60. The ratio of mortality in the
Charity Hospital was enormous, out of 337 admissions, 239
deaths and only 98 cures took place.
An ordinance for the establishment of another Board of
Health in New Orleans, was again passed by the General
Council in June, 1841. The Board consisted of nine members —
three aldermen, three physicians, and three private citizens.
It was invested with ample powers to adojd and enforce such
sanitary regulations as were thought conducive to the health
of the city. This Board performed its functions during the
first year of its existence ; but we have seen that a fearful epi¬
demic of yellow fever desolated New Orleans in 1841, destroying
1641 of her inhabitants, the mortality for the months of August,
September and October reaching 2231.
The second year there was a falling off, but a dissolution did
not take place till 1843. In 1844, the Board of Health having-
ceased to officiate, the General Council invited the Medico-
Chirurgical Society to take charge of the sanitary interests of
New Orleans. This proposition was accepted, and a committee
of nine members appointed with full powers to act as a Board
of Health.
Acts were passed by the General Council 15th August, 1846,
23d June, 1847, and by the Legislature of Louisiana March 6tli,
1848, May loth, 1848, and June 13th, 1855, relating to the
Board of Health and Quarantine. The present system of quar¬
antine was established on June 13th, 1855, and at this date
Dr. Samuel Choppin, President of the Board of Health, held
the position of Quarantine Physician.
The years 1853, 1854 and 1855, are justly regarded as the
most destructive and pestilential period in the history of New
Orleans, the deaths from yellow fever alone numbering 12,780,
and from all causes 37,076.
YELLOW FEVER A DISEASE OF SHIPS, CITIES, AND TOWNS, AND
ITS ORIGIN AND SPREAD DEPENDENT UPON A CERTAIN DEN¬
SITY OF POPULATION.
As far as is known, yellow fever never originated sponta¬
neously and sporadically among the sparse population of' the
country, no matter how malarious the region ; malarial fevers
on the contrary, are rife in the thinly populated countries,
and decrease steadily in number and virulence with the in¬
crease of population and the improvement of agriculture.
We w ill illustrate this proposition, and at the same time pur¬
sue the general spirit of the investigation, by the following
statistics of the city and Charity Hospital :
164
Abstract of Proceedings
[July
Statistios of Yellow Fever in the Charity Hospital of New Orleans during a
pei'iod of 57 years.
Year.
xJ- C
a © ©
$ xBu
i *
u
£ ©
.
S'*
Date of First
Date of Last
'Z $ .
2*2
— 3} o
~ © —
O .
Q
58 ® ©
£ t* 'M
Q
© w
O U
* 2
® a
Ph
Case.
Case.
1822
337
98
239
70.92
September 3.
December 21.
1823
1
1
100.00
September 11.
August 4.
1824
167
59
108
64.67
November 13.
1825
99
40
59
59.45
June 23.
December 19.
1825
24
19
5
20.83
May 18.
November 18.
Total in
628
216
412
65.63
5 years.
1827
372
263
109
29.30
July 17.
December 5.
1828
290
160
130
44.83
June 19.
December 10.
1829
435
220
215
49.43
May 23.
November 29.
18 i()
256
139
117
45.72
July 24.
November 29.
1831
3
1
2
66 67
June 9.
October 7.
Total in
5 years.
1356
783
573
42.23
1832
26
8
18
69 23
August 15.
October 25.
1833
422
212
210
49.77
'July 17.
November 17.
1834
150
55
95
63.33
August 28.
November 22.
1835
505
221
284
56.24
August 24.
November 27.
1835
6
l
5
83.33
August 24.
October 25.
Total in
5 years.
1109
497
612
55.18
1837
998
556
442
44.29
July 13.
November 28.
1838
24
5
19
77.25
August 25.
November l.
1839
1086
634
452
41.62
July 23.
November 17.
1840
3
3
100.00
53.14
July 9.
August 2.
November 17.
December 8.
1841
1114
520
594
Total in
5 years.
3225
1715
1510
43.72
1842
425
214
211
49.65
August 4.
November 26.
1843
1096
609
487
44.44
July 10.
December 31.
1844
169
86
83
49.11
September 4.
November 25.
1845
1
1
August 10.
August 10.
1846
146
50
96
65.82
August 29.
December 1.
Total in
5 years
1837
960
877
47.74
1847
2479
1584
895
36.11
June 29.
December 11.
1848
1226
806
420
34.26
June 7.
December 2.
1849
1055
510
545
51.66
July 28.
December 4.
1850
10
6
4
40.00
August 23.
November 16.
1851
7
5
2
28.57
August 1.
October 9.
1879J
Louisiana State Medical Society.
165
Statistics of Yellow Fever — Continued.
Year.
Admissions,
cases Yel¬
low Fever.
Discharges,
Yellow
Fever.
aT &
-0 ® *
* ® £
| Per cent, of
mortality.
Date of First
Case.
Date of Last
Case.
Total in
4777
2911
1866
39.06
5 years.
1852
496
157
339
68.74
August 20.
November 29.
1853
3217
1327
1890
58.71
May 21.
November 23.
1854
2743
1510
1233
44.91
July 2.
December 1.
1855
2198
1099
1099
50.00
June 3.
December 11.
1856
98
47
51
52.04
August 10.
November 3.
Total in
8752
4140
4612
52.69
5 years.
1857
235
80
155
65.91
September 17.
December 18.
1858
2727
1345
1382
50.67
June 16.
December 23.
1859
107
23
84
78.50
August 29.
November 29.
1860
2
2
August 12.
November 4.
1861
Total in
3071
1450
1621
52.78
5 years.
1862
1863
1864
2
1
1
50.00
1865
.
1866
130
95
35
26 92
August 27.
November 14
Total in
132
96
36
27.27
5 years.
1867
1493
821
672
45.01
June 9.
October 22.
1868
8
3
5
■62.50
October 5.
October 22.
1869
3
2
i
33.33
1870
518
256
262
50.57
1871
29
9
20
68.96
Total in
2051
1091
960
46.36
5 years.
1872
11
3
8
72.72
1873
118
43
75
63.55
1874
9
3
6
66.66
1875
16
5
11
68.75
1876
3
i
2
66.66
Total in
157
55
102
64.96
5 years.
166
Abstract of Proceedings
[July
Statistics of Yellow Fever — Continued.
Year.
Admissions,
cases Yel-
Fever.
Discharges,
Yellow
Fever.
Deaths.
Yellow
Fever.
Per cent, of
mortality.
Date ok First
Case.
Date ok Last
Case.
1877
1878
’'817*
406
411
50.44
July 18.
November.
10 years,
1822-’31
1084
999
985
49.64
10 years,
1832-’4 1
4334
2212
2122
48.75
10 years,
1842-\51
6614
3871
2743
41.47
10 years,
1852-’61
11,823
5590
6233
52.71
10 years,
1862-’71
2183
1187
996
45.57
Total in
50 years.
26,958
13,859
13,079
48.55
From the preceding table consolidated from the yearly reports
of the Charity Hospital, it will be seen that during a period of
50 years, 1822-1871, 26,958 cases of yellow fever were treated
in the Charity Hospital, with a mortality of 48.55 per cent.,
and if we include the 5 years, extending to 1876 inclusive,
27,095 cases of yellow fever were admitted, 13,181 of which
proved fatal, giving a mortality of 48.65 per cent, for the entire
period.
During the entire period of 55 years, extending from 1822-
1876 inclusive, only 4 years can be specified in which no cases
of yellow fever were entered upon the Hospital Register,
namely, 1861, 1862, 1863 and 1865. In 1864, only
two cases were entered. It is important to note
that the period 1861-1865, embraces the American
Civil War, when the relations of New Orleans to
commerce and emigration were altered, and the city was, to a
great extent subjected to a strict military government and rigid
quarantine.
A progressive increase in the number of cases of yellow
fever, admitted into the Charity Hospital, is observed from
1879]
Louisiana State Medical Society.
167
1822 to 1858. Thus, if periods of ten years be compared, the
following results wrill be obtained :
Admissions during 10 years 1822-1831, 1984 ; 1832-1841,
4334 ; 1842-1851, 6614 ; 1852-1861, 11,823.
This increase should be referred not so much to a relative in¬
crease of the disease, as to the growth of New Orleans, and the
progressive increase of emigration from European countries
and Northern and Northwestern States, during the 40 years,
extending from 1822-1861 inclusive.
The truth of this proposition can be shown by the statistics
of the Charity Hospital and the march of population.
Total Admissions and Deaths in Charity Hospital during 55 years — 1822-1877,
inclusive.
Year.
2.2
'O at
<
X>
. ©
cc bfi
Cl ce
A
O
Deaths.
a
■a
a m
® a
M"*
Year.
•2 8
S.8
'O ®
Dis¬
charges.
Deaths.
a
2 si
3 o
© -r-«
«
1822
1689
1116
573
82
1850
18,476
15,989
1884
719
1825
1266
983
283
78
1851
18,420
16,777
1871
1824
100
1852
18,035
15,057
2098
....
1825
1-267
989
218
70
1853
13,759
10,733
3164
1826
1408
1212
196
125
1854
13,192
9976
2702
1827
1853
1549
304
90
1855
12,192
9701
2391
545
1828
2390
1989
401
94
1856
9432
8389
974
... -
1829
2548
2065
483
138
1857
8897
7913
1017
1830
2790
2366
424
148
ia58
11,337
8923
2290
572
1&31
3558
3149
409
116
1859
12,775
11,257
1321
664
1832
2271
1703
568
309
1860
14,060
12,605
1390
730
1833
3731
2617
1114
169
1861
8665
7918
798
891
1834
5797
4745
1052
262
1862
6016
5532
719
1835
6225
4999
1226
265
1863
373
1836
4748
4163
585
222
1864
4861
3999
812
423
1837
6060
4640
1420
228
1865
6466
5880
669
423
1838
4573
3890
683
271
1866
9329
8108
1122
637
1839
4566
3611
955
239
1867
8612
7260
1438
640
1840
4989
4370
619
267
1868
4981
4365
490
660
1841
4249
3093
1156
314
1869
6177
5327
784
716
1842
4277
3516
761
1870
7837
6764
1118
672
1843
4713
3672
1041
1871
6651
5730
891
700
1844
5772
5059
713
1872
5541
4846
825
570
1845
6009
5446
563
283
1873
5090
4124
993
543
1846
7929
7074
855
401
1874
5231
4360
860
554
1847
11,406
9369
2037
427
1875
4845
4121
753
525
1848
11,907
10,010
1897
828
1876
5690
4780
742
693
1849
14,878
12.133
2745
609
Abstract of Proceedings
168
[July
Nationalities of Patients admitted to the Charity Hospital, New Orleans, far the
periods specified.
Ykak.
1
| Foreign¬
ers.
1
1
| Nalives
| U. S.
1
Natives
| of La.
r un- “
| known.
Year.
Foreign -
| ers.
Natives
U. S.
1
Natives
j of La.
Un¬
known.
12 years,
1858
9568
1391
360
18
1830-1841
37,543
16,247
512 ’ • • •
1859
10,753
1634
377
11
1842
3277
954
341- ••
1864
2966
1167
623
4
1843
3937
1017
59 -•
1868
3422
1014
524
21
1844
4530
1203
113 282
1869
3480
1841
837
19
1845
4704
1231
119 82
1870
4907
2163
723
44
1846
6151
1628
145 121
1871!
4101
1847
671
32
1847
10,171
1507
53 157
1872
3255
1622
631
33
1848
10,280
1468
111 86
1873
3038
1363
672
17
1849
13,634
1645
1471 142
1874
3013
1437
764
17
1850
16,598
1510
264 104
1875
2634
1332
866
13
1851
16,503
1485
241 191
1876
2991
1669
1015
15
1852
16 144
1561
248: 181
1853
12,333
1078
228 120
Total.
238,753
44,119
11,760
i ■
1854
1 1,606
1250
252 84
1855
10,861
960
328 38
Total admissions of Foreigners, na-
1856
8045
1020
349 18
tives of United States and of
Louis-
1857
7307
1183
394 ....
iana. 1830-1876 inclusive. 317,286.
A comparison of the preceding tables, will illustrate the rela¬
tions of the foreign population to the diseases and especially
to yellow fever, treated in the Charity Hospital of New Orleans.
During the period of 40 years 1830-1876, 317,286 patients
were admitted to the Charity Hospital, and of this number
238,753 were foreigners ; 44,119 natives of the United States,
outside of Louisiana, and 11,760 were natives of Louisiana.
During a period of 30 years, 1830-1859, total admissions
260,372; foreigners 203,946; natives of the United States
29,664 ; natives of Louisiana 4334.
During a period of 10 years 1864-1868 -1876, total admissions
56,914 ; foreigners 34,807 ; United States 14,455 ; natives of
Louisiana 7426.
It is clearly shown by the statistics that the elfects of the
American Civil War and the subsequent destructive and
hostile legislation during the following ten years, was
to diminish emigration from foreign countries, and at the
same time to impoverish the natives of Louisiana, who
in 30 years, preceding our war, furnished only 4334
patients to the Charity Hospital, out of a total of 260,372, and
who, in the 10 years, including 1864, 1868, 1869, 1870, 1871,
1872, 1873, 1874, 1875 and 1876, furnished 7426 patients, out of
a total of 56,914 admissions.
That the severest epidemics of yellow fever were intimately
connected with the increase of population, and chiefly with emi¬
gration, is shown not merely from the preceding statistics of the
Charity Hospital, but also from the various enumerations of
the population and the mortuary records of the city.
1879]
Louisiana State Medical Society,
169
Table illustrating the Relations of the Population of New Orleans to Total Mor¬
tality Jr om all causes and from Yellow Fever, during a period of 92 years.
Year.
Population
of New
Orleans.
! Deaths
from all
' causes.
Deaths
from Yel¬
low Fever
Year.
| Population
of Noav
Orleans.
Deaths
from all
causes.
Deaths
from Yel-
| low Fever
1787
5284
338
1854
156,556
11,347
2425
1796
8756
638
1855
158,980
10,096
2670
1807
17,001
....
1856
161,404
5689
74
1808
17,081
773
1857
163,828
5581
199
1810
17,242
963
1858
165,450
11,720
4855
1811
18,235
1239
1859
166,500
6849
92
1812
19.229
624
1860
168,670
7341
15
1813
20,212
939
1861
169,907
5772
1814
21,216
926
1862
171,134
6278
2
1815
22,209
1252
1863
172,361
7172
2
1816
23,303
651
1864
173,588
8498
6
1817
24,196
1772
823
1865
174,815
7016
1
1818
25,190
1106
115
1866
178,042
7754
185
1819
26,183
2138
425
1867
181,269
10,096
3107
1820
27,176
1766
400
1868
184,496
5343
3
1821
29,441
1165
1869
187,723
6001
3
1822
31,706
2734
808
1870
191,418
7391
587
1823
33,971
1662
1
1871
193,276
6059
54
1824
36,236
1748
108
1872
195,234
6588
39
1825
38,501
2177
49
1873
197,092
7995
226
1826
40,766
1248
5
1874
198,950
7193
11
1827
43,031
1057
109
1875
200,708
6535
61
1828
45,296
1490
130
1876
204,404
6685
42
1829
4 7,561
2520
900
1877
207,282
7169
1
1830
49,826
2022
117
1878
210,000
10,717
4056
1831
52,455
1926
2
—
1832
55,084
8099
400
10 years,
17,506
2734
1833
57,713
4976
1000
1817-’26
1834
60,342
3687
95
1835
62,971
3873
284
10 years,
32,382
3042
1836
65,600
2734
5
1827- ’3#
1837
68,229
4807
1300
1838
70,858
2606
17
10 years,
37 821
4453
1839
73,487
3934
800
1837-’46
1840
76,116
2977
3
1841
78,745
4549
1325
10 yea s,
92,018
18,043
1842
81,374
3375
211
1847-’56
1843
84,003
4050
487
1844
86,632
4620
148
10 years.
74,981
1845
89,261
2783
2
Lb;)7-’66
1846
102,070
4220
160
1847
108,699
9043
2804
10 years,
69,886
41331
1848
115,503
7407
872
1867-’76
122^11
9862
769
1850
129,747
7819
107
2 years
17,886
4057
1851
138,599
7275
17
1877-78
1852
147,441
8693
456 |
1853
154,132
15,787
7849
years..
342,480
41,629
22
170 Abstract of Proceedings [July
MARCH OF POPULATION IN NEW ORLEANS AND ITS RELATION
TO THE PREVALENCE OF YELLOW FEVER.
The preceding table lias been constructed from the mortuary
records of the Board of Health and various cemeteries, and
from the data furnished by Barton, Howler, Fenner and others.
The population relates to the city proper, up to the year 1846,
when that of the town of Lafayette is included. The mortuary
records are in some years incomplete, and different authorities
assign different figures to the number of deaths by yellow
fever, in different epidemics. Some of the figures given may
be the subject of critical discussion, but this is not necessary
to the general results which so far from being exaggerated are
below rather than above the absolute numbers. It is import¬
ant that the data with reference to the population of New Or¬
leans, should be clearly stated.
Population of Nf.w Oh.eans.
Year.
1769 .
Whites.
Blacks and Colored. Total
. 3190
1785 . . . . .
4980
1788 .
. . 5331
1797 .
8056
1810$ City .
$ Parish Orleans .
. 11,281
5961 17.242
. 2447
4863 7310
27,176
lew $ Parish Orleans . .
. 14,175
f Parish of Orleans on the Right )
| Bank of the river, and on the Left >
| Bank all below Mandeville street. S
1830 <; Lower suburbs of New Orleans,
I Northern suburbs of New Orleans,
| Fort Pike .
j Upper suburbs of New Orleans.. .
(Old Square, City of New Orleans.
[ Municipality No. 1 .... # .
| Faubourg Tr6me .
j McDonoughtown .
Municipality No. 2, 1st ward .
“ “ 2d ward .
“ “ 3d ward .
Municipality No. 3 .
Total Parish and City of New
Orleans .
1847 $ City Census, March .
/ ( State Census, August .
1850 $ City of New Orleans including
) Lafayette . 89,459
1860 . 144,596
1870 . 140,923
1878 (Estimated) . 155,000
26,916
27,074
50,456
55,000
3744
2926
3976
83
9437
29,694
33,780
14,351
3871
6092
7207
7724
29,168
102,193
94,526
79,503
116,375
168,670
191,418
210,000
If this data be connected with the preceding table, the fol-
lowing results are worthy of note —
During ten years, 1817-1826, inclusive, the population of the
city proper of New Orleans, increased from 24,196 to 40,766 ;
1879]
Louisiana State Medical Society.
1.71
actual increase 16, 570, or 64 per cent. The deaths from all
causes numbered 17,506, and the deaths from yellow fever 2734,
or one death from yellow fever in 6.7 deaths from all causes.
During the ten years, 1827-1836, the population increased
from 40,766 to 65,600. Actual increase 24,834 or 69 per cent.
Deaths from all causes 32,382 ; deaths from yellow fever 3042 ;
one death from yellow fever in 10.6 in deaths from all causes.
During the ten years, 1837-1846, the population increased
from 65,600 to 102,0.70; actual increase 36,470, or 55.6 per cent.
Deaths from yellow fever 4453 ; one death from yellow fever
in 8.4 deaths from all causes.
During the 10 years, 1847-1856, the population increased
from 102,070 to 161,404, actual increase 59,334, or 58 per cent. ;
deaths from all causes 92,018 ; deaths from yellow fever 18,043 ;
one death from yellow fever to 5.1 deaths from all causes.
During the 10 years, 1857-1866, the population increased from
161,404 to 178,042, actual increase 16,638, or 10.3 per cent.;
total deaths from all causes 74,981 ; total deaths from yellow
fever 5,367, or one death from yellow fever in 14.14 deaths
from all causes.
During the 10 years, 1867-1876, the population increased from
178,042 to 204,424, actual increase 26,382, or 14.8 percent;
deaths from all causes 69,886 ; deaths from yellow fever 4133,
or one death from yellow fever in 16.9 deaths from all causes.
During the entire period extending from 1817 to 1878, inclu¬
sive, 62 years, the population of New Orleans increased from
24,196 to 210,000, actual increase in 62 years 175,804, or 727.
per cent.
The total deaths during this period, amount to 342,480, and
the total deaths from yellow fever 41,829, or one death from
yellow fever in 8.2 deaths from all causes.
During this entire period of 62 years, 1817-1878, inclusive,
yellow fever was not merely present, but caused deaths in
New Orleans every year, with the exception of 1821 and 1861.
If the disease was imported, it was annually imported, quar¬
antine notwithstanding.
If the disease was always imported, it found no difficulty at
short intervals of gaining a foothold, so that in the space of 62
years it swept off 41,829 victims out of a total mortality of
342,480 from all causes.
If the so-called germ of yellow fever “ -hibernates, ” it has
most successfully resisted the action of cold, for during the
entire period of 62 years, as we shall show in the next division
of our subject, there has annually occured a freezing temper¬
ature, the thermometer even in secluded places, always falling
during some period of the winter or spring to 32° and below.
In view of the powerful u hibernating powers of the yellow
fever germ ” in New Orleans, it would be well to consider the
probable utility of refrigerating ships and apparatus. If cold
is capable of being so applied in mid-summer as u to f reeze out
and destroy ” u the yellow fever germs ” under the blazing heat of
172
Abstract of Proceedings
[July
the tropics and along the low muddy banks of a great river,
in front of dreary quarantine buildings, enlivened by the song
of the mosquito, the croak of the frog and the thunder of the
alligator, let it be freely, fully and effectually applied to the
cargo at least, if not to the passengers themselves.
.Whatever the statistics of Mew Orleans may prove as to the
valuelessness of cold as a permanent and reliable disinfectant
capable of preventing the return of yellow fever, after the ice
has melted , the experiment is worthy of a trial, however feeble
the imitation may prove of the grand operations of the physical
universe.
If the increase of the population of New Orleans be esti¬
mated at the regular intervals of the United States census, we
obtain the following figures : In the 10 years 1820-1830, New
Orleans gained 19,134 inhabitants, or 70 per cent. ; in 10 years
1830-1840, increase 55,883, or 120 per cent. ; in 10 years 1840-
1850, increase 14,192, or 13 per cent. ; in 10 years 1850-1860,
increase 52,295, or 46 per cent. ; in 10 years 1860-1870, increase
22,748, or 13 per cent. There are no accurate statistics to show
the actual population in 1878, but judging from the disturbed
state of politics from 1870 to 1878, and the contraction of busi¬
ness, and the loss of commerce, the increase of taxes and pub¬
lic debt, the estimate of 210,000 as the population of New
Orleans in 1878, is above rather than below the true figures.
It is worthy of note, that during the 10 years, 1860-1870, em¬
bracing the entire period of the Civil War, and the still more
disastrous period of so-called u Reconstruction f there was an
actual decrease in the white population of New Orleans from
144,596 to 140,923, whilst there was an increase of colored pop¬
ulation (negro race) from 27,074 to 50,456.
Whilst, therefore, the whites actually decreased 3,673, the
colored population increased 23,382, or 85 per cent.
While the negro population of New Orleans had nearly
doubled itself in the ten years, 1860-1870, inclusive, on the con¬
trary, during the ten years, 1850-1860, according to the United
States Census, the white population had increased from 59,459
to 144,596, showing a gain of 55,137 ; and the negro population
from 26,916 to 27,074, showing a gain in this element of only
L58. A complete revolution was therefore made in the popula¬
tion of New Orleans, by the results of the civil war. The loss
of 3,673 white citizens during the period embracing the civil
war, 1860-1870, did not represent the actual destruction occa
sioned among the whites by the casualties of the war, for it
will be admitted on all hands that a large immigration set into
New Orleans from all parts of the Southern States after the
close of the war, and this city probably contained a larger
white population in 1866 and 1867 than at any previous or sub¬
sequent time. The prevalence of yellow fever in 1867, was
mainly due to two causes : 1st, the absence of yellow fever as
an epidemic since 1858, so that all children under 8 years of
age were liable to the disease ; and 2d, the influx of uuaccli-
mated strangers into the city.
1879]
Louisiana State Medical Society.
173
The immunity of New Orleans from yellow fever in 1888,
1864 and I860, can no more justly be referred to the sanitary
measures of the United States Government during this period,
than to those of the city and State, and Confederate Govern¬
ments in 1859, 1860, 1861 and 18(52, when New Orleans enjoyed an
almost equal immunity from yellow fevei, the deaths from this
disease being in these years respectively, 1859, 92; 1860, 15;
1861, 0; 18(52, 2. We have no data to show the actual number
of deaths amongst the Federal troops on land and water in and
around New Orleans, 1863-1865 ; that yellow fever was present
during this period and that it originated de novo in the port of
New Orleans is well established.
Dr. Elisha Harris, in his article, “ Yellow Fever on the Atlantic
Coast and at the South during the War” established that
“ Yellow fever visited twenty-five vessels in the fleet anchored
in the river in front of New Orleans during the summer of 1864,
and that the disease appeared first, namely, as early as Septem¬
ber 12th, in vessels that had been for a long time anchored
there. Filthiness, crowding, excessive heat and moisture, and
utter lack of ventilation and lighting, together with the stagna¬
tion of the local atmosphere of these oven-like boats, incident
to anchorage in a tideless stream, constitute the leading facts
relating to the infected vessels.”
The comparison of the preceding facts, with the statistics of
yellow fever in the Charity Hospital, already presented, leads
still more strongly to the conclusion, that epidemics of yellow
fever occurred most frequently and prevailed to the greatest
extent in those seasons in which a large number of passengers
from foreign countries arrived in the city.
Thus the following number of passengers from foreign coun¬
tries arrived in New Orleans and paid a specific tax to the
Charity Hospital : 1842, 30,832 ; 1843, 24,930 ; 1844, 19,788 ;
1845, 29,979 ; 1846, 34,549; 1847, 41,052, 1848, 40,9(52; 1849,
43,398 ; 1850, 38,423 ; 1851, 36,376 ; 1852, 45,335 ; 1853, 34,870.
It will be observed that the mortality from yellow fever in
the Charity Hospital, was, as a general rule, inversely propor¬
tional to the number of cases admitted. When a comparatively
small number of cases were entered, the mortality was rela¬
tively great, reaching in 1831, (56 per cent., 1832, 69 per cent.;
1834, 63 per cent.; 1836, 83 per cent.; 1838, 77 per cent.; 1840,
100 per cent.; 1841, 53 per cent.; 1846, (55 per cent.; 1852, 68 per
cent.; 1857, 65 per cent.; 1859, 78 per cent.; 1868, 62 per cent.;
1871, 68 per cent.; 1872, 72 per cent.; 1873, 63.55 j>er cent.; 1874,
(5(5 per cent.; 1875, 68 per cent.; 1876, 66 per cent.
It would appear, therefore, that when the pestilence appears
in a sporadic or even epidemic form, the mortality relative to
the number of cases, is much above the average of wide-spread
epidemics. Such facts sustain the view that the disease was
strictly sporadic and showed no marked tendency to spread in
New Orleans, in the period embracing 1871-1877, and that its
limitation was due to exterior physical causes, and not to the
174
Abstract of Proceedings
[July
lavish and expensive and empirical use of carbolic acid within
and around the premises where the disease appeared.
The mortality from yellow fever in the Charity Hospital, has
been fearfully great, 13,079 deaths occurring in 26,938 admis¬
sions. That is 48.55 per cent., or nearly one-half of all the
yellow fever patients admitted into the Charity Hospital during
a period of 55 years (1822-1878) perished.
In 1878, the number of cases of yellow fever admitted to the
Charity Hospital were less relatively to the number of victims
to this disease, than in former epidemics, owing to the absence
of foreigners, strangers and emigrants from the city.
The whole number treated was 817, with 411 deaths, or about
50 per cent, mortality. During the entire year there were in
the Charity Hospital, 1120 deaths and 4615 discharges ; remain¬
ing from 1877, 600. Total cases, 6335. Yellow fever, there¬
fore, caused in the Charity Hospital, less than one-half the
total mortality from all causes.
If the effort be made to determine the ratio of cases of yel¬
low fever, in the different epidemics to the population of the
city, the following data will serve for purposes of comparison.
The first authentic account of a yellow fever epidemic in New
Orleans, was in 1796, and from this date to the present time
1879, embracing a period of 92 years, there have been thirty-
eight epidemics, namely, in 1796, 1797, 1799, 1800, 1801, 1804, 1809,
1811, 1812, 1817, 1818, 1819. 1820, 1822, 1824, 1825, 1*27, 1828,
1829 , 1830. 1833, 1834, 1835, 1837, 1839, 1841, 1842, 1843, 1847,
1848, 1849, 1853, 1854, 1855, 1858, 1867, 1870, 1878. Of these 36
epidemics, 34 occurred between 1796 and 1755, a period of 59
years ; a period of rapid movement and increase of the popula¬
tion of the city. Whilst during the past 22 years, 1856-1878,
only four epidemics have occurred, namely, 1858, 1867, 1870
and 1878, a period of stagnation and of actual retrogression of
the wThite population, in which the disease has gathered force
in proportion to the unacclimated population. The mortuary
records of many of these epidemics are either wholly wanting
or are incomplete, and the data for the accurate determination
of the relations of the mortality to the number of cases, are in
most cases wanting.
We have shown that during a period of 62 years, 1817-1878,
the deaths from yellow fever alone, numbered in New7 Orleans
41,829; and if the proportion of cases to deaths be estimated
at 6 to 1 then we have an approximate estimate of 250,974 (two
hundred and fifty thousand, nine hundred and seventy-four)
cases of yellow fever in New Orleans, during a period of 62
years.
In 1817, deaths from yellow fever 823, or about one in 30 of
the population ; 1819, 425, 1 in 61.60 of population ; 1820, 400,
1 in 67.72 of population, 1 in 6 of adults, white cases, and 1 in
10 of all others ; 1822, 808 deaths, 1 in 39.24 of population ; 1829,
900 deaths, 1 in 52.84 of population ; 1832, 400 deaths, 1 in
137.71 of population ; 1833, 1000 deaths, 1 in 57.71 of population ;
1879]
Louisiana State Medical Society.
175
1837, 1300 deaths, 1 in 52.48 of population ; 1839, 800 deaths,
1 in 91.85 of population, in 892 cases, 68 deaths reported, or 1
in 13.1 cases; 1841, 1325, 1 death in 59.43 of population ; in this
year the proportion of deaths to cases was estimated by Dr.
Thomas as 1 in 3 ; 1847, 2318 deaths, 1 death in 46.85 of popula-
tion ; the number of cases in 1847, has been estimated as high
as 20,000, Dr. Thomas places them at 15,000, and the deaths at
2544, or 1 in about 40 of the population, and 1 in 6 of the cases
and according to these estimates, the mortality in 1847, ranged
between 1 in 6 and 1 in 8.62 cases ; 1848, 872 deaths, 1 in 132.45
of population ; 1849, 769 deaths, 1 in 159.72 of population.
In the great epidemic of 1853, the details for the correct
estimate of the total number of cases of yellow fever, although
still far from being perfect, were more precise than ever before
in the history of the epidemics of New Orleans.
Dr. E. H. Barton estimates the entire population of New
Orleans in 1853, to be 158,699, of which number 60,000 were
susceptible to yellow fever ; about 36,283 persons left the city
during the epidemic, and the population during the summer
amounted to at least 125,000 ; the total mortality from yellow
fever reached 8,101; ratio of mortality from yellow fever to the
the entire permanent city population, 1 in 19.02, or 5.25 per
cent.; to remaining population, 1 in 15.43, or 6.48 per cent.; to
unacclimated or susceptible population, 1 in 7.40 or 13.49 per
cent.; total mortality of the year, deducting all other causes
than disease, 1 in 10.19, or 9.8 per cent., and including all
causes of mortality, 1 in 9.76, or 10.23 per cent.; total number of
cases of yellow fever 29,020, deaths 8,101 or 27.91 per cent., or
1 death in 3.58 cases. In 1854, the deaths from yellow fever in
New Orleans numbered 2425, or 1 death in 64.74 of the popula¬
tion; in 1855, 2670 deaths, or 1 death in 61.7 of the entire
population ; 1858, 4855 deaths from yellow fever, or 1 death hi
34.1 of the population. The mortality from yellow fever alone
in the six years, 1853-1858, reached 18,325. Total deaths from
yellow fever in 1867, 3107, or 1 death in 59.2 of inhabitants, the
number of cases have been variously estimated between 25,000
and 50,000. In 1867 the mortality amongst the cases treated
has been variously estimated between 1 in 8 and 1 in 16 ; in
the Charity Hospital however, it was much greater, 672 deaths
occurring in 1493 cases, or 45.01 per cent., one death in 2.2
cases.
In 1870, the total deaths from yellow fever were 587, and the
total cases have been estimated at about 1700, or 1 death in
about 3 cases; 262 deaths occurred in 518 cases treated in the
Charity Hospital, or 50.57 per cent. In 1878 the officially
reported and recognized deaths by the Board of Health, Num¬
bered 4056, the number of cases was estimated variously
between 25,000 and 30,000 ; if we accept the first figure, the
ratio of deaths to cases was 1 in 6.16 cases. The total mortality
for 1878, was 10,318 (exclusive of still-born, 599), of which 8062
w ere whites, and 2256 colored, making of all colors the ratio of
176
Abstract of Proceedings
[July
50.17 per 1000 of population, or 55.32 per 1000 white, and 39.13
per 1000 colored population. The number that died of yellow
fever was 4046, of which 3863 were whites, and 183 were
colored; 4046 deducted from 10316, would give for all other
diseases 6272 ; making of all colors a ratio of mortality 30.62
per 1000 of population, or 28.31 per 1000 white population, and
33.95 of colored population. The ratio of mortality per 1000
from yellow fever was 19.30, and from malarial fevers, 3.77 of
entire population.
We have thus established a close relationship between the
origin and spread of yellow fever in New Orleans and the accu¬
mulation of un acclimated persons.*
* In confirmation of the view which I have advocated in the preceding pages, as to the
prevalence of yellow fever in New Orleans, at remote periods, the testimony of the cele¬
brated Andrew Ellicott, is worthy of the most careful consideration. In his Journal,
Andrew Ellicott states that on the 15th of November, 1796, he “arrived at Gallipolis
about eleven o’clock in the forenoon. This village is situated on a fine high bank on the
west side of the river, and inhabited by a number of miserable French families. Many of
the inhabitants that season fell victims to the yellow fever, which certainly originated in
that place, and was produced bv the filthiness of the inhabitants, and an unusual quantity
of animal and vegetable putrefaction in a number of small ponds and marshes within the
village. Of all the places I have yet beheld, this was the most miserable,” p. 13. With
relerence to the climate of Natchez, he s ys : “ The climate is very changeable during the
winter, but the summer is regularly hot; during my residence at h'atehez the greatest
degree of cold was about 17°, and of heat 96°, by Farenheit’s scale. The permanent degree
of heat may be stated at about, 1 4° beyond that of Pennsylvania. The conclusion is drawn
from the following facts : In Pennsylvania the mean temperature of the best spring and
well water is about 51°, and from the Mississippi east of the Atlantic, in the parallel of
31°, 1 found it about 65°, the difference is 14°, ” p. i35. “ The weather during the summer
season at New Orleans is warm, sultry and disagreeable ; but, during the cool months there
are few places more desirable ; it then abounds with health.” “ When the winds have
been unfavorable, vessels have been known to be upwards of six weeks in going up to
New Orleans from the Balize, which is a serious drawback upon the profits of a voyage ;
add to this the danger of sickness among the hands, if they should be unfortunately de¬
layed in that low, marshy country in summer, or the beginning of autumn.” p. 192.
Having finished his account of his labors in establishing the sonthern boundary of the
United States, Andrew Ellicott recorded valuable observations on the prevailing diseases
of Mississippi and Lonisiana, that made their appearance whilst he was in these southern
countries, during the years 1797. 1798 and 1799, from which we extract the following;
“ The prevailing diseases in the lower part of the Ohio, on the Mississippi and through
the Floridas, are bilious fevers, they varying their forms according to the state, or force
of their remote and exciting causes. Some seasons they are little more than the common
mtermittents and remittents, which prevail in the Middle States, but in others they are
highly malignant, and approach nearly to, if not become, the genuine yellow fever of the
West Indies. Gen. Sinclair, who had the advantage of a medical education, and is, more¬
over, a gentleman of a discriminating mind and distinguished talents, has assnred me
that he is well convinced the yellow fever is an endemic complaint in a large portion of our
south-western country where he resided as Governor a number of years,” p. 288.
“It did not appear to me during my residence in the country that temperance by any
means prevented the attacks of the fever ; on the contrary the free-livers frequently escape
it while the temperate suffer from it but there is this difference to be observed, the tem¬
perate with good management generally recover, and on the contrary the others when
attacked commonly 'sink funder the complaint in a few days. The natives, though not
wholly exempted from these fevers, are much less subject to them than strangers. I his
no doubt arises from a very natural cause, the constitutions of the natives are accommo¬
dated to the climate from their infancy, while the constitutions of strangers being
moulded to a different one yield more readily to those diseases. For although the human
species can exist in all climates, the constitution appears to be naturally adapted to that
in which the person is born and raised, and therefore upon changing the climate, the con
stitution is generally found to change also, and this change which is called the seasoning,
Is commonly effected by the prevailing endemic of the country. This change is very
sevem in the firm constitutions of our Northern citizens, which, like strong oaks in a
tempdlt, are broken off or torn up by the roots, while weak constitutions, like flexible
reeds, yield to the tempest, and rise when the storm is over.
At Natchez, in the month of June, 1797, we had a few cases of the fever among our
people, but the complaint was not general until about the middle of July. The attacks
were then severe, and one of my assistants and several of our people were then carried
off. Some of those who survived, were for several months extremely debilitated by
frequent relapses, which appear to be almost unavoidable in that country.” pp. 290, 291.
A ndrew Ellicott was himself attacked with a severe and dangerous fever on the 7t,b
of October, which left him greatly debilitated,
1879] Louisiana State Medical Society. 177
RELATIONS OF MALARIAL AND YELLOW FEVER TO CLIMATE.
Malarial fevers prevail chiefly in the summer and autumn iu
New Orleans, but they are never absent during any portion of
the year. Yellow fever on the other hand prevails chiefly dur¬
ing the months of June, July, August, September and October,
the heaviest mortality occurring as a general rule in August
and September, as will be seen from the following tables :
With reference to the causes of those fevers, and especially of yellow fever, Ellicott
observes: “It has been doubted by some, whether the climate of the Middle and some
of the Northern States is capable of producing the malignant fever of our Southern
States and the West India Islands ; but these doubts would, in my opinion be removed
from the mind of any person who would reside for a few years in the latter, unless ho
was previously wedded to a preconceived hypothesis or supposed facts, and his mind
entrammelled by prejudice.
A reluctance to admit truth, is little less in.j urious than the propagation of falsehood, and
the longer we contend that the climate of the Middle and some of the Northern States Is
incapable of geneiating the malignant fevers of the Southern States and West Indies, the
longer we shall be in danger of suffering by those scourges ; for while our measures are only
taken to oppose a foreign enemy, a domestic one may begin its ravages. Experience teaches
us that there are generally three things necessary to the production of the malignant
Southern fevers, first, heat ; secondly , water, swamps or marshes ; and thirdly a collection
of persons. And whenever we have a long continuation of heat, aided by the miasmata
from impure water, and marshes partially dry, coated with putrid vegetables, added to
a large collection of persons, each of whom by respiration is constantly rendering one
gallon of air per minute unfit for the functions of animal life, we are iu danger of being
attacked by a malignant fever.
From the locality of those fevers in the United States, may not a conclusion be fairly
drawn, that the cause, or causes, is, or are, in some degree local also, for if this were not
the case, these fevers would not be confined to our large towns on the water, but- extend
generally over the face of the country, which is contradicted by experience. And again,
if the fever had its origin from importation, why is it confined to particular places ? The
answer it is presumed, would be, thatinthe.se places there is a greater predisposition
from some exciting cause, whatever it may be, to receive the infection. Now let us see
to what point this answer would conduct us. If in these places there is a greater pre¬
disposition to receive the infection, it follows, that this predisposition in some degree de¬
pends upon local causes which produce this predisposition to receive the infection, can
from concurring circumstances be increased, may not a just and logical conclusion be
drawn, that they may be so heightened, as to produce that species of fever, which in a
milder form they prepare the system for.
As these fevers appear evidently to depend in part upon local causes, the means of pre -
vention will in an equal degree depend upon removing or correcting those causes.
It is the opinion of many persons, that our large commercial cities would be materially
injured, if they were thought capable of producing the malignant fevers of our South¬
ern country and the West Indies. This opinion however plausible, certainly rests upon
a slender foundation, because this opinion alone cannot prevent the recurrence of these
fevers, and it must be the recurrence whatever may be the origin, that will eventually be
found injurious.
If the fevers can possibly be generated in our larger commercial cities, in the Middle
and Southern States, we may, as has already been observed, be attacked by a domestic
enemy, while our measures are only taken to avoid a foreign one ; and if it should be
discovered that these fevers are not of domestic origin, it must be granted that from
some cause or other, there is a greater predisposition to receive the infection in our
large towns and villages, situated on our rivers, than in other places ; an investigation of
this cause would therefore be a subject of the highest importance, for in all priba-
bility, the removing the cause would secure us against this scourge, so injurious to
the interests, population and happiness of our country,” pp. 293, 294.
“ The Journal of Andrew Ellicott , late commissioner on behalf of the United States, dur¬
ing part of the 1796, the years 1797, 1798, 1799 and part of the year 1800, /or determining the
boundary between the United States, and the possessions of His Catholic Majestyin Amer¬
ica," Philadelphia, 1814.
The just and philosophical observations of Andrew Ellicott. expressed eighty years
ago, may well be considered at the present day. when the advocates of quarantine attrib¬
ute every epidemic of yellow fever to foreign importation and clo»e their eves blindly
to those local causes << i disease which the experience of three centuries have shown to be
so destructive to human life, in tropical, sub-tropical and Insular America.
23
178 Abstract of Proceedings [July
Monthly Deaths by Yellow Fever during a period of 32 Years, 1847-1878.
•£
GO
f-S
o
p— 1
s
£
V
—
£
<V
a
£
V
pO
a
* &
£ ©
C3 n .
O) ® f-
Date of First Case.
z
>>
A,
X*
So
o
>
V
<v
2
<5
CO
6
&
Q
H ^
1847
74
965
1100
198
33
2359
July 6th.
1818
4
33
206
467
226
20
759
June 21st.
1849
1
17
214
416
112
9
769
July 28th.
185(i
i
4
62
33
4
107
1 death Jan., 2 Mar., 1 May
1S51
8
6
2
1
17
1852
2
8
91
198
105
11
415
July.
1853
2
31
1521
5133
982
147
28
4
7849
May 22d.
1854
2
29
532
1234
490
131
7
2425
1st death June 12th.
1855
5
382
1286
874
97
19
7
2670
Juue 19th.
1856
14
40
16
4
7
74
■June 28th.
10
y’rs
3
42
2046
8225
5041
1796
453
38
17,444
1857
1
1
1
8
98
82
8
200
1 death reported in Janu’y
1858
V
132
1140
2204
1137
224
5
4845 1 death reported Jan. 10th
1859
1
59
28
3
91
June.
1860
3
7
5
15
1861
0
1862
1
i
2
1863
2
2 About 100 eases in II. S.
river lleet.
1864
4
1
1
6
deaths U. S. gunboats
1865
1
1
1866
5
56
89
31
4
185
1 death 10th August.
10
y’rs.
3
137
1154
2277
1387
339
21
5347
1867
3
11
255
1637
1072
103
26
3107
1 case died Juue 10th.
1868
5
5
Oct. 5, died in Charity Hosp.
July 17th.
May 26th.
1869
1870
1
2
3
1
3
231
242
106
5
588
187.
2
1
19
9
22
19
2
54
July 30th.
August 28th.
July 9th.
1872
5
24
7
2
39
1873
3
108
79
17
226
1874
2
6
2
1
11
August 19t.h.
August 8tb.
August 11th.
1875
5
24
20
9
3
61
1876
1
19
17
4
1
42
10
y’rs.
-•
4
15
288
2037
1484
267
39
4136
1877
1
1
November.
1878
2
50
974
1893
1044
90
3
4056
May 22d.
2
2
50
974
1893
1044
91
3
4057
y’rs.
32
5
49
2248
10,641
11,158
5711
1150
101
30.984
y’rs.
1879J
Louisiana State Medical Societi/.
179
From the preceding table it is evident that as a general
rule the great epidemics, as those of 18 47, 1848, 1^49, 1>53,
1854, 1855, 1858, 1867 and 1878, commenced early in the hot
months, May, time and July, and attained their maximum
intensity in August and September. Thus, during the entire
period of 32 years, the deaths from yellow fever in New
Orleans were as follows: January 6, February 0, March 2,
April 0, May 5, June 49, July 2248, August 10,641, September
LI, 158, October 5711, November 1150, December 101.
The curve of yellow fever, therefore, corresponds to a certain
extent with the curve of temperature. Thus, from the records
of 38 years, which I have consolidated and calculated from the
most reliable data, the mean temperature of New Orleans is as
follows : January 56.28, February 58.03, March 64.27, April
69.41, May 75.00, June 81.35, July 83.21, August 83.14, Septem¬
ber 79.64, October 70.27, November 62.30, December 56.43,
Spring 69.56, Summer 82.53, Autumn 70.75, Winter 56.91, year
69.51 F.
The origin and spread of yellow fever therefore depends
absolutely upon an elevated temperature ranging from 70° to
85°, and its decline depends upon a mean temperature ranging
from 65° to 56° F. These figures of course relate to the mean
or a verge monthly temperature, the extremes being much
higher and lower, ranging during the year in New Orleans, as
shown by meteorological observations extending from 1817 to
1878, from 16° to 100° F.
On the other hand the various forms of malarial fever are
more uniformly distributed throughout the months of the year,
although this class of diseases as well as yellow fever, show
their maximum intensity in number of cases and fatality in
those months of the year, in which the temperature is most
favorable to the putrefaction of animal and vegetable matters,
and the development of the lower and most prolific forms of
animal and vegetable life, and especially those forms which are
active agents in putrefaction and fermentation. Thus the
deaths caused by the various forms of malarial fever, were in
1878, as follows: January 6, February 3, March 9, April 15,
May 12, June 13, July 25, August 136, September 146, October
111, November 41, December 6.
The mortuary records, however, give but an imperfect and
delusive view of the relative prevalence of the various forms of
paroxysmal or malarial fever in New Orleans, from the well
known fact, that these diseases rarely prove fatal. The favor¬
able results obtained in the treatment of intermittent, remit¬
tent and congestive malarial fever, are at the present day
mainly due to the free and prompt administration of quinine by
the physicians of this city and of other parts of the Southern
country.
The relationship of the forms of malarial fever, to the climate
and seasons, and to other diseases as yellow fever, are best es¬
tablished by the statistics of fever hospitals situated in malarial
180 Abstract of Proceedings [July
districts, where also yellow fever is at times endemic and
epidemic.
The records of the Charity Hospital of New Orleans furnish
the best field for such inquiries, as it has been justly regarded
as one of the great fever hospitals of the world. The follow¬
ing statistics will serve as illustrations of the numerical rela¬
tions of malarial fevers to climate and yellow fever.
It appears from the records of the Charity Hospital, that
during a period of ten (10) years — 1st January, 1841, to 1st of
January, 1851, there were admitted into this hospital 91,892
patients; of which number there were admitted of all the differ¬
ent forms of fever 45,149; and among these last for intermittent
fevers, 25,183.
It would thus appear that nearly one-half of all the patients
admitted into this hospital were for the different forms or types
of fever and that more than half of these were intermittents. It
should be mentioned that this vast number of patients, included
a lunatic asylum, having from sixty to ninety inmates, up to
June, 1848, when it was removed to Jackson. This large
number of fever patients included many that were imported by
sea, and brought from neighboring States and foreign coun¬
tries, and furnished also by the army of Mexico, which twice
passed, during this period, through New Orleans. The inter¬
mittent and paroxysmal form of fevers, mostly originate in
the Mississippi Valley, whilst the continued fevers are mostly
imported.
The following statement will show the prevalence of inter¬
mittent fevers at the different seasons of the year, for the time
specified.
Table of Admissions of Cases of Intermittent Fever , in Charity Hospital of New
Orleans, in the diffierent Seasons of the Year. 1841-1849, inclusive.
Intermittent Fever.
Year.
Spring.
Summer.
Autumn.
Winter.
All Fevers.
Yellow Fever.
1841
112
403
177
92
1991
1113
1842
114
453
394
135
1758
410
1848
85
208
413
137
2222
1053
1844
117
469
732
231
2207
152
1845
180
353
664
206
1763
1
1846
236
569
1045
218
2603
148
1847
391
508
691
602
6901
2811
1848
282
(589
874
535
8361
1234
1849
420
1701
3738
1275
7575
1060
Total.
2443
5353
7728
2331
33,381
9782
During the years specified, there was but one single year
(1845), in which New Orleans was exempt from yellow fever.
1879]
Louisiana State Medical Society.
181
It is evident, from this table that intermittent fever prevails
in New Orleans the year round, gradually increasing from the
winter up to the autumn, when it begins to decline. Whilst
variations appear in different seasons and years, and whilst the
cases were most numerous when there was less yellow fever ;
still intermittents are never absent, even when yellow fever
commits its greatest ravages, as in 1841, 1847, 1848 and 1849.
If during the nine years specified, the months be selected in
which yellow fever prevailed to the greatest extent, the follow¬
ing relations to the cases of this disease and malarial fever,
will be established.
Fever Statistics, Charity Hospital, Sew Orleans, La. — Tables showing the An¬
nual and Monthly Admissions of the Different Fevers.
Year.
_ ® •
i'3 ;
S'V £
8 s x
4380
Fevers.
a
a
March.
P«
<J
>>
s
<£>
P
P
►“2
CD
P
<5
Sept.
O
O
>
0
J5
Dec.
1
Total
Fevers.
1841
Intermittent...
Typhoid .
3
1
4
3
27
45
39
28
9
65
6
187
7
31
3
151
'3
13
3
174
18
5
642
66
*3
1
252
93
5
1
7
37
T43
72
6
2
2
8
0T
794
12
24
39
6
1113
3
1991
Congestive ....
Remittent .
Mal’g, Intermt .
Yellow .
3
2
1
2
Bilious .
Total.... 1841 11
32
46
41
37“
7 r
228
362
665
322
1842
4404
Intermittent ..
45
29
35
39
45
121
160
169
144
140
110
61
1092
Remittent _ _
4
1
3
4
8
1 i)
o4
41
35
11
3
155
Typhoid .
9
2
4
2
2
2
1
22
Bilious.. .. _ _
2
3
9
3
1
2
2
1
23
Congestive....
i
3
3
2
10
5
4
9
2
1
40
Gastric .
1
2
6
1
1
11
Catarrhal .
1
1
1
3
Yellow .
47
247
93
23
410
Nervous .
1
1
Adynamic .
1
1
Total . 1842:59
31
39
47
52
142
197
259
439
284
150
79“
1758
1843
5013
Intermittent.. .
31
30
35
31
19
40
70
98
128
136
149
76
843
Typhoid . .
2
2
4
Remittent. ...
1
1
9
40
75
49
12
8
io
205
Catarrhal .
1
1
2
Bilious .
1
1
15
3
37
5
2
2
3
2
71
Typhus .
3
6
9
Congestive ....
3
17
4
24
Gastric .
l
1
1
4
7
Continued ....
1
1
Yellow .
32
188
365
351
111
15
1053
Cephalic .
3
Total.. .1843
36
30
35
33
34
60
194
372
544“
501
273
107
2222
182 Abstract of Proceedings [July
Fever Statistics of Charity Hospital — Continued.
1844
5846
Intermittent ..
66
49
41
32
44
75
176
258
255
261
216
116
1589
Remittent ....
2
4
2
1
4
24
30
47
67
55
5
3
244
Yellow _ _ _
2
2
1
1
1
68
52
25
152
Typhoid .
6
1
3
3
10
12
1L
8
6
20
80
Simple .
3
6
3
12
Gastric .
1
2
1
5
2
11
Typhus .
4
4
2
4
2
l
3
1
13
Inflammatory..
1
2
~2
2
2
2
11
Congestive ....
1
11
17
14
13
15
3
81
Advnatnic .
2
2
4
Continned .
2
3
5
Eruptive .
1
Total.... 1844
IT
6iT
50
41
59
n?
239
333
423
40T
254
145
2207
1845
6136
Intermittent...
7
75
57
44
79
112
145
96
279
196 189
124
1403
Tvphoid .
7
6
5
2
io
8
11
14
18
20
15
23
139
Remittent .
2
1
1
11
17
38
34
33
17
154
Congestive....
3
i
1
2
1
4
5
4
I
21
Inflammatory..
2
1
1
4
Yellow .
1
1
Continued .
1
2
1
1
5
Nervous .
1
1
1
3
Bilious .
1
2
6
1
1
1
2
14
Simple .
1
4
1
1
1
1
9
Pernicious .
2
2
4
Other fevers. . .
2
1
2
1
6
Total.... 1845
21
84
63
52
106
151
201
151
339
‘241
206
148
1763
Year.
t-i *
2 § a
© .2
8s*
8044
Fevers.
a
eS
l-S
2=
J.
5b
13
3
o
u
IS
75
7
5
1
p.
_
76
5
ce
s
G
G
l-5
214
14
2
4
August.
Sept.
©
O
376
7
36
9
83
1
1
2
6
1
>
0
Sb
310
23
7
2
32
1
4
l
380
6
©
Q
Total
Fevers.
1846
Intermit’nt
Typhoid. ..
Remittent.
Congestive.
Yellow .
79
30
3
85
10
7
l
138
12
6
2
227
17
9
2
359
5
22
5
29
2
9
2
81
52
3
5
4
1
1
147
2078
195
103
31
148
4
11
1
3
8
2
6
11
l
1
Bilious ....
1
1
*1
1
2
2
Pernicious.
Catarrhal .
Nervous.,..
Scarlet ....
Malignant .
Larvata _
2
1
2
i
'2
Pern’c’s iu’t
Gas. Hep’tc
Ataxic .
, ' ’
246
! Total 1846
117
75
90
83
104
161
255
433
522
2603
1847
11,890
Intermit’nt
144 117
98
153
140
211
223
74
53
258
380
341
2192
Typhoid....
40
21
50
73
66
20
7
2
1
6
60
111
457
Typhus.. . .
..
2
4
107
165
369
57
1
4
100
236
1045
Remittent .
4
1
4
9
17
38
69
64
25
12
18
8
269
Congestive.
1
1
1
2
3
12
10
1
1
0
2
36
Yellow .
5
148
Kill
777
219
49
2
2811
Bilious... .
2
2
4
7
2
1
9
7
8
42
Pern. Int’m
1
2
1
l
5
Other fev’s.
1
3
1
1
2
6
26
40
Total, 1847
193! 142
157
346
3961661
521
1756
857
512 622
834
6897
1879] Louisiana State Medical Society. 183
Fever Statistics of Chanty Hospital — Continued.
1848
11,945
Intermit’nt
187
115
101
72
no
160
219
310
299
334
271
233
2411
Remittent
5
8
17
14
25
57
101
87
64
68
39
5
490
Typ’s, typ’d
520
588
267
169
117
28
23
11
9
56
64
30
1883
2
2
31
462
597
105
34
1
1234
Catarrhal . .
10
. .
1
2
13
Bilious ....
22
17
11
14
4
13
32
27
19
6
5
3
173
Ephemeral.
10
5
8
6
4
3
5
14
9
5
. _
4
83
Congestive.
2
2
2
3
13
8
16
2
1
4
1
54
2
1
1
1
2
7
Dengue ....
5
1
1
7
Puerperal. .
1
.
1
Continued.
1
1
l
1
1
• •
1
6
Total, 1848
757
734
406
280
267
280
421
929
1004
576
*-
*0
c 1
277
6361
1849
15,558
Intermit’nt
109
114
138
117
69
155
368
592
763
720
360
684
4439
Typhus. .. .
127
193
140
128
65
43
44
49
21
23
58
891
Typhoid. . .
79
79
Remittent..
5
10
13
14
30
49
72
166
223
116
76
50
824
Bilious . . . .
6
6
19
9
6
10
39
20
11
3
1
130
Yellow .
. .
. .
2
28
374
520130
6
1060
Ephemeral
4
8
is
18
6
2
7
8
7
1
2
1
82
Congestive.
1
4
2
6
8
8
4
6
39
Puerperal. .
1
2
..
1
4
Scarlet .
i
...
1
Cerebral . .
1
1
1
3
Continued..
1
-
6
6
1
2
2
1
1
20
Total, 1849
205
265
381
298
241 1293
590
869
1418
1392 806
806
7575
1850
18,676
Intermit’nt
7891
Remittent .
2278
B-.lious .
80
Congestive
31
Cong. Inter
103
Typhous.. •
1044
Cong, remit
4
Malig in’mt
34
Contiinued.
]
77
Ephemeral.
83
Malignant. .
1
Puerperal . .
4
Scarlet .
3
Ataxic .
4
Yellow .
9
Dengue....
1
Mesenterica
1
Total, 1850
11,768
Tables 1841-1849, embrace those consolidated from records of Charity
Hospital by Dr. Fenner.
It is thus made evident that paroxysmal fevers prevail every
year and in every month of the year in New Orleans, thus pre¬
senting a marked contrast to the prevalence of yellow fever,
which is shut up to much narrower limits.
It appears that the cause of yellow fever, requires for its
generation and propagation a higher degree of heat, and that
the conditions of its existence are more narrowly defined than
those of malarial fever. The cause of the latter disease not
only resists successfully a much lower temperature than that
of yellow fever, but when once engrafted on the human system,
184 Abstract of Proceedings [July
it is far more persistent and indefinite in its duration, and in
fact in many cases produces such profound alterations in the
constitution of the blood and in certain organs as the spleen
and liver, as to constitute a condition of the system, which
may underlie and modify supervening diseases. In this respect
therefore, the prolonged action of the malarial poison, resem¬
bles that of syphilis, in that it produces radical changes in the
blood and arteries.
Yellow fever, on the contrary, acts as a specific well defined
disease, affecting as a general rule, the constitution but once,
and in the vast majority of cases leaving no recognizable traces
of its action.
CLIMATE OF NEW ORLEANS -ITS RELATIONS TO MALARIAL AND
YELLOW FEVERS, MONTHLY AND ANNUAL ELEVATIONS AND
DEPRESSIONS AND MEAN OF TEMPERATURES— SUMMARY OF
METEOROLOGICAL OBSERVATIONS.
T have consolidated the following tables from the most relia¬
ble sources, and they constitute valuable records for present
and future records in the study of epidemics in New Orleans
and the Mississippi Valley :
Monthly Mean Temperatures ; Mean Temperatures, Spring, Summer, Autumn and
Winter ; Mean Annual Temperature in New Orleans, La., lat.29' 57', long. 90°50'.
alt. 10 ft. Consolidated by Joseph Jones, M.D.
*4
<D
X
Janu'ry.
Febru’y.
March.
| April.
CS
tH
June.
j July-
j August.
u
a
-S
p*
<D
m
| October.
u
"g
©
>
o
a
8
o
©
ft
J Spring.
Summer.
0
a
0
d
Winter.
Year.
1820
79 00
8f> 00
82.00
85 00
81 00
65 00
57 00
60.00
84 AA
67 66
1822
52.90
51.60
64.10
70.80
72.20
•*4.30
81 50
82.80
79.50
71.40
67.30
57.70
68.86
82,86
72.73
54.06
70.10
1825
53.26
53.33
67.80
66.90
81.82
88.54
82.95
84.33
30.17
65 70
62.60
44.00
72.17
85.27
69.49
50.21
68.90
182(i
53.20
63.27
70.71
72.54
77.61
83.24
84.16
85.15
86.64
72.97
65-55
58.28
78.62
84.18
73.05
58.25
72.27
1827
56.74
66.85
64.31
73.03
74.00
82.65
84.50
82.40
80.60
67.57
62.04
62.00
70.1!
83.15
71.91
61.86
72.30
1828
64.58
66.01
65.34
1 832
60.50
74.25
78.64
82.75
82.52
77.65
81.30
1833
55.37
60.35
60.71
1 834
70.74
63.03
59.10
1835
51.60
49.60
60.40
68.00
79.50
81.80
81.10
83.00
76.60
69.90
63.70
63.90
69.30
81.63
66.73
51.70
68.30
1838
56.61
52 38
64.10
67.19
68.65
82.07
82.47
82.11
77.85
68.39
57 07
52.85
66 65
82.22
67.60
58.95
67.61
1839
56.22
54.48
60.96
70.98
77.33
83.03
82.48
82.25
79.22
75.35
57.40
48.09
69.76
82.59
70.67
52.93
68.99
i84C
55.09
61.77
69.15
70.38
77.30
79.97
85.56
84 96
78.9!
74.32
65.66
56,13
73.61
S3.50
72.96
57.66
71.96
ieu
55.46
55.61
64.81
71.62
76.17
84.35
87.02
83.86
78.48
69.17
61.83
55.40
70.87
85.08
70.16
55.49
70.40
1849
56.96
58.50
71.35
69.80
74.96
80.56
-0.25
79.58
78.63
69.03
59 06
33.29
72.03
80.13
68.91
55 25
69.33
1843
55.43
54.16
62.03
70.85
75.79
78.50
81.40
80.20
80.60
68.20
68.13
55.77
62.22
8o.08
69.03
56.12
67.61
1844
58.54
•r9.29
68.55
72.52
78.46
79-80
84,30
82.00
79.10
68 20
65.02
57.18
71.51
81.51
70.75
58.33
70 52
1845
57.25
59.91
62. 1 1
72.75
73.20
79.40
69.85
184b
67.16
75 28
80. 1 4
82.73
68 82
63.94
62.14
67.98
1847154.85
57.30
61.90
71.48
76.56
78.75
81.82
82.68
77 85
71.16
69.37
58.25
69.98
81.08
71.13
55.13
69.33
1848 58.18
61,67
64.38
68.39
76.47
82.86 80.42
81.25
79.51 73.67
59.58
59.43169.73
81.51 179.92
59.76
70.48
1849 60.89
56.08
70.17
71.00
76 82
81.08 81.10
85.10
81.0069.80
66.00
61.90
72.63
82.4272.23
59.62
71.70
1850
59.31
55.32
63.89
68. 1 3
72.26
70.12 82.54
36.10
83.40 66.41
60.58
55.49
68.09
81.58 70.13
56.71
79.10
1851
54 43
59.79
61.64
68 24
75 80
83.10 85.20
84.00
80.5069.67
60.89
55. *1
68.23
84.10 70 35
56.48
71,50
1852
46.59
62.10
63.96
67.27
78.10
80 80 84.00
83.20
80.90 74 25
61.37
61.98
69.77
82.66 72.17
56.89
70.40
1853
50.65
56.51
62.70
70.42
74.33
80.23 82.60
84.3(1
80.10 65.80
66.00
51.10
69.15
82.37 70.93
52 78
67.79
1854
53 40
56.50
66 20
64.60
75.10
80.60 80.10
81.50
78.1069-90
57.10
52.20
68 63
80.73 68.36
54.03
68.00
1855
54 80
51.85
59.80
70.33
79.16
81.88 82.78
84.80
82.14 67.10
66.68
56.66
69.76
82.38*71 .97
54.43
67 90
1856 55.27
58.35
64.15
70.06
75.62
81.11 82.79
82.87
78 94 71.75
62 44
55.98
69.94
82 26 70 71
56.53
69.86
185750.58
64.98
62.35
64.96
74.16
80.09 81.80
81.80
80.15 69.77
61.10
58.13
67.15
81.23 70.34
57.89
69.15
185859,96
56.23
64.41
71.50
77.05
81.07183 57
83.93
79.9674.96
54.73
61.47
70 99
82.86 69.88
59.22
70.73
1859 53 91
63.40
66.48
70.43
79.10
82.11 83.35
82.50
80.43 70 74
65.67
53.65
72 01
82 97 72.28
57.02
71.07
1860
56.99
59.51
64.97
76 04
80.03
86.46 88.66
85.37
82.99,72.13
61.55
35.31
73.68
86.83 72.22
53.97
72.50
1873
49-88
60.12
61.37
67.95
75.19
81.66 a3.57
82.28
79.5668 21
61.46
56.92
68.17
-2 50
69.74
55 64
69.14
1874
56.71
59,59
67.81
66.22
76.91
82.62 86.33
85.02
80.41
70,94
64.10
59.48
70.37
83.32
71.65
58.58
70.99
1875
53.89
55.23
64.10
65.82
77.4280.89183.09
80.14
77.21
68.15
66.44
62.62
69.11
81.34
70.60
57.24
69.57
1877
53.08
55.93 60.64
67.50
73.53
78.13 81.71
83.29
78,44
70 49
58.41
56.77
07.24
81 04
69.11
56.26
68.16
1878
51.08
55.50
66.36
71.41
75.54
81. 95(83.83
83.59
78.75
71.42
59.46
50.85
71.10
83.12
69.87
52.49
69.14
Mean
1820
of 38
to
56.28
58.03
64 27
69.41
75.00,81.35
83.21
83.14
79.64
70.27
62.30
56.43
69.56
82.53
70.75
56.91
69.51
years
1878
1879|
Louisiana, State Medical Socict; /.
185
The preceding record has been constructed from the most
reliable data extant, with reference to the climatology of New
Orleans : namely, the metrological records of the Military Post
of New Orleans, extending over a period of 20 years, 1825,
1853; the statistics published by Dr. Barton, embracing a
period of 19 years, extending from 1833 to 1853 and the manu¬
script of D. T. Lillie, Esq., and from reports of the Board of
Health.
From the preceding record of 38 years, extending with some
interruptions from 1820 to 1878, inclusive, the mean annual
temperature of New Orleans is 69.51°. According to the
meteorological records of the Military Post of New Orleans, ex¬
tending over a period of 25 years, the mean annual tempera¬
ture is given a fraction higher ; namely, 69.9° ; whilst accord¬
ing to Dr. Barton, it is much less, or 67.6°.
The statistics which I have presented in the preceding table
must be regarded as the fullest and most accurate expression of
the temperature of New Orleans, and we must accept the mean
annual temperature as 69.51°, with a range during the period
specified of 72.50° maximum to 67.61° minimum annual tem¬
perature. The mean annual temperature of New Orleans is
lower than that of Havana, Cuba, 75.9°; of Matanzas, Cuba,
78.3°; Ubajay, Cuba, 73.4°; of Nassau, Bahamas, 78.7°;
of Rio Janerio, South America, 73.7°; of Vera Cruz, Mexico,
77 to 79.8°; of Kingston, Jamaica, 78.7°. The isothermal
line of mean annual temperature of New Orleans passes
through the north of Africa, through Morocco and Barbary,
skirting the northern boundary of the Great Desert of
of Sahara, and crossing Egypt in a line with the Isthmus of
Suez, and in the latitude of Alexandria, and passes on through
the northern portion of Arabia, the middle of Persia, and
Afghanistan, the north of India and the south of China. By
its climatic relations, and especially by its mean annual tem¬
perature, New Orleans is connected with those portions of
Africa and Asia, from whence have sprung in past ages some
of the greatest plagues which have desolated the human race.
The isothermal 70°, for the year, which is very nearly that
of New Orleans, is nearly on the parallel of 30° — rising above
it at the Gulf of California, and falling below in the interior
and in Texas, it follows the northern coast of the Gulf of
Mexico, and crosses the Atlantic and Africa nearly in a
straight line. It bends north at the head of the Red Sea,
and across the desert until it strikes the Himalayas, from
which point it turns southward and is below the Tropic of
Cancer. Off the west coast of California it falls nearly
as low' — its general course being in a right line along the
the 30th parallel, from which it is abruptly turned southward in
approaching Canton from the west, and in leaving the Cali¬
fornia coast. The last curvature is due to the now' ■veil known
24
186
Abstract of Proceedings
fJnly
mass of cold water off that coast, and at the east of Asia it is
apparently a merely continental effect, which would have been
felt here if the continent had occupied the place of the Gulf of
Mexico.
It is remarkable that the average position of this line is farther
north in the new than in the old world.
The average temperature of the spring in New Orleans is
69.56°, and very nearly 12 i° below that of the winter, 56.91°.
The average spring and winter temperatures of those places
in which yellow fever is said by the contagionists and quaran-
tinists to be indigenous are as follows : Havana, Cuba, spring
75.7°, winter 68.4°; Kingston, Jamaica, spring 78.1°, winter
76.1°; Matanzas, Cuba, spring 78.9° winter 78.4°; Nassau,
spring 77.7°, winter 70.7°; Rio Janeiro, spring 74.7°, winter
79.1°; Vera Cruz, Mexico, spring 77.8°-78°, winter 77°-79.8°.
The mean summer temperature of New Orleans is 82.53° ; of
Havana 84.2°; of Vera Cruz 81.5°. The mean autumnal tem¬
perature of New Orleans is 70.75°; of Havana 75.5°; of Vera
Cruz 77.2°-78.7°.
The most marked difference between the climate of New
Orleans and that of Havana, Cuba, is that the winter is colder
by 11°, F., and the spring colder by 6°, F., in the former. The
average temperature of the summer in New Orleans, is 1°
higher than that of Vera Cruz, and 1.7° cooler than that of
Havana ; the average autumnal temperature of New Orleans is
4.8° lower than that of Havana, and between 7° and 8° lower
than that of Vera Cruz. It is evident, therefore, from these
results, that the differences of climate between New Orleans
and Havana are not so great as to warrant the dogmatic
and oft repeated assertion, that yellow fever cannot originate
de novo in New Orleans ; neither do they sustain the idle lucu¬
brations about the so-called hibernation of the yellow fever
germ.
If the curve of the monthly temperature of New Orleans be
projected upon a chart, it will be found to rise in January,
from a mean temperature of 56.28°, to 58.28° in February,
64.27° in March, 69.41° in April, 75° in May, 81.35° in June,
83.21° in July, and 83.14° in August; the maximum tempera¬
ture of June and July then descends to 79.64° in September,
70.27° in October, 62.30° in November, and 56.43° in December.
The rise and progress of the temperature during the summer
corresponds to the rise and progress of yellow fever in New
Orleans.
■UIJV
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188
Abstract ; of Proceedings
[July
The maximum temperature, 100° F., for the entire series of
years 1817-1878, was attained in 1841 and 1850; in the former
year about 1800 deaths were occasioned by yellow fever, and in
the latter the victims numbered only 107. The next highest
temperatures with the annual mortality by yellow fever, were as
follows: 1874, 99°, deaths from yellow fever, 11; 1838, 98°, no
epidemic; 1840, 98°, 3 deaths; 1873, 98°, 220 deaths; 1800, 97°,
15 deaths ; 1877, 90.5°, 1 death ; 1820, 96°, 5 deaths; 1839,96°,
800 deaths ; 1852, 96°, 450 deaths; 1843, 95°, 1000 deaths;
1855, 95°, 2015 deaths;- 1875, 95°, 01 deaths; 1878, 95°,
4050 deaths; 1847, 94°, 2000 deaths; 1848, 94°, 872
deaths; 1849, 94°, 709 deaths; 1853, 94°, 7849 deaths ; 1862.
94°, 2 deaths; 1803, 93.5°, 2 deaths; 1804, 93.5°, 0 deaths.
Such facts indicate that the prevalence of yellow fever in New
Orleans is not necessarily associated with the prevalence dur¬
ing the hot months of the highest degrees of heat.
The minimum temperatures were reached in the following
years, with the accompanying mortality from yellow fever:
1870, ] 6°, F., 587 deaths ; 1852,17°, 450 deaths; 1804, 18°, 0
deaths; 1872, 19°, 39 deaths; 1877, 21°, 1 death ; 1838, 22°, F.,
no epidemic ; 1878, 23°, 4050 deaths ; 1870, 24°, 42 deaths ; 1820,
25°, 5 deaths ; 1845, 20°, 2 deaths; 1850, 20°, 107 deaths. Such
facts woidd seem to sustain the proposition, that extremes of
cold were unfavorable to the generation of yellow fever. But
a more critical examination will show, that this proposition
should not be unconditionally accepted : for the effects of the
extreme cold temperatures of each year should be considered
in the months of January, February and March, and of the
months of December, November and October of the year imme¬
diately preceding. The early supervention of cold weather
and of frost without doubt, exerts a marked effect, in arresting
the progress of epidemics of yellow fever, and it would also
appear that an excessive degree of cold in the winter preceding,
tended to remove or retard the operation of the cause or causes
inducing yellow fever. It is worthy of note, that during the
entire period covered by the preceding table, in almost every
year, the temperature fell in New Orleans, during the winter
months, to that point which insured the occurrence of frost,
and the induction of that low point of temperature, which in¬
sured the arrest of the epidemic constitution necessary to the
generation and propagation of yellow fever.
The connection of yellow fever with the rain fall is worthy of
study ; and as a scientific basis for this investigation we have
consolidated from the most reliable sources the following table.
L879J I At wisiana State Medical Society. 189
Monthly and Annual Bain-fall in New Orleans, La., for a series of years, consolidated
by Joseph Jones, M.D., expressed in inches and fractions of an inch.
Year.
*4 ®
as -
hM i—
March.
Inches.
April.
Inches.
May.
Inches.
June.
Inches.
July.
Inches
CD &
Sept’r.
Inches.
Octo’r.
Inches.
Nov’r.
Inches.
. OC
¥
O rT*
2L S
W >— <
Year —
Inches.
Mean 6 )
years. >
57.85
1633-18-38 S
Mean 3 ^
years, >
4.66
2 25
2.59
6.21
2.95
6.10
6.38
5.72
560
1.37
3.18
2.87
1836-1838 )
18 19
8.10
3.40
2.19
2.10
2.02
3.11
9.86
4.80
0.12
2.40
3.92
4.40
46.42
1840
0.11
2.01
1.09
3.10
4.80
7.10
5.60
3-10
1.80
7.80
5.55
2.22
44.28
1841
19.50
5.10
6 90
5-10
1.70
3.10
0.89
3.41
2.87
2.41
0.11
9.44
60.53
1842
4.21
3.51
2.71
5.20
1.12
1.13
4.52
7.40
4.80
1.50
3.25
1.70
41 .05
1843
4.00
3.80
5*31
2.67
0.45
14 57
6.33
5.11
5.51
3.49
1.93
6.04
1844
4.41
0.73
3.90
0.53
3.16
2.75
9.80
5.21
1.08
2.18
7.78
1.35
38.97
1845
6 24
1.19
5.16
1.99
8.06
3.20
1.88
4.53
4.30
6.26
4.62
6.20
1846
9.20
6.66
7.88
10.70
9.37
7.98 8.86
6.90
6.32
1.14
1.56
1.55
1847
7.71
3.77
3.40
4.63
4.80
3.43 5.06
6.81
2.83
0.75
2.59
7.73
53.51
1848
5.42
1 26
1.97
3.92
4.75
9.36 7.7P
8.37
0.80
2.31
8.83
1.86
56.66
1849
3.55
2.45
2.83
2.43
8.01
3.7911.09
4.85
4.01
6.88
4.48
2.52
1850
7.40
4 53
2.27
4.10
6 20
8.92
6.31
10.95
1.85
0 96
1.58
3.46
1851
3.82
3.18
1.20
3.49
2.93
2.21
2 13
10.46
3.85
3.70
9.00
2.69
1852
0.80
1.45
4.24
5.25
7.23
1.64
7.44
1.75
1.16
2.83
7.00
5.30
1853
3.20
4.20
7.38
1.88
2.80
1.86
11.71
7.01
5.04
5.17
7.03
4.57
1854
1.89
9.84
4.18
3 81
6.15
4.03
2.94
3.48
8.92
4.84
1.55
1.16
52.75
1855
0.86
2.06
0.82
2.00
1.77
1.75
7.24
4.12
4.36
2.10
5.59
8.23
1856
8.90
3.68
3.73
2.85
2.53
5.79
8.63
16.12
3.20
2.29
4.65
4.75
67.12
1857
2.68
1.97
2.86
1.73
7.33
2.90
5 86
4.64
2.55
5.01
3.05
5.10
45.68
1858
3.71
4.30
4.71
2.26
3.45
4.89
7.72
7.35
3.67
4.13
3.20
3.42
52.81
1859
6.40
3.77
7.84
3.99
1.94
7.12
0.93
6.17
1.19
2.17
2.79
5.09
49.40
1860
0.64
8.61
0.76
2.42
1.26
5.07
1.50
4.50
1.80
5.66
4.28
2.74
39.24
1861
7.58
0.01
4.41
3.62
8.71
6.14
3.95
0.25
0.76
1862
3.79
2.76
2.83
4.10
0.65
0.58
4.54
2.15
4.68
1.03
0.36
1.59
1863
2.11
3.56
3.73
0.31
3.02
2.62
3.3(i
4 44
1.74
1.67
0.26
4.12
1864
3.42
0.30
3.05
0.98
0.68
2.86
1.91
7.98
2.15
2.22
0.77
0.46
1865
3.97
3.94
5.30
0.24
1869
13.90
4 47
1.10
9.88
4.64
8.73
8 19
5.09
5.21
3.13
1870
9.46
3.61
2.85
9.22
4.41
4 09
6.08
11.58
1-64
1.85
5.15
9.52
1871
13.52
1.29
6.11
2.75
572
9.96
6 43
8.63
6.88
15,65
9.04
2.14
1872
5.22
5.91
9.73
6 73
3.97
5.78
7.03
3.95
2.36
3.38
9.06
5.69
1873
5.61
2.20
5.49
1.73
28.50
8.58
6.75
10.83
4.46
1.80
7.35
1.87
1874
2.30
3.70
7.31
18.44
0.04
11.97
17.37
5.92
5.08
1.76
3.57
1875
9.17
16.22 13.73
10.44
3.19
6.22
8.19
11.32
8.54
2.26
6 86
5.72
1876
5.47
9.3311.65
8.20
8.54
7.19
5.19
5.55
0.39
0.10
2.97
8.29
1877
8.20
0.85
5.31
4.51
1.14
2.30
7.07
3.27
16.29
9.62
6.20
5.95
1878
5 36
3.50
4.63
1.51
6.14
7.12
5.26
4.90
2.67
5.07
7.78
8.59
The animal rain-fall in New Orleans, during the period em¬
braced in the table, embracing a period of 40 years, may, in
round numbers, be regarded as ranging from 35 to 70 inches.
The general mean of the months may be stated thus : January
5.61, February 2.90, March 3.90. April 3.29, May 4.10, June
4.97, July 6.66, August 5.65, September 2.20, October 2.74,
November 4.68, December 4.20 inches. If an average of a
series of years be selected, it will be found that the heaviest
190
Abstract of Proceedings
[July
rain fall occurs in the summer and the least in the autumn.
Thus if we select the statistics of the U. S. Barracks for a
period of 15 years, 1839-1853, inclusive, the rain fall in inches
was as follows: spring 11.29, summer 17.28, autumn 9.62,
winter 12.71 ; year 50.90. The extreme quantities of rain in
New Orleans, for a period of 17 years, according to the U. S.
Military Register and the observations of Dr. Barton, were,
January, max. 19.5, min. 0.11 ; February, max. 9.84, min. 0.73 ;
March, max. 7.88, min. 0.90 ; April, max. 10.70, min. 0.53 ; May.
max. 8.06, min. 0.45; June, max. 14.07, min. 1.31; July, max.
14.74, min. 0.89; August, max. 8.39, min. 1.37 ; September, max.
8.92, min. 0.63 ; October, max. 6.45, min. 0.75 ; November, max.
8.83, min. 0.1 L ; December, max. 9.44, min. 0.80 ; maximum for
year 62.64 (1853) ; minimum 39.96 inches (1852). The rain fall
of 1841, when yellow fever destroyed a large number of citizens
was large, 60.53 ; it was also much above the average amount
in 1847 and 1848, but it reached 67.12 inches in 1856, when
yellow fever did not prevail as an epidemic. It is worthy of
note that during the entire period embraced in the table, there
is not a single month in any year without more or less rain fall.
Owing to several causes, as the one just mentioned, the
absence of protracted droughts, the abundant rain-fall, and the
presence of large bodies of waters in the city and lakes sur¬
rounding New Orleans, the climate, as well as that of the gulf
coast, comprising a large area in the Southern States, is very
humid, containing a large quantity of vapor, though not in the
sensible form of clouds or fogs. This condition of the atmos¬
phere, combined with the tropical heat of summer, favors the
rapid putrefaction of animal and vegetable matter, and the rapid
development of low forms of animal and vegetable organisms.
Dr. Barton has accurately observed the humidity at New
Orleans for many years, and the following results for 1853,
when yellow fever prevailed in its most destructive form, will
show nearly the general average then.
Month.
New Orleans.
New Orleans. St.
Louis.
Greenwich.
Humidity.
Weight of va¬
por per cubic Humidity,
foot, grains.
Humidity.
January .
88
3.85
68
85
February .
84
4.58
67
85
March .
83
5.38
61
80
April .
83
6.80
46
80
May .
84
7.60
66
75
J une .
81
9.14
69
73
July .
82
8.80
70
77
August .
87
9.74
78
77
September .
85
8-57
80
74
October .
80
6.05
63
83
November .
84
6.06
71
86
December .
82
4.01
68
84
Year .
86
6.72
67
80
Louisiana State Medical Society,
1.91
1879]
This shows a high measure of humidity, for the whole year,
at New Orleans, and an excess of vapor in the air in the warmer
months, proportional to the excess of mortality for these
months. At St. Louis the humidity is greatest in summer, the
months of greatest mortality, whilst at London the percentage
is much less at the same part of the year.
From the preceding observations upon the history of yellow
fever, during the present century, in New Orleans, and especi¬
ally during the American Domination, during which time there
has been a rapid growth of population and increase of com¬
merce and the accumulation of more exact data, bearing on
the mortality and climatology of the city, the following conclu¬
sions may be drawn :
1st. The increase in the number and extent of the epidemics
of yellow fever in New Orleans, has been intimately associated
with the accumulation of unacclimated human beings in the
city, and with the increase of commerce and the consequent
crowding, and the accumulation of filth and crow cl poison in
ships and in badly constructed and badly drained and policed
habitations.
2d. By its geographical position, by its peculiar topography,
situated upon a low alluvial, badly drained, swampy plain, sur¬
rounded by large bodies of water ; by the exposure of an ex¬
tended river bank, putrid stagnant canals and marshes; by
defective drainage, sewage and police ; and by its hot and moist
climate, New Orleans has been peculiarly exposed to the rav¬
ages of yellow fever.
.‘hi. No such marked differences exist between the climate of
New Orleans and that of Havana and Vera Cruz, as would
warrant the assertion that yellow fever is always endemic in
the latter two cities, and that at the same time it cannot origin¬
ate de novo in the former. Whilst it is the wish of every true
patriot to claim all excellencies of position and health for the
land of his choice and love, at the same time the future ad¬
vancement of sanitary science and the highest interest of
humanity demand that all causes of disease, whether existing
in the soil or climate, should be honestly stated and fully
weighed. In sanitary science as well as in disease and the
science of medicine, the proper remedies and preventatives can
only be fully appreciated by a comprehension of all the dan¬
gers and difficulties.
4th. Those who hold to the view that yellow fever never
originates in Now Orleans, but is always imported , must at least
be forced by the past history of the great epidemics of this
city, to admit that its climate and situation are such as to
admit of the easy lodgement and rapid propagation of the
seeds of this disease.
5th. Every system wdiich would look exclusively to the defence
of New' Orleans from pestilence by quarantine, is vicious, and
destructive at once to commerce and the best interest of the
city, in that it leads to the neglect of those sanitary measures
Abutruvl of Proceedings
iUJ
[July
which will best promote the removal and eradication of the
causes of disease, and the removal of those physical conditions
which promote the rapid spread of destructive epidemics.
6th. It may be possible to institute at once a just and enlight¬
ened system of quarantine, and hygienic rules among the
agents, and in the vehicles of commerce, and an enlarged and
progressive system of sanitation, embracing thorough drainage,
abundant water supply, rapid and efficient removal of all ex-
crementitious matter and the proper elevation and construction
of well ventilated and thoroughly policed houses.
GENERAL OUTLINE OF THE SYMPTOMS AND PATHOLOGICAL
ANATOMY OF YELLOW AND MALARIAL FEVERS.
Yellow Fever. Malarial Fever.
YELLOW FEVER SYMPTOMS AND MALARIAL FEVER SYMPTOMS
PATHOLOGY. AND PATHOLOGY.
Definition — A pestilential fever of
continuous and specific type, origi¬
nally developed in tropical and
insular America ; confined to defi¬
nite geographical limits and de¬
pendent in its origin and spread
upon definite degrees of temperature,
and capable of transportation and
propagation in ships and in towns
and cities, in those portions of North
and South America, which lie between
45° N. lat. and 35° S. lat. ; the disease
has been limited chiefly to the coast
of tropical Africa, rather from the
number aud position of the commer¬
cial towns, than from any climatic
causes adverse to its propagation
elsewhere ; it has been imported
from the Antilles and from the
shores of the Gulf of Mexico and
from tropical America, far in the
interior of the Valley of the Missis¬
sippi, from New Orleans to St. Louis
and along the Atlantic coast, from
St. Augustine to Portland, Maine, and
even across the Atlantic oceau to
Cadiz, Carthagena, Barcelona, Gib-
ralta. Lisbon, St. Nazarre to Ply¬
mouth and Southampton, England.
It presents two well-defined stages :
the first characterized by intense
pain in the head and back, injected
eyes, rapid circulation, elevated
temperature, which may extend
from 24 to 160 hours, according to
the severity of the disease : the
second characterized by depression
of the nervous and muscular forces,
and of the general and capillary
circulation, capillary .congestion,
The general division of malarial
or paroxysmal fevers into three
types, namely intermittent, remit¬
tent and pernicious or congestive
fever, admits of several subdivisions.
Thus the forms of malignant inter
mittent are numerous but all are
attended with congestion of one or
more vital organs, which may endan¬
ger the life of the patient, and which
may pass into actual inflammation
attended with effusion of plastic
lymph, serum or blood. In many
cases in which no structural altera¬
tions have ensued during the con¬
gestive stage, there comes on at the
conclusion of the paroxysm, a per¬
fect intermission of all the violent
symptoms. The sudden disappear¬
ance of the most alarming symptoms,
may lead to a false prognosis, and
prevent the institution of energetic
measures. It is well known that in
the malarious regions of the Southern
and Western States, one of these
violent paroxysms, whenever occur-
ing, either at the onset of the disease,
or during the progress of an ordinary
mild intermittent, is the harbinger
of others still more violent. If un¬
heeded the disease may prove fatal,
at the third, fourth or fifth paroxysm.
The nature and effect of the malig¬
nant paroxysm will depend upon
various causes as the state of the
constitution of the patients, peculiar
idiosyncracies, pre-existing diseases,
the effects of diet and occupation,
the composition of the blood, and
the organ or drgans chiefly involved.
1879J
Louisiana State Medical Society.
193
Yellow Fever.
slow and intermittent pulse, jaun¬
dice, urinary suppression, passive
hemorrhages from the stomach and
bowels, nares, tongue, gums, uterus,
vagina, gall bladder and anus, and
in extreme cases from the eyes, ears
and skin ; black vomit; convulsions,
delirium and coma. In its origin
and propagation, it is not dependent
on those conditions and causes which
generate malarial paroxysmal fever,
from which it differs essentially in
symptoms and pathology. One of
the prominent symptoms of the first
stage, is the rapid increase of the
pulse within the first few hours of
the febrile excitement, and the pro¬
gressive diminution of the beats of
the heart, even whilst the tempera¬
ture progessively rises : and in like
manner the slow and feeble action
of the heart constitutes a promi¬
nent and striking symptom of the
second stage. Yellow fever in com¬
mon, with such contagious diseases
as small-pox, measles and scarlet
fever, occurs as a general rule but
once during life, and may be propa¬
gated by contagion : it differs, how¬
ever, from the exanthematous dis¬
ease, in that it has never been known
to propagate beyond 48° North lati¬
tude, nor below a temperature of
70° F.
I will now briefly present the
general conclusions as to the nature
of yellow fever which I have drawn
from my original investigations dur¬
ing the past twenty-three years.
During this period I have at various
times, and in different journals, pub¬
lished cases sustaining the various
conclusions, and I have also in my
possession, in manuscript, the de¬
tails of a large number of careful
chemical and microscopical investi¬
gations, and numerous cases illus¬
trating the symptoms and patholo¬
gical anatomy of malarial and yel¬
low fever. I hope to present the
most important of these researches
and cases, as well as a minute his¬
torical account of yellow fever and
other fevers, in the second volume of
my Medical and Surgical Memoirs,
in that division of the work which
relates more especially to the natural
history and treatment of fevers.
Malarial Fever.
If the cerebro-spinal system is chiefly
affected, the paroxysm may be char¬
acterized by delirium, coma, convul¬
sion, and tetanic spasms, hence some
writers have distinguished the coma¬
tose, the delirious, the convulsive and
the tetanic varieties of the malignant
intermittent.
In many cases, in which the whole
force of the disease appears to fall
upon the cerebro-spiual system,
these symptoms indicating serious
disturbances of the functions of
animal life, as disorder of the mind,
coma, apoplexy and paralysis cate-
lepsy and various involentary spas¬
modic movements, may disappear
entirely as the paroxysm abates, not
even a trace of headache being left
during the intermission : in some
cases however effusion may take
place into the ventricles, or within
and around the cerobro-spinal sys¬
tem, and lead to the establishment
of permanent coma, with dilatation
of the pupils general paralysis aud
death. In some cases the effusion
consists chiefly of serum; and iu
others of blood with all the symp¬
toms of hsemaplegia, paraplegia,
apoplexy, and paralysis. A true
inflammation of some portion of the
cerebro-spinal substance may result
from the congestion induced during
the malignant paroxysm. Recovery
is possible Irom such states, but
convalescence is often tedious, and
accompanied with paralysis of one
or more sets of voluntary muscles.
In many cases of malarial coma, I
have observed the temperature to be
elevated to a degree varying from
102° to 106° F., and such elevation
may be attended either with a hot
dry skin, or with a surface bathed
in a hot profuse perspiration. The
action of the malarial poison, is
without doubt one of the causes of
fatal and sudden apoplexy. It is
probable that tbe result during the
paroxysm is largely determined by
preceding alterations of the arteries
of the brain, and spinal cord, such
as fatty and calcareous degenera¬
tion.
If the lungs or the pleura be pri¬
marily and chiefly involved, diffi¬
culty of breathing, syncope, capillary
25
194
A bstraet of Proceedings
Yellow Fkvkr.
GENERAL CONCLUSIONS AS TO
THE NATURE OF YELLOW
FEVER; AS DRAWN FROM
ORIGINAL INVESTIGATIONS.
1. Yellow fever is a continued
pestilential fever, presenting two
well-detined stages : the first char¬
acterized by active chemical change
in the blood and organs, attended
with elevation of temperature and
aberration of nervous action, which
may constitute the entire malady,
and prove fatal in a manner similar
to the infectious form of small-pox ;
and the other, a stage of depression,
induced both by the sedative action
of the febrile poison, and by pro¬
found changes excited in the blood,
and in certain organs, viz., the heart,
liver, and kidneys, and by the direct
sedative and poisonous action of the
excrementitious matter retained in
the blood, in consequence of the
failure, arrest, or perversion of the
functions of the liver and kidneys,
and by the arrest or perversion of
the digestive function, in conse¬
quence of the action of the yellow
fever poison, in causing perverted
nervous action, capillary conges¬
tion, and active desquamation of the
secretory cells of the stomach, and
in consequence of the elimination by
the gastric mucous membrane of
certain constituents of blood and
urine, viz., urea and carbonate of
ammonia.
The various manifestations — as the
intense capillary congestion, depres¬
sion of the action of tbe heart, deli¬
rium, coma, convulsions, vomiting,
headache, urinary suppression, urae¬
mic poisoning, jaundice, and biliary
poisoning — may all be referred to
the action of the poison producing
the disease, and should not form the
bases for the erection of distinct
types of the disease.
The action of the yellow fever
poison is the same in all cases,
whether mild or severe ; The pro¬
gress and termination of the case,
as well as the manifestation of the
various symptoms, depending upon
the extent of the action of the
poison, the condition of the system
at the time of its introduction, the
peculiarities of the constitution, and
the supervention of other diseased
states.
[July
Malarial Fever.
obstruction, and excruciating pains
in the pleura, lungs and diaphragm
may characterize the paroxysm. In
like manner these alarming and dis¬
tressing symptoms may vanish,
after the disappearance of the parox¬
ysm, or structural alterations charac¬
terized chiefly by serous efiusion
into the air cells, bronchial tubes,
and pleural cavities, may ensue, and
either destroy the patient suddenly,
or lead to painful and protracted
pneumonitis and pleuritis. In some
cases the effusion into the air cells,
consists chiefly of blood, and such
pulmonic haemorrhage must be regar¬
ded as similar, to the haemorrhages
from the stomach, small intestines
and large intestines, which charac¬
terize certain forms of malignant
intermittent fever.
In a third form, the heart appears
to be chiefly affected, either directly
or through the cerebro spinal and
sympathetic system. This, the so-
called cardialgic variety, is marked
by excruciating pain at the epigas¬
trium, either continuous or intermit¬
tent, intense suffering, great anxiety
of countenance, vomitiug and some¬
times general spasm of the muscles.
In a fourth form, the abdominal
viscera, the peritoneum, the stomach ,
the small intestines, the large intes¬
tines, the liver and the kidneys, may
one and all be involved, giving rise
to the so-called, peritonitic, gastric,
choleraic, dysenteric, hepatic and
nephritic forms of malignant inter¬
mittent. The tenderness of the
peritoneum, the profuse vomitings
of biliary matters, and the choleraic
and dysenteric and bilious discharges,
may one and all disappear during
the intermission.
In a fifth form known as algid
fever, the cold stage is unusually
protracted, there is great oppression
at the chest and abdomen, restless¬
ness, and prostration of nervous and
mnscular power. The attempt at
the formation of the hot stage proves
abortive, the skin becomes cold,
pale and shrunken on the extremi¬
ties, and covered with a cold clammy
prespiration, while on the contrary
the central portion of the body and
the internal organs are hot. In some
cases of algid fever, I have observed
the temperature of the extremities,
to be 80°, whilst that of the trunk
1879J
Louisiana State Medical Society.
195
Yellow Fevek.
The action of the yellow fever
poison is definite, and the disease is
characterized by definite manifesta¬
tions. Yellow fever is a self-limited
disease.
II. The changes of the blood
appear to be continuons from the
time of the introduction of the poi¬
son to the fatal termination ; the
intensity of the changes being in¬
creased, and their character being
modified, as the disease advances,
not only by the direct action, upon
the constituents of the blood, of the
poison, but also by the addition of
certain noxious substances, as bile,
urea, carbonate of ammonia, sul¬
phates, phosphates, and extractive
matters, in consequence of the pro¬
found lesions induced in the liver
and kidneys.
Certain constituents of the blood,
as the albumen and fibrine, are not
only altered physically and chemi¬
cally in the early stages of yellow
fever, but, as the disease advances,
from the causes just specified, certain
excrementitious matters, which in a
state of health are continuously
eliminated, accumulate in the cir¬
culating fluid, and by their direct
action upon the elements of the
blood, and upon the nervous system,
and by their disturbing actions upon
the processes of nutrition and diges¬
tion, still further alter the physical
and chemical, and vital properties
of this fluid.
III. The maximum elevation of
temperature is rapidly attained upon
the first and second days of the dis¬
ease, varying, according to the se¬
verity of the attack, from 102° to
110° Fahr., in the axilla, and, as a
general rule, from the third to the
fifth day, steadily falling and sinking
down to the normal standard, and
even below ; in some fatal cases it
rises again toward the end, rarely,
however, reaching or exceeding 106°
Fahr., and only in certain rare
instances attaining the high degree
of temperature characteristic of the
stage of active febrile excitement.
In the preceding tables (see
History of Epidemic of 1878 by
author, published in N. O. M.
and S. J.) we have recorded
(case 94) a sudden rise upon the
5th day from 101.7° to 111° ;
(case 96) 106.8° on 4th day ; (case
97) 106.5° on 6th day ; (case 105)
Malarial Fever.
has reached 104" F., and higher. The
patient complains of intense thirst,
and when water is drank it is fre¬
quently rejected by vomiting, the
pulse is small, frequent and almost
imperceptible at the wrist, the heart
beats in a tumultous irregular
manner, giving a thumping sound
to the ear, the number of beats to
the minute sometimes reaching 180 ;
the respiration is irregular, often
panting, and numbering 40 and over
to the minute ; there is great rest¬
lessness, jactitation, impatience of
bed covering, with continuous com¬
plaints of oppressive heat, not only
at the chest and abdomen, but even
on the cold extremeties, so that the
patient refuses to have them covered.
The intellect is generally undistur¬
bed and the expression of the counte¬
nance may be quiet, even when the
pulse cannot be felt, and when the
disorder of the circulation and tem¬
perature becomes so extreme that
the heat of the trunk is reduced, and
even the tongue and mouth become
cold. This irregularity continues
through the whole period of the
paroxysm, and it is only at the end
of it in favorable cases that, the tem¬
perature and circulation are partially
restored.
In algid fever, we have conjestion
of the internal organs, prostration of
the nervous and muscular forces and
marked disturbances of the circula¬
tion and calorification. As the circu¬
lation and calorification depend
mostly upon the cerebro-spinal and
sympathetic nervous systems, as well
as upon the physical and chemical
changes of the blood and organs, the
algid state must be referred at least
to lesions of certain ganglionic cells
or tracts of the cerebro-spinal and
sympathetic nervous systems; and
whilst similiar phenomena, but less
in degree and duration, are manifes¬
ted in every true malarial chill; it
is not entirely correct to regard the
algid state as simply a prolonged thill ,
for in the algid state, tL-e chill is
followed by imperfect reaction, and
the elevated temperature of true
chill, is rarely reached in the central
organs, whilst there may be an actual
diminution of heat.
When from any cause, as bad diet,
excessive exposure to cold and wet,
the continuous use of salt meat, or
the prolonged action of the malarial
A bstract of Proceedings
[July
19(1
Yellow Fever.
105° on 4th day ; (case 122) 107.2° on
9th day ; (case 133) 107° on 3rd day ;
(case 146) 109° on 6th day; (case
154) 111.1° on 9th day ; (case 168)
108.2° on 9th day. The superven¬
tion of an inflammatory disease, or
the occurrence of an abcess, or the
access of paroxysmal malarial fever,
may in like manner cause a progres¬
sive elevation of temperature, with
slight evening exacerbations. The
pulse at the commencement of the
attack is often rapid and full ; the
increase in the frequency of the
pulse does not, however, as a general
rule, continue to correspond with
the elevations and oscillations of
temperature, as in many other febrile
diseases ; and in many cases of yellow
fever the remarkable phenomenon is
witnessed of the pulse progressively
decreasing in frequency, and even
descending below the normal stand¬
ard, while the temperature is main¬
tained at an elevated degree ; and,
on the other hand, the pulse often
increases in frequency, but di¬
minishes in force near the fatal
issue; the occurrence of copious
hemorrhage from the stomach and
bowels may be attended with sudden
depression of temperature, and in¬
crease in frequency, but diminution
in the force and fullness of the pulse.
The cause of the rapid rise and
declension of the temperature in
yellow fever must be sought chiefly
in the changes induced in the blood
and in the organs upon which the
circulation and integrity of the
blood depend ; neither the rapid rise
nor the sudden declension of the
temperature can be referred wholly
to the effects of the yellow-fever
poison upon the nervous system.
IV. The fever of the first stale of
yellow fever, like fever in general ,
however caused, consists essentially
in elevation of temperature, arising
from increased chemical change iu
the blood and tissues, and is attend¬
ed with changes iu the physical and
chemical constituents of the blood,
and aberrated nervous action.
As long as the skin, kidneys, lungs,
and gastro-intestiual canal, perform,
their functions, this stage is charac¬
terized, as in other fevers, by an in¬
crease in the amount of solids ex¬
creted. But this increased elimina¬
tion of the products of chemical
change is not, in yellow fever, a con-
Malarial Fever.
poison, the constitution of the blood
is altered, haemorrhages take place
during the congestive stage of ma¬
lignant intermittent fever, we may
have a sixth variety, which has
been indicated as haemorrhagic mala¬
rial fever.
Without doubt, in this sixth form
of malignant intermittent, haemor¬
rhages from various organs as the
stomach, lungs, kidneys and bowels,
are directly due to the prolonged
and potent action of the malarial
poison upon the fibrin and colored
corpuscles of the blood, as well as
to the various alterations in the
spleen and liver, characteristic of all
the forms of malarial fever.
The haemorrhagic form of malarial
fever, may be attended with many of
the prominent symptoms of the pre¬
ceding varieties, as obstinate vomit¬
ing of biliary (grass green) acrid mat¬
ters, intense thirst, restlessness, fee¬
ble rapid .pulse, oscillations of tem¬
perature, oppression of breathing,
coma, convulsions, and apoplexy.
In many cases of malarial haema-
turia, after the supervention of jaun¬
dice the pulse becomes slow fall¬
ing even below the standard ofhealth,
even when the temperature of the
trunk may be elevated to from 101°
to 104° F. In this respect as well as
in the great irritation of the gastric
mucous membrane accompanied with
incessant vomiting, the haemorrhagic
form of malarial resembles yellow
fever. The latter disease however,
differs from the former in the char¬
acter of the vomited matters. Whilst
in the tirst stages of yellow fever
the vomited matters may consist of
mucous and bile, in the latter stages
the black vomit is essentially altered
blood. In malarial haematuria the
dark and in some cases black vomit
consists almost always of dark green¬
ish black biliary matters, and rarely
contains blood. The urine also dif¬
fers essentially in the two diseases ;
in grave cases of yellow fever, the
urine contains albumen and yellow
grauular casts and detached cells of
the tubular uriniferi. In well marked
cases of yellow fever, albumen may
appear as early as the first day of the
disease, but most generally it appears
upon the second, third or fourth day.
Blood may be present in the urine
of yellow fever, but it is rarely a
constituent ; and even when present
1879]
Louisiana State Medical Society.
197
Yellow Fever.
stant concomitant of the increased
temperature.
Not only are large quantities of
the products of oxidation firmed
during the hot stages of yellow
fever, but, as we have shown, by
numerous analyses of the blood,
black-vomit, urine, brain, heart,
liver, spleen, and kidneys, in this
disease, they are altered to a certain
extent from their characteristic state
of health ; the albumen of the blood,
under the action of the poison, be¬
ing transformed into nitrogenous
and non-nitrogenous compounds, a
portion of which, as the fatty mat¬
ter, and altered fibriue, being arrest¬
ed or accumulated in certain organs,
as the heart, liver, and kidneys.
The peculiar phenomena of yellow
fever, like those of acute phosphor¬
ous-poisoning, are due to the nature
of the specific poison, and the char¬
acter of these changes, which it is
capable of exciting primarily in the
blood, and secondarily in the nervous
and vascular systems, and in the
nutrition of the various organs.
Neither the rapid rise nor the sud¬
den declension of the temperature
in yellow fever is necessarily refera¬
ble solely to the effects of the poison
upon the nervous system ; because,
in the first place, the changes of the
blood are among the first manifesta¬
tions of diseased action, and the
progress and termination of each
case are largely dependent upon the
extent and character of the changes
of the blood, and the degree of the
elevation of the temperature ; and,
in the second place, the sudden fall
of the temperature during the suc¬
ceeding stage of calm may be re¬
ferred to the peculiarity of the
self-limited chemical changes excited
by the poison, and to the structural
alterations induced in the muscular
tissue of the heart, and in the liver
and kidneys, and the sedative action
of the bile, urea, and oilier excre-
mentitious products retained in the
blood, upon the nervous system ; and
finally, in the third place, the
changes of the blood and of tbe
heart, liver, and kidneys, are of
a definite physical and chemical
nature, and could never be induced
by a mere exaltation or depression
of nervous action, and must be re¬
ferred to the introduction and action
of some agent or material related in
Malarial Fever.
the granular casts of the tubuli
uriniferi present a yellow color. In
malarial hsematuria the urine con¬
tains albumen, but this constituent
of the blood is invariably associated
with blood corpuscles and hsematin.
The casts of the tubuli uriniferi in
the urine of malarial hsematuria,
present a red or reddish brown color.
Suppression of urine in yellow fever
appears to be due to the blocking up
of the tubuli uriniferi with granular
and oleagenous matter and detached
cells, the symptoms in malarial
hsematuria appear to be due not
merely to congestion of the kidney,
but to the filling of the urinary tubes
with coagulated blood.
The microscopial examination of
the blood also reveals marked dif¬
ferences in the two diseases ; in yellow
fever the colored blood corpuscles
frequently assume a crenated appear¬
ance, and in uncomplicated cases
there is no accumulation of pigment
particles and pigment cells, and the
dark cells of an algse, resembling
enlarged colorless corpuscles filled
with spores of a dark brownish red
color.
In malarial hsematuria, it is rarely
the case that the colored corpuscles
present any other than the normal
form of biconcave discs; whilst pig¬
ment particles, dark granular masses,
and cells of a dark reddish brown
hue, some of which are similar in
all respects to certain palmellse, are
often present in considerable num¬
bers.
In malarial hsematuria, after death,
the intestines give the reaction of
bile throughout their entire extent ;
in yellow fever we thus obtain no
evidence of the presence of bile.
CHANGES OF THE BLOOD IN
MALARIAL FEVER.
! he malarial poison is capable of
altering the constitution of toe sol¬
ids and fluids and of modifying and
altering the type, and progress and
effects of various diseases, even when
no symptoms of aberrated, physical,
chemical, and nervous actions have
been manifested sufficient to arrest
the attention of the patient.
The colored blood-corpuscles are di¬
minished during malarial fever ; the
extent and rapidity of the diminu¬
tion of the colored corpuscles corres-
198
Abstract of Proceedings
[July
Yellow Fever. Malarial Fever.
a definite manner, in its constitu¬
tional and physical properties, to
the fluids and solids in which it in¬
duces these profound physical and
chemical changes.
Without doubt, the action of the
yellow fever poison upon the nervous
system may he of the most direct
and important character ; but well
established facts do not justify us
in locating the origin of the disease
wholly in the action of the poison
upon the nervous system ; aud, in
fact, the earliest sensible manifesta¬
tion of disordered nervous action,
as evidenced by uneasiness, loss of
appetite, and chilly sensations, may
he entirely secondary to the changes
in the blood, by which all parts of
the nervous system are surrounded
and supplied.
V. While many of the most strik¬
ing phenomena of yellow fever, as
chills and fever, and collapse, must
necessarily be attended with dis¬
ordered vascular innervation, at the
same time we must look to the blood
as the seat of the operations of the
fever poison ; and, as the nutrition
of every organ and tissue depends
upon the proper constitution of this
fluid, its alterations must affect the
entire organism, and the true com¬
mencement of yellow fever is in the
alterations of the relations between
the blood and tissues.
The nervous system, both cerebro¬
spinal and sympathetic, suffers at
first in common with the entire
system ; hut as the most important
offices are performed by the nervous
system which relates the mind to
the various parts of the body, and
to the exterior world, and also
regulates the actions of the cir¬
culatory and respiratory systems,
and coordinates the actions of the
component members of the system,
in all the phenomena which succeed
the invasion of fever the Mood and
nervom system become joint factors.
VI. During ihe active stages of
yellow fever, profound changes take
place in the organs and tissues,
especially in the Kidneys, heart, and
liver ; oil and granular albuminoid
or fibroid matter transude through
the capillaries and fill up the cells
and excretory ducts, and arrest the
function of certain organs. The
liver of yrellow fever does not pre¬
sent the soft, friable condition char-
pond to the severity and extent of
the disease. The fixed saline con¬
stituents of the colored blood-corpus¬
cles are often diminished in malarial
fever.
The colored blood-corpuscles are
destroyed bol h in the li ver aud spleen.
The colored blood-corpus les are
more uniformly and rapidly destroy¬
ed in severe cases of malarial fever,
than in any other acute disease,
with the exception perhaps of pyae¬
mia.
In the severe forms of malarial
fever the serum presents a golden
yellow color. I have shown by
numerous analyses that this color in
the various forms of malarial fever,
aud even in the so-called Malarial
Hsematuria, is due to the presence
of the coloring matter of the bile,
and not as has been erroneously stated
upon superficial observations to the escape
of the hoematin of ihe colored Mood-cor¬
puscles.
The fibrin is diminished greatly in
severe cases of malarial fever; the
diminution of this element of the
blood is characteristic, not only of
malarial fever, but of all the fevers ;
while its increase on the other hand
is characteristic of the phlegmasise.
As a general role, the diminution of
the fibrin in malarial fever as in the
pyrexiaj generally corresponds with
the severity of the disease, provided
there be no inflammatory complica¬
tion. The diminution and alteration
of the physical properties of the
fibrin in malarial fever to any great
extent, was always accompanied by
congestion of the spleen, liver and
brain, and serious cerebral disturb¬
ances. The fibrin is not only dimin¬
ished in malarial fever, but it is
altered in its properties, and in its
relation to the other elements of the
blood, and to the blood-vessels, and
in severe cases, heart clots, (fibrinous
concretions) are frequently formed be¬
fore death.
The albumen is diminished during
the active stages, but such diminu¬
tion is not due to any loss of this
constituent of the blood in the urine.
As a general rule, albumen is absent
from the uriue in malarial fever, and
when present, as in malarial hsema¬
turia, it is accompanied with blood
corpuscles, and with casts of the
tubuli uriniferi containing colored
blood -corpu scles.
Louisiana /State Medical Society.
199
1879]
Yellow Fever.
acteristic of true fatty degeneration.
The jaundice resulting from the
suppression or alteration of the ex¬
cretory function of the liver would
appear to be due to the same causes
which induce the suppression of the
urine, viz., to the deposits of oil
and fibrinous or albuminous matter
in the excretory structures of the
kidney and liver.
We do not mean to say that, in
the case of the liver, its secretion
ceases, or is even in many cases
diminished ; on the eontrary, it may
even be increased, especially in the
stage of active febrile excitement ;
but, from the cause indicated, ob¬
struction takes place in the biliary
tubes, and there is a rapid absorp
tion of the bile directly into the
blood-vessel system, and in this
manner the delivery of the bile into
the intestinal canal is impaired and
sometimes arrested.
The heart in yellow fever appears
to be as fully permeated with oil as
the liver : in the latter organ, how¬
ever, a large amount of the oil is
inclosed within the cells ; in the
former, in addition to the deposits of
oil, there is also granular degenei’a-
tion of the muscular structures.
VII. While yellow fever is char¬
acterized in common with several
other diseased states by an irritation
of the gastric mucous membrane,
the peculiar nature of the vomited
matters does not rest entirely upon
the congestion and irritation of the
mucous membrane of the stomach,
but is influenced to a greater or less
extent by the changes of the blood,
liver, kidneys, and nervous system.
The vomiting in yellow fever, may,
to a eertain extent, be regarded as
salutary, and as an effort for the
elimination of certain excrementi-
tious materials from the blood. In
some cases, the first effect of the
black-vomit may seem to be salu¬
tary ; the tongue improves in ap¬
pearance, the febrile heat abates,
and, if it were not for other profound
changes in the blood, liver, and
kidneys, lying back, as it were, of
this almost universally fatal symp¬
tom, beneficial results of the most
important character might flow from
the relief afforded by tbe removal of
a certain amount of excrementitious
matter, as urea, and ammonia, and
bile, from the blood.
Malarial Fever.
The results of my microscopical
investigations upon the blood of
malarial fever, pursued during the
past twenty-three years, may be
thus formulated.
1st. The malarial poison produces
more rapid destruction of the colored
blood corpuscles than any other
known febrile agent.
2d. The destruction of the colored
corpuscles takes place chiefly in the
spleen and liver.
3d. The black pigment resulting
from this haematin of the blood
corpuscles, is frequently observed in
the blood as it circulates in the
vessels and capillaries in masses of
various sizes, and in the form of cellu¬
lar elements.
4th. In the malarial blood we
observe frequently black pigment or
melamemic corpuscles, varying from
the one ten-thousandth to the one-
thousandth of an inch and even less
in diameter ; conglomerations of
these melansemic particles, in masses
of various sizes ; colorless corpuscles
or leucocytes which contained
granular masses of black pigment ;
pigment cells containing ovoid bodies
resembling sporules, and in all re¬
spects similar to the brownish red
palmellse obtained by passing the
air of malarial regions through melt¬
ing ice. Many of the particles of
the melanremic pigment are spheri¬
cal, others irregular and angular,
some entirely free, others incased in
a hyaline mass, others incorporated
with cellular elements which are
more or less related to the white
corpuscles of the blood and to cer¬
tain forms of alga;.
5th. The black pigment particles
indicate the destruction or alteration
of the blood corpuscles, and the
escape of the haematin of the red
globules.
6th. The black pigment is de¬
posited in the capillaries of various
organs and tissues, as those of the
liver, medulla of the bone, brain and
subcutaneous tissue.
7th. The peculiar sallow, greenish-
yellow and bronzed hue, which char¬
acterizes those who have been for
a length of time subjected to the
prolonged action of the malarial
poison, or to its powerful action in
pernicious remittent fever, and in
malarial hrmnaturia, is due not
merely to hepatic and splenic deran -
A bs tract of Proceedings
[July
200
Yellow Fever.
Black vomit, is to a certain extent
an excrementitiow product, containing
urea and carbonate of ammonia, in
addition to altered blood-corpuscles,
epithelial cells, broken capillaries,
mucus, various matters received
into the stomach, as food and medi¬
cine, serous exudations, and acetates,
lactates, phosphates, and chlorides.
Black-vomit in yellow fever is due
to several causes, as —
1. To the direct irritation and
structural alteration of the gastric
mucous membrane by the poison —
the active agent which probably is
first received into the blood, and
acts in this manner or through this
medium upon the gastric mucous
membrane, for we fiud contempora¬
neous changes taking place in the
heart, liver, and kidneys ; and these
changes would most probably succeed
the gastric irritation, if the poison
was received in food or drink prima¬
rily by the stomach.
2. To the structural alterations
of the blood, and esjiecially to the
marked dimunition of the fibrinous
element which appears to sink to a
lower figure than in any other known
disease.
3. To suppression of the action
of the kidneys, and the retention in
the blood of urea and other excre-
mentitious products, and the elimin¬
ation of urea as carbonate of am¬
monia by the gastro-intestinal mu¬
cous membrane.
4. To the direct irritant action of
the ammonia and excrementitious
materials, eliminated vicariously,
upon the mucous membrane of the
stomach and intestines.
5. To the irritant and nauseating
effects of the bile in the blood. The
bile retained in the blood, without
doubt, produces its characteristic
effects upon the nerves supplying
the stomach, inducing nausea and
vomiting.
(i. To the degeneration of the cells
of the gastric mucous membrane,
attended with or characterized by
the deposit of granular fibroid or
albuminoid matter and oil-globules
in the secretory cells, and iu the
walls of the smaller blood-vessels
and capillaries.
7. To the capillary congestion of
the gastro-intestinal mucous mem¬
brane, similar in all respects to the
intense capillary congestion which
Malarial Fever
gement, but also to the deposit of
pigment particles in the subcuta¬
neous capillaries.
8th. During the epidemic yellow
fever of 1878, in New Orleans, I
endeavored by the condensation of
the organic and organized and inor¬
ganic and particulate matters of the
air in various portions of the city to
determine whether the living par¬
ticles found in the air, differed in
accordance with the locality whether
malarious or non-malarious. After
a minute examination of the solid
organic organized, living inorganic
and inanimate particles of the air in
residences in which yellow fever
was prevailing, it was observed :
a. In the well paved and well
drained non-malarious portions of
New Orleans, the solid matters of
the air examined not only during
the prevalence of the yellow fever,
but also at various intervals, during
a period of six to eight months, I
discovered no form which could be
referred to such microscopical plants,
as the chloro-eoccum, vulgare, proto-
coccus, viridis, palmella, cruenta,
coccochloris, brebinonii and other
confervoidm, or unicclular algas capa¬
ble of producing chloropbyl. Cer¬
tain granular cells observed in the
blood of malarial fever, resemble
most nearly the resting spore of
bulbochsete intermedia, and the gran¬
ular cells of palmella cruenta; but
no such cells were observed in the
atmosphere of the houses situated
in well paved and well drained sec¬
tions of the city.
The forms of the non-malarial, sick¬
rooms (rooms containing yellow
fever patients) were referable to
those most nearly connected with
putrefaction and fermentation, as
the bacteria and torulte, penicillus
and micrococci and cryptococae. The
abseuce of any of the known forms
of algai in the air of yellow fever,
collected iu the non-malarious, well
drained and well paved portions of
the city of New Orleans, is impor¬
tant, in that this class of plants is
thus excluded from the consideration
of the question relating to the orgin
and causation of y ellow fever.
b. The water obtained by passing
the air through ice and melting ice
and ice cold water, was preserved,
and portions added to solutions of
sugar. The water from the rooms
1879]
Louisiana /State Medical /Society.
201
Yellow Fever.
characterizes all the tissues in this
disease, in consequence of the phy¬
sical and chemical alterations of the
blood, and of the morbific action of
the poison and its producrs upon
the vaso-motor system of nerves.
Black-vomit, therefore, is an effect
or result of preceding changes or ac¬
tions, and it is not a cause ; it is an
error,' therefore, to search, either by
chemical reagents or by the micro¬
scope, for the cause of the disease in
one of its products.
VIII. The chief causes of death in
yellow fever appear to be:
1. The direct action of the febrile
poison upon the blood and nervous
system, depressing and deranging
the actions of the one, and render¬
ing the other unfit for the proper
nutrition of the tissues.
2. The suppression or alteration
of the functions of certain organs,
as the kidneys and liver, and the
retention in the blood of the excre-
mentitions matters normally elimi¬
nated by these organs.
3. The structural alterations of
the heart, and consequent loss of
power in this organ
4. Profuse ha*moirhages from the
stomach and bowels.
IX. Yellow fever differs essential¬
ly in its symptoms and pathology
from malarial fever.
In the latter, the c nstituent of
the blood, which appears to suffer
to the greatest and most essential
degree, is the colored blood corpus¬
cle ; in the former, the constituent
of the blood which suffers to the
greatest extent is the albumen.
The changes of temperature in
yellow fever follow a definite course,
and are never repeated in uncompli¬
cated cases ; in malarial fever, on
the other hand, they recur at regular
intervals, and m*y be indefinitely
reproduced.
As a general rule, yellow fever
attacks but once ; malarial fever
produces no exemption, but, on the
contrary, establishes a disposition
to frequent recurrence
Convalescence from yellow fever
is comparatively rapid, and the con¬
stitution of the blood is rapidly
restored ; in malarial fever, the
changes of the blood and organs,
and especially of the liver and
spleen, may be profound and long
continued.
26
Malarial Fever.
in which yellow fever patients lay
caused the developement in solution
of sugar, of a delicate fungus, the
spores of which were distributed in
regular rows, within the thallus.
This plant as well as that developed
in the yellow fever blood, assumed
a distinct yellow color. Both p mi-
eillnm and torulae were observed in
these solutions.
CHANGES OF THE CIRCULATION
RESPIRATION AND TEMPER¬
ATURE.
Intermittent Fever. During the
cold stage, (chill), there is a rapid, fee¬
ble pulse, rapid respiration, and hot
trnnk and cold extremeties — the tem¬
perature ofthe extremities, is reduced
far below that ofthe trunk, and even
below the standard of health, because
the circulation of the blood in the
peripheral capillaries is to a great
extent arrested, apparently by the
contraction of the unstriped muscu¬
lar tissue of the walls of the ultimate
artierioles. The diminution of the
capillary circulation, and the reduc¬
tion of the temperature of the ex¬
tremities precede the aberated ner¬
vous and muscular phenomena de¬
nominated chill. This fact corres¬
ponds with the changes in the con¬
stituents of the blood, and indicates
that the first phenomena of the cold
stage are connected with derange¬
ments of the vaso-moter system of
nerves. As a general rule, the higher
the temperature of the trunk during
the cold stage, the more rapid will
be the equalization of the circulation
and temperature. The severity of
the fever (animal temperature),
which often reaches in the hot stage
107° F., is by no means an index of
the character and severity of the
subsequent effects. As a general
rule, the higher the temperature
(within of course, certain defined
limits, not exceeding 102° and
107.5° F.,) the more readily does
the attack yield to treatment The
changes of the temperature in inter¬
mittent fever, are characterized by
abrupt elevations and depressions,
so that when the cases are projec¬
ted upon a chart, they differ in the
rapidity ofthe elevations and depres¬
sions from those furnished by yellow
fever, typhus and typhoid fever and
202
Abstract of Proceedings
[July
Yellow Fever. Malarial Fever.
The liver in yellow fever presents
variousshndes ofyellow, andcontaips
numerous oil-globules ; the liver of
malarial fever is of a dark color,
most generally slate upon the ex¬
terior and bronze within, and is
loaded with dark pigment-granules ;
the spleen is comparatively unaf¬
fected in yellow fever, while it is
enlarged and softened iu malarial
fever; the heart and kidneys are
soften* d and infiltrated with oil and
granular albuminoid matter in yellow
lt-ver, while they are comparatively
unaffected iu malarial fever; the
urine is almost always albuminous,
and contains casts and bile in yellow
fever, while in malarial fever albu¬
men and casts are almost always
absent, and the uriue presents
morbid periodic changes, correspond¬
ing with those of the paroxysm.
X. Yellow fever is a self-limited
disease, occurring, as a general rule,
but once in a lifetime. The constitu¬
tion of the blood, and even of the
textures of the body, is altered ; the
most important organs, as the heart,
kidneys, and liver, as well as the
most important nutritive fluids,
are profoundly impressed. These
changes of the blood, heart, kidneys,
and liver, as well as of the nervons
system, may be compared to the
profound changes induced in the
blood and organs, and especially in
the integument, by small-pox. If
this view be correct, we cannot by
drugs arrest or cure yellow' fever any
more than we can arrest or cure
small-pox, measles or scarlet fever.
If drugs accomplish the effect of
promoting the free and regnlar ac¬
tion of these emunctories through
which the poison and the product of
its action are eliminated, and if,
further, they tend to preserve the
integrity of the blood, and to sustain
the actions of the circulatory and
nervous system, they will, without
doubt, achieve much good, and
perhaps all that we are justified in
loo 'a mg for, in the present state of
our knowledge. By judicious treat¬
ment, by proper ventilation, diet,
and rest we place the patient in
that condition which is best adapted
to the successful elimination of the
poisou and its products ; but we do
not arrest or cure the disease, as
we certainly may do in paroxysmal
other diseases, the phlegmasia, phthi¬
sis, hospital gangrene and pyaemia.
Remittent Fever. — The phenom¬
ena of the cold stage preceding the
hot stage of remittent fever, are simi¬
lar to those of intermittent fever; the
difference is one of degree, and not
of kind ; the phenomena of the cold
stage of remittent fever are more
protracted than those of intermit¬
tent fever ; the sympathetic system
does not so rapidly regain its normal
action, and the circulation in the
capillaries of the extremities is not
so rapidly restored in remittent as
in intermittent fever. The altera¬
tions of the blood are more profound
in remittent than in intermittent
fever, and therefore it results that
the cold stage is more prolonged in
remittent than in intermittent fever.
The elevation of temperature corres¬
ponds more accurately with the in¬
creased action of the circulatory and
respiratory system in intermit¬
tent than remittent fever. Remit¬
tent fever may be distinguished from
typhoid fever by the greater and
more sudden elevations and depres¬
sions of temperature.
Congestive or Pernicious Fever.
— The complete prostration of the
muscular and nervous forces, the re¬
duction of animal temperature, both
in the trunk and extremities, the
cold, clammy sweat, the rapid febrile
puls**, the rapid, thumping action of
the heart, and the sudden interven¬
tion of the most alarming cerebral
symptoms, may occur gradually or
suddenly, in either intermittent or
remittent fever, and may be induced
by several distinct causes, acting
singly or in conjunction. There is a
want of coordination between the cir¬
culation, respiration and animal tem¬
perature in congestive fever. The
respirations are full, accelerated, and
often panting and heaving, varying
from 30 to 50 per miDute, the pulse
beats from 120 to 160, and feels like a
delicate thread, and is often so small
that it cannot be counted ; the heart
thumps irregularly and spasmodically
and rapidly, against the walls of the
chest as in some cases of narcotic
poisoning; the circulation in the capil¬
laries is feeble; the temperature of
the trunk, notwithstanding the full,
rapid respiration, sinks below the
1879]
Louisiana State Medical Society.
203
Yellow Fever. Malarial Fever.
malarial fever, by the proper admin¬
istration of quinine.
XI. Upon a careful comparison
of the main features of malarial
haematuria, with those of yellow
fever, the following points may be
noted :
(a) In the last stages, after the
supervention of jaundice and urinary
suppression, many cases of malarial
haematuria bear a striking resem¬
blance to yellow fever in the period of
calm, depression of circulation and
black vomit. The vomited matters,
however, in malarial haematuria con¬
tain bile, and tfye dark color is due to
bile, rather than to blood.
(b) Important differences are re¬
vealed by the microscope between
the organic and organized elements
iu the urine of these diseases : in yel¬
low fever, the casts of the tubuli
uriniferi are filled with yellow granu¬
lar matter and oil globules; in
malarial hiematuria, the tubuli urin¬
iferi in mauy cases present a dark
biownish-red color, and contain dark
pigmentary matter, and altered col¬
ored corpuscles, in addition to the
yellow granular matter.
(c) After death from malarial
haematuria, the fibres of the heart
present under the microscope a nor¬
mal appearance, the transverse striae
being distinct, and the oil globules
and yellow granular matter charac
teristic of yellow fever, being in
most cases absent. When no preced¬
ing lesions have existed, the heart of
malarial fever, and of malarial htema-
turia, presents a firm structure,
wholly different from the softened,
altered and flabby yellow heart of
yellow fever.
(d) There is less congestion of the
mucous membrane of the stomach,
and it is almost uniformly discolored
by bile iu malarial haematuria. Bile
is absent from the contents of the
stomach in yellow fever. Bile is
universally present in the stomach
of malarial haematuria.
( e ) The heart, liver and spleen in
malarial haematuria present the same
structure, and the same microscopi¬
cal and chemical characteristics, as
iu the various forms of paroxysmal
malarial fever. In malarial fever,
the spleen and liver are loaded with
dark pigmentary particles ; iu yellow
fever the former organ is without
auy special increment of pigmentary
normal standard, and the surface is
covered with cold, clammy sweat.
CHANGES OF THE URINE IN
MALARIAL FEVER.
Intermittent Fever— The amount
of uriue excreted during the active
stages, and during the earliest
stage of the intermission, is less
than that of healih, and this diminu¬
tion relates to the water and uot to
the solid constituents. During con¬
valescence, aud especially under the
action of depurants, the amount of
urine is increased. The color of the
urine vAies from light orange to deep
red. During the active stages tue
free acid is increased, but diminishes
during convalescence. The nrea is
increased during the active stages
above the standard of health, and es¬
pecially during similar conditions of
rest aud starvation. The uric acid is
diminished both with and without
the action of the sulphate of quinia,
during the active stages, wheu the
pulse is full and rapid and the respir¬
ation full aud accelerated, and the
temperature elevated. As a general
rule wheu the fever declines the uric
acid increases above the standard of
health, both with and wiihout the
actiou of the sulphate of quinia. In
some cases the uric acid i» increaseu
to four fold the normal amount dur¬
ing convalescence. The uriue of ihe
intermission of malarial fe\ er is char¬
acterized by heavy yellow deposits of
urate of soda, aud tr iple phosphates,
the former, in the form of granular
aud acicular matses, ami the latter as
beautiful prismatic crystals Phos¬
phoric acitl is greatly diminished and
may have entirely disappeared dur¬
ing the chill and first stage of the
febrile excitement. The phosphates
are more abundant in the stage of
couvalesceuce than during the active
stage. The deposits (so-called criti¬
cal discharges), so common during
convalescence, consist chiefly of The
urates of soda, ammonia, and the phos
phates, most generally iu the form of
triple phosphates.
The chloride of sodium is abun¬
dant during the cold and hot stages.
The sulphuric as well as the phos¬
phoric acid, is iucreased during the
height aud decline of the hot stage.
The uriue excreted during the fever
is generally deficient in uric acid,
204
Abstract of Proceedings
[July
Yellow Fever.
particles, and the latter is of a yellow
color, and loaded with oil globules
and yellow granular matter. When
yellow lever supervenes in malarial
fever, both the dark pigment par¬
ticles, and the oil globules and yel¬
low granular matter are found in
the liver, aud this organ presents
a deeper color and more mottled
appearance than in uncomplicated
yellow fever. The gall bladder con¬
tains much more bile in malarial fever
than in yellow fever, and this liquid
is absent from the stomach and ali¬
mentary canal in yellow fever, but is
universally present m malarial fever
in all its forms. ^
(/) When in malarial haematuria
the congestion of the kidneys is so
great, aud the structural alterations
so profound as to cause urinary sup¬
pression, then another distinct train
of phenomena is set up, which has
much in common with the analagons
condition in yellow fever when the
function of the kidney is suspended.
CHANGES OF THE URINE IN YEL¬
LOW FEVER.
The reaction of the urine in yellow'
fever is acid. Even in the gravest
cases, attended with suppression of
the urinary excretion, jaundice ax.d
alkaline hlack vomit, the urine, how7-
ever small the quantity excreted,
maintains an acid reaction.
As a general rule, the specific
gravity of the urine iu jellow fever
uoes not vary from that of health,
and ranges from 1009 to 1028. In
those specimens which gave the high¬
est specific gravity, the increase iu
density was clearly referable to the
increase of albumen ; for when this
constituent w as coagulated by heat,
and removed b.v filtration, the urine
was of low7 specific gravity.
Iu some of the gravest cases, the
specific gravity of the urine was only
1010, and presented a yellow color
aud w'as turbid from the pi’esence of
cells and casts of the excretory tubes
of the kiduey and gi anular and
fibrinous matters and colorless cor¬
puscles.
During the early stages of the dis¬
ease, the urine is normal iu color,
clearness and quantity ; as the dis¬
ease proceeds, the urine becomes of
a deep ^ ellow color, from the admix¬
ture of bile, and at this stage, after
Malarial Fever.
and the earthly salts, while its acid¬
ity and power of resisting decompo¬
sition is greatly increased, and it
will remain for a great time w ithout
undergoing decomposition. On the
other hand, during convalescence the
urine rapidly undergoes change, and
deposits of the urates of soda and
ammonia, and the precipitation of
the triple phosphates, by the ammo¬
nia generated during the decomposi¬
tion of the uxea, form the so-called
critical discharges of malarial fever.
Albumen is almost uuiversally ab¬
sent from the urine of uncomplica¬
ted malarial fever; it is present,
however, in that form called mala¬
rial haematuria, characterized by in¬
tense jaundice, and congestion of the
kidneys, and passive haemorrhage.*..
In such cases the urine contains
blood corpuscles aud casts of the
tubuli urinifVri filled w ith granular
unit er, detached uriniferous tubes
aud colored blood corpuscles.
The changes of the urine in remit¬
tent fevrr, are the san e in kind, bur,
different in degieefrom th se of in¬
termittent fever. The urine is higher
colored, more concern rated, and rich¬
er in urea, phosphoric acid and sul¬
phuric acid. If the case be protracted,
the chloride of sodium diminishes as
in typhoid lever. Whin the tempera¬
ture falls below7 tho normal standard
iu the early stage of convalesence,
the ux’ea, as in tae similar stage of
intermittent fever, decreases in
amount. During the period of remis¬
sion and couvalesence, the uric acid,
which had suffered decrease in the
active stages, increases above the
normal standard. The formation of
depoUts of the urates of soda, and of
ammonia, and of the tiiple phos¬
phates (critical discharges,) iu the
urine of remittent fever, is similar in
all respects, takes place at analogous
periods, and is duo to ihe same causes
as in the uriue of intermittent fever.
1879]
20
Louisiana State Medical Society.
Yellow Fever. Malarial Fever.
the full establishment of the febrile
excitement, about the third, fourth
or fifth day, becomes turbid from the
presence of the excretory cells, tube
casts and yellow granular albumin¬
oid or fibroid matters.
The color may deepen to orange
red as the disease progresses ; or if
the case terminates iatally from dim¬
inution and suppression of the urinary
excretion, it maintains a j ellow color,
sometimes presenting an oily appear¬
ance and motion, and consists of but
little else than albumen, bile, excre¬
tory cells aud casts of the tubuli
uriniferi, in a weak solution of the
urinary constituents.
In some cases of suppression, al¬
though the urea is greatly diminished
in the small amoun i. of urine excreted,
it is rarely it ever entirely absent.
If the case ends iu couvalesence, the
urine is copious and the color pro¬
gressively increases in depth, aud
may even appear black when viewed
eu massv.
As far as my investigations extend
albumen is au invariable constituent
of the urine in grave cases of yellow
fever, aud may appear as early as
the first day of the disease, but most
generally it appears upon the second,
third or fourth day. In yellow
fever albumen may be found in the
uriue, as the only abnormal element,
with or without other blood element,
iu company of abundant deposit of
lithates, with or without deposits of
purpurine, or other coloring matters
in excess : in connection with biliary
coloring matters, in connection with
apyrexial states, aud in connection
with apyrexial states.
The constituents of bile are almost
universally present iu the uriue,
eveu in those cases which progiess
favorably aud end in convalescence.
When there is no suppression of
the urinary excretion, the urea is
increased above the standard of
health during the active stages of
the disease aud during the period of
exhaustion or calm. I have obtained
upon analysis as much as 150(1 grains
of urea, during 24 hours in a case of
yellow fever, aud that, too, when no
nourishment was taken. Of all
known diseases, yellow fever is
characterized by the earliest and
most uniform appearance of albumen
and casts in the urine, aud by the
most marked tendency to urinary
206
Abstract of Proceedings
[July
Yellow Fever.
Malarial Fever.
suppression ; when, therefore, this
occurs, owing to the chemical changes
excited by the febrile poison, the
blood is rapidly charged with urea
and coma and uremic convulsions
are the lesult.
In yellow fever the presence of
albumen in the urine is attended by
desquamation, fatty degeneration and
disintegration of the excretory cells
of the tubuli uriniferi. The grauu-
lar casts so common in yellow fbver,
are composed of excretory cells, oil
globules, and granular fatty and albu¬
minoid graunlar matter, in some cases
intimately mixed with urate of am¬
monia.
Those who have failed to detect
albumen and casts at some period of
grave cases of yellow fever, are either
ignorant of the ordinary chemical
tests and microscopical appearances,
or have been careless and superficial
in their so-called researches aud ob¬
servations.
When the kidneys are not seriously
impaired by structural alterations the
amount of urea excreted both during
the stage of active febrile excitement
and that of calm or depression, is at
least five times more abuudant than
the amount of this constituent which
would be excreted by a patient in
health or even in Bright’s disease
similarly situated, lying perfectly
quiet in bed, aud taking little or no
nourishment. This fact illustrates
the absurdity of comparing the eifects
of uriuary suppression in yellow
fever, with the more tardy results in
chronic Bright’s disease.
In yellow fever urinary suppres¬
sion causes the retention of not only
the greatly increased amount of urea,
but also of the various products of
the action of the poison, as sulphuric
acid, phosphoric acid, extractive,
coloring and biliary matters.
The fever of the first stage of yellow
fever, like Jever in general, however
caused, consists essentially in eleva¬
tion of temperature, arising from
chemical changes in the blood and
tissues, an is attended with changes
in the physical and chemical constitu¬
ents of the blood and aberrated nerv¬
ous action. As long as the skin, kid¬
neys and lungs and gastro-intestiual
canal perform their functions, this
stage is characterized as in other
fevers, by an increase in the amount
of the solids excreted. But this in-
1879]
Louisiana /State Medical Society.
207
Yellow Fever. Malarial Fever.
creased elimination of the products
of chemical change is not, in yellow
fever, a constant concomitant of the
increased temperature, because, in
virtue of the lesions of certain or¬
gans, as the kidneys and skin, the
constituents of the urine and bile ac¬
cumulate in the blood and become
active agents in the production of
aberrated nervous and muscular ac¬
tions, and even of death itself.
TABULAR VIEW OF THE PATHOLOGICAL ANATOMY OF YELLOW
FEVER AND MALARIAL FEVER.
Exterior. — Generally full and not
reduced in flesh ; features may even
present a swollen, bloated aspect.
Skin of face and upper portions of
trunk of a golden yellow color.
Dependent portions of body of a
mottled purplish and yellow ecchy-
mosed appearance. Black vomit
frequently oozes from corners of the
mouth, and trickles down the face
and neck. When the muscles are
cut a large quantity of dark blood
escapes, which upon exposure to the
atmosphere changes to a bright
scarlet hue. Putrefactive changes
take place rapidly after death. lu
some cases of yellow fever, especially
when the functions of the kidueys
have been arrested for some time be¬
fore death, the putrefactive changes
take place with great rapidity and
energy, and sometimes even appear
to commence before death, the body
exhaling a disagreeable odor.
Cerebro-Spinal Nervous System
— Sympathetic Nervous System. —
The post-mortem examinations of
the brain, spinal cord, and sympa¬
thetic system have thus far revealed
no characteristic lesions to which
the aberrated nervous symptoms of
yellow fever can be referred. Be
yond congestion of the capillaries of
the cerebro-spinal and sympathetic
systems, which congestion appeared
to be referable to the same cause as
that producing capillary congestion
in the internal organs, I have ob¬
served no structural lesion, as fibrin¬
ous effusion, hemorrhage, or soften-
Exterior. — The general appear¬
ance of those who die from the effects
of malarial fever will depend upon
the nature and length of time and
the effects of the disease. When stout
healthy men are suddenly destroyed
by pernicious malaria: fever, the
body may present the fulness of
health; and in such cases the supe¬
rior portions of the body may, as in
yellow fever, present a golden yellow
color, whilst the dependent portions
present a purplish and mottled ap¬
pearance. The jaundice aud mottling
of the skin, however, is, as a general
rule, present to a less degree than in
yellow fever. In cases of protracted
bilious fever the body is frequently
greatly emaciated. In chronic ma¬
larial poisoning, attended wflth en¬
largement of the spleen and cirrho¬
sis of the liver, the belly and body
and limbs generally are distended
with dropsical eff usion. The cut sur¬
face of the muscles presents a pur¬
plish hue, and the change to the
arterial hue, upon exposure to the
atmosphere, is much slower and less
perfect than in yellow fever.
Cerebro-spinal Nervous Sys¬
tem — Sympathetic Nervous Sys¬
tem. — As far as my observations
have extended in malarial fever, the
dura matter was always normal; the
arachnoid membrane pearl-colored,
opalescent in some cases, in others
perfectly transparent and normal in
appearauce ; i lie blood-vessels of the
pia mater congested with blood, but
most generally without marks of in¬
flammation. Subarachnoid fluid in
almost all cases clear, transparent,
and in some cases of a golden color;
the amount varied in different cases,
sometimes exceeding, bat most gen-
208
Abstract of Proceedings
Yellow Fever.
ing of the cerebro-spinal and sympa¬
thetic nervous structures. Chemi¬
cal analysis revealed the presence of
urea, bile, and leucine in the brain,
and to t he effects of these substances,
as well as to the direct action of the
yellow fever poison, must be referred
the aberration of intellect, the rest¬
lessness, convulsions and coma.
The amount of the congestion of
the blood-vessels of the brain will to
a certain exteut vary with the stage
and with the conditions under which
death takes place. Thus, when the
fuuctions of the kidneys are greatly
impaired or wholly suppressed, owing
to the retention of the watery ele¬
ment of the blood, the vessels
throughout the entire system are
filled with blood to repletion, and the
brain is especially from its soft struc¬
ture and the character o- its circula¬
tion, the organ most affected. In
such cases, the blood is seen issuing
from numberless vessels when sec¬
tions of the brain are made. Under
the microscope the thin sections of
the brain reveal a state of great
hyperseiuia, the minute capillaries
being filled with colored blood cor¬
puscles.
The golden hue of the brain sub¬
stance and membranes, as well as
that of the tissues generally, is due
to the presence of the coloring mat¬
ter of the bile, and not to the escape
of haimatiu from the blood-vessels.
When death occurs after profuse
hismorrhages from the stomach,
and bowels, the cerebral structures
present less evidences of congestion
than when these symptoms have
been absent or present to a small
degree.
It is probable that the cerebral
ganglia aud commissures, as well as
those of the spinal cord and sympa¬
thetic nervous system are affected
with the same chain of chemical re¬
actions which result in the formation
aud accumulation of oil in the blood
aud in the heart, liver and kidneys.
In this connection the recent obser¬
vations of Dr. H. D. Schmidt dur¬
ing the yellow fever of 1878, in the
Charity Hospital of New Orleans are
of interest, in that they sustain the
view that the accumulation of oil is
not confined exclusively to the liver,
heart and kidneys.
Dr. Schmidt affirms that he has ob¬
served fatty degeneration of the
Malarial Fever.
erally falling short of the usual
amount. Blood-vessels of the brain
generally filled with blood. The struc¬
tures of the brain appeared, iu acute
cases, as a general rule, to be unal¬
tered either in structure or appear¬
ance ; in chronic cases the nervous
structures sometimes presented a
deeper and more grayish color, from
the presence of pigment grauules.
The structures of the brain aud
spinal cord, in malarial fever, were
therefore, as a general rule, altered
neither in consistence nor appear¬
ance, aud the same is true also with
reference to the sympathetic nervous
system.
The rapidity with which the symp¬
toms of cerebral disturbance, such as
coma and delirium, vauish under ap¬
propriate treatment, in many cases,
render it evident that the congestion
of the cerebro-spinal system is tem¬
porary and unattended with struc¬
tural alterations. When death occurs
in coma, the blood-vessels of the brain
even to their minutest ramifications,
are distended with blood, such con¬
gestion being not merely evident to
the naked eye but also more fully
shown under the microscope, when
thin sections are made of the brain
structures. The ventricles of the
brain are also filled with serum,
often of a golden color. The paralysis
which sometimes results from a par¬
oxysm of malarial fever, may be due
to several causes, as the actual rup¬
ture of blood-vessels and the effusion
of blood, the detachment of a fibrin¬
ous clot and the obstruction of some
one of the arteries of the brain, and
the impaction of the minute capil¬
laries by pigment granules. Occa¬
sionally in cases of chronic malarial
poisoning attended with a watery
condition of the blood, coma, with
dilated pupils, sometimes supervenes
suddenly, and in such cases I h »ve
fouud the ventricles to be greatly
distended with serous tluid, which by
its pressure had caused the cerebral
symptoms.
1879]
Louisiana State Medical Society.
209
Yellow Fever.
Malarial Fever.
nuclei in the walls of the minnte ves¬
sels of the pia mater venules as
well as arterioles. In many vessels
the nuclei have disappeared, leav¬
ing a number of fat globules in their
places; others are met with in which
an increase of the mere trace of pro¬
toplasm, surrounding the nucleus
in the normal condition has taken
place, causing a thickening of the
wall of the vessels. “Witu refer¬
ence to the brain the most prominent
observation thus tar made is the ex¬
istence of fatty degeneration of the
blood vessels of the cortex-cerebri,
similar to that observed in the ves¬
sels of the pia-mater, together with
degeneration of the ganglionic bodies
of the cortex.”
If these observations should be
confirmed by farther research and
especially by chemical analysis, de¬
termining the exact proportion of oil
m the brain in health and various
diseased states, it will thus be shown
that the nervous system both cerebro¬
spinal and sympathetic is involved
in a similar series of changes as the
other organs. The universality of
these changes, poiut to the blood as
the great medium and source of the
chemical actions, and we have a con¬
firmation of this view in the fact
which I have determined by chemical
analysis, that the oleaginous constitu¬
ents are greatly increased in the
blood of yellow fever.
That the mere presence of oil in
increased amounts in certain organs,
during yellow fever, is not the cause
of the gravest symptoms, is evident
from the rapidity of the conva¬
lescence in many cases; and also
from the well known fact that in
many cases the general health is
greatly improved by an attack of
yellow fever.
The grave symptoms of this disease
must be sought not merely in the
structural alterations of certain or¬
gans, but in the initial chemical
changes induced by the poison, which
precede the final lesions discover¬
able after death.
Heart. — Pale yellow and brown- Heart. — Normal in color, presents
ish yellowy as if undergoing fatty the deep purplish red muscular ap-
degeneration ; structures of heart pearance of the healthy heart. Mus-
flabby and somewhat softened ; nu- cular fibres of the heart firm and of
merous oil globules deposited within normal appearance under the micro-
aud around the muscular fibrillm of scope. No deposits of oil in the mus-
the heart. Cavities of the heart, in cular structures.
27
210
Abstract of Proceedings
[July
Yellow Fever.
many cases, filled with dark fluid
blood ; yellow fibrinous clots some¬
times present. Blood contains ab
normal amounts of urea and ex¬
tractive matters and ammonia. Fi¬
brin of blood greatly diminished in
amount.
I have determined, both by chemi¬
cal analysis and microscopical exami¬
nation, that the heart undergoes
acute fatty degeneration in yellow
fever. As far as my observations
have extended, the heart undergoes
more rapid and extensive degenera¬
tion in yellow fever than in any
other acute disease. The acute fatty
degeneration of the heart in yellow
fever should not be confounded with
similar changes observed in spirit
drinkers and in certain chronic dis¬
eases, but is most probably depend¬
ent upon the same or similar chemi¬
cal actions, as those leading to a
similar result in phosphorus poison¬
ing and in typhoid and typhus
fevers.
In yellow fever the fat is deposited
within and around the muscular
tibnlhe of the heart, in the form of
minute globules of various sizes.
There is also an alteration or degene¬
ration of the muscular fibrill* of the
heart, leading to a disappearance of
tne striation. The removal of the
particles of oil from the muscular
structures of the heart by sulphuric
eiher does not restore the obliterated
stri* ; neither does this agent re¬
move all the molecular particles, a
portion at least being insoluble in
ether, alcohol and chloroform, and
having an analagous constitution to
albumen and fibrin.
Fatty degeneration of the heart,
therefore, is not the sole state of this
organ in yellow fever; a molecular
change bas taken place in the sub¬
stance of the muscular fibres, and
this change affects tne albuminoid
or nitrogenous constituents, and most
probably represents one of the stages
of acute fatty degeneration.
The pericardium in yellow fever
presents a congested appearance.
Under the microscope the minute
blood-vessels appear to be injected
with colored blood corpuscles. Peri¬
cardial fluid of deep yellow color.
Malarial Fever.
Cavities of the heart frequently
distended with dark blood. Firm
laminated, fibrinous concretions very
common : and in some cases of perni¬
cious fever, the formation of these
heart-clots during the cold stage
without doubt causes death, and ren¬
ders unavailing the action of reme¬
dial agents.
The fibrinous concretions are not
only attached to the carne* column*
and chord*, tendine* and aurieulo-
ventricular valves, but they also
frequently send forth long branches
into the pulmonary arteries. The for-
matiou of these concretions is rare in
yellow fever, and when formed they
are much smaller and softer than in
malarial fever. The blood of malarial
fever contains more fibrin, fewer
colored corpuscles, aud changes more
slowly to the arterial hue, upou ex¬
posure to the atmosphere, than the
blood of yellow fever.
In malarial fever the heart does
not as in yellow fever, undergo fatty
degeneration. We do not by any
means wish to be understood as
affirming that fatty degeneration of
the heart is characteristic of yellow
fever in contradistinction to all other
diseases ; but only as distinguishing
this disease from the various forms
of malarial, paroxysmal or paludal
fever.
After careful microscopical aud
chemical examination of the heart,
in the various forms of inter¬
mittent, remittent, congestive or per¬
nicious malarial fever, aud malarial
haematuria, 1 have never observed
any increase in the normal amount of
fat or any condition which could be
designated as molecular change, or
acute fatty degeneration. If the
heart be compared in malarial and
yellow fever, it will be possible to
distinguish by the naked eye, the
flabby, softened, yellowish aud
brownish-yellow hue of the latter,
from the dense firm, dark colored
heart of the former disease. All
doubts are immediately removed by
the chemical and microscopical ex¬
amination, the malarial heart pre¬
senting no accumulation of oil, aud
revealing a firm, normal, distinctly
striated structure of the muscular
fibrillae. If acute fatty degeneration
ot the heart was characteristic of
malarial fever, from the almost uni¬
versal prevalence of this disease in
1879]
Louisiana State Medical Society.
211
Yellow Fever.
Lungs. — Dependent portions great¬
ly congested ; otherwise normal. In
some cases circumscribed effusions of
blood in textures of lungs.
I have in a few instances observed
pneumonia as a supervening disease
in yellow fever; in such cases the
sputa consisted of almost pure blood.
The supervention of pneumonia
causes a continuation of the febrile
phenomena beyond the usual period
of the uncomplicated disease.
StOxWach. — Mucous membrane of
stomach in many cases intensely con¬
gested, softened, and eroded. Stom¬
ach often contains large quantities
of black vomit. Reaction of black
vomit often alkaline from the presence
of ammonia, resulting from the de¬
composition of urea, eliminated by
the gastro-intestinal mucous mem¬
brane. Ammonia and urea present in
the black vomit ejected during life
and also when examined almost im¬
mediately after death. The presence
of ammonia in the stomach and black
vomit was not the result of post¬
mortem putrefactive changes. In
many cases ammonia was present
in such large amount, that when a
rod, dipped in hydrochloric acid, was
held over the mucous membrane of
the stomach, or over the black vomit,
dense fumes of chloride of ammonium
were formed, as if the rod had been
held over a bottle containing liquor
ammonia). Chemical analysis re¬
vealed the presence of ammonia and
also of urea in the black vomit.
Under the microscope the black
vomit was seen to contain colored
blood corpuscles, and cells of the
Malarial Fever.
the Misssssippi Valley, and other
portions of the Southern and West¬
ern States, and from the oft recur¬
rence of the disease in the same in¬
dividual, fatty degeneration of the
heart would become one of the com¬
mon diseases in malarial regions.
Pericardium not specially congested.
In some cases pericardial fluid of
clear straw color, in others, especially
when jaundice has existed, the peri¬
cardial fluid is of a golden color.
Lungs. — Dependent portions con¬
gested with blood ; otherwise healthy.
Owing to the effects of the mala¬
rial poison in decreasing the fibrinous
element of the blood and the colored
corpuscles, pneumonia engrafted up¬
on an individual suffering with ma¬
larial fever tends to spread by diffi-
sive inflammation, and in the case of
pleuritis as a supervening disease,
the effusion into the pleural cavity
is rapid and destructive in its effects.
If pneumonia be complicated with
malarial fever, the periods of conges¬
tion of the lungs, attended with op¬
pressed breathing and increase of
pulmonic inflammation are periodic
and may be to a certain extent con¬
trolled by quinine.
Stomach. — Mucous membrane of¬
ten presents a normal appearance ;
sometimes ecchymosed; rarely in¬
flamed or softened; sometimes discol¬
ored with bile; rarely contains black
vomit (altered blood). Reaction of
mucous membrane of stomach and
intestines acid. The pathological al¬
terations of the stomach, observed
after death, do not correspond, as a
general rule, with the severity of the
symptoms, the vomiting and pain on
pressure daring the progress of the
fever. The injection of the blood¬
vessels, and the mottled, purplish-
brownish red color, after death, ap¬
pear to be indie ttive, not of inflam¬
mation, but rather of stagnation and
accumulation of theblood in the cap¬
illaries, consequent upon the dis
turbauce of the relations of the blood
to the capillaries. The distressing
vomiting, so often a troublesome
symptom in malarial fever, appears
to depend upon the contact of the
altered bile and the irritation of the
nervous centres which supply the
stomach with nervous force, by the
altered blood and bv the malarial
poison.
212
Abstract of Proceedings
[July
Yellow Fever. Malarial Fever.
mucous membrane of the stomach,
and broken capillaries. In some
cases vihriones and fungi were
numerous in the black vomit; in
others they were absent.
That the stomach suffers and suffers
severely in yellow fever is evident
from the fact, that in a great major¬
ity of cases the stomach is finely in¬
jected with blood, and exhibits even
when examined immediately after
death, abrasions of the tissue in pit¬
like holes and furrows. In some cases
the whole surface of the stomach is
affected, in others the effusion and
injection is confined to the cardiac
or pyloric portion, but in some rare
instances the stomach, duodenum
and intestines have been said to
present an almost entire absence
of appreciable lesions. I have not
myself in post mortem examinations
observed the absence of lesions in
the gastro intestinal mucous mem¬
brane. The congestion of the stom¬
ach is to a certain extent due to the
disturbance of the circulation in the
liver, but uot wholly to this cause ;
we must f^om careful chemical and
microscopical examinations admit
the existence of irritation, desqua¬
mation and haemorrhage.
Intestines. — As a general rule
dark-colored and distended with gas.
In some cases the reaction of the in¬
testinal contents was strongly alka¬
line from the presence of ammonia.
Haemorrhage from * the intestinal
mucous membrane has been observed
during life, and in such cases, as
well as in .others in which no blood
has been discharged previous to
death, the intestines have been
found upon post-mortem examina¬
tion distended with blood. A re¬
markable feature in yellow fever is
the frequent occurrence of intersus-
ception of the small intestines. The
late Professor John Harrison, M.D.,
states that intersusceptions of the
small intestines were exceedingly
common in autopsies made in 1839,
in New Orleans. The quantity of
intestines invaginated, sometimes
exceeded a yard. The large in¬
testines and the lower portion of
the small, are not so often found
congested, as the stomach and
duodenum, yet such a condition is
by no means rare. The congestion
In cases where there has been
chronic inflammation of the stomach
before the appearance of the fever,
and in cases of long standing, where
the solids and fluids were perma¬
nently altered, decided lesions of
structure were found in the stomach.
It may be asserted, however, that
there is no constant or character¬
istic lesion of the stomach in mala¬
rial fever.
The vomited matters of the va¬
rious forms of malarial fever, unlike
those of yellow fever, contain bile.
Even in that form of malarial fever
which most nearly resembles yellow
fever, namely: in malarial hmma-
turia, the dark, almost black vomit,
owes its color chiefly to altered bile.
It is true that in some cases of ma¬
lignant malarial fever, we may have
the vomiting of dark blood and
bloody matter, resembling the vomito
nigra of yellow fever, but as a gen¬
eral rule bile is present, eveu in
these rare instances, whilst it is al¬
most always absent from the black
vomit of yellow fever. The presence
of blood and its constituents, occa¬
sionally, in the vomit of malarial fe¬
ver is due to the same causes, name¬
ly : desquamation rupture of capilla¬
ries, and the transudation of the lrse-
moglobin of the colored corpuscles
Intestines. — These remarks relat¬
ing to the stomach, apply also to the
small intestines. The mucous mem¬
brane frequently presented a pur¬
plish, irregularly injected, mottled ap
pearance, especially after the admin¬
istration of purgatives, and it was
frequently observed that the injec¬
tion of the blood-vessels was great¬
est in the dependent portions of the
intestines. In several cases Brun¬
ner’s glands in the duodenum were
enlarged and distinct. The solitary
glands of the small intestines ap¬
peared in many cases enlarged and
distinct. Peyer’s glands were uni¬
formly free from any well-marked
morbid alteration. In some cases
they were distinct and well defined
in their outline, and presented a
honey-comb surface, dotted with
dark points ; but they were always
free from marks of inflammation and
even of irritation, and in their pale,
white color contrasted strongly with
the surrouudiug mucous membrane,
discolored with bile and often irreg¬
ularly injected with blood.
1879]
Louisiana State Medical Society.
213
Yellow Fever.
of the veins, venules, and mucous
membranes generally of the intes¬
tines in yellow fever, have been re¬
ferred to the anatomical distribution
of the veins, which like those of the
stomach, are tributaries to the portal
vein. But we have been inclined in
many cases to regard t.he congestion
asactiveand notpassive. Dnringlife
the rectum in yellow fever presents
an intensely red, and congested ap¬
pearance, and some cases of yellow
fever in 1878, were followed by. irrita¬
tion and fissure of the rectum.
Liver. — Yellow color and blood¬
less, resembling this organ in fatty
degeneration, but firmer and denser
in structure. Under the microscope,
textures of the liver infiltrated with
oil; secretory cells of liver contain
much oil. The liver of uncompli¬
cated yellow fever, as far as my ob¬
servations extend, and acco ding to
the observations of Louis and many
others, is of a bright yellow color.
It is probable that this color, as in
the case of the malarial liver, varies
with the length of the attack and
the effects of previous diseases. Thus
Dr. Samuel Jackson, of Philadelphia,
found the livers of those who had
died in the early stages engorged
with blood. The decoction of the
yellow fever liver is of a golden yel¬
low color, whilst that of the malarial
liver is of a brownish yellow color.
The golden yellow color of the yel¬
low fever liver can be extracted both
by alcohol and water. The yellow
fever liver is firmer and harder than
that of malarial fever, contains much
less blood, and is much less readily ac¬
ted upon by liquor potass* and acids.
Liquor potass* readily d ssolves the
malarial fever li ver, the decoction pre¬
sents the appearance of veuous blood,
while no such effect is produced by
the action of this alkaline solution
upon the yellow fever liver.
Chemical analysis reveals the pres¬
ence of urea and fat in abnormal
amounts; animal starch and grape
sugar are also present in the yellow
fever liver. As a general rule grape
sugar is absent from the malarial
liver.
In some cases the deposit of oil is
confined to certain portions of the
tubuli and may even differ in amount
in different portions of the liver, but
Malarial Fever.
As a general rule, bile is found in
the intestinal canal of malarial fever,
aud in some cases in large quanti¬
ties, whilst it is absent from the en¬
tire alimentary tract in fatal cases
of yellow fever.
Liver. — The weight of the liver is
increased in malarial fever above the
standard of health. This increase
of weight is due in part to the stag¬
nation and accumulation of blood in
the capillaries and blood-vessels, and
to the deposit of pigment matter in
the structures of the liver. This
observation applies to the liver in
the acute stages.
In all the different forms of mala¬
rial fever, intermitient, remittent
and congestive, which had continued
longer than five days, and in which
there had been no previous altera¬
tions of the structures, as in cirrhosis
and fatty degeneration, I found the
exterior of a slate color, and the in¬
terior of a bronze color. In that
form of cirrhosis of the liver which
is directly induced by the prolonged
action of the malarial poison, the
liver is in like manner of a slate
color upon the exterior, and olive
green within, and loaded with dark
pigment granules. The change in
the color appears to be very persist¬
ent, and in several cases I have ob¬
served the liver to retain shades of
light slate and light bronze several
weeks, and even months, after the
relief of the attack of malarial fever,
the patients having been destroyed
by other diseases or by violence. The
liver, especial ly in the peripheral
portions of the lobules, contains pig¬
ment granules, resulting from the
alteration of the colored blood-coi-
puscles and the hasmatin. The pig¬
ment granules are frequently dis¬
tributed uniformly through both the
portal and hepatic systems of capil¬
laries. There is no accumulation of
oil globules, as in the yellow fever
liver. If malarial fever precedes or
succeeds yellow fever, the liver may
214
Abstract of Proceedings
[July
Yellow Fever. Malarial Fever
in the majority of cases the fatty
infiltration, and fatty degeneration
of the protoplasm of the hepatic cells,
extends througout the whole organ.
The oil is deposited both within and
around the hepatic cells. Careful
investigation of the relations of ma¬
laria to yellow fever, and an extend¬
ed examination of the statements of
various observers, have convinced
me that, the apparent contradictory
statements made by various observ¬
ers, as to the presence or absence of
the yellow color of the liver, which
Louis regarded truthfully as the
characteristic lesion of the disease,
lias arisen from two sources, namely,
errors of diagnosis, and failure to de¬
tect the preceding and concurrent,
and subsequent action of malaria
upon this organ. In uncomplicated
yellow fever* the pigment particles
so uniformly present in the malarial
liver are entirely absent. When yel¬
low fever has been engrafted on ma¬
larial fever, the preceding changes
wrought by the paludal poison alter
and mask those developed by the
yellow fever. And hence a mingling
of the yellow color of acute fatty
degeneration with the dark bronze
and slate of the malarial liver, may
produce a color very closely resem¬
bling the Spanish brown of the
healthy liver. Careful sections and
examinations of the organ under the
microscope will reveal both the oil
globules and the pigment particles.
Gall Bladder.— The gall bladder
in yellow fever is, as a geueral rule,
contracted, flaccid, small, and con¬
tains little or no bile. The amount
of bile generally does not exceed 100
grains. In malarial fever, on the
other hand, the gall bladder is, as a
general rule, distended with dark,
greenish, black bile. In yellow fever
the vomiting is rarelv bilious, unless
in the commencement of the disease ;
and the black vomit contains little
or no biliary matter.
The small intestines are rarely, if
ever discolored by bile in yellow
fever, whilst in malarial fever it is
common to find the gastro-intestinal
mucous membrane discolored by
bile.
I have observed cases in which the
gall bladder contained only a serous
liquid coagulable by heat. In two
cases, a decided haemorrhage bad
contain both oil globules and pig¬
ment granules.
The peculiar color of the malarial
liver can to a certain extent be ex¬
tracted by boiling w’ater, and the
filtered decoction presents a brown¬
ish mahogany color, from the pres¬
ence of the dark coloring matters of
the pigment granules ; the decoction
of the yellow fever liver, on the other
and, presents a golden color. The
blood issuing from the cut sur¬
face of the malarial liver pre¬
sents a dark purplish hue, and does
not change to a brilliant scarlet, as
in the yellow fever liver. Upon
chemical examination, the malarial
liver contains animal starch, but no
grape-sugar ; the yellow fever liver
contains both substances.
Whilst, by careful analysis (quan¬
titative), I have shown that the oil
may amount to over 40 per cent, of
the yellow fever liver ; I have also
clearly demonstrated that there is
no increase of oil in the malarial
liver.
I speak of uncomplicated malarial
fever ; of course when this disease,
is engrafted upon cirrhosis or fatty
liver, the effects of the malarial pois¬
on upon this organ will be marked.
Gall Bladder.— In most cases dis¬
tended with more than 1000 grains
of thick, greenish black bile, having
frequently a specific gravity ranging
from 1.030 to 1.037. The bile is more
abundant in malarial fever and is of
a deeper color, and frequently con¬
tains concretions of epithelial cells,
from the coats of the gall bladder
and biliary ducts, and casts of the
biliary tubes. In thin layers, and
when added to water, it presents a
deeper shade of green. The yellow
fever bile presents a golden color in
thin layers and when added to water.
Whilst haemorrhage occasionally
occurs in the gall bladder in yellow
fever, I have never witnessed this
remarkable condition in malarial
fever ; neither have I ever observed
the entire absence of bile and the
replacement of this secretion by an
albuminous fluid in malarial fever.
1879]
Louisiana State Medical Society.
215
Yellow Fever. . Malarial Fever.
taken place into the gall bladder,
which was distended with black
blood. The bile in yellow fever con¬
tains numerous cells from the mu-
cons membrane of the gall bladder,
and casts of the hepathic ducts.
Spleen. — As a general rule but
slightly enlarged. In many cases
normal in size and appearance. In
many cases of yellow fever the spleen
is neither enlarged nor softened, nor
altered in appearance, either upon
the exterior or within. There ap¬
pears to be no special alteration
or destruction of the colored cor¬
puscles in the spleen of yellow fever
as in that of malarial fever. The
enlargement of the spleen in fevers
does not, from these observations,
depend upon the diminution of the
fibrin, because this element of the
blood is diminished to a much greater
extent in yellow fever than in mala¬
rial fever, and at the same time the
spleen is enlarged to a great and
marked degree in the latter. An¬
other fact worthy of consideration
in this connection is, that in yellow
fever the colored blood-corpuscles
are not specially diminished in
amount, whilst in malarial fever
they are rapidly destroyed, and this
destruction appears to be greatest in
the liver and spleen. In malarial
fever both these organs are loaded
with the altered blood-corpuscles
and with the pigment granules
resulting from the alterations of the
colored corpuscles, whilst neither
the spleen nor the liver in yellow
fever afford any evidence of altera¬
tions of the colored blood-corpuscles.
Supra-Renal Bodies.— These bod¬
ies appear to be subjected to similar
changes with the liver and heart,
and oil is increased in amount in the
cells of the cortical and medullary
substance.
Kidneys. — These organs, as a gen¬
eral rule, present a brownish yellow
color, much lighter than that of
health. They, in common with the
heart and liver, contain much free
fat. When thin sections of the kid¬
neys are examined under the micro¬
scope, the Malpighian corpuscles and
tubuli uriniferi are found to be filled
with granular albuminoid and fibroid
matter, excretory cells detached, and
Spleen. — Enlarged, softened, and
loaded with altered blood corpuscles
and pigment granules ; of a dark
slate color upon the exterior ; the
blood of the spleen does not change
to the arterial hue upon exposure to
the atmosphere. In many cases the
spleen is so soft that it ruptures
when the attempt is made to remove
it from the cavity.
When the splenic mud is subjected
to microscopical examination it is
found to contain nnmerous pigment
granules of various sizes, and pig¬
ment cells, many of which resemble
the colorless corpuscles in size,
whilst others are much larger and
contain oval nuclei and resemble cer¬
tain palmellae.
Supra-Renal Bodies. — Frequent¬
ly discolored of a dark brownish hue,
from the deposits of melanotic or pig¬
ment particles, around the cortical
and medullary cells and capillaries.
No accumulation of oil has been
observed in these bodies in malarial
fever.
Kidneys. — Normal in appearance
and structure, except in malarial
hsematnria, when the textures are
congested, and dark colored in some
cases. Occasionally slate colored
spots appear upon portions of the
kidneys.
I have, by careful clinical studies,
and by analysis of the urine, at dif¬
ferent stages of malarial ha&maturia,
established the fact that many of
Abstract of Proceedings
[July
21<)
Yellow Fever.
oil globules. As far as my observa¬
tion extends, these structural altera¬
tions of the kidney have escaped the
notice of preceding observers. The
importance of these changes in the
kidneys cannot be over-estimated,
for upon them apparently depends
the suppression of the urinary excre¬
tion, which is an almost universally
fatal symptom. The changes in the
kidneys may depend upon several
causes, amongst which may be men¬
tioned as of prime importance the
alterations induced in the albumen
and fibrin of the blood by the febrile
poison, and the congestion of the
capillaries induced by derangement
ot the vaso-motor system of nerves
and by the altered blood.
This condition of the kidneys is
preceded by capillary congestion, as
has been .shown by the results of
post-mortem examinations at differ¬
ent periods of the disease. The same
observation applies to the liver.
The tatty degeneration and struc¬
tural lesions are preceded by hyper-
i»mia ; but neither in the kidneys
nor in the liver and other organs,
can the mere stagnation of the blood
ia the capillaries be regarded as the
prime came of the subsequent degene¬
ration and disintegration of the tex¬
tures, and more especially of the
secretoi’y cells. The chief cause is
the action of the yellow* fever poisou
on the blood and textures. The yel¬
low fever poisou excites a train of
chemical changes, the final result
of which is fatty degeneration and
molecular disintegration. Thus in
the case of the muscular fibres of the
heart, there is fatty degeneration,
although from the structure and
action of this organ, there could be
no such passive congestions as we
have in the liver and kidneys. It is
probable that this fatty degenera¬
tion extends to all the unstriped
muscular fibres, and may even dis¬
able the muscles of locomotion and
animal life. The granules of the
cells of the epithelium of the urini
ferous tubes set free by the disin¬
tegration of the protoplasm, oil glo¬
bules, detached cells, and albumi¬
nous matters and mucus, form opaque
granular masses which block up the
tubuli uriniferi.
We have in these structural alter¬
ations of the kidney, which vary in
kind and degree according to the
. Malarial Fever.
the symptoms of the disease as well
as the fatal termination are connect¬
ed with the progressive failure of the
kidneys to eleminate the constituents
of the urine and of the bile.
When sections were made of the
kidneys of those who had died in the
acute stages of malarial haematuria,
the cortical and mendullary portions
presented a deep purplish red and
bloody appearance. The color wTas
deeper in some portions than others,
resembling circumscribed effusions
of dark blood. In many cases all por-
tons of the kidneys wrere altered in
appearance, and the tubuli uriniferi
especially at the termination of the
pyramids could be seen resembling
dark red lines of coagulated blood.
Microscopical examination of sections
with Valentine’s knife, revealed the
fact, that many of the tubuli urini¬
feri throughout their entire extent,
were filled with coagulated blood*
The haemorrhage appears to have
taken place through the rnalpi-
ghian corpuscles chiefly ; little or no
blood was efi'used around the tubuli
uriniferi. It would appear that dur¬
ing the prolonged cold stage, the
kidneys become in this form of mala¬
rial fever, congested, in a manner sim¬
ilar to what occurs in the spleen.
During this congestion, rupture of
the blood-vessels and of the capsular
membrane of the malpighian cor¬
puscles occurs : such rupture being
mainly due to their anatomical struc¬
ture, and the greater tension of the
blood in tuis portion of the renal
capillary circulation. When from
any cause the blood coagulates
in the tubuli uriniferi, their
function as excretory tubes is
destroyed, and the extent of the
impairment of the exeeretory func¬
tion of the kidneys, will depend np-
ou the number of exeeretory tunes
blocked up by coagulated blood.
The grand cause of the severe, dan¬
gerous and often fatal character of
malarial haematuria will be found
chiefly in these structural altera¬
tions of the kidneys.
1879J
Louisiana iState Medical Society.
217
Yellow Fever.
Malarial Fever.
stage of the disease, an explanation
of tho frequent occurrence of albu¬
men casts, detached cells of the epi¬
thelium of the uriniferous tubes,
and oil globules and granular mat
ter in the urine of yellow fever.
Urinary Bladder. — As a general Urinary Bladder — Often distend-
rule the bladder contains little or no ed, with high-colored urine, free
urine in yellow fever. The urine is from albumen and casts. In mala-
of a light yellow color, without any rial hmmaturia the urine contains
crystalline bodies, and loaded with casts and blood-corpuscles, and des-
aJbumen, granular fibroid matter, quamated cells of the tubuli urin-
urate of ammonia, casts of the tu- iferi. Casts high colored, and often
buli uriniferi, and excretory cells of contain colored corpuscles,
the kidney. In many cases the urine
is entirely suppressed for as long a
period as 48 hours before death. So
long as the kidneys perform their
functions freely and regularly the
patient may recover, even though
black vomit may have appeared,
but if the action of the kidneys has
been arrested by structural changes,
death is inevitable.
( Abstract of Proceedings Continued in Next Number.)
NEW ORLEANS
Medical jlnd Suhgicjll Journal
AUGUST, 1879.
PAGINAL
UNICATIONS,
Extirpation of a Floating Kidney.
By A. W. SMYTH, M.D., New Orleans.
Mrs. Honora Arnetto, nee Cunningham, a native ot' Ireland,
thirty-five years of age, of medium stature, delicate build, dark
complexion, fifteen years married, no children, was brought to
Dr. Smyth by Dr. Greensville Dowell, of Galveston, in April,
1879.
She gave the following history of her case :
Eight years previously, she began to be afflicted with a pain
in her right side. Shortly after the commencement of this
pain, she discovered a tumor in her right side, to which she
attributed her suffering. She tried various remedies for the re¬
lief of her pain, without any benefit. In 1873, Drs. Wilkinson
and Calloway, of Galveston, where she and her husband re¬
sided, performed on her the usual operation for ovarian tumor?
without removing the cause of her trouble. The year follow¬
ing, her suffering still continuing, Dr. Greensville Dowell, be¬
lieving that the pain was owing to the mobility of the tumor,
passed a large curved needle with a tape-seton through the
walls of the abdomen, and through the tumor, with the pur¬
pose of causing adhesion, so as to prevent the moving of the
218 Original Communicatiom. [August
tumor in the abdomen. Some hfematuria was noticed after
this operation. The seton was retained for three months, and
gave some relief. At the end of that time the tape broke and
came away. The seton caused a persistent offensive discharge
from the wound.
Six months afterwards, Drs. Calloway and Penny — Dr. Dow¬
ell being absent from Galveston — attempted twice to re-intro¬
duce the seton. But, on both occasions, broke their needles,
leaving the broken ends in the abdomen.
Two months later, Dr. Dowell introduced the seton again,
but without giving as great relief from pain as in the first-
instance.
From continual suffering after this, her mind gradually be¬
came impaired, and in June, 1875, she was taken to the State
Lunatic Asylum, in Austin, Texas, where she remained for two
years. During her confinement there, the second seton came
away. Her husband, in the meantime, having removed to
New Orleans, received a communication from Dr. I). R. Wal¬
lace, the Superintendent of the Asylum, of the fact that his
wife had recovered sufficiently to return home; and in No vein
her, 1877, she came alone to New Orleans.
On her arrival there she applied to the Charity Hospital,
when Drs. Pratt and Miles, the surgeons in charge of the insti¬
tution, told her that the tumor was a floating kidney.
She says this is the first intimation she received that it was
her kidney that was the cause of her suffering. The medi¬
cal officers of the Charity Hospital did not, however, suggest
the propriety of surgical interference.
At the time of the meeting of the State Medical Association
in New Orleans, in the month of April, 1879, she was called on
by Dr. Dowell, who finding her anxious for a surgical opera¬
tion, brought her to Dr. Smyth, with a request that he would
attempt the removal of what he believed at this time to be the
fans et origo mali — the floating kidney.
Dr. Smyth promised that if she persisted in desiring it to be
removed, after being informed of the risk, that he would at¬
tempt the operation.
Finding that the promise was received with so much courage
1879] Smyth — Extirpation of a Floating Kidney. 219
and hopefulness, that she kept continually calling for its fulfil¬
ment. Dr. Smyth, after once or twice deferring the time for
operating, engaged that on the 3d of June, at the Hotel Dieu,
*at 11 o’clock, A. M., he would perform the operation.
At this appointed time, Dr. Smyth, in company with Drs.
Boyer, Burns, Lewis, Devron, White, Jamison and Murphy,
found the patient at the Hotel Dieu, quite courageous and as
determined as ever to have the operation performed.
She was removed to the room in which it was to be attempted,
and with the same courage and coolness that had always
characterized her, took the position assigned to her on the bed,
and, even with cheerfulness, submitted to the administration
of chloroform.
The operation was commenced by making an incision in the
right side of the lumbar region, extending externally from the
crest of the ilium to the edge of the eleventh rib, two and a
half inches by measurement from the median line of the spine
and parallel with it. internally the incision extended to the
edge of the twelfth rib. The muscles and the transversalis
fascia having been divided, search was made for the kidney,
which was found in the umbilical region. The kidney, by
pressure upon the abdomen, was forced into its place, and
while held there by an assistant, the fascia covering the kid¬
ney was ruptured by the finger, and the organ was extracted with -
out difficulty. While still in the wound, a strong ligature was
passed round the renal vessels and other connexions, at a dis¬
tance of less than an inch — perhaps, about half an inch — from
the hilus ; and the organ was then detached. No elongation
of the connexions of the kidney were observable.
Nothing worthy of special note — much less anything un¬
toward — occurred during the operation. At its conclusion,
two sutures were inserted, to bring the edges of the integu¬
ments together, in the upper part of the wound, the ligature
being left hanging out of the lower part. The wound was
dressed with a solution of carbolic acid, of the strength of one
drachm to a pint of water. A hypodermic injection of half a
grain of sulphate of morphia was administered, and repeated
at bed time.
220 Original Communications. [August
On the day following there was slight febrile disturbance,
which increased on the third day, when the temperature
reached 103° F., and the pulse 100.
On the fourth day the temperature was 102° F., and the
pulse 80.
On the fifth day the temperature was normal, and the pulse
70. Very free suppuration occurred from this time to the tenth
day, when the ligature came away.
On the eleventh day, the patient got up and walked about
without pain.
She complained of little or no suffering after the operation ;
and objected to the use of the hypodermic injection on account
of the pain it gave her, after the fourth day.
No medicine, whatever, of any kind — not a dose of anything
— was given to the patient, either before or after the operation ;
the only treatment used being four hypodermic injections, of
half a grain each, of sulphate of morphia.
The kidney removed was found to be of normal size, but to be
scarred with a deep cicatrix, extending, from the inferior and
outer edge, obliquely up, and out, and apparently through the
pelvis. The length of the cicatrix, was about two inches and
a half. It was evidently the result of the seton introduced,
which had cut its way completely out of the organ.
The operation has been followed by complete recovery ; and
the patient no longer complains of the trouble afflicting her,
on account of which it was undertaken.
Owing to the limited information to be gathered from the
ordinary text-books on the subject of this operation, it is not
generally known that there had been more than one — that of
Prof. Simon — successfully performed. We find, however, in
Bryant’s Practice of Surgery, that at least as many as twelve
are reported, with four recoveries.
It may be worthy of special note that in this case of Dr.
Smyth’s, the operation was performed through the lumbar
region, that it was found not difficult of performance, and that
it was not followed by any apparent dangers or risks.
1879]
Jones — Treatment of Yellow Fever.
Treatment of Yellow Fever.
221
BY JOSEPH JONES, M. D.
Professor of Chemistry and Clinical Medicine, Medical Department University of Louis¬
iana; Visiting Physician of Charity Hospital, New Orleans.
{Extracts from Clinical Lecture delivered in the Amphitheatre of the Charity
Hospital, February 5th, 1879. Reported for the New Orleans Medical and
Surgical Journal.)
LECTURE Y.
TREATMENT OF YELLOW FEVER, ANL) CLINICAL LECTURES ON
THE YELLOW FEVER EPIDEMIC OF 1878, Concluded.
Gentlemen —
1 endeavored to conclude the subject of yellow fever at our
last lecture, but 1 was led by your kind and earnest attention
to enter into details which consumed the hour, before our ob¬
servations on the Treatment of Yellow Fever were more than
half finished.
At the close of the lecture we were considering the febri¬
fuge properties of the Yellow Jessamine (Oelsemium Semper-
virens ), but before reaching u the thread of our discourse,” we
desire to present some general observations relating to the
present and future advances of therapeutic experiment and
research.
GENERAL OBSERVATIONS ON PRINCIPLES OF TREATMENT OF
YELLOW FEVER AND OF THERAPEUTIC INQUIRY.
If it were possible to isolate the poison of yellow fever, it
would also be possible to experiment with it, as with other well
known poisons ; and thus not only might its physiological tox¬
icological and lethal effects be established ; but it might also
be possible to determine its antagonistic remedies.
Toxicologists have long been familiar with the fact, that the
well known laws of chemical affinity may be applied to the
neutralization of the effects of certain poisons ; thus alkalies
neutralize acids, equally within or without the stomach ; tan¬
nin forms an insoluble compound with tartar emetic, albumen
with corrosive sublimate, sulphuric acid with soluble salts of
lead, and the hydrated sesquioxide of iron with arsenious acid ;
these actions, however, related to the poison remaining in the
alimentary canal, and did not extend their antagonism to that
which was absorbed, and reached all the organs and tissues
222 Original Communications. [August
through the medium of the blood. Since the year 1661, when
Horstius gave opium to relieve the consequence of a large
dose of belladona, facts have slowly accumulated illustrating
the power of one drug to modify and counteract another ; but
it is only within the present generation, and 1 might almost
say, within the last fifteen years, that this, the most potent
and withal the subject capable of the most precise demonstra¬
tion connected with therapeutics, has been elucidated by the
experiments of Hois, Camus, Onsum, Brown Sequard, Claude
Bernard, Prof. Preyer, of Jena, Bartholow, of Cincin¬
nati, Schmiedeberg, Koppe, Kleiuwachter, Bourneville, Frazer,
J. Hughes Bennett, Oscar Leibreich, of Berlin, John Harley,
Weir Mitchell, Keen, Morehouse, Mackendrick, Crichton
Browne, Sydney Ringer, Lander Brunton, W. J. S. Ladell, W.
Outhwaite, Francis L. Haynes, Levinstein, H. C. Wood, J.
Milner Forthergill and others.
A few brief and well known illustrations will serve at once
to illustrate the great importance of a knowledge of the antag¬
onism of medicines, and at the same time will indicate the im¬
mense and rapid advance which will be made in the precise
therapeutic knowledge of diseases, when their specific poisons
are discovered and their physical and chemical, and physio¬
logical and toxic properties, relations and effects are precisely
established.
The effects of belladona upon the pupil of the eye are so
pronounced that they have tempted observers to experiment
with these drugs which contract the pupil ; thus a large and
valuable series of observations illustrating the antagonism
which exists between calabar bean and belladona have accu¬
mulated; and experiments have led to the discovery, that
these drugs which have an opposite effect upon the iris, have
also an antagonistic action in other directions quite as marked.
In the various experiments of Prof. Frazer, the influence ex¬
erted by atropia upon the action of physostigma is shown to be
a most remarkable and conspicuous one, for it effectually coun¬
teracts the lethal activity of certain doses of physostigma,
whether it be given within a certain time before, simultaneously
with, or within a certain time after that substance. The ex¬
periments of Oscar Liebreich, of Berlin, and of Prof. Hughes
1879] Jones — Treatment of Yellow Fever. 323
Bennet, of Edinburgh, have displayed in a clear light the an¬
tagonism of chloral hydrate and strychnia. Prof. Bennet has
also shown by experiments, that hydrate of chloral modi¬
fies to a great extent the action of a fatal dose of extract of
calabar beau, mitigating symptoms and prolonging life, and
even saving life in some instances from a fatal dose of extract
of calabar bean. The antagonism of morphia and belladonna
has been shown by numerous observers, and it has been shown
that the toxic effects on the cerebral organs, of these two agents
were mutually antidotal.
Whilst it must be admitted that we cannot at this moment
formulate in such precise language, the mode of action of drugs,
in neutralizing, mitigating or antagonizing the poison of yellow
fever, we are nevertheless led by such facts as we shall now
briefly consider, to the belief that the knowledge arrived at by
experimentation, will give greater precision and efficiency to
the efforts of the physician in combatting this much dreaded
pestilence, and will .still farther enlarge that most important
and useful body of experience which has been accumulating
with the medical profession in the city of New Orleans during
the past century. The facts which inspire the physician with
renewed confidence even when leading a forlorn hope against
one of the most destructive pestilences of the age, may thus be
rapidly recalled.
Seizing upon the fact that calabar beau lowers the pulse
rate and respiration, and depresses the action of the spinal mo¬
tor centres, Dr. Crichton Browne administered with the most
benificial results, this drug in controlling the violent outbreaks
of excitement to which sufferers from general paralysis are
subject.
From the actions of calabar bean and chloral, as established
by experiments, it is evident, that they are unsuited to cases
where both the respiration and the circulation are implicated,
as tending to increase the probability of failure in these sys¬
tems, and so of causing death. But in other conditions where
there is vascular excitement and corresponding respiratory
activity, the persistent use of these depressant remedies is
admissible, and often may be resorted to with advantage.
It is well known that chloral is an hypnotic of great value,
224 Original Communication*. [August
especially when the insomnia is not due to pain ; and when the
insomnia is associated with excitement, and especially vascular
excitement, chloral is par excellence the hypnotic , in virtue of its
double effect upon the brain cells and upon the circulation. It
has thus been considered by many therapeutists as peculiarly
adapted to conditions of pyretic insomnia with vascular excite¬
ment, but as will be shown more fully hereafter, it should be
used with caution in certain stages of yellow fever. Chloral
lowers the heart action, so that the circulation is rendered less
active, while its effects upon the cutaneous vessels is to dilate
them, and by this double action of impaired chemical inter¬
changes from lowered circulatory aeitvity, and increased mass
of blood in the external or heat-losing area of the organism,
the bodily temperature is much reduced. In addition to its
action on the circulation, chloral powerfully affects the respira¬
tion, and in chloral poisoning the immediate cause of death is
generally a paralytic arrest of respiration, but there may be
also a simultaneous arrest of the cardiac action and fatal syn¬
cope. Therefore the practical conclusion has been reached that
chloral should never be given, or if so, only with the greatest
caution, in cases where the respiration and circulation are
both involved, as in chronic bronchitis with dilatation of the
right heart, and emphysema, and in cases of valvular disease of
the heart, and in the second stage of yellow fever attended
with fatty degeneration of the heart, feeble general and capil¬
lary circulation and embarrassed respiration.
It is well known that in the majority of cases, death occurs
from opium by failure of the respiration, and experiments have
shown that such failure is due to the direct action of the poison
upon the respiratory centres in the medulla ; thus, whilst
strychnine obstructs the respiration by inducing spasm of the
respiratory muscles, morphia on the other hand, kills by bring¬
ing those muscles to a standstill in paralysis. The experiments
of Professor Hughes, Bennett and others, have established
the antagonism betwixt theme and caffeine and morphia, and
that the action of the one substance modifies that of the other,
and may even save life from a fatal dose of either substance.
In bronchitis, morphia should be used with great caution,
for it not only arrests secretion and thus increases the difficulty
Jones — Treatment of Yellow Fever.
225
1879]
of expectoration and respiration, but its action upon the respi¬
ratory centres is such as to paralyze them when already embar¬
rassed. In the hacking cough of phthisis, when cough is
excited by the presence of diseased masses in the lungs, and
when the cough is distressing, and yet useless, in that it is in¬
capable of getting rid of the source of irritation, morphia is
useful in effectually stopping the retlex mechanism of cough ;
but at the same time it destroys the appetite, locks up the
bowels, lowers the respiration, and produces exhaustion by
the profuse sweats which it excites. Morphia acts upon the
skin, and aggravates the night sweats, to which patients suf¬
fering with phthisis are subject. Dr. J. Milner Forthergill has
combined belladonna with morphia, and found that this checks
the sweats, while the morphia allays the cough, the action of
morphia upon the cough not being interfered with by the co-
administration of the belladonna, which affects the terminal
ends of the vagi in a manner which aids the action of mor¬
phia, the favorable effect being not confined to the skin, but
to the respiration also.
I might multiply these well known examples, by detailing
the effects of strychnia, digitalis, belladonna, aconite and other
remedies, which are capable of neutralizing, antagonizing and
relieving various diseased states, but we conceive that those
briefly related are sufficient to illustrate the idea that there
will be a progressive advance in the application of therapeutic
principles and agents, even to such a dangerous and rapidly
fatal diseases as yellow fever.
The impression appears to be wide spread, that treatment
accomplishes but little in diminishing the mortality in yellow
fever; but the old adage that familiarity breeds contempt,
might even be applied to this disease, for those who have met
it most frequently in its native haunts, are, as a general rule,
the last to admit the truth of this impression, and the first to
acknowledge that important principles have been established,
and much valuable experience accumulated, relating to the
therapeutics of this disease. Thus it has been estimated that
during the epidemic of 1878, between 25,000 and 30,000 cases
of yellow fever occurred in New Orleans (the President of the
Board of Health in his report, estimates the number of cases
2
Original Communication*.
226
[August
at 25,000; Col. Hardee, of the Board of Health, and United
States Yellow Fever Commission, in his canvass of the city,
places the number over 27,000) ; both figures should be regarded
as mere approximations to the entire number which will never
be precisely determined, and of this number, 4046 proved
fatal. We may express the results thus : Of the entire popu¬
lation of New Orleans, about one case of yellow fever occurred
in 7.77 of the entire population, and one death in ol.9 of the
population, and one death in <>.00 of the entire number of cases.
The relative mortality was greatest in the Charity Hospital,
reaching over fifty per cent., it was far less in private practice,
reaching, in my own limited series of cases, 18 deaths in 256
cases, or one death in 14.0 cases, or 7.0 per cent, mortality.
Such rates of mortality are not greater than those character¬
istic of other severe diseases, as pneumonia, pleuritis, peri¬
tonitis and typhoid fever, and far less than in unmodified
small pox and Asiatic cholera and the true plague.
It is true that the mortality was much greater in those places
where yellow fever was comparatively unknown, and the differ¬
ent rates of mortality must be referred to several causes, as
the following :
1st. In New Orleans, a large proportion of the population
were exempt in virtue of previous attacks of the disease, and
were therefore in a condition to render efficient and continuous
aid to the sick and afflicted.
2d. A large number of experienced nurses, familiar with the
treatment, nature and sudden changes of the disease, were at
all times at the command of the sick in New Orleans.
3d. The medical profession of New Orleans, as a rule, have
had extended experience in the treatment of the disease, and
they have inherited the precepts and experience of near an en¬
tire century, in a city which has suffered more frequently and
to a greater extent than any other on the face of the globe.
4tli. When yellow fever formed a lodgment in interior towns
and cities to which it had previously been a stranger, it found
an unprotected population, which was prostrated almost simul¬
taneously by the pestilence and tortured by harrassing fears.
Whole families were stricken down. The husband was unable
to nurse the wife, and the mother and father could render no
J ones — Treatment of Yellow Fewer.
1870]
9.9.1
assistance to their stricken children; the servants tied panic-
stricken, and the faithful physician yielded up his life almost
by the bedside of his patients ; and even the dead were de¬
prived the last rites of love and religion. Under such cir¬
cumstances, with a pestilence sweeping almost with the rapid¬
ity of the whirlwind and prostrating all before it, who can
wonder that many perished for want of proper nursing and
medical attendance, and that the mortality was necessarily
much greater than in cities furnished with experienced and
seasoned and acclimated physicians and nurses !
It is evident from the preceding facts that the profession in
all places where yellow fever prevails, should form a corps of
well instructed and trained acclimated nurses.
We will now resume our observations on the treatment of
yellow fever, at the abrupt point at which we terminated on
on the 29th of January.
YELLOW JASSAMINE ( Gelsemium Sempervirens), Continued.
Dr. W. W. Durham, in a letter addressed to the Purveyor of
the Confederate Army, dated Decatur, Georgia, 5th of October,
1802, says that gelsemium is without doubt the most potent
febrifuge known to the profession. This potency seems to de¬
pend on its relaxing and antispasmotic properties, as may be
inferred from its efficacy in the treatment of tetanus, in con¬
trolling which, according to Dr. Durham, no other known agent
is comparable. It is now used and highly extolled by many
respectable physicians in all fevers except the congestive form.
It is said by some to be the only agent yet discovered capable
of subduing in from two to twenty hours, and without the
least x>ossible injury to the patient, the most formidable and
most complicated, as well as the most simple fevers, incident
to our country and climate, quieting all nervous irritability and
excitement, equalizing the circulation, promoting perspiration,
and rectifying the various, secretions without causing nausea,
vomiting or purging, and is also adapted to any stage of the
disease. It may follow any preceding treatment with safety.
Its effects are clouded vision, double sightedness, or even com¬
plete prostration and inability to open the eyes, and which pass
off in a few hours, leaving the patient refreshed and completely
228 Original Communications. [August
restored ; and as soou as the heaviness or partial closing of the
eyes is induced no more of the remedy is necessary, although
these effects should follow the first dose. If carried to such an
extent that the patient cannot open his eyes, the relaxation
may be too great for the system to recover from, hence its use
should cease as soon as the symptoms above named are pro¬
duced. Drs. Cleveland, Branch, Nash, Douglass, aud others,
have, in like manner, testified to its narcotic, antispasmodic
and sedative effects.
The control of gelsemium over the nervous system is marked,
and hence it has been used with advantage in all forms of neu¬
ralgia, nervous and bilious headache, chorea, haemorrhage,
rheumatism, gout, and various diseases.
It is, however, in pneumonia pleuritis, and fevers, that its
good effects have been most observed by Southern and West¬
ern physicians, in controlling irregular nervous action, promo¬
ting perspiration, reducing febrile heat, and thus aiding greatly
the powers of nature in fever, and also the action of other
remedies.
Dr. It. N. Taylor, of Kentucky, in his inaugural thesis (Rich¬
mond and Louisville Medical Journal, June 1875, p. 593-624)
has shown by experiments and vivisections that the gelsemium
sempervirens has a direct depressant effect upon the heart, di¬
minishing both the force and frequency of its action, and that
it exerts marked effects upon the temperature. In one case
the temperature of a healthy subject was reduced, in seven
hours, by a hypodermic injection of five minims, as low as
96.6° F., and it did not regain its normal standard until the
expiration of nearly eighteen horn s. In the experiments upon
animals under the influence of poisonous and fatal doses, the
temperature was very much diminished and in one case it fell
from 100° to 95.8°.
Dr. Taylor also details cases illustrating the power of gelse¬
mium to reduce the frequency of the pulse and the temperature
in remittent fever, pneumonia, and acute articular rheumatism.
Dr. Taylor thus explains the action of the drug in reducing the
temperature :
“ It has been seen, heretofore, that respiration is very much
diminished in frequency, and the fall in temperature is, no
1879]
Jones — Treatment of Yellow Fever.
229
doubt, dependent in part upon the diminished consumption of
oxygen and the consequent diminution in the processes of com¬
bustion going on in the body. The temperature and the circu¬
lation bear a direct relation to each other, rising and falling
together ; the temperature always being in direct ratio to the
arterial pressure. Gelsemium lowers the frequency of the
pulse, and by dilating the capillaries, produces a remarkable
diminution of the blood pressure. Upon this, no doubt
depends principally the fall in temperature. The action of the
drug in producing a reduction of fever temperature, admits of
an easy explanation. According to the very accurate
researches and studies of Traube, every fever begins with an
energetic contraction of the cutaneous capillaries, preventing
the going off of heat to the air, and thus more heat is collected
in the body. Gelsemium dilates the capillaries, even in medi¬
cinal doses, and thus the accumulation of heat in the body is
prevented.” Dr. Bartholow has also recorded the fact that
gelsemium causes a very great fall of temperature in animals.
The physiological action of gelsemium sempervirens has been
more recently investigated by Drs. Murrell and Sydney
Ringer, (Hand-book of Therapeutics, 1878, p. 487, and London
Lancet, 1870 and 1877), Dr. Roberts, Dr. Berger and by Dr.
Isaac Ott (Action of Medicines, 1878, p. 124.)
Prof. T. G. Wormley, in 1870 (American Journal of Phar¬
macy), first showed that the root of the yellow or Carolina Jes¬
samine, contains an alkaloid, gelsennia in combination with gel-
seminic acid.
According to Dr. Isaac Ott, on the lower animals, gelsemina ,
destroys voluntary movement increases and decreases spinal
reflex excitability, produces convulsions, has no action on the*
motor nerves, muscles and sensery nerves, reduces the heart¬
beat by an action on the excito-motor ganglia, and disperses
the arterial tension by diminished tonus of the vaso motor
centre in the brain, decreases respiratory frequency by an
action on the centres of respiration ; the temperature of the
body is also reduced.
Gelseminic acid convulses more than gelsemina, and causes
a brilliant fluorescence of the humors of the eye ; in other
U30 Original Communications. [August
respects it acts ou the nervous system like gelsemina. Artifi¬
cial respiration will save poisoned animals.
On man, gelsemina produces double vision, ptosis, want of
co-ordination, disagreeable feeling in the head, great muscular
relaxation, drooping of the lower jaw, tongue stiff, sensation
blunted, pupils dilated, respiration slow, irregular, pulse slow,
surface cold, and congested, unconsciousness, and death by as¬
phyxia. Ringer and Murral state that during the diplopia,
the images in the upper part of the field of vision appear at
different heights, although actually in the same plane. Locally
the drug contracts the pupil, whilst internally it contracts and
dilates it, by paralyzing the third pair. The medicine affects
the sixth nerve before the third, as the external rectus is the
first muscle weakened. Taylor states that it increases the
urine and reduces the pulse, respiration and temperature.
Tweedy states that it impairs the power of accommodation of
the eye for near objects.
Its value in neuralgia, and especially in trigeminal affections,
appears to depend upon its power of diminishing the excita¬
bility of the receiving ganglia.
In fevers of a sthenic character, the diminution of pulse, ar¬
terial tension, and temperature afford an explanation of its
value.
In the treatment of yellow fever, as well as of other fevers,
and pneumonia pleuritis and acute rheumatism, I have employed
the tincture of the gelsemium semper virens with benefit. The
same precautions, however, should govern its use in yellow
fever as were pointed out with reference to veratrnm viride :
the use of this remedy should be confined chiefly, if not en¬
tirely, to the early and what might appropriately be termed
the sthenic stage of yellow fever before the completion of the
tissue changes peculiar to this disease. The grand objects to
be accomplished in the treatment of this stage are diminution
of pulse, arterial tension and temperature, and the promotion
of free diuresis and diaphoresis, and the prevention and control
of undue ccrebro spinal excitement. We have employed other
remedies as aconite to produce similar results, but have relied
chiefly upon the veratrum viride.
231
1879] Jones — Treatment of Yellow Fever.
9. MEASURES FOR THE REDUCTION OF TEMPERATURE IN
YELLOW FEVER.
We* have shown by careful observations that if the temper¬
ature in yellow fever rises either in the first or second stage of
yellow fever above 105° F., the patient is in imminent danger;
and if it reaches from 107.6° F. (42° C.), to 11 1.2° F. (44° C), death
is almost inevitable whatever may be the treatment adopted
In this fact we have a powerful argument for the constant em¬
ployment of the thermometer in the investigation of the phe¬
nomena of this disease, as affording sure grounds not only for
prognosis but also for treatment.
If the thermometric changes of yellow fever be projected
upon a chart, and a comparison be instituted with the thermo-
metric changes in other diseases, it will be observed that the
former more nearly resemble the rapid rise and fall of tempera¬
ture observed in varioloid, without secondary fever, mild scar¬
latina, and simple, uncomplicated pneumonia, which runs its
course without fresh accessions of inflammatory action, while
on the other hand they differ materially from the rapid and oft
recurring elevations and depressions of temperature charac¬
teristic of the various forms of paroxysmal malarial fever.
These remarks apply to those cases of yellow fe er in which
the fever is confined to one paroxysm; but as we have pre¬
viously shown, there is another class of cases in which, and
that too often without any warning, there is a sudden rise of
temperature to extraordinary heights with rapid fatal issue.
These two types correspond to the two chief modifications of
smallpox; the brief, continuous form, resembling the modified
or moderated disease varioloid ; the relapsing type, resembling
variola vcra, in which there is a marked secondary rise of fever
in the suppurating stage. It is well known that in variola vera,
as in yellow fever, in some fatal cases, the temperature may
rise rather quickly from moderate heights to very considerable
degrees, and death may occur at 107.6° (42° C.), or even more,
although during the stage of secondary (suppurating fever),
the patient may sometimes die with only very moderate eleva
* Changes ot Temperature and Pulse in Yellow Fever, by Joseph Jones, M.D., Ameri¬
can Practitioner, September, 1873 ; Boston .Medical and Surgical Journal, August 28th,
1873.
Original Com muni cation*.
232
[August
fcion of temperature. Simon has published cases of smallpox,
in which the temperature (which, however, was measured after
death) was 110.750 F. (43.75° C.) and 112.1° F. (44.5° O)
With reference to the application of remedies to control and
prevent the great rise of temperature in yellow fever, two
views may be held as to the relations of the elevated tempera¬
ture to the fatal issue.
1st. The elevated temperature induce* those changes of the tis¬
sues , and more especially of the heart , liver , kidneys , and of the
blood , which precede and cause death.
2d. The elevated temperature is only an evidence of active, chem¬
ical change , and a result , and not the cause of the tissue changes .
The latter view appears to be correct because as we have
shown by numerous elaborate studies of cases of yellow fever*,
that jaundice, urinary suppression, and black vomit are often
accompanied by a slow pulse and but moderate elevation of
temperature.
The cause of the rapid rise and fall of the temperature in
yellow fever must be sought chiefly in the changes in the blood,
and in those organs upon which the circulation and integrity
of the blood depend. Neither the rapid rise nor fall of the
temperature can be referred wholly to the effects of the poison
upon the nervous system.
While it must be admitted that the experiments of Chossat,
Brodie, Nasse, Claude Bernard, Brown-Sequard, Budge, l)e
Ruyter, Waller, Schifif, Naunyn, and Quincke, and the experi¬
ments of Tscheseliichin, in which division of the medulla ob¬
longata, near its juncture with the pons caused a remarkable
elevation of temperature from 102.9° to 108.68°, and finally
convulsions and death, and a large number of pathological
observations, in which most remarkable variations of tempera¬
ture accompany profound alterations and disturbances of the
nervous system, without corresponding changes in respiration
and circulation, sustain the theory of centres of control , which
* New Orleans Medical and Surgical Journal. 1873-1874; New York Medical Journal ,
Boston Medical Journal; Richmond and Louisville Medical Journal; American Prac¬
titioner.
1S79] Jones — Treatment of Yellow Fever. 233
have their seat in the brain, and which regulate the activity of
the spinal cord (when they are destroyed the activity of
the spinal cord being morbidly increased, as manifested by
increased reflex action, quickened respiration, acceleration of
the cardiac systole, and increased animal heat), and that a
great part of the pathological phenomena of warmth, may be
oidy the expression of the action of the vaso motor nerves;
and still further, that the integrity of the central parts of the
central nervous apparatus is more necessary for the regulation
of animal heat than that of any other parts of the body. On
the other hand, Breuer and Chropak, after an investigation of
the question whether the nerves of a part supply elevation of
temperature in an inflamed part, by means of experiments on
animals, in which they have as far as possible divided all the
4
nerves of one part of the body, think themselves justified in
concluding that the force of the traumatic inflammation is inde¬
pendent of the nervous connections of the inflamed part with
the nerve centres'; and by an extended series of observations*
I have established the fact that in hospital gangrene and py¬
aemia the elevations of temperature are independent of the
local lesions of the structures, and are coincident with the
introduction of the gangrenous and pyaemic poisons into the
blood, are intimately associated with the changes of the blood
and urine, and are invariably accompanied by increased
amounts of such constituents as urea, phosphoric and sulphuric
acids ; and even the traumatic fever accompanying gun-shot
wounds arises from the introduction of inflammatory products
into the blood, and depends not so much upon the extent and
nature of the wounds as upon the state of the solids and fluids
at the time of the injury, and upon the character of the inflam¬
matory products absorbed into the circulation. Even in such
inflammatory diseases as pneumonia, attended with extensive
tissue change, the introduction of certain inflammatory products
into the blood must more or less influence the production of
high temperatures.
It is well known that some of the most violent poisons during
* Investigations upon the Nature, Causes, anil Treatment of Hospital Gangrene as it
irevailed in the Confederate Armies 1861-5, by Joseph Jones. M.D. , Surgical Memoirs
Tnited States Sanitary Commission, vol. ii, pp. 1 46 -570.
3
234 Original Communications. [August
their direct action upon the nervous system are unattended
with elevations of temperature, while on the other hand putrid
matters, pus, and certain animal secretions, as the poison of
the rattlesnake and copperhead, induce profound alterations in
the blood, attended with the most marked variations of temper¬
ature; and in the latter class of poisons the phenomena appear
to be akin to the changes whica may be induced by ferments,
which are not only capable of increasing the amount of heat,
but may be limited in their actions , or in the amount and charac¬
ter of the changes which they induce, in virtue of their chemi.
cal constitution and that of the blood or medium in which they
are active.
Certain substances, as woorara, colfee, musk, and camphor,
and putrid fluids have a direct effect in raising the temperature
after their entrance into the circulation. Voisin and Lionville,
by means of subcutaneous injections of woorara, induced a
complete artificial fever in human beings, with rigors, heats,
and sweatings, the temperature rising to 104.8°, accompanied
witli all the signs of febrile circulation and secretion and dis¬
turbance of the nervous system.
When certain putrid solutions or pus are injected into the
blood the temperature rises considerably within two hours, and
reaches its maximum in from two to twenty-eight hours.
After a single injection rapid defervescence generally sets in
shortly after the acme has been reached, while on the other
hand, after repeated injections, death constantly occurs, gen¬
erally with high temperatures. Fluids from inflamed tissues,
pyamiic and septica-mic blood, and even the blood drawn in
simple inflammatory or other kinds of fever, produce similar
elevations of temperature.
Fresse has determined by experiments that the rise of tem¬
perature induced by the introduction into the blood of the
products of decomposition and of inflammatory tissue destruc¬
tion do not depend upon the pus-corpuscles , nor upon the so-
called germinal matter , but upon the serum of the fluid. Even
boiling and subsequent filtration does not destroy the property ;
and the removal of the fibrin, and even the filtration of the
blood of animals suffering from fever, does not deprive it of the
pyrogenic effects when injected into the circulation.
Jones — Treatment of Yellow Fever.
235
1879]
The unknown cause which excites the specific morbid pro¬
cess of yellow fever would appear to have something’ in com¬
mon with the action of such putrid animal substances, and the
fact is worthy of note that the property possessed by such mat¬
ters of exciting chemical changes and elevation of tempera¬
ture was not destroyed by boiling and subsequent filtration ;
for we have thus a clear demonstration that the animalcular,
vegetable, or germinal theories as to the origin of yellow fever
are not absolutely necessary to the explanation of the febrile
phenomena.
Neither the rapid rise nor the sudden declension of the tem¬
perature in yellow fever therefore are necessarily referable
solely to the effects of the poison upon the nervous system ;
because, in the first place, the changes of the blood are among
the first manifestations of diseased action, and the progress
and termination of each case is largely dependent upon the
extent and character of the changes of the blood and the
degree of temperature ; in the second place, the sudden fall of
temperature during the succeeding stage of calm may be
referred to the peculiarity of the self-limited chemical changes
excited by the poison, and to the structural alterations induced
in the muscular tissue of the heart and in the liver and kid¬
neys, and the sedative action of the bile, urea, and other ex-
crementitious products retained in the blood, upon the nervous
system ; and finally the changes in the blood, heart, liver, and
kidneys are of a definite physical and chemical nature, and
could never be induced by a mere exaltation or depression of
nervous action, and must be referred to the introduction and
action of some agent or material related in a definite manner,
in its chemical constitution and physical properties, to the
fluids and solids in which it induces these profound, physical
and chemical changes.
Without doubt the action of the yellow fever poison upon
the nervous system may be direct and most important, but the
facts do not justify us in locating the origin of the disease
wholly in the action of the poison upon the nervous system ;
and in fact the earliest manifestations of disordered nervous
actions, as uneasiness, loss of appetite, and chilly sensations,
may be entirely secondary to the changes in the blood, by
236 Original Communications. [August
which all parts of the nervous system are surrounded and
supplied.
It is, however, impossible in the present state of our knowl¬
edge to refer the changes of temperature in yellow fever with
certainty to either the decrease or increase of any one constit¬
uent of the blood ; for M. Andral* has shown that when the
blood contains more than four one-thousandths of fibrin the tem¬
perature rises, and in a corresponding ratio. Thus of all dis¬
eases pneumonia is marked with the greatest increase of fibrin,
and is the highest in temperature of all the phleginaske. Of
eighty-five cases, in only thirteen was the temperature below
102.2° ; in forty -four it was between 102.2° and 104° ; in twen¬
ty-six between 104° and 105.8° ; and in two rose to 106.16°. In
acute pleurisy, in which there is always less fibrin, the temper¬
ature only once reached 105.8°, and usually oscillated between
101.3° and 103.1°. M. Andral, however, records exceptions to
this relationship of the increase of fibrin and the elevation of
temperature in inflammatory diseases, as in erysipelas, where
there have been only seven one-thousandths of fibrin, the tem¬
perature has been 107.24° ; and he very justly does not consider
the increase of fibrin and the rise of temperature as cause and
effect ; for in the pyrexue, when there is no excess of fibrin,
but rather a diminution of this constituent, the temperature is
as high or higher than in the pldegmasue. Indeed, the highest
degrees are reached in diseases where there is the least fibrin
in the blood. Neither does the number of red globules affect
the rise of temperature to an appreciable degree in inflamma¬
tions and fevers, as I have carefully determined by a compari¬
son of the constitution of the blood witu the elevations of
temperature in various diseases.
It is evident, therefore, that the cause of the rapid rise and
sudden decline of the temperature in yellow fever must, as 1
have said, be sought chiefly in the changes induced by febrile
poison in the blood, and in those organs, as the heart, liver and
kidneys, upon which the circulation and integrity of the blood
depends.
* Medical Times and Gazette, London, July l, 1870.
(To be continued.)
1879]
Richardson — Chancre and Chancroid.
237
Diagnostic Differences Between Chancre and Chancroid.
[In a recent iiscassion upon chancroid and syphilis before the Orleaus
Parish Medical Society, Prof. T. G. Richardson, M. D.. presented the fol¬
lowing summary statement of his views upon the distinctive differences
between the primary stage of acquired syphilis and chancroid :]
Such is the conservatism of all truly philosophic investiga¬
tors in medicine, as well as in other departments of scientific
research, that notwithstanding the great advance made within
the past century in the diagnosis, pathology and treatment of
nearly all diseases, the influence of great names in the perpet¬
uation of error is still strongly felt by all who propose a new
departure. The justly renowned John Hunter, the acknowl¬
edged English authority, not only in surgery, but also in gen¬
eral pathology during the last quarter of the last, and nearly
the first half of the present century, pronounced all venereal
diseases to be dependent upon one and the same exciting cause.
He proved to his own satisfaction and that of the rest of the
world, that gonorrluea, soft chancre (or as we now call it chan¬
croid) and syphilis were essentially identical, and the appar¬
ent differences resulting from their introduction into the human
system were due to the mode of contagion, the tissues involved,
and the peculiar state of the constitution of the patient.
Strange as it may seem to us of the present day, this opinion
prevailed to a large extent throughout England and this coun¬
try until comparatively modern times, and resulted, as may be
readily conceived, in plans of treatment as often disastrous to
the patient as to the disease.
Scarcely had gonorrhoea been detached from this alliance,
and proved to be a local inflammation, having a definite his¬
tory and amenable to non-specific remedies, than it was hinted by
the French pathologists, that by pressing the wedge of investi¬
gation still farther another rupture might possibly be effected;
that what was termed soft or simple chancre, might be sepa¬
rated from its only remaining associate, and each made to
stand upon its own individual foundation. I need scarcely say
that what was only a suggestion thirty or thirty-five years ago
is now an accomplished fact. ; that chancroid (soft chancre) and
syphilis are now recognized by the great majority of surgeons
and pathologists as totally distinct affections, having separate
238 Original Communications. [August
histories, productive of entirely different effects upon the
human system, and demanding for their relief modes of treat¬
ment al most diametrically opposed the one to the other. 1 do not
mean to imply that this u dual doctrine,” as it is sometimes
called, though based upon rigid observation and experiment
made in all the great centres of medical learning, has no oppo¬
nents. On the contrary, the influence of the great men who
are now passing away, and who have not abandoned the views
which formerly prevailed, is still felt at the circumference of
the profession, and will continue to exert itself until the text¬
books on medicine and surgery commonly recommended to
medical students have been revised, or a new series introduced.
Indeed, judging from what I almost daily hear from patients
as to their previous treatment, I am warranted in the belief,
that comparatively few general practitioners have had their at¬
tention particularly directed to the diseases in question, and
are not therefore fully informed as to the true position which
has been reached, and the great practical importance of the
points which have been established. I would not have it
thought that I am over-credulous of the stories which many
patients indulge in with reference to their medical advisers
(whom in nine cases out of ten, they have deserted without
settling their just accounts), but when I ascertain either by
examination or questioning that in a case of ulcer upon the
genital organs, mercurial remedies have been employed steadily
for a longer or shorter time with the view to ptyalism, I can¬
not be mistaken as to tl\e pathological ideas held by the pre-
scriber, and am therefore entitled to draw my own private in¬
ference as to his acquirements and practical sense. As the
matter now stands, I do not hesitate to declare that the phys¬
ician who undertakes to treat these diseases without a clear
understanding of their radical pathological and therapeutical
differences is criminally responsible for the sad mistakes he is
sure to make.
Asking your pardon for these prefatory remarks, I now pro¬
ceed to the consideration of the special question selected for
discussion this evening, which 1 understand to be the etiolo¬
gical, clinical and pathological resemblances and differences
between chancroid and the initiatory stage of syphilis known as
Richardson — Chancre and Chancroid.
239
1879J
chancre. For the purpose of bringing the subject clearly and
concisely before the Society, I shall present it in the form of a
series of dogmatic statements with the hope that these may be
freely criticised by all whose observations and deductions dif¬
fer in any manner from my own.
I. POINTS OF RESEMBLANCE IN CHANCROID AND ACQUIRED
SYPHILIS.
1. Both are infectious diseases, the result of local contagion,
and present themselves primarily as sores which secrete a poi¬
son similar to that by which they have been produced.
2. The primary sores occur only at such points where the
virus lias been brought into contact with the sub cuticular layer
of the skin or mucous membrane.
3. Both are most commonly propagated by sexual intercourse,
hence the greater frequency of the primary sores upon the gen¬
ital organs. Any portion of the cutaneous or mucous surfaces
may however become the seat of either of the two diseases
when the conditions mentioned in the preceding proposition
exist, as is sometimes witnessed in the case of dressers and
surgeons who become accidentally inoculated in the perform¬
ance of their duties by means of minute sores, abrasions or
wounds upon their fingers.
4. In both affections the primary ulcers are liable to assume
different phases of action, such as the phagadenic, serpiginous
and gangrenous.
In these four particulars the two diseases often present a
very strong likeness, which for the moment may occasionally
lead even a very skilful surgeon to reserve his diagnosis. The
distinctions however, a brief synopsis of which 1 will now pre¬
sent, are usually sufficiently well marked to justify an early if
not an immediate decision.
II. POINTS OF DISTINCTION BETWEEN CHANCROID AND AC¬
QUIRED SYPHILIS.
1. a. In chancroid there is scarcely an appreciable period of
incubation. When the virus has been brought into contact
with a cutaneous or mucous surface from which the cuticle has
been removed, within a very few hours thereafter a running
240 Original Communications. [August
sore is produced whose secretion possesses the same infectious
quality as that from which the inoculated poison was derived.
The rapidity of the effect is somewhat moderated when the
virus has been inserted beneath the cuticle by means of a lancet
or other sharp pointed instrument, or lias become imprisoned in
like manner by a slight rupture of the cuticle which closed im¬
mediately as often occurs in coition. In such cases a small papule
is developed within twenty- four or forty-eight hours which soon
becomes a pustule terminating in a day or two in a defined sup¬
purating sore.
h. Syphilitic, like vaccine virus, produces no apparent effect
for several days after contact, and the primary sore (to which
the name chancre should be strictly limited) does not ordinarily
attain its full development in less than three and sometimes in
less than four weeks. This fact has been conclusively proven
not only by clinical experience but by experimental inoculation.
2. a. Chancroid, in its formation and progress, is nearly
always accompanied by heat, pain, redness and swelling. It
thus declares its jiresence unmistakably to the patient, and
compels him to seek relief.
h. Chancre is seldom attended by any inflammatory symp¬
toms, and sometimes reaches its maturity without having at¬
tracted the attention of its victim.
3. a. Chancroid is very commonly multiple, the sores num¬
bering from two to as many as six or eight. This multiplicity
may result from as many consentaneous inoculations, but more
likely from rapid propagation from one or two original sores.
In the latter case the abrasion of the cuticle necessary to effect
the result is usually produced by the inflammation excited in
the surrounding parts by constant contact with the irritating
purulent secretion, and also not rarely by scratching and fric¬
tions on the part of the patient.
h. Chancre is nearly always single, and seldom or never du¬
plicates itself by subsequent contamination of the adjacent sur¬
faces. When double, as has been occosionaljy observed, inoc¬
ulation of the two points must have occurred simultaneously
or within two or three days of each other.
I. a. The virus of chancroid, as may be inferred from what
1879 J Ktchardson — Chancre and Chancroid, 241
lias been just stated, is anto-inoculable. The purulent secre¬
tion furnished by the sore during its active stage and up to
within a very short time of its complete cicatrization is capa¬
ble, either by accidental or experimental inoculation, of pro¬
ducing any number of similar sores in the same individual.
h. The secretion of chancre when brought into contact with
an abraded surface or introduced beneath the cuticle of the in¬
dividual in whom the primary sore exists, produces either no
effect or else a very greatly modified sore possessing no power
of infection so far as has been ascertained.
5. a. Chancroid varies in size from a line to an inch or more
in diameter, has usually clearly defined edges, a surrounding
inflammatory areola and a slightly depressed angry -looking sur¬
face. Its secretion is abundant and purulent, varying in its
consistency, but often presenting the physical qualities of
laudable pus. It is essentially a wet sore, and the adjacent
surface for a considerable distance is kept continually bathed
in the foul discharge.
b. The ulcerated surface of chancre is not often larger than
v three or four lines in diameter, but is frequently smaller, has
sloping edges, no inflammatory areola, and except when irri¬
tated by injury or other accidental cause, or by the application
of stimulating substances, or unless pliagadenic in its charac¬
ter, furnishes a very meagre amount of sero-purulent secretion.
It is, comparatively, a dry sore, but the secretion slight as it
is, is capable of doing an amount of damage that is truly
appalling.
(i. a. Chancroid is usually superficial, and unaccompanied by
decided thickening or hardening of the surrounding or subja¬
cent tissues. Hence it was formerly and is still called by some
writers mft chancre. This characteristic is, however, frequently
lost by the application of escharotics.
b. Chancre is generally distinguished by a remarkable thick¬
ening and induration of the tissues beneath and around the
ulcerated surface. This may be easily determined by lightly
grasping the parts between the finger and the thumb, when
the sensation imparted will be like that of a disc of imlia rub¬
ber beneath the skin or mucous membrane. At other times,
4
242 Original Communications. [August
however, this circumferential hardening is not well marked,
although it is probably never altogether absent. This differ-
erence in degree should be always borne in nund in making a
diagnosis, and the value of the symptom as a characteristic
esti mated accordingly.
7. a. Chancroid nearly always shows a tendency to spread,
and sometimes attains to a very large size in a few days.
I>. Chancre is indolent and frequently remains unchanged in
dimension or otherwise for several weeks.
8. a. Chancroid is frequently productive of bubo, but this is
not a necessary result, and should be looked upon rather in
the light of an accident. When present, it is ordinarily limited to
the lymphatic ganglhe nearest the sore, but the imflammation
may spread to other ganglia upon the route of the lymphatic
vessels leading from the spot, and thus give rise to a poly-
ganglionic swelling. The bubo of chancroid is commonly ac¬
companied by acute inflammation, which results in the forma¬
tion of a collection of pus possessing the same infectious qual¬
ity as that of the original ulcer. In such cases the virus seems
to be carried from the chancroid by the lymphatic vessels and
lodged in the rete of the ganglion, where it excites suppurative
action. In other instances where suppuration does not take
place, the probability is that the swelling is due to a simple ex¬
tension of the inflammation along the lymphatic vessels, as is
often observed in connection with non-specific ulcerations.
/>. In chancre there is always enlargement of a number of
the adjacent lymphatic ganglia, unaccompanied by pain or
other marked symptoms of acute inflammation, and possessing
little or no tendency to suppurate. When the primary sore
is seated upon the genital organs all the ganglia of the upper
inguinal group upon each side are usually affected. Suppura¬
tion occasionally occurs in consequence of external injury or of
a depraved state of the system, but this is rare.
9. a. Chancroid is not succeeded by discolorations of and
eruptions upon the skin and mucous membranes, ulcerations of
the throat, falling of the hair, specific inflammations of the
deeper tissues or other symptoms of constitutional infection.
b. Chancre when left to itself is invariably followed by cuta-
1879] DeRoaldes — Treatment of Bright^ Diseases. 243
neous and mucous eruptions, ulcerations in different parts of
the body, deep seated inflammation, morbid deposits in various
tissues and organs, and numerous other effects which character¬
ize it as one of the most penetrating and dreadful constitutional
diseases to which the human body is liable. Superadded to
the power of producing these dreadful consequences in its orig¬
inal victim, it possesses the quality of heredity in a marked
degree, and thus the sins of the parent are visited upon the
children throughout several generations.
10. a. As chancroid is not a constitutional disease it is in no
degree protective. On the contrary it may repeat itself an in¬
definite number of times in the same individual when the latter
is exposed to the exciting cause.
h. Chancre is as strictly constitutional as the vaccine pustule,
and like the latter so modifies the system that no new infection
possessing the true characteristics like the original cau be
produced.
11. a. Chancroid is not arrested or moderated but often pow¬
erfully aided in its destructive action by mercurialization or
iodism.
b. Chancre is frequently cured and its secondary results pre¬
vented by the judicious administration of mercury. When the
infection has reached the secondary and tertiary stages mer¬
cury and iodine when properly employed are truly antidotal.
Contribution to the Hydrological Treatment of Bright’s
Diseases.
By DR. A. W. de ROALDES, Resident Physician, Waukesha Springs,
Wisconsin.
Read before the New Orleans Medical and Surgical Association.
In bringing the discussion to bear upon Bright’s diseases, our
confrere and friend Dr. Loeber has chosen, with great pro¬
priety, I think, to limit the wide field of albuminuria, which is
too vast to run over in one evening. Limited as the question
may be, it still affords room for different views.
244 Original Communications. [August
No one will dispute that, in some cases of albuminuria, the
disease is entirely constituted by a renal lesion, as, for exam¬
ple: Albuminuria resulting- from exposure to cold, or again
cantharidian nephritis. But what constitutes Bright’s diseases "l
There lies the question. For some physicians it is merely and
primarily a local renal lesion ; for others, and this seems to be
a more philosophical view, Bright’s diseases are in their very
incipiency general affections, constitutional disorders, dys-
crasirn, as scrofula, gour, rheumatism, syphilis, of which albu¬
minuria, at the start, is only a symptom. The excretion of
albumen may in these conditions be the initial phenomenon
without being accompanied, in the beginning at least, by any
lesion of the kidneys. Albumen may be excreted by these
organs as sugar is. The only difference between diabetes and
incipient albuminuria of Bright’s diseases, lies in the excreted
substances. If it be sugar, a hydro carbon possessed of dialy-
sable properties, the excretion will be effected without produc¬
ing any local disorder in the parenchyma or stroma of the kid¬
ney; if, on the contrary, it be albumen, a colloid substance,
the kidney will soon become affected. This transudation of
albumen is accompanied by renal congestion ; if it be mod¬
erate, the disease may run a very slow course. There are cases
of Brightic albuminuria, which may have a very long duration,
ten, fifteen, twenty and more years. I was consulted, two
months ago, by a medical gentleman, who has been passing
albumen ever since 1874. It is only in the last two years that
the examination of his urine has revealed the presence of
casts, and it is only since this comparatively short time that
his general health has become affected. Last summer, at the
springs, I had under my charge a lawyer from Paris ; his phys¬
ician, Dr. Gr u bier, stated in his letter to me, that our patient
had been passing albumen ever since 1853. This slow progress
of the disease is witnessed only in such constitutions, as are
free from a diathetic influence. Take, for instance, a scrofu¬
lous, a syphilitic, a rheumatic, or a gouty patient, whose con¬
stitution shows a tendency to the evolution of morbid products
of a retrogressive character. The congestion, in such cases, will
soon lead to the formation of neoplasms, to the proliferation of
245
1879] DeRoaldes — Treatment of Bright's Diseases.
new cellular elements, etc. Simple albuminuria will then be of
very short duration and will soon result in Brightic diseases.
But I shall not stop to enquire the cause, by reason of which
albumen escapes from the blood to mingle with the urine. Is
it the kidney which just becomes diseased, or is this organ
secondarily affected ! Must we, on the contrary, look for the
incipiency of the malady in a functional disorder of the liver
and stomach ? Or is it the blood which is primarily affected ?
1 particularly desire to-night to direct your attention to a
few special points of therapeutics of Bright’s diseases. In con¬
tending with these affections, you must with me have observed
the striking discrepancy in the results obtained in the treat¬
ment of hospital patients, as against those obtained in the treat¬
ment of patients of a better class — the former, as a rule, are
extremely discouraging, whilst the latter afford, at times, a
reasonable degree of satisfaction. 1 am aware that the dis¬
crepancy may, in a measure, be due to the fact that, in the
former instance, we are called upon to see our patients when
the disease has reached an advanced stage. But are they not
also measurably due to the fact that we are, unfortunately,
limited almost exclusively, 1 may say, to the use of pharmaco¬
dynamic agents ?
♦Medical hydrology, climatology, hy giene and electricity now
seem to take precedence in the treatment of chronic diseases.
And 1 am inclined to the belief that in Bright’s diseases you
will often obtain more satisfactory results if, with due regard
to the indications furnished by the etiology of the affection,
you give a greater weight when possible to these powerful tnod-
ificators. 1 have had occasion during the past few years to
obtain some happy results by the use of medical hydrology
applied to Bright’s diseases. You will, therefore, before I pro¬
ceed further, permit me to condense a few observations which
will enable me to draw some conclusions in regard to the use
of this therapeutical method.
* Medical hydrology treats of the internal and external use of water in disease, and
comprises mineral spiings, sea-bathing, douches of all sorts, medicated baths, Turkish
and Russian baths, etc.
346 Original Communications. [August
OBSERVATION I.— CASE OF CHRONIC PARENCHYMATOUS NE¬
PHRITIS.
Mr. C., a gentleman about 47 years of age, was directed by
bis physician, Dr. L’h6ritier, of Paris, to follow a water cure at
the calcic springs of Vittel. Mr. C. had an attack of chol¬
era in 1871, and of rheumatism in 1872. With these exceptions
his health has been good up to 1877, when he began to lose
flesh and strength without any apparent cause. In September,
of the same year, he suffered from intense dyspeptic troubles,
with marked dysphagia and shortness of breath. In March, 1878,
got wet in a very heavy rain and had a spell of acute desqua¬
mative nephritis followed by two relapses, at short intervals.
Fever, general pains over the body, with marked sensibility
over the lumbar region, gastric symptoms, oedema of legs and
thighs, urine heavily loaded with albumen, were among the
characteristic symptoms. Patient arrived at the springs June
5th. His urine presents an acid reaction, it is frothy and clear,
except at the bottom of the vessel, where a white yellowish
sediment is observed. His urine of the day contains 5 grammes
18 centigr. (a little over 80 grains) of albumen ; the one of the
night, 3.13 gr. (about 49 grains) ; urea, 15.30 gr. (about 228
grains). Microscopical examination of sediment shows numer¬
ous large, dark colored crystals of uric acid, broad granular
casts in large number, a few narrow, pale, slightly curved
casts with some renal opaque epithelial cells adherent . No
fatty globules nor any waxy cylinders. Blood corpuscles nu¬
meration gives 3,490,000. Weight of the body 152 pounds.
Patient was advised to drink from 8 to 12 glasses of mineral
water, to take one bath a day of one hour’s duration at 39°
Centigr., followed by frictions and kneading, and a hot revul¬
sive douche at 42° Centigr. of five minutes over the lumbar
region.
On the 8th day the quantity of albumen is reduced to 1.90
gr . (about 30 grains) in the day, and 1.33 gr. (about 20 grains)
in the night’s urine. On the 25th day the urine shows but a
trace of albumen and contains but a few hyaline casts. Upon
departure, July 12th, 37th day of the water cure, the urine is
entirely free from albumen and casts. The numeration of blood
corpuscles gives 3,900,000. Weight of the body 161 pounds.
1879] DeRoaldes — Treatment of Bright’s Diseases. 247
The microscopical examination, which was repeated several
times during treatment, has shown a disappearance of the casts
parallel with the diminution of albumen, until at last, a careful
micro-chemical test revealed the absence of both. The quan¬
tity of urine, which during treatment was increased to 1700 C.
C., has fallen back to 1290 C. C. upon departure ; specific
gravity =10 17 and urea=19 grammes (about 289 grains).
OBSERVATION II.— CASE OF INTERSTITIAL NEPHRITIS.
Mr. R., a merchant, 44 years of age, was prescribed by Dr.
Gubler, of Paris, a water course at the Springs of Vittel,
where he arrived dune 20, 1876. When 29 years of age, patient
had an attack of double ure thro- orchitis, which has left as a
sequela some weakness about the genital organs. His father
was subject to gout, and died in epileptiform tits. Mr. R.,
himself, has been attacked three or four times with articular
gout, the last time in May, 1874. During past 4 or 5 years,
patient has noticed in his urine a frequent deposit of a yellow-
pinkish hue. On January 10, 1876, was laid in bed for a fort¬
night with erratic pains of the whole body, fever, epistaxis,
bronchitis, lumbar pains greater on the right side. His sputa
were streaked with blood. Urine was diminished in quantity,
highly colored, albuminous and containing few casts, but
wholly deprived of its deposit of mates or uric acid. This
acute spell subsided gradually, and patient was finally relieved
by the appearance in his urine of a copious, brick-colored,
sandy deposit. However, he never since enjoyed his ordinary
health, and his urine has kept albuminous.
Condition upon arrival at the springs : The skin is dry and
branny, appetite poor, thirst normal, digestion torpid and
sleep impaired. Patient experiences a very uncomfortable
sensation of prickling about the inferior extremities. Slight
oedema of the ankles and feet ; frequent micturition. Passes
1600 C. C. of a cloudy, acid urine, containing 22 grammes of
urea, 1.75 gr. of phosphates, 7 gr. of chlorides, 2 gr. of albu¬
men. Uric acid and urates are diminished. There is a slight
hypertrophy of the heart, but no valvular lesion, no palpita¬
tions. Respiratory murmur normal. Blood corpuscles=3,600,000.
Microscopical examination shows numerous granulo-fatty cyl-
248 Original Communications. [August
inders, some few hyaline casts, some others dotted over with
tine dark granulations. Hare, waxy-like casts.
Patient was directed to drink 12 to 14 glasses of mineral
water a day, 1 glass of Pulna water every fourth day, to over¬
come costiveness. Tepid bath at 37° C., followed by frictions
and kneading of the whole body. Hot revulsive douche at
42° C., over the lumbar region.
About the seventh day, albumen began to diminish ; on the
twentieth day, the quantity was reduced to 0 gr. SO centigr ;
on the thirty-seventh day, when patient left the springs, a
trace of albumen, some hyaline cylinders and a very few gran-
ulo-fatty casts only are to be found upon close research. Dur¬
ing the first week of treatment, the quantity of urine passed
daily was increased from 1000 0. C. to 2300 C. C. and was
heavily loaded with uric acid. General neuropathkvsymptoms
have subsided ; the sleep is improved and patient no longer
experiences his troublesome cerebral lassitude. Numeration of
blood corpuscles gives 4,200,000. Patient has gained o pounds
and a slight exercise will promote perspiration.
OBSERVATION III.— CASE OF CHRONIC PARENCHYMATOUS
NEPHRITIS.
Mr. H., aged 38 years, a banker, arrived at La Bourbon I c
Arsenical Thermal Springs, June 26, 1878, sent by his Paris
physician, Prof. Chauffard. Has attended him during 4 years.
In his letter, after rapidly going over the history of the case,
he remarks that Mr. H. was forced to abandon Constantinople
in 1874, on account of obstinate intermittent fevers, accompa¬
nied with enlargement of the spleen. The type of fever was
at first modified by the change of climate, and patient, after 13
months, was entirely free of malarial attacks. His health,
notwithstanding, was far from being restored to its normal
standard. Patient remained anemic, although iron, quinine
and strychnia were administered. Complained of general
weakness, of palpitations accompanied with repeated attacks of
bronchitis, characterized by intense dyspnoea, mostly noctur¬
nal, and by sputa occasionally tinged with blood. Site]) dis¬
turbed by cough and frequent desire to micturate. Urine clear
and frothy. A close investigation led Dr. Chauffard to diag-
1879] DeKoaldes — Treatment of Bright7 s Diseases.
249
nose the ease as one of incipient parenchymatous nephritis
from malarial poisoning. During two years, various treatments
were uselessly employed, the disease following a progressive
course.
At last Dr. C. decided upon removing his patient from the
confined and hot summer atmosphere of Paris, and he was or¬
dered to resort to a water cure, with the hope that the change
of climate and the use of arsenical springs would help to re¬
build Ids general constitution and put a check to the pulmonary
and renal congestions. Upon arrival at the springs Mr. H. is
in the following condition : General appearance is bad, whether
this be the result of his journey or not ; mucous membranes
are unusually pale, the skin is dry and the seat of a marked
epithelial desquamation (pityriasis), marked emaciation, pa¬
tient weighing 137 pounds, waxy appearance of the teguments.
Liver and lungs are normal, spleen slightly enlarged. The
eyelids are somewhat bloated. Patient is troubled with fre¬
quent micturation at night (8 to 10 times). Quantity of daily
urine 1410 0. C. specific gravity =1009. Night urine contains 3
gr. 69 centigr., and day urine about 6 gr. 19 centigr. of albumen.
Quantity of urea exceedingly small=l 1 gr. 70 centigr. Phos¬
phates and chlorides are in normal proportions. Microscopical
examination shows : numerous and thick crystals of uric acid,
granulo-fatty casts with oil globules, numerous narrow cylin¬
ders with fine granulations, some broad waxy casts and degen¬
erated epithelial cells with irregularly defind edges. Mr.
H. is advised to rest a week before beginning treatment. Ou
the third day, I am called to see him. Patient is laboring un¬
der an attack of severe bronchitis, with slight pulmonary
(edema. Heart is normal, but rather impulsive. Feet cedema-
tous. Next day the oedema has reached the scrotum ; thighs
and legs are considerably swollen. Quantity of urine dimin¬
ished to 900 C. C. Sp. gr.=1014.
Patient feels pretty well on the tenth day of this attack, with
the exception of the anasarca of the inferior extremities. The
swelling is such that patient’s weight has been raised from 137
to 172 pounds. Obtaining no result from purgative plan, ad¬
vised him to begin at once hydropathic treatment, consisting
5
250 Original Communications. [August
in liot air baths — Turkish baths — which were administered, for
a period of two weeks (one bath every other day). Patient
gradually reached a temperature of 170° F. As much as 1200
grammes of water (nearly 2^ pounds) were abstracted from
the system in one bath ; urine passed in 24 hours, averaging
050 0. C. After the eighth bath, patient was nearly relieved
of his anasarca; his weight fell down to 150 pounds, or 1
pound less than he weighed upon arrival.
The hydromineral treatment was then instituted, and patient
advised to drink from 2 to 4 glasses of mineral water. Baths
at 39° C. were also ordered, and were followed by a hot revul¬
sive douche applied over the splenic and lumbar regions.
This treatment, kept up for a month, brought on a most
remarkable improvement. The condition of the patient upon
departure, August 18th, that is, 92 days after his arrival, was
as follows : Appetite restored ; sleep interrupted but once or
twice for micturation ; patient has made frequent excursions
in the mountains with comparative ease ; the functions of the
skin are normal ; no oedema ; complexion darker, but still
retaining an amende taint ; only a trace of albumen in the
urine. Casts are few in number, broad and grauulo-fatty, no
waxy cylinders nor any oily globules. Some renal epithelial
cells with natural dull tint. The quantity of urea has been
raised up to 15 grammes, aud amount of urine daily excreted =
1370 C. C. Has gained 15 pounds. Patient left the springs
after being advised to sojourn in the south of France or Italy
during winter, and to return next summer to the springs.
Had occasion to hear from Mr. H., through his physician.
He has wintered at Cannes, and during January has drank
the transported waters. Has followed, otherwise, no special
treatment, but exercised in the open air. Has had no recur¬
rence of his bronchitic attacks ; his general health, which is
very good, has allowed him to enjoy ordinary life. His urine
still shows a trace of albumen, detectable only with Heller’s
test. The microscope shows the presence of a fewr broad gran-
ulo-fatty casts, with degenerated epithelial cells.
OBSERVATION IV.— CASE OF CHRONIC PARENCHYMATOUS
NEPHRITIS.
George Brungard, 27 years of age, entered Charity Hospital
March 8, 1879. A year ago, patient then living in Arkansas
251
1879] DeRoALDES — Treatment of Bright’s Diseases.
was attacked with malarial fever, of a tertian type. In Octo¬
ber, after exposure to rain and cold, was seized with rigors,
followed by fever, nausea, and pains in the lumbar region, and
swelling of the inferior extremities.
Upon admission, patient says he has been unable to leave his
bed for the past two months on account of excessive weakness.
Mucous membranes and teguments show a waxy nue, face is
bloated, appetite impaired, bowels loose. Inferior extremities
and scrotum are the seat of considerable serous effusion.
Heart normal, but spleen is enlarged. Patient’s sleep is often
interrupted by cough, due to slight oedema of the lungs.
Patient is put under observation for a few days. The urine
is very pale, frothy and acid ; average about 2000 C. C. a day,
with a sp. gr. of 1007. It contains a large quantity of albu¬
men ; 7 gr. 90 cgr. Urea=14 gr. 75 cgr. At the bottom of the
jar, there is an opaline deposit of formed elements, which,
under the microscope, proves to be composed of small and nar¬
row hyaline casts, with very few granular cylinders, and some
renal epithelial cells, with a number of uric acid crystals.
Patient was ordered 15 drops of dilute phosphoric acid three
times a day, and 10 to 12 glasses of Waukesha water (Orescent
Spring). From March 18th to April 28th, microscopical exam¬
ination and analysis of urine were made daily ; from these tab¬
ular records, 1 condense the following : Urine rapidly became
neutral, with marked tendency to ammoniacal decomposi¬
tion after being voided.
March 21st, Day urine=1490 C. C., with sp. gr.=1010.
Night urine=1090 C. 0., with sp. gr.— 1009.
April 7th, Day urine— 000 O. C., with sp. gr.=1018.
Night urine=1240 0. C., with sp. gr.=1009.
Albumen passed in 24 hours=4 gr. 22 centigr.
Microscopical examination shows a few hylaine casts, and
renal epithelial cells, with amorphous earthy phosphates.
April 13th, Day urine=400 C. O., sp. gr.=1022.
Night urine=879 C. C., sp. gr.=1011.
No casts, and but a few renal epithelial cells and amorphous
phosphates.
April 20tli, Day urine=700 C. C., sp. gr.=1018.
Night urine=900 C. C., sp. gr.=1012.
Quantity of albumen in 24 hours=2 gr. 29 centigr.
Original Communications.
252
[August
Microscopical examination shows a complete absence of casts.
Urea=18.10 gr. During the time (38 days) patient has been
under treatment, he has had live attacks of malarial fever, for
which quinine was administered. The fever seemed to have
no other effect on the urine except in diminishing its quantity
and deepening its color. Notwithstanding this, general con¬
dition of patient steadily improved, appetite increased. Dowels
have become regular and digestion is normal. All liquid effu¬
sion has been removed. His complexion looks healthier, and
auscultation reveals no abnormal sounds. Patient has been
able during the last two weeks to assist the nurse of the ward
in the discharge of his duties. Was last seen on May 14th.
Has had another attack of fever, but his general condition con¬
tinues very good. Quantity of urine about normal, so are its
reaction and color. No casts, but still contains about two
grammes of albumen. Urea=17.80 gr.
I Avill now be permitted to draw some conclusions, which
seem to me justified by the study of these observations.
1st. There is a marked diminution of the albuminuria as a
consequence of the diuresis produced by the use of calcic min¬
eral waters. The renal congestion, instead of being exaggerated ,
has on the contrary been diminished by this diuretic influence.
This result corroborates the statement of Cl. Bernard, based
on actual experiment, namely : the disgorgement of glands by
increased functional activity. In observation No. 3, arsenical
waters having no marked effect on diuresis, we have to look
elsewhere to explain their efficacy. The explanation lies, I
think, in the undoubted properties of arsenic to diminish con¬
gestion by its in uence on the vaso motor nerves. We all
know the good results attained with arsenic in the treatment
of congestive headache, neuralgia, pulmonary congestion, etc.
Besides this explanation, arsenic seemed to have filled a pre¬
cise indication furnished by the fact of previous malarial intox¬
ication, and the use of hot air baths by stimulating the func¬
tions of the skin to their utmost capacity, certainly had the
effect of diminishing the tension of the blood in the renal blood¬
vessels.
2d. In all four observations the diminution of the quantity
253
1879] DeKoaldes — Treatment of Bright1 s Diseases.
of albumen has been progressive and very nearly parallel with
the diminution of the gravity of easts and epithelium of renal
origin. 1 will remark also that, as the worst form of cylinders
disappeared or were modiiied, there seemed to have been a
species of substitution of hyaline casts.
3d. The general health ’and strength of these four patients
were remarkably improved by this course of treatment. The
numeration of blood corpuscles was resorted to in two in¬
stances, and showed a marked increase. Corresponding to this
an increase in weight, ranging from live to fifteen pounds was
also obtained, except in case 4, where this observation was
neglected for want of scales.
1 feel consequently justified in saying that the treatment has
fulfilled what should be considered the principal indications in
Bright’s diseases, viz :
1st. To uphold the constitution and rebuild the impoverished
general conditions.
2d. To diminish, if not to suppress, the congestion of the
kidneys.
3d. To clear and if possible modify the tubuli uriniferi.
Before closing, allow me to direct your attention to the influ¬
ence gout holds in the production of interstitial nephritis. It
is such that the gouty kidney is, with English writers, synoni-
mous with contracted kidney. This etiological influence is well
exemplified by Case No. 11. it is in those cases that the calcic
waters of Vittel in France, Wildungen in Germany, Capon and
Poland in this country, will prove efficacious. Those of Buffalo
and the Waukesha Crescent Springs containing, in addition,
bi-carbonate of lithia, are specially indicated. Their first effect
is to render the urine alkaline, and then to favor the elimina¬
tion of uric acid — accumulated in the blood — under the form of
urate of lithia, the most readily soluble combination of uric
acid. It frequently occurs, when, in gout, or in Bright’s dis¬
eases, the urinary secretion is scanty, that uric acid, and even
urate of soda, will be deposited in the tubuli uriniferi, in the
shape of what Bayer has termed, microscopic gravel. In these
254 Original Communications. [August
cases, these diuretic calcic and lithia mineral waters, filtering
rapidly and in abundance through the kidneys, will have a sort
of lixiviating result, and thus favor the solution of these infarc¬
tions, open and keep free the tubuli uriniferi. It is useless to
insist upon this beneficial effect, for in a contracted or gouty
kidney, it is preparing the way for urtemic^poisoning, not to
avail ourselves of every possible means to prevent those tubuli,
which are still sound, and through which the urea, uric acid,
and extractive matters are excreted, from being blocked and
clogged by this microscopical^gravel.
I will lastly recall the influence of chronic malarial poison¬
ing in the etiology of Bright’s diseases. Case No. Ill and No.
IV exemplifies this point, and, although I have had this win¬
ter, in my wards of the Charity Hospital, three cases of chronic
parenchymatous nephritis, in which the disease was clearly at¬
tributable to malaria, I am not prepared as yet to assert that,
in the majority of such cases, we will be more apt to meet
with parenchymatous than with interstitial nephritis.
In those cases we will have to administer quinine, even if
the patient is free from paroxysm. But when it has led to un¬
doubted disorder of the kidney, we will, 1 think, find in
arsenic, hydropathy, mineral springs, with change of climate,
modificators which will act in a more direct manner upon the
lesion, provided, of course, it be not too far advanced.
If Bright’s diseases present themselves in a decided scrofu¬
lous constitution, we may with advantage advise a course of
treatment by the saline alkaline and iodo-bromine waters, as
Kreutznaeh, Hombourg, Darklieim in Germany, Solies, Brides
in France, Saxon in Switzerland, and St. Catherine’s Wells and
Caledonia Springs in this country. If, on the other hand, our
patient is subject to rheumatism, or has had syphilis, if the
kidneys are but recently involved, and we believe rheumatism
or syphilis has had an etiological influence, we will then
find in thermal waters, of the indeterminate class, as Hot
Springs of Arkansas, or of the sulphur class, as those of Vir¬
ginia., a valuable adjuvant.
Current Medical Literature.
255
1879J
URRENT
EDICAL
ITERATURE.
THE CURE OF HAEMORRHOIDS BY THE HYPODERMIC SYRINGE.
By Edmund Andrews, A ir., M.D., Prof, of Surgery in the Chicago Medical College.
Iii a former number of this journal, I published the secret
method of certain itinerant “ File Doctors,” and asked for in¬
formation from all physicians who had any knowledge of the
practical results of the treatment. This request, supplemented
by other inquiries, has brought me responses from about 300
physicians, and given me more or less knowledge of the results
of over 3300 cases treated by the new method. From the
material thus collected l am able to present the following
history :
In the year 1871, there lived in the village of Clinton, Ill., a
physician named Mitchell. His practice being small, he em¬
ployed his superabundant leisure in planning a new treatment
for luemorrhoids. He was a good thinker, and soon conceived
the idea of charging a hypodermic syringe with equal parts of
carbolic acid and olive oil, and injecting the contents into the
luemorrhoidal tumors. He also devised another and totally dif¬
ferent plan, which was to take two large needles with triangular
points, like those used by saddlers, and then to pick the piles
to pieces little by little with the needles. Mitchell himself is
said to prefer the needle operation, and several others have
adopted it from him, but the plan of injections has proved by
far the most popular with others, and has recruited, in a quiet
way, a surprising number of operators. The secret was sold
from man to man, and the price and enthusiasm rose simul¬
taneously. u State and county rights ” to practice it, were
vended at high rates, reaching in one instance the sum of
$3000. Regular physicians abandoned their practice, and even
mortgaged their property for money with which to buy the
secret, and set themselves up as itinerants, while ignorant lay¬
men joined in the rush until they tilled the whole West with
their clamor, and at last whitened the sands of the Pacific
shores with their hand-bills.
The chief managers of the business settle in the larger towns
in the winter, where they advertise and practice, but as spring
advances to the time when the wild geese begin to fly, they
feel the migratory instinct, and go from place to place, selling
the secret to all who will buy it, and operating meanwhile on
the people of the farms and villages. In this way they have
treated more than 10,000 patients in the States west of the
Alleghany mountains. A secret so extensively sold always
gets out. Three years ago 1 discovered and published it, thus
putting a check on the business of selling, and induced large
Current Medical Literature.
256
[August
numbers of the regular profession to try the plan among their
patients. These physicians have furnished me my best infor¬
mation, but I also opened communication with the principal
itinerants themselves, and induced several of them to come out
frankly and tell what they knew, and by checking one state¬
ment against another, was able to sift out pretty well the few
attempts at deception.
Mitchell’s original plans have excited widely extended thought
and experimentation among his followers, so that his two
methods have branched out into numerous varieties. The
original injection seems to have consisted of equal parts of
crystalized carbolic acid and olive oil. The operator exposes
the piles to view, and smears the anus with an ointment to pre¬
vent smarting in case the fluid should chailee to drop ; he then
takes a sharp-pointed hypodermic syringe, charged with the
carbolized liquid, and slowly throws a few drops into one of the
piles. The pipe is left in the puncture a few moments to pre¬
vent the fluid from running out, and to allow it to become
fixed in the tissue. The pile turns white, and in the most
successful cases withers away without pain, suppuration or
sloughing. Only one pile is treated at a time, and about a
week is allowed between the sessions, until all are cured. The
itinerants often advertise their method as “ painless,” but as a
matter of fact only about one patient iu four gets anything like
exemption from pain. Most of them suffer a sharp temporary
smarting, and a few have a terrible and prolonged agony. The
majority are cured, however, without interrupting their busi¬
ness.
The original plan has sprouted into numerous varieties. In¬
stead of using olive oil as the excipient, many use glycerine.
Then every operator has his favorite degree of strength. Sev¬
eral claim that the stronger the fluid the better it is, and act¬
ually inject crystals of carbolic acid melted by heat, while
others use mixtures varying in strength all the way down the
scale, until we find Dr. Weir, of New York, experimenting
with one part of acid to 20 or 30 parts of the solvent. The
dose injected varies in like manner. Some advocate great
caution, and only put in from one to three drops, while others
cram the pile with a syringe full, and seek to make it sup¬
purate or slough. I find two mem using creosote instead of
carbolic acid, and several add anodynes, such as morphine,
chloral or iodoform. Ergotine is also a favorite injection, and
a great number of mixed formulae have been imparted to me,
some of them containing five or six ingredients. Mr. Oolles,
of Dublin, injects muriated tincture of iron. Dr. Hill, of
Bloomington, 111., and Dr. Drake, of Hastings, Mich., use the
iron per- sulphate, while others have tried tannin, chromic acid,
tincture of iodine, etc. One itinerant, who writes in a straight¬
forward, manly tone, says that he has experimented on almost
every coagulating agent in the vegetable and mineral king¬
doms. His preference is for the strongest carbolic acid. He
1879 J Current Medical Literature. 257
adds the following remarks : “ The difficulty with all remedies
except carbolic acid is the suppuration being limited to a small
portion of the tumor, or, like the preparations of iron, causing
it to swell and become very painful. Carbolic acid is, so to
speak, used up in cooking the blood throughout the entire
tumor. The appearance of the pile in from five to twenty sec¬
onds shows such to be the fact. Suppuration takes place in
three or four days, with sloughing. No danger of haemorrhage.”
The results of these various methods of treatment may be
summed up as follows: In the first place the needle operation
has never become a favorite. I can learn of only five persons
who make much use of it. The following case was probably
treated in that way. The patient, a plethoric man of 45 years,
went to a quack in Chicago, and as a result, a varicose lnemor-
rhoidal vein was widely opened. He says the blood gushed out
freely, but after some trouble was arrested through the applica¬
tion of means not clearly understood by him. He then returned
home in great agony; and sent for his family physician, who in
turn called me in council. The family physician took off sundry
cloths and compresses, and found a large opening in a vein
plugged with a vial cork. The quack, 1 presume, tore open the
thin walls of a dilated vein, and being driven to his wits’ end
by the gush of blood, finally concluded to cork up his patient
like a demijohn.
My informants agree that the in jection method seldom fails to
cure the disease, but they report some serious disasters. The
writers know' of about 3304 cases treated in their vicinities by
these methods, and though they cannot always give exact num¬
bers and details, yet the circumstances are such that a case of
rapid death from the treatment could not be concealed, though
minor troubles, such as pain, sloughing, etc., might frequently
escape their notice. It is probable, therefore, that the list of
deaths is pretty complete, while the figures giving the minor
accidents are too small.
List of Accidents.
Deaths . 9
Embolism of the liver (suspected) . 8
Very dangerous luemorrhage . 5
Less dangerous luemorrhage . 5
Carbolic acid poisoning (recovered) . 1
Sloughing (generally, but not always confined to
the piles) . 23
Abcess (of the liver) . 1
Severe inflammation . 10
Violent pain . 83
Stricture of the rectum . 2
Permanent impotence . 1
Long sickness (2 w^eeks to 0 months) . 6
Relapsed . 7
Failed of cure of piles . 11
Sundry other accidents . 12
6
184
258
Current Medical Literature.
[Align st
Cases of sloughing and suppuration of the piles, are innu¬
merable. Some itinerants use strong injections with the ex¬
press purpose of producing these results, deeming that the
plan of causing them to atrophy without suppuration lacks
certainty and permanence.
The list shows that, while the deaths are so few that the risk
is no greater than in other modes of treatment, yet the minor
accidents are very numerous. The imperfection of the reports
renders a thorough study of the accidents impossible, but the
following information has been gleaned : One of the deaths
was caused by inflammation, followed by immense abscesses,
erysipelas and pyaemia. The patient died on the fifth day.
Another death apparently resulted from embolism of the
liver. That viscus nearly ceased its function; the stools were
light colored and scanty, the skin yellow, and all the lymphatic
glands of the groin, axilla?, and neck became enlarged. A full
dose of calomel always brought temporary improvement, but
no permanent benefit. The patient lingered long, and died un¬
relieved, about one hundred days after the operation. The
next fatal case was that of a man 84 .years of age. The person
who injected the pile, said it was u very large and very deeply
seated.” It was suspected that he mistook the enlarged pros¬
tate for a haemorrhoid. Be that as it may, the patient was
attacked with violent pain and retention of urine, and though
relieved by the catheter, died on the third day. There is no
proof, however, that the prostate was injected, nor that it
would be fatal if it were.
The fourth death was also attributed to injecting the pros¬
tate, but no symptoms are given.
The five remaining deaths are so vaguely reported that 1 am
unable to give any particulars about them. It is possible that
three of the reports refer to the same patient, and ought to be
counted as one, in which case the whole number of deaths is
only seven. This number of fatal results in 3300 cases, treated
often in the most reckless and ignorant manner, is certainly
not large, and tends to show that the injection method is as
safe as any other, so far as life is concerned.
The same relative immunity appears respecting haemorrhage.
Five dangerous cases of it are reported, but in most, if not all
of them, it occurred from the foolhardy practice of allowing the
patient to take long rides and walks when he should have been
in bed; but even with all this imprudence the haemorrhagic
cases are fewer than occur after the use of the clamp and the
ligature. Allingham reports more instances of haemorrhage
after his favorite operation, the ligature, than I can find among
all these cases of injection.
The chief objection of the profession to this operation, has
been the fear of embolism. The two lower pairs of luemor-
rhoidal veins send their blood by the route of the internal iliacs
to the heart, but they are small, while the upper pair is much
larger, and carries the great mass of the blood of the lnemor-
Current Medical Literature.
259
1879]
rhoidai plexus to the liver, hence vve should expect that embol¬
ism, if it occurred at all, would be of the latter organ. The
facts agree with the indications of the anatomy, for not a single
case is reported of a sudden death, such as would proceed from
clots swept to the heart and lungs, but there are eight instances
of suspected embolism of the liver ; only one of them died, and
there was no post-mortem examination, so that possible proof
is wanting.
The first is the fatal case of liver trouble already described.
The second was marked by an abscess of the liver, but the pa¬
tient recovered. In the third case the patient was attacked
one hour after the injection with severe pain in the liver.
After some time the pain was relieved, and no furthej trouble
followed, but the physician feared to repeat the injection.
In the remaining cases it is simply reported to me that the
patients, after operation, were attacked with disease of the
liver, but did not die ; no particulars were given. It is probable
that in a portion of the cases the liver disease pre-existed, and
was the cause of the piles and not the consequence of the oper¬
ation. On the whole, there does not appear to be any decided
danger of embolism, if the case is carefully handled. I may
mention here, that Dr. Whitmire, of Metamore, 111., practices
tamponing the upper part of the rectum for 24 hours, to pre¬
vent any emboli from moving in that direction.
Sloughing and suppuration of the j>iles generally follows
large and concentrated injections, but not the small and dilute
ones. A few cases only of extensive abscesses have occurred.
The most frequent of all accidents is the occurrence of severe
pain. The verge of the anus is extremely sensitive, and injec¬
tions put in near that circle are liable to produce fearful dis¬
tress, but above the verge, the sensibility rapidly diminishes,
so that much less suffering is entailed by the injection of in¬
ternal piles. In about one-fourth of the patients, the pain is
very slight. Dr. Weir, of New York, injected two series of
patients, one with strong, and the other with weak carbolized
solutions, using in the latter only one part of carbolic acid to
ten, twenty or thirty of the excipient. He found that the pain
and the abscesses followed the use of the strong injections, but
were escaped when weaker ones were employed.
The remaining accidents in the list are not peculiar to this
operation, nor greater in number than occur in other methods.
The operation was a new one, and its conditions of safety were
unknown. When we consider that many of the operators
were ignorant blockheads, with no qualifications for the busi¬
ness except a bottle of carbolic acid and a hypodermic syringe,
and with no idea of efficiency but to distend the hsemorrhoidal
plexus with all the liquid caustic they could get into it, we
shall not be surprised at discovering a few deaths and a num¬
ber of minor accidents. Had the method itself not been an
unusually safe one, they would certainly have slaughtered their
scores of victims, for the difference is world wide between their
2C0 Current Medical Literature. [August
ignorant injecting, and cautious, scientific surgery. If the
following rules be observed, I believe that the method of treat¬
ment by hypodermic injection will be less painful than any
other, and equally safe :
1. Inject only internal piles.
2. Use diluted forms of the remedy at first and stronger ones
only when these fail.
.‘3. Treat one pile at a time, and allow from four to ten days
between the operations.
4. Inject from one to six drops, having smeared the mem¬
branes with cosmoline to guard against dripping. Inject very
slowly and keep the pipe in place a few moments to allow the
fluid to become fixed in the tissues.
5. Confine the patient to bed the first day, and also subse¬
quently if any severe symptoms appear. Prohibit any but
very moderate exercise during the treatment.
Under all treatments, as well as when left without treatment,
piles are subject to possible haemorrhage. Allingham gives
the following method of applying the tampon, where the bleed¬
ing vessel cannot be found promptly, and controlled by other
means : He takes a good-sized sponge and fastens a strong
double string through its centre. (He prefers a bell-shaped
sponge inserted with the open end downward.) Having pushed
the sponge up the rectum some inches beyond the bleeding-
point, he fills the parts below with cotton dusted with pow¬
dered alum or persulphate of iron, and ties a stick across the
finished tampon with the double string. By turning the stick
like the handle of a gimblet, he twists and tightens the string,
forcing the tampon firmly up against the sponge and causing
it to spread laterally and compress the bleeding vessels. He
advises the insertion of a large catheter with the tampon, to
give exit to the flatus. By the help of opiates the tampon is
often tolerated several days.
My final conclusion is that the wild itinerants of the prairies
have really made a valuable contribution to scientific, knowl¬
edge, and that the cautious injection of haemorrhoids with car-
bolized solutions will remain as one of the permanent opera¬
tions of surgery. — Chicago Medical Journal and Examiner.
GASTROTOMY.
The operation for making a permanent opening into the
stomach, called gastrotomy, done to prolong life and relieve
the agony of patients suffering from closure of the (esophagus
as the result of disease, or the mere opening of it for the
removal of foreign bodies, is recommended as a proper surgical
procedure, and has been done a number of times — still, to Mr.
Howse, of Guy’s Hospital, is certainly due the credit of demon¬
strating its absolute feasibility, comparative safety and evident
necessity.
Mr. Howse considers that the uniformly successful result
Current Medical Literature.
20 1
1879 J
following liis efforts so far is mainly due to the special method
of procedure which he has followed in all his cases ; this man¬
ner of operating accomplishes perfectly the very desideratum
which Prof. Freer deemed so necessary and urgently advised.
The first part of the operation is devoted to and done with the
intention of securing a firm, wide attachment of the stomach
to the abdominal walls This consists in fastening the two
together by ligatures introduced in a special manner and leav¬
ing them so attached for five or six days, which is long enough,
according to Mr. Howse’s experience, to develop firm union ;
after which the stomach itself is opened. In none of these
cases was there any undue inflammation or any other interfer¬
ence with the progress of the case to recovery. The fistula is
completed by opening the stomach through the lips of the
abdomiuo-gastric junction — a proper gum elastic tube is intro¬
duced into the cavity of the viscus and retained there by strap¬
ping, and through tins tube the patient can be fed without dis¬
comfort or trouble.
Mr. Howse naturally expresses the hope, encouraged as he
is by his successes, following the operation, that this procedure
will be earlier resorted to in the class of cases for which it is
oftenest done — epithelioma of the (esophagus, and in addition
that it will come to be looked upon as a necessary and accepted
course of treatment in cases of traumatic occlusion or specific
stricture. Up to the present time five operations have been
done by him, four for closure of the oesophagus by epithelioma
and one for traumatic stricture.
Of those done for epithelioma, one lived seven months after
the operation and finally died from extension of the cancerous
disease to surrounding vital organs. During this long period
the patient was entirely free from the agonizing distress inci¬
dental to slow starvation — feeding herself comfortably and
easily through the tube or external (esophagus. 1 might even
justly say that the feeding was not robbed of enjoyment, for the
patient masticated her food and then introduced it into the
stomach through the tube. Two others, operated upon for the
same disease, lived for weeks and months respectively, and
died from epithelioma of the lungs, each deriving benefit
from the operation. The fourth one died from renal coma a
few days subsequent to the operation. In none of them was
there the least discomfort arising from the operation, and the
pathological specimens of each case, now preserved in the
museum, demonstrate positively that in neither case was there
any peritonitis developed from the interference, as is shown by
the entire absence of any adhesions other than those sought
for and obtained between the stomach and abdominal walls.
Through Mr. Howse’s courtesy and kindness to me, 1 witnessed
the operation in the fifth-case, and have seen the patient several
times during the several weeks following the operation, and can
bear witness to the comfortable condition of the patient, the
relief afforded her, and to the absolute absence of any local
262 Current Medical Literature. [August
trouble from the wound. The patient had swallowed a quantity
of muriatic acid with suicidal intentions some months ago, and
as a consequence of this act, stricture of the (esophagus had
gradually developed, defying and resenting all efforts at dilata¬
tion. Any such like attempts at relief were followed by severe
bleeding and other bad signs, sufficient to make the efforts
dangerous. Mr. Howse did the operation partly to avoid ex¬
pected emaciation from inability to swallow, but mainly to put
the parts above absolutely at rest for months, so that all granu¬
lating surfaces might become healed over and toleration of
dilating instruments follow. If this result came about, well and
good ; if not, then the patient could live quite comfortably with
the new mouth to her stomach — digestion, apparently, being
very little affected by the new way of taking food. Au oblique in¬
cision was made, about 9 Cm. long, parallel to the cartilaginous
margin of the chest on the left side, in the epigastric region, far
enough away from the cartilage to allow of room for the appli¬
cation of the outside row of stitches used to fasten the stomach
to the abdominal walls, and carried down to the rectus abdominis
muscle, the fibres of which were the landmark as to position.
The under layer of its sheath is the indication of close proximity
to the peritoneum. All bleeding vessels were controlled with
catgut ligatures. The peritoneum was then carefully opened
and the anterior wall of the stomach sought for. Mr. Howse
gives three means of recognizing this organ. The mistake of
opening the transverse colon has been made, but according to him
such an accident should never happen. 1st, the walls of the
stomach are much thicker than those of any intestine ; 2d, the
color is lighter, and there are uo longitudinal fibres ; 3d, the two
layers of the omentum, passiug from the stomach to t he colon,
can be easily recognized. Having reached the stomach, the next
step is to stitch it to the abdominal walls, and in this consists the
essential part of the operation, and this part must be carefully
and accurately done. He employs two rows of sutures. The
first introduced at intervals of 1 Cm. from each other all
around the margin of the external wound, fully 3i Cm. from
that margin. The second joins the stomach to the edges of the
incision, leaving about 1 Cm. of its surface exposed in the
wound, as its edges are subsequently drawn together. In passing-
all of the sutures into the walls of the stomach, great care is
taken to prevent the needle entering the cavity of that organ.
Great stress is laid upon this matter, for if they do enter, fatal
peritonitis is sure to follow upon the escape of gas or other
matters through even these slight wounds. With the greatest
impunity and entire absence of any dread of doing harm, the
stomach walls are grasped by the fingers at the poiuts chosen
for the introduction of the needle, and in this way the operator
absolutely assures himself that only the peritoneal covering
and a portion of the muscular coat is pierced by the ueedle or
included in the ligature. Perhaps a quarter of an inch of tissue
is taken up in the grasp of each suture. Of course the needle
1870 j Current Medical Literature. 263
is first passed through the entire thickness of the abdominal
walls at the proper distance from the edge of the entrance
wound, then through the stomach with the care specified, then
out through the external coverings of the body again, and
finally the two ends are tied over a piece of catheter ; to give
breadth of contact between the two parts and to prevent puck¬
ering. All the sutures of the outer row were thus carefully
introduced until the entire circuit of the external wound was
made ; catgut was used for tljese sutures. The edges of the
external wound w ere then united to the stomach in the same
careful manner, and finally the wound itself was closed almost
entirely by sutures. A silver ligature was introduced into the
walls of the stomach, to indicate the point at which the knife
should be introduced into it, to complete the fistula after suffi¬
cient time had elapsed, to be sure that the adhesions desired
were sufficiently firm. In all the five cases operated upon, this
final opening was safely made; the post-mortem examination
in those who died showing the union complete and perfect.
The feeding tube is then introduced, and all is well. Mr. Howse
is a firm believer in the benefits of Mr. Lister’s antiseptic dres¬
sing, and carries out that method of treatment in all operations,
and to its great aid gives the credit of the safety after this
rather formidable operation. One of Mr. Howse’s colleagues
at Guy’s, has done the operation twice ; once for epithelioma,
and once for syphilitic stricture. The first of these died in a
few days from general prostration, the operation being done
after the old plan, such as is followed in colotomy. The second
was done with all the care so earnestly insisted upon and fol¬
lowed out by Mr. Howse, and is now living comfortably with
the fistula completely established, five months after the opera¬
tion. So a great deal of credit must be accorded to the method
of doing the operation. — Parkes, Chicago Medical Journal and
Examiner.
NOTES ON OBSTETRIC PRACTICE IN SIAM.
By SAMUEL R HOUSE, M. D.
The Siamese Twins, on one of their tours of exhibition
through the country many years ago, paid a visit to the Hart¬
ford Asylum for the Deaf and Dumb. The writer not long
after, visiting the institution, was introduced to the pupils as a
medical missionary about returning to his work in Siam. While
all seemed to comprehend where he was going and on what er¬
rand, one bright looking lad was observed to talk very earnestly
in the sign language to his instructor, ending all by putting his
two thumbs together very significantly. The only response
from his teacher, himself a mute, was an immoderate fit of
laughter. When he could command himself sufficiently, he
wrote on the slate “the boys ask whether all the people in
Siam are born twins ?” He had simply made too broad a gen¬
eralization, though the old motto reads, ‘ ah uno disco omnes.'1
264 Current Medical Literature. [August
Still, how people come into the world in that remote land, is a
subject that may prove not without interest even to medical
men.
Obstetric practice in Siam, as will be conjectured, is of the
rudest kind. Were all left to unassisted nature, mother and
child might fare better, but not a little “ meddlesome mid¬
wifery ” is resorted to, and one strange custom is universally
prevalent, as abhorrent to good sense as it is to humanity.
Elderly women are their chief dependence on these occasions,
and they are as officious and as wise in their own conceit as “ ex¬
perienced nurses” in more civilized communities are apt to be.
Male practitioners are summoned only in exceptional cases.
Utterly ignorant as these are of anatomy and of the nature of
the process of parturition, and holding as they do that all de¬
lays and obstructions are caused by demoniacal interference,
their practice consists much of it in incantations and exorcisms
and in rudest methods to hasten expulsion. A favorite
way to expedite matters is to press with great force on the ab¬
domen and its contents — shampooing vigorously with thumbs
and fists. They even stand with bare feet upon the poor
woman’s body, crowding the heel upon the front or sides of
the distended uterus, and all without the slightest reference to,
or knowledge of the condition of the os uteri. The writer has
seen a large proas abscess produced by the violence used on
such an occasion.
Is the patient feverish and restless ? the doctor tills her mouth
with perfumed water over which a charm has been muttered,
and spirts it dexterously in a tine and not unrefreshing spray,
over the all but naked body of the sufferer — bidding at
the same time the evil spirit to begone. If the same peremp¬
tory order were given to the many sympathising female friends
who crowd the little room and keep up a loud and incessant
chattering, more good might result.
Does the labor prove still tedious ? a large brass bowl is pro¬
cured, a long wax taper is lighted and fastened in the bottom of
it by a few drops of the melted wax, silver coins to the amount
of ninety cents (which are to revert to the doctor as the invari¬
able fee for this service) are stuck on the sides of the candle,
and the bowl is filled up with uncooked rice, on which some
coarse salt, dried peppers, etc., are thrown, and over this,
with hands laid palm to palm and bowed head, an incantation
is addressed to the invisible powers which have control over
the malicious demons that are hindering the birth of the child.
Meanwhile, for any bad symptoms that may arise, medicines
are administered in accordance with their simple theory of
pathology and therapeutics, that all disturbances of the system
are produced by undue preponderance of one of the four ele¬
ments — fire, wind, earth or water. As a specimen of their
prescriptions, the following may answer. It was made by the
Court physician in the presence of the writer, for a lady of
high rank, at the time of her confinement. Rub together shav-
Current Medical Literature.
265
1879]
mgs of sapan wood, rhinoceros’ blood, tiger’s milk (a white
deposit found on certain leaves in the forests), and the cast-off
skins of spiders.
But at last the delivery is accomplished. Then a scene of
confusion begins ; one rushes out for salt, another for warm
water and an earthern basin to wash the child, a third with
frantic haste brings for the mother’s comfort an earthen tray
full of firebrands, snatched up from the kitchen-fire, which
soon filled the room with a blinding smoke. Meanwhile, a
piece of split bamboo is looked up, from which a rude knife is
fashioned, and with this the umbilical cord is cut or rather
sawed through, for with nothing metallic may the cord be sev¬
ered under any circumstances. Since they never tie the cord,
this is not bad practice, as by it liability to bleeding is pre¬
vented. An old earthen jar is now found to receive the placenta,
which with two or three handfuls of coarse salt thrown upon
it is then buried somewhere in the garden, averting thus evil
that would otherwise befall mother and child.
Next the child is washed and laid on a soft pillow, around
which to protect from drafts and mosquitoes, a close curtain is
extemporized by using the three yard piece of printed muslin
that constitutes a Siamese dress. From the very first day,
babes in Siam are fed with honey and rice water, and have the
soft pulp of bananas crammed into their little mouths.
And now with the mother begins a month of penance, expo¬
sure to true purgatorial fires. It is inground into the native
female mind in Siam, that the most direful consequences to
both mother and child will ensue, unless for thirty days after
the birth of her first child (a period diminished five days at
each subsequent birth) she exposes her naked abdomen and
back to the heat of a blazing fire, not two feet distant from
her, kept up incessantly day and night.
From this curious Siamese custom of “ lying by the fire,”
this cruel addition to the unavoidable trials of woman in child¬
birth, none in palace or bamboo hut dare to exempt themselves.
No superstition has greater hold upon them or more terrifies
them with fear of coming evil if they fail to comply with it.
And their medical science bolsters up the custom, by teach¬
ing that after the birth of the child there is always a diminu¬
tion of the fire element in the system tending to produce stag¬
nation, a flabby state of the uterus, bad humors in the blood,
a bad quality of the milk and other unknown and terrible dan¬
gers to parent and offspring, from which this free external
application of heat alone can deliver them. They think, too,
the due quantity, quality and proper duration of the loeliial
discharge depends on this exposure to the fire. Vain is it to
tell them of the mothers in other countries who receive no
detriment from their dispensing with such a usage. They are
sure Siamese women require it, and they confirm their faith in
this practice by pointing to the wives of European residents,
7
266 Current Medical Literature. [August
who, it must be confessed, owing, of course, to the initiating
heat of that tropical climate, do not generally rally very well
after cli i 1 d- 1 >eari n g.
The manner of conducting this slow self-torture is as follows :
A lire-plnce is brought in, or extemporized on the floor of the
lying-in chamber by having a flat box or a simple rectangu¬
lar framework of planks or trunks of banana trees, some three
feet by four, filled in with earth to the depth of six inches. On
this the tire is built with sticks of wood nearly or quite as
large as one’s wrist. By the side of this oblong frame and
in contact with it, raised to the level of the tire, a piece of
board six or seven feet in length is placed, and on a coarse mat
spread upon this, or on the bare plank itself, the unfortunate
woman lies, with bare back and limbs, quite nude indeed, save
a narrow strip of cloth about her hips, with nothing else to
screen her from a tire hot enough to roast a duck. There, act¬
ing as her own turnspit, she exposes front and back to this
excessive heat ; an experience not to be coveted in any land,
but in that burning clime of perpetual summer, a fiery trial
indeed.
The husband or nurse is ever hard by, like her evil genius,
to stir up and replenish the lire by night and by day. True, if
it blazes up too fiercely for flesh and blood to endure, tliere is
at hand a basin containing water, and a small mop with which
to sprinkle it on the flames and keep them in check. For the
escape of the smoke no provision is made, for chimneys are un¬
known in Siamese kitchens even. It ought to be added that
hot water alone is allowed to quench the patient’s thirst.
Of all the strange customs of tnat strange people, the writer,
during his thirty years’ sojourn among them, found none more
barbarous — more unreasonable. He wells remembers the honest
indignation he felt when first he witnessed it, and learned the
obstinacy of their senseless prejudices respecting it. He had
been sent for to treat a woman suffering with inflammation of
the breast, and found the poor creature, though in a high fever,
lying so near a hot tire, made with half a dozen blazing fire¬
brands, that his face was fairly scorched as he approached her
to note the pulse, while the smoke that tilled the close apart¬
ment blinded his eyes. At another time, visiting a native lady
of lighter complexion than usual, who had been for some days
exposed to this treatment, he was startled with the appearance
of the surface of the abdomen, which resembled that of a
porker just roasted, and done, too, to a crisp. This encrusta¬
tion proved to be, nowever, an eczematous eruption, produced
of course by the extreme heat. On another occasion, called to
see a woman who “ u fai mai dai ” (could not endure the tire),
she was found, with burning skin and bounding pulse, so near
a furious fire that her back had become so hot that the hand
could hardly bear it. All remonstrances with her three female
tormentors proving vain, and declining to treat the patient un¬
less the tire was at once removed, he left. The next morning,
Current Medical Literature.
1879 j #
207
curious to watch the case, he called again, but finding all cleared
up, no vestige of fireplace or fire or patient either, he thought
at first he had mistaken the house. On inquiry he learned,
what was not very strange, that the subject of this high pres¬
sure treatment had had a fit, foamed at the mouth, and died
and was already buried. Buried , because those «whose lack of
merit causes them to die in child-birth are buried , not cremated,
as is the rule with nearly all others who die in Siam.
When and with whom this truly heathenish practice orig¬
inated is unknown, but it is a custom universal in that land,
and probably throughout the entire peninsular of Indo-Ohina,
for the women of all the various races resident at Bangkok,
not only the Siamese, but the Laos, the Burmese, the Peguaus,
Malays, Anamites and Cambodians, practice it. The women of
this last race, indeed, improve upon the discomfort experienced
by those of other nationalities, for they plant their couch of
repose, the bench of bamboo slats on which they lie, not along¬
side of, but actually directly over the fire, so that the smoke
and heat ascending can do their full work, and they see their
thirty days and nights drag slowly along, broiling on this
Montezuma bed of misery. Cambodia, once the leading nation
of Farther India, as its recently discovered wonderful ruins of
stone palaces and temples attest, has been nearly depopulated.
Need we wonder when such an atrocious attack upon the life
of its inhabitants at the very fountain head has been going on
so long ?
His late Majesty, Malia Mongkut, the enlightened father of
the intelligent young king now on the throne, admitted the su¬
periority of our Western obstetric practice, and would gladly
have abolished this absurd and injurious custom of his people.
When he succeeded to the throne in 1851, after spending twen¬
ty-seven years in the celibacy required of the Buddhist priest¬
hood, and children began to be born to him in his well-stocked
harem, he made some attempts in this direction. Upon the
birth of the first of the eiglity-one children begotten by him
during his seventeen years’ reign, the writer was summoned,
in consultation with an older medical missionary, to the royal
palace.
As that was the first occasion when a foreign physician was
ever admitted within the forbidden precincts of the royal ha¬
rem, a detailed account of it may prove of interest. I)r.
Bradley had been sent for in the morning, and found the lady,
who had given birth to a princess five days before, doing the
usual penance of lying before a hot fire on a hard board, with
the window shutters of the apartment all closed, suffering from
fever greatly aggravated by the heat and smoke. Represent¬
ing the urgency of the case to his Majesty, lie obtained prompt
and full permission to treat the patient as he thought proper.
The fire was at once of course removed, the window-shutters
thrown open, the patient transferred to a comfortable mattress
and cool water freely used with some simple medicinal treat-
Current Medical Literature.
268
[August
%
merit. On Dr. B.’s return to the palace in the evening, the
writer, at the King’s request, accompanied him. Passing the
guard at the outer gate, at the inner a parley ensued, the gate
was then unlocked and women attendants with torches took
us in charge, one going before, another to prevent straggling
bringing up the rear. The torch-glare showed us we were now
in quite a well-built town, with paved streets, grand halls, a
bazaar, a temple and many separate tiled-roof dwellings, gar¬
dens and tanks.
Turning several corners, we came at last to the substantial
brick residence of the lady patient. Admitted to her apart¬
ments we found a white canopy suspended from the centre of
the ceiling, under which the young princess was slumbering on
a more elevated couch than the mother, in whose veins flowed
no royal blood. All around the room, as in all Siamese houses
at such times, a cotton yarn was stretched to which were fas¬
tened papers bearing cabalistic figures, one for each of the four
walls, to keep off evil spirits from the mother and child.
The patient was doing well, and out of danger evidently.
At eleven o’clock the chief of the Royal Physicians joined us, a
prince, half brother to the King. After another visit to the
patient’s apartments and finding everything as favorable as we
could wish, about midnight we proposed going home. u Oh !
going home is out of the question,” said the prince-doctor.
“How will you get out ? the gates are locked and sealed, and
the keys are sent in to the King. Happen what will, you can¬
not get out now,” and so we made the best of it till morning,
sleeping some and talking more. But it was a strange place
for foreign physicians to pass the night, and know that 3,000
women, and women only, were slumbering around them. And
it was an unprecedented event too, in the history of the
kingdom.
In a few days a convalescence was established and a messen¬
ger came to Dr. B. from the King, bearing a purse of silver and
an autograph note in the King’s pecular English, which is
worth transcribing.
My Dear Sir :
Royal Hall.
My mind is indeed full of much gratitude to you for your skill and some
expense of medicine in most valuable favor to my dear lady, the mother
of my little infant daughter, by saving her life from approaching death.
I cannot hesitate louger than perceiving that she was undoubtedly
saved.
I beg, therefore, your kind acceptance of 200 ticals for Dr. D. B. Bradley,
who was the carer of her, and 40 ticals for Dr. S. R. House, who has some
trouble in bis assistance, for being your grateful reward.
1 trust previously the manner of curing in the obstetric of America and
Eur pe, but am sorry to say I could not get the same lady to believe be¬
fore her approaching death because her kindred were many more who lead
her a. cording to their custom. Your present curing, however, was just
now most wonderful in this palace.
I beg to remain your faithful well wisher,
S. P. P. M. Mongkut,
The King of Siam.
1879J Current Medical Literature. 26! I
But custom is omnipotent in the East, and it proved too
much for even an absolutely despotic king to overcome. There
is no reason to suppose this lady in her subsequent confine¬
ments dispensed with the broiling process. The queen herself,
who, the ensuing year gave birth to a prince, lay by the fire
from choice, though suffering at the time with a grave disease
which eventually caused her death.
In some instances those in the employ of the missionaries
and living on their premises, have been prevailed upon to dis¬
pense with this baptism of fire, but these same mothers in sub¬
sequent confinements when living among their own people
yielded to the force of universal custom. Indeed, had they not
conformed to it, they could have secured no native attendance
in the trying hour.
The missionary ladies at Petchaburi, startled by the sad fact
of the death when but eight or nine days old, of three out of
six or seven born in their immediate neighborhood, succeeded
after long persuasion in inducing a married Christian woman
to try their way when her next child was to be born. But she
undertook it from a sense of Christian duty, in the spirit of a
martyr. “It is a dark road and full of fear,” she said, “but I will
trust in God. If he lets me die, all will be right, many women
die also by the fire, but if I do not die I will always be glad
that I set an example for Siamese women.” All went on favor¬
ably in her case, to the astonishment of many in that region
who visited her. They were very curious, however, to learn
what medicine she took to avert the great peril she incurred.
Her room where she lay cool and comfortable on a mattress
with a white sheet spread over her, her little one washed and
dressed by her side, presented a striking contrast to the scenes
ordinarily witnessed when children are born in Siamese homes.
It may be observed of this custom of “ lying by the fire,”
that the origin of it can hardly be religious, for the Malays,
who are Mohammedan, are as observant of it as the Siamese,
who are all Buddhists, though, as Sir John Bowring suggests,
there may be some vague idea of pacification or purification
connected with it.
Nor is the custom one imposed on women by the tyranny of
the other and stronger sex, like the veiling of the face required
in Mohammedan countries. It seems to be a self-imposed addi¬
tion to what one would think was already a sufficient amount
of suffering incident to motherhood, and only furnishes another
proof that “ the dark places of the earth are full of the habita¬
tions of cruelty.”
It must be added, there is one compensation to offset the
mischievous consequences of this practice. It makes the women
of the laud escape the evils (prolapsus, etc.), that result in
other countries so often from resuming household duties too
soon after the birth of a child. The Siamese mother is guar¬
anteed by this custom for one month at least, the fullest liberty
to rest by her own fireside, undisturbed. — Archives of Medicine ,
June, 1879,
270
Current Medical Literature.
[August
METALLOTHERAPY.
The marvels of metal lotherapy will never cease. Dr. Dupuy
relates, in a recent number of the Gazette Obstetricale , a case of
retention of urine, in which he made a successful application
of metallotherapy. The case was that of an hysterical woman,
aged 40, who had been treated for several years for permanent
and painful spasm of the neck of the bladder, accompanied by
a little metritis and accentuated hyperaesthesia of the left
ovary. For the last year, she had retention of urine, which
necessitated a live months’ daily catheterisation ; she at last
was relieved of this by antispasmodie treatment and by the
employment of suppositories of belladona. The cure was con¬
tinuous till the month of last November ; then retention reap¬
peared, more painful and more persistent than before. The in¬
troduction of the sound provoked a spasm of the muscles of the
urethra, and immediately awoke in the patient a sensation of
heat and violent pain, frequently provoking an attack of con¬
vulsion with lost of consciousness. The patient had arrived at
such a point as to have so much horror of the catheterisation as
not to drink, and to endure the torture of thirst for two or
three days at a time in order to put off* the moment when the
use of the sound would become indispensable. Things were
at this pass when, after having exhausted all the series of an-
tispasmodics, M. Dupuy had the idea of having recourse to
metallotherapy in order to discover the metal suitable to the
patient, who was at this time suffering from convulsive spasms
of the limbs. He ascertained that gold, when applied to the
skin, increased the convulsions, whilst other metals, such as
copper, steel and silver, made them disappear immediately.
M. Dupuy then applied over the vesical region and round the
upper part of the thighs the metallic bracelets of Dr. Burq ;
and an hour afterward the patient passed urine abundantly
and without pain. From that moment, the catheter was no
longer called for ; when the urine did not pass, the armatures
were applied and micturition occurred naturally, although
sometimes with pain. The ovarian hyperesthesia had also dis¬
appeared, and the patient could swallow more easily, thanks
always to the metallic bracelets.
M. Landouzy relates an extremely curious example of metal -
loscopy or metallotherapy observed by him in the wards of Dr.
Hardy. A woman suffering from severe hysteria, convulsions,
contractions, etc., presented, at the time at which these obser¬
vations were being made, attacks of meteorism provoking very
severe abdominal pains. With the view of calming these pains,
M. Landouzy, after having previously bandaged the eyes of
the patient, tried upon the belly the application of a magnet,
which at first only gave rise to a sensation of disagreeable
cold ; but about two moments later there occurred in the right
wrist and labial commissure some slight convulsive movements;
at the same instant, the speech of the patient, who up to that
time had continued to answer questions which were being put
Current Medical Literature.
271
1879]
to tier, became slow and heavy, like the conversation of a per¬
son who is tailing asleep, and then the patient became silent;
all efforts made to awake her by all sorts of means were in
vain ; she remained plunged in profound sleep, with general
ansethesia and muscular resulution. Seeing that this state
much resembled natural sleep, except that absolute ansethesia
continued, the magnet was withdrawn; at the end of six
seconds, the same movements occurred in the face and the
wrist as those already observed, and the patient, whose eyelids
had been unbandaged, opened her eyes and seemed to come
out of a profound sleep; at this moment, it was ascertained
that sensibility had returned all over the body. A new obser¬
vation was then made ; the eyes of the patient were at first
simply bandaged, without making use of the magnet, and for
more than ten minutes nothing particular occurred. At the
end of this time, a portion of the magnet was put in contact
with the anterior surface of the left forearm ; about a minute
afterwards there occurred what had been observed when the
magnet had been applied on the first occasion , that is to say,
slight spasmodic movements in the wrist and in the right labial
commissure. Then the patient became insensible to all means
of stimulation, and seemed to fall profoundly asleep, respiration
and circulation remaining as they were before the experiment. It
sufficed to remove the magnet in order that at the end of from
six to eight seconds the patient, whose eyes this time had been
bandaged, awoke, when, after having presented the same
slight clonic movements which have been already mentioned,
she asked if they were not going to take off' her bandage. This
being taken away, the magnet was replaced in contact with
the abdominal walls, and for a quarter of an hour the patient
conversed tranquilly when interrogated; then, while still con¬
versing, M. Ladouzy closed her eyelids with his fingers and
thus kept the eyelids closed ; two minutes had not elapsed,
when the patient fell again into a state of complete sleep with
general anaesthesia. This time, instead of withdrawing the
magnet, it was left in position, and the patient’s eyes were
drawn open. !5he immediately came to herself, said that she
had not dreamed at all and experienced nothing during her
sleep, but felt something heavy and cold on t he stomach. This
experiment was repeated a great number of times, and this truly
lethargic sleep was always produced under the same conditions,
viz: Application of the magnet on a given point of the body,
the patient having her eyes closed and covered ; the patient
always returned to herself and recovered sensibility as soon as
the magnet was withdrawn if the eyes remained closed, or as
soon as the eyes were opened if the magnet still remained in
in contact with the skin. We publish to-day some interesting
contributions to the knowledge of the subject. — British Medical
Journal, April 20.
272
Current Medical Literature.
[August
PREPARATION OF IMITATION KUMYS.
Fill into a strong champagne bottle, good, fresh, unboiled
cow’s milk to such a height that, after the addition of thirty
grammes (1 oz.) of granulated or powdered sugar, and after
corking, there would still be left at least an inch of empty
space below the cork. Before corking, add a piece of fresh
compressed yeast, a teaspoonful of good beer yeast may be
taken. The contents of the bottle are well shaken, repeatedly,
then the bottles are placed in the cellar, where they are turned
up and down a few times during the day. From alid after the
fifth day the mixture is ready, and may be drunk to about the
twentieth day. It is best to prepare about six bottles full at a
time, refilling each after it has been emptied and cleaned, so
that the treatment, after being begun, may not be interrupted.
On opening the bottles, the contents are very apt to foam over,
hence the bottle should be opened while being held over a
plate. It should never be opened where there may be any
furniture or dresses about, which might be spoiled by sput¬
tering.
A good mild wine or kumys should have a homogeneous ap¬
pearance, of theconsistance of thin cream, should be effervescent
when poured out, of an acidulous, agreeably vinous odor and
taste, and should not be full of lumps, or taste like buttermilk.
On first using kumys it produces loose bowels, but this effect
soon passes off. — Pharm. Zeit. — New Remedies. — N. G. Medical
Journal.
POISONING WITH SALICYLATE OF SODIUM.
Dr. Feltz reports the*poisoning of a man who took 200 grams
of salicylate of sodium in one month, lie took 4 grains three
times daily for seven days, then increased the dose to 0 grams,
and, in the the last 17 days to 8 grams three times daily. The
intoxication symptoms were principally- frequent vomiting and
repeated attacks of very painful headache, preceded by redden¬
ing of the neck, lace and head, llis pupils were very much
contracted and the symptoms continued for 17 days after the
last dose of medicine had been taken, while the acid could be
detected in the urine for 10 days. — Ap. Ztg. Dec 14th, 1878. —
Am. Journal of Pharmacy.
STAMMERING.
Dr. W. B. Hammond ( The Voice , No. '6) gives his method of
self- treatment of this annoying affection. He considers it a
functional disorder of that part of the brain which presides
over the faculty of speech. Having himself been a sufferer,
he is able to speak as one having authority. He describes his
method in the following words :
“If the attention of the stammerer can be diverted from
himself and his articulation, lie will often speak to others as
f hi rrent Medical Literature.
1879 1
calmly and as perfectly as he does to himself when alone. Now,
there are various ways of accomplishing this object, but the
one that I found most effectual was the performance of some
slight muscular action synchronously with the articulation of
the difficult syllables. The words that troubled me most were
those that began with the explosive consonants — those that
require the sudden opening of the lips for their enunciation —
b, p, and t. 1 could no more have repeated the alliterative
lines, ‘ Peter Piper picked a peck of pickled peppers,’ etc., to
other persons without stammering, than 1 could have walked
to the moon, though perfectly able to say the whole piece
through without a flaw when speaking alone. With each
troublesome word, especially with one beginning a sentence,
l made some slight motion with the hand or foot, or even with
a single finger, and I found that this plan enabled me to get
the word out without stammering. With the enunciation of
‘ Peter,’ for instance, 1 would tap the side of my body with the
hand just as I opened my lips, and the word was articulated
without the least halting. In the procedure, the attention is
diverted from the effort to speak to the performance of the
muscular action mentioned, and hence the speech becomes more
automatic than it is with stammering. It consists in efforts to
render the speech automatic. No orator thinks of his articula¬
tion wheu lie is making a speech ; no one in ordinary conversa¬
tion thinks whether or not he will be able to pronounce a cer¬
tain word, or to acquit himself well in the management of his
tongue and lips. His mind is concerned with his thoughts,
with what he is going to say — not with the manner in which
he will articulate, and the more thoroughly we can succeed in
bringing stammerers into the same way of procedure, the more
successful will we be in our efforts to cure them.”
He followed this method about two years before the cure
was accomplished, and has succeeded in curing several of
his young friends by recommending it to them. Sometimes
it has failed, as all other plans sometimes fail ; in some cases,
probably from want of perseverance in carrying out his plans.
— British Medical Journal , May 3.
YELLOW FEVER-EPIDEMIOLOGICAL SOCIETY.
J. Nettkn Radcliffe, M. R. C. S.. Vico- President in the Chair, May 5, 1879.
A paper on the diagnosis and causes of yellow fever was
read by Mr. Lawson, Inspector-General of Hospitals. The
author pointed out the distinctive clinical feature of yellow
fever was the occurrence, usually on the third or fourth day,
of albumen in the urine, accompanied by desquamation of the
bladder, and, on the following day, of the tubes of the kidneys,
with great reduction or disappearance of the chloride, and
reduction of the urea. Fever, with these and the other char-
8
Current Medical Literature.
274
[August
acters of yellow fever fully developed, was met with both in
the continued and periodic forms. Healthy persons going into
a locality where its cause was known to be in a state of activity
were very liable to be attacked ; but if they, or others infected
in such a locality, returned to a healthy one, they went through
the fever there without communicating it. Healthy localities
were often in close proximity to those where the disease origi¬
nated, as at the military station at Newcastle, in Jamaica,
where, in 1756, in a cantonment on the narrow crest of a moun¬
tain spur, there were three such sickly zones, alternating with
four healthy ones, in a length of eight hundred yards. Porous
materials, such as clothing, etc., might undoubtedly imbibe a
quantity of the emanation if exposed in places where it was
generated, and some American authors believed that when a
box of such articles packed in a yellow fever locality had been
opened at a distance, that disease had sometimes been excited
among tliose present. The general impression in yellow fever
localities, however, was that the disease produced by the quan¬
tity carried in the ordinary clothing was infinitesimally small.
There was no evidence to show that persons laboring under the
yellow fever, or the bodies of those who had died of it, gave
otf a poison capable of exciting the disease. Should the eman¬
ation from a ship with a source of yellow fever on board, or
from fomites, meet with a suitable locality on shore, could it
fructify so as to produce a fresh focus of the disease, giving
rise to a similar emanation ? Many believed it could ; but, to
establish the point, it was necessary to exclude the possibility
of the disease having arisen at such points under the actiou of
the general factor mentioned above, which at present there
were no means of effecting. — In the discussion which followed,
the Chairman, Sir W. U. E. Smart, Sir Joseph Fayrer, and 1 )r.
Caddy took part. — British Medical Journal , May 3.
ON THE USE OF SALICYLIC ACID.
There are two independent effects of salicylic acid : the
germicide and the antipyretic ; there are many conditions of
disease where it would be well to make use of both these
actions, and some where the antipyretic is distinctly aided by
the germicide effects of the acid, so that fever is lowered more
certainly and quickly by its use than when the more easily
administered, soluble salt is prescribed. This is well seen in
scarlatina anginosa, and sometimes in diphtheria, whether the
acid be conveyed to the throat directly, or be suspended in
mucilage, or by means of glycerine, its most convenient solvent.
Half an ounce of glycerine, when hot, will dissolve half a
drachm of salicylic acid. This is stronger than necessary, and,
when cold, will either deposit some of the acid or may become
solid ; in either case, it will redissolve when heated, and can
be mixed in a warm spoon with an equal quantity of hot water,
and given in small quantities with or without any drink after-
1879J Current Medical Literature. 275
wards ; or, a solution of five grains of salicylic acid to die
drachm of glycerine can be used, either alone or given with a
little cream. In this way, not only are tlie mouth and throat
cleansed, but the fever is soon lessened ; it is only while the
fever is high that the strong doses need be continued. In cases
of moderate severity, it suffices to prescribe this weaker gly¬
cerine solution, and to order half a drachm or a drachm to be
mixed with an ounce of water at the time of administration.
The latter is quite strong enough for an adult, and is better
followed by a drink of water. Or half an ounce of the gly¬
cerine in half a pint of water forms a suitable mixture ; this
sipped frequently or given as a drink every two or three hours,
diminishes fever and improves the throat. Such a solution of
two grains to the ounce is efficient as an antiseptic, and can be
used in spray. Where a general antipyretic effect is desired,
salicylate of soda may be given at the same time, fifteen grains
being equivalent for this purpose to ten grains of the acid. It
is contraindicated where there is renal congestion or an albu¬
minuria, as most of the acid is secreted by the kidneys. This
method of administration is more suitable to scarlet fever than
to diphtheria, where the necessity for giving iron restricts the
use of salicylic acid to the intervals when the stronger form
can be applied in small quantities frequently. In erysipelas,
no form of salicylic acid is advisable; not only would it inter¬
fere with the use of iron, which is then essential, but there is
no febrile condition over which it has so little control as erysi¬
pelas. In typhoid fever, the use of salicylic scid presents some
advantages over that of salicylate of soda. The glycerine
solution is suitable for administration in diabetes, salicylic acid
having a power of checking the formation of sugar not pos¬
sessed by salicylate of soda. For this purpose the acid is
required in full doses ; it might take the place of carbolic acid
in rendering diabetes more tolerant of operations and less lia¬
ble to suffer from boils and from suppuration. In catharrhal
sore-throat, or at the commencement of a common cold, the
weak solution of salicylic acid is beneficial. For checking the
febrile reactions in phthisis it is also preferable. It also acts
as a sedative to the pneumogastric, and the weaker glycerine
solution in water relieves cough. As a remedy in whooping
cough, this solution may be found as effective and more conve¬
nient than the laryngeal insufflation of the powder. Hay-fever
is checked by dropping a grain to the ounce solution into the
nares. The great obstacle to the freer use of salicylic acid is
its sparing solubility in water; this difficulty lias been over¬
rated. Solutions of one or two grains to the ounce keep clear
or deposit a few flocculi only, when theoretically all but one-
fifteenth of a grain should separate. — Wm. Squire, M.D., F. K.
0. P. — British Medical Journal , April 26.
THE HISTORIC EVOLUTION OF THE PERCEPTION OF COLORS.
In a memoir presented to the Academy of Sciences and Lit
erature of Lyons, Dr. Henry II. 1 >or, a well-known oculist,
Current Medical Literature.
276
[August
contests the view held by Mr. Gladstone, and by Geiger and
Magnus, of Boston, that our ancestors were color-blind ; a view
deduced from their writings and from the different names which
they hate given to colors. Dr. Dor endeavors to demonstrate
that now, as in the time of Homer, poets insist too little upon
the indications of the colors, but much more upon their lumin¬
ous intensity. Moreover, M. Dor says that persons who do not
possess any knowledge of physics find much difficulty in dis¬
tinguishing the colors of the rainbow, and only see it in three
or four colors, in place of the seven classical colors of its com¬
position. Further, it results even from the very study of the
Assyrian and Egyptian monuments, that those nations had not
only perceived, but imitated, the greater part of the colors of
which we are at present cognizant. — British Medical .Journal,
April 26.
THE TREATMENT OF AGUE BY QUINETUM SULPHATE.
By W. AINSLIE HOLLIS, M.D*.
1 have recently tried the administration of quinetum sulphate
in about a dozen cases of ague. The substance recommended
itself first to my notice on the score of economy ; it is scarcely
half the price of quinine. Quinetum represents the whole of the al¬
kaloids of the Cinchona xuccir ultra bark. The tree itself grows
plentifully in East India, Ceylon, and Java. The sulphate
contains, according to Mr. Whiffent, of Battlesea: Quinine
sulphate, 2.“) to 30 per cent. ; cinchonine sulphate, 20 to 25 per
cent. He further states that the variations of tne alkaloids
rarely range to the extent of five per cent., as above mentioned.
This fact is, of course, of some importance in estimating the
therapeutic value of the drug.
The sulphate of quinetum is a white fiocculent substance
consisting of numerous fine aeicular crystals, bitter in flavor,
and possessing, according to Dr. De Vrij, a molecular rotation
of 38 deg. to the left. It readily dissolves in acidulated water.
Drs. Ohevers, Ewart, and Bird have used it in India in the
treatment of intermittent fevers with success. Dr. Vinklmysen
narrates same cases in the Practitioner (February, 1878),
wherein quinetum successfully cured ague after quinine had
failed to do so. He found it to be especially serviceable in
those protean forms of malaria classed usually as masked
ague. The curative value of the red cinchona alkaloids, as
far as my own experience avails, far exceeds that of the
comparatively small quantity of quinine which they contain.
*Kead at tho Last ami West Sussex District Meeting of the South-Eastern Branch.
tStoeder Weekbad vanhet Nederl. I'ijdschrift voor Geneeskunde, vol. 17, p. 249), in com¬
paring the analyses of the English (so-called) quinetum with that from the Japanese
cinchona kuccirubra, finds that the former contains 24 til* per cent, of cinehonidine, 5 4
percent, of quinine and 38.24 per cent, of cinchonine; the latter 45 to 46 percent, of
I'iuohonidiue, 6 to 14 per cent, of quinine, and ot.ly 26 to 27 per cent, of cinchonine.
In the English drug there was 21 per cent, of amorphous alkaloid against 4 to 5 per
cent, of the same in the Dutch sample.
1879]
Current Medical Literature.
277
I am, therefore, led to believe, with Dr. Dougall, that the other
alkaloids are valuable antiperiodics. MM. Colletti ( London
Medical Record, 1878, p. 129) and liaffertie f Philadelphia Medi¬
cal and Surgical Report , vol. 20, p. 383,) both ascribe important
antiperiodic properties to cinchonidine. If we refer to the
analysis of quinetum sulphate, we shall find that about half
the drag is composed of the sulphate of this alkaloid ; it ap¬
pears, therefore, probable that some of the valuable properties
of the mixed alkaloids are derivable from this substance.
A dose of quinetum sulphate of from ten to fifteen grains is
almost invariably sufficient of itself to stop the course of a fe¬
brile intermittent. In two cases wherein it failed to do so, 1
subsequently tried quinine with no better result. A man with
tertian ague, living at Selscombe, came under my care on the
19th of February last. He had been under treatment for this
disease since Christmas without relief. One dose of fifteen
grains of the quinetum sulphate entirely checked the shivering
fits, and the subsequent administration of three-grain doses,
three times daily for three weeks, cured him. In another case,
a youth aged 16, who had been taking six grains of quinine
daily for three weeks for a quotidian fever, and under this treat¬
ment had greatly improved, was completely cured of the dis¬
ease by nine grains of quinetum sulphate in twenty-four hours.
1 select these two cases as illustrating the value of quinetum
sulphate when other remedies were of less avail.
Finally in quinetum sulphate I believe we have a valuable
antiperiodic remedy second only to quinine. Its comparative
cheapness recommends it specially to the favorable considera¬
tion of the medical staff of hospitals and other charitable insti¬
tutions where economy is, or ought to be, particularly practised.
— British Medical Journal, May 10.
A GIANT BIRTH— THE CHILD WEIGHING TWENTY-THREE AND
THREE-QUARTERS POUNDS.
By A. P. Beach, M.D., Seville, Ohio.
At the request of many readers of the The Medical Record
I am persuaded to report a case of labor which 1 attended a
few weeks ago. The great size of the child at birth was the
remarkably feature of the case, it being probably the largest
human birth on record. It perhaps would be well to state
here, that when we take into consideration the immense
proportions of the parents, the size of the child need not
astonish us. The mother, Mrs. Captain M. V. Bates, whose
maiden name was Annie Swan, of Nova Scotia, stands 7 feet
9 inches in height. Captain M. V. Bates, formerly of Kentucky,
is 7 feet 7 inches in height. These large people have, un¬
doubtedly, been visited by many of the readers of this journal,
as they have given public receptions in nearly all of the large
cities and towns of Europe and America.
278
Current Medical Literature.
| August
At 12, M., January 15, 1871), 1 was called upon to attend
this lady in confinement, it being her second labor. I found her
surrounded with competent attendants, and everything in order
and at hand that would in any way add to her comfort and
convenience. Her pains were quite infrequent and light.
After a convenient time, with my patient in the usual position,
I proceeded to make an examination, but was unable to reach
the os uteri, it being so far up. 1 could not with my hand, by
any ordinary effort, make a satisfactory examination, but con¬
cluded that she was in the initial stage of labor. She remained
iu much the same condition for the next 24 hours, passing the
night comfortably, and 1 saw no necessity for any interference
with the order of things. At the end of hours the pains
became more frequent, and on examination I found the os
dilating and labor progressing favorably. The head engaged;
position, second occipito anterior. Notwithstanding the long
interval between pains the head made good speed through the
depth of pelvis. At 4, P. M., on the 18th, while conducting
an examination during pain, the membranes gave way spon¬
taneously and the amniotic fluid came pouring out so profusely
as to startle every one. 1 had my patient very close to the
margin of the bed, as was necessary in order to facilitate manip¬
ulation on account of her great size.
The bed was well protected with rubber blankets, which
carried the waters over the side of the bed where they were
caught in vessels to the amount of live gallons. That lost by
absorption and evacuated with succeeding pains, would make
the total of water not less than six gallons. This was, un¬
doubtedly, a case of dropsy of the amnion, co-existent with
general dropsy, from which she suffered to some extent during
the last months of pregnancy.
Soon after the rupture of membranes the ffetal head was
disengaged, and in the soft parts. The mother was in good
condition, the f<»tus seemed strong and healthy, and everything
indicated a speedy and successful termination. But here the
trouble began. After the escape of the waters all pain ceased.
The great abdominal muscles which had been so much distended
lay lax over the foetus like the blanket which covered the
person of the mother.
Inertia was complete. There was no pain except as the
result of manipulation. Ten grains of quinine, Squibb’s ergot,
and brandy were administered. The forceps were resorted to
early, but all to no purpose. The forceps could not be success¬
fully applied because of the unusually large head which lay,
with the neck, in a vagina that would measure on its posterior
aspect 12 inches at least, and from 7 to 9 in its anterior. The
safety of the child was my great fear. The head was seem¬
ingly almost born, but the shoulders were fast. How to
disengage them was the question. The hand could not be
passed to reach the shoulder. I had telegraphed for Dr. ,T. D.
Robinson, of Wooster, O., who now came to my assistance.
1879]
Current Medical Literature.
279
lie attempted the use of the forceps with but little success.
The child could not be so delivered. After further consultation,
as it was our great desire to deliver if possible, without mutila¬
tion, we passed a strong bandage over the neck of the child and
while one made downward and lateral traction, the other after
several attempts, succeeded in bringing down an arm, and
finally after a laborious seige we succeeded in delivering our pa¬
tient of a male child, it weighed 23f pounds; its height, 30
inches; breast measure, 24 inches; breech, 27 inches; head,
19 inches; foot, inches in length. The secundines, which
were soon removed, weighed 10 pounds. The mother was con¬
siderably exhausted, but is making a good recovery. Mrs.
Bates, six years ago, gave birth to a dead child in London,
weighing 18 pounds, and 24 inches in height. She was at¬
tended at the time by one of the celebrated obstetricians of
that city, who encountered the same difficulties in delivery
that 1 had.
[We believe that this is the largest infant at birth of which
there is any authenticated record. Cazeaux refers to one that
weighed 19 pounds. There is a foetus in the London Hospital
Museum 24 inches long. The average length is 20 inches ; aver¬
age circumference of head 134 inches. The placenta usually
weighs one-sixth as much as the foetus. In this case the secun¬
dines in all weighed nearly half as much as the child.] — Medi¬
cal Record.
PHYSIOLOGICAL ALBUMINURIA.
In connection with the interesting paper by Dr. Saumlby,
which we publish in another column, it may be well to refer to
a communication made to the Medical Society of Florence on
May 12, 1878, and reported lately in IJ Imperziale by Dr. Mar-
cacci. Dr. Marcacci observes that the presence of albuminuria
in the urine is considered by the majority of physicians as the
index of a pathological condition, although Bernard, Vogel,
Hoffman, and others, have pointed out that albuminuria may
be met w ith in men whose health is perfect, and under certain
conditions of alimentation. The excessive consumption of eggs
is only one of the conditions of this sort of physiological albu¬
minuria. It is somewhat difficult to prove that the. presence of
albumen is not related either to a morbid state or to a special
regime. Moreover, there exists a certain number of cases of
error. In these researches, it is only with small quantities of
albumen that one deals, while the blood, pus, and the urethral
mucus, or that of the other neighboring organs or protatic
fluid, may in themselves constitute a cause of error when they
are mixed with the urine. Nevertheless, according to M. Mar¬
cacci, a series of observations made upon himself has proved
to him that albumen may be found in a physiological urine.
280
Current Medical Literature.
| August
Albumen, lie says, is constantly absent in noctural urine ; on
the contrary, it is very rarely absent in diurnal urine; it is pos¬
sible to make albumen appear in the diurnal urine by execut¬
ing rotary movements of the arm for from ten to fifteen min¬
utes in such fashion as the pulse is raised from seventy-five to
one hundred and fifteen pulsations a minute. These results
are in some sort confirmatory of the researches made by Leube at
Erlangen in 1877, which are worth while summarising. Leube
undertook his research 011 the soldiers of the garrison at Erlan¬
gen, and took the necessary precautions to avoid cases of blen-
norrhagia. The following was his method of research : Fresh
urine was filtered, and a certain quantity carried to the boiling
point ; the other was treated by nitric acid, both being com¬
pared with the intact urine on a block tablet. In the urine
which showed opacity, a small quantity of acetic acid was
added to precipitate the deposit.
This precipitate was washed and treated by Millon’s fluid, and
another test was made with the liquor potassse, and possibly
with the sulphate of copper and heat, when the purple red or
violet color was obtained with Millon’s fluid, or the violet color
with the potassa, the urine was considered as albuminous.
Leube examined the night urine of 119 soldiers. The number
of observations was 154, which were then divided ; 90 soldiers
were examined once, 23 were examined twice on two different
days, and 0 were examined three times at intervals of three,
days. Briefly, out of 154 examples of nocturnal urine only a
very small quantity of albumen was found in five cases, and
in only one case a notable proportion. Researches performed
on the urine secreted during the day after military exercise,
and in the mouths of June, July and August, gave very differ¬
ent results; in fact, of five soldiers who had shown albumen in
the night urine, a much larger quantity was found in the day,
and further, albumen was found in 18 soldiers who had not
presented any in the night. Bringing the frequency of albu¬
men in these observations to a percentage, it was found that
the morning urine was albuminous in 5 soldiers out of 119, that
is to say, in 4.2 per cent. ; that of the middle of the day was
albuminous in 19 soldiers out of the 119, that is to say, in 10
per cent. The day urine was only albuminous in 14 soldiers
out of 119, that is to say, 11.8 per cent. Finally the urine of
the morning and that of the middle of the day were equally
albuminous in 5 soldiers out of 119, that is to say, in 4.2 per
cent. It may be added, that the quantity of albumen in the
urine most heavily loaded with that substance was from 37 to
38 milligrammes per cent. Such are the facts which seem to
prove the possibility of albuminuria in the physiological state.
— British Medical Journal , May 10.
1879 1
Current Medical Literature.
281
DERMATOPHONY.
Prof. Hueter, of (1 riots wold, lias shown that we can hear with
the microphone the rush of blood through the capillaries of the
skin (dermatophonv), the sounds of muscular contraction (myo
phony), of tendinous extension (tendophony), and of the vibra¬
tion of long bones when percussed (osteophony).
As the microphone is, in general, not easy of application to
the skin of the body, Prof. Hueter has invented a special in¬
strument or dermatophone, consisting of a flexible stethoscope
with a thin caoutchouc membrane stretched over the end ap
plied to the skin, and a perforated horn plug to fit and close
the ear perfectly. With this instrument he has clearly proved
that the capillary murmur is most clearly heard where the cir
dilation is most vigorous. In acute inflammation of the skin,
with marked inflammatory liyperannia, the manner is louder
but deeper in tone than in the normal state. — Times and Gazette ,
Feb. 15, 1879. — Chicago Medical Journal and Examiner.
POSTURE IN THE EXPULSION OF THE PLACENTA.
Dr. A. T. A. King, in an article in the National Medical Re
dew, is inclined to believe that if a woman sits up immediately
after the delivery of the child, the placenta is much less apt to
be retained. He states that he has repeatedly secured the
delivery of the placenta by instructing the female to sit after
delivery, the child having been previously separated in the
usual way. He does not, however, positively recommend this
practice, though he points out that if the womb were not well
contracted, its contraction would be promoted in the manner
stated, and what is more, should haemorrhage occur in the sit¬
ting posture, it would probably be less profuse and less fre¬
quently fatal than when the woman was recumbent, for the
reason that syncope would occur sooner, and thus the force
of the cardiac ventricle would be reduced earlier and before
time had been allowed for it to pump out the horrible sluices of
blood that so often occur during post-partal haemorrhage in
the recumbent posture. — Medical and Surgical Reporter , June 28.
PURULENT OPHTHALMIA OF INFANTS.
Dr. Luton, of Rheirns, states that the tincture of iodine in
distdled cherry-laurel water is a far more efficacious and innoc¬
uous means of treatment than the nitrate of silver. One
gramme of the tincture may be added to twenty grammes of
the water of medium strength (20°), and produces a collyrium
the color of pale brandy. Some of this should be dropped into
the eye four or five times a day, external lotions being also
abundantly employed. It has proved rapidly successful at the
Hotel-Dieu of Rheirns. — Revue Med. — Obstetric Gazette.
9
282
Editorial.
[August
TREATMENT OF SICKNESS DURING PREGNANCY.
I am happy to send a report of the further progress of the
case of sickness during pregnancy published in the Journal of
May 17th. “ The patient is doing very well.” She was about
six weeks pregnant (not six months, as stated in the Journal).
Since my former communication, a gentleman iu Scotland has
forwarded me the following case:
u Mrs. aged 23, complained of great sickness when six
weeks gone in her third pregnancy. (The sickness during the
two former pregnancies had been occasional and slight.) For
a fortnight before I saw her, she had vomited everything she
took, and was continually sick. Nothing medicinal gave her
the slightest relief. 1 proceeded carefully to dilate the os, and
with little difficulty introduced the end of my finger through
the os internum. The operation caused very little discomfort,
and the result was most gratifying. She was only once slightly
sick, and that immediately after the operation. She has not
had the slightest difficulty since. I have closely followed the
reports of your cases and of others cured by your operation,
and I have great pleasure in being able to add one to what is
already an extensive list of successes.” — E. Copeman, M. D.,
F.R.C.P., Physician to the Norfolk and Norwich Hospital. —
British Medical Journal , June 21.
j^DITOf\IAL.
YELLOW FEVER OUTBREAK OF 1879.
The assiduous and intelligent student of the habitudes of
yellow fever contagium is not taken by surprise at the recent
outbreaks in Memphis and on the Gulf coast. They are events
quite in harmony with the natural history of yellow fever poison.
At every point which the senior editor of this journal vis¬
ited in 1878, he endeavored to impress upon the respective
communities a knowledge of the fact that the contagium might
be preserved for an indefinite period of time under couditious
favorable to its preservation. For the purpose of presenting
this truth in a forcible manner he was in the habit of using a
homely form of illustration, and of saying that “yellow fever
poison was something which could be put away and kept
through the winter like sweet potatoes, and like them would
grow again iu the warmth of the succeeding summer, under
circumstances favoring its growth.”
1879]
Editorial.
283
We are not able to formulate in a precise manner the condi¬
tions under which the vitality of the yellow fever poison is best
secured. It is, however, our firm conviction that exclusion of
air is a sine qua non to this end. At all events the assertion
can safely be made that the histories of long preservation of the
cause of yellow fever invariably include confinement in some
closely shut receptacle. The Plymouth cases have, in the opin¬
ion of many observers, thrown considerable doubt upon the
doctrine hitherto nearly universally held, that low temperature
is positively destructive of yellow fever contagium. In our own
minds no change of opinion has taken place in consequence of
the Plymouth outbreak. The same conditions, whatever they
were, which protected the hid away germs from the air proba¬
bly protected them from a degree of cold sufficient for their
devitalization.
To those but little conversant with the natural history of yellow
fever it may appear strange that an outbreak from hybernated
germs should take, place in Memphis and yet nothing of the
kind should occur up to the same date in New Orleans or any
place near its latitude where yellow fever prevailed in 1878. We
suppose this fact to be based upon the truth of the statement
previously made that herrnetical enclosure of yellow fever germs
is more apt to occur in houses built with thick walls and bat¬
tened doors to exclude cold air, than in houses constructed to
keep us cool and secure us good ventilation. In this respect
yellow fever poison has its perfect analogy with the materies
morbi of other infectious diseases. We do not believe that a
flannel cloth worn around the throat of a scarlet fever patient
would retain its power of infection for twelve months in this
climate and in our houses, as Sir Thomas Watson describes to
have occurred in London. Let us as physicians profit by these
recent events and direct our energies to their prevention in
future.
CREOLE IMMUNITY IN YELLOW FEVER.
In the November number of this journal, under the title of
“ Calling Things by their Right Names,” we alluded to a
theory now less prevalent than formerly, of the exemption of
natives of New Orleans from yellow fever ; also to the fact,
284
Editorial.
[August
that our mortuary records show an apparently marked increase
in the prevalence of malarial fevers during yellow fever
epidemics. The following table, compiled from the annual
mortuary reports of the Board of Health, confirms the state¬
ment :
Mortality from .
1867
*1868 I86i>
1870
1871
18721873
1874
1875
1877
1878
Yellow Fever .
i 3
587
54
39 226
11
61
1
4046
Malarial Fevers .
751
v36j 332
406
348
291 439
488
383
409
777
The obvious conclusion, from a comparison of this table with
the theory of Creole exemption, must be that there is a logical
connection between the two, in the abscence of any special
explanation of so striikng a relation. The late Dr. Fenner was
the most able and prominent advocate of the identity of yellow
fever and the malarial fevers, but we are not aware that any
of our Creole confreres invoke his authority, and the adherents
of that notion must be very few. Now, assuming the all but
universal agreement of medical men, of the non-identity of
yellow fever and the malarial fevers, how explain this remark¬
able increase of malarial fatality during the epidemicity of
yellow fever, except on the ground that large numbers of cases
of yellow fever are mistaken for paludal fevers ?
But it is the general observation of those physicians who
do not hold the theory of Creole exemption from yellow7 fever,
that, during the prevalence of that disease, paludal fevers are
less prevalent than usual, so that this magnifies the significancce
of the apparent increase of malarial fatality.
In the previous article we urged the importance of calling
things by their right names simply in behalf of correctness in
recording vital statistics. Now we observe that this question
concerns the living at least as much as the dead. No intelli¬
gent layman, in regions visited by yellow7 fever, no physician
with the smallest understanding of his business, w7ould apply
the same treatment to yellow fever and the paludal fevers.
Intelligent laymen hereabouts have made diligent observations'
and have arrived at some such conclusions as the following, in
common with the most judicious and candid physicians : (1)
that medication scarcely, if at all, controls the course or limits
‘First 9 months.
Obituary.
285
1879]
the duration of yellow fever ; (2) that, in general, those prac¬
titioners who write most prescriptions lose most patients ; (3)
that a . ignorant or careless physician is more dangerous than
the disease itself.
Some years ago we indulged in a little philosophy on small
pox as a factor in civilization. Since the introduction of vac¬
cination no wrell regulated community allows small pox to get
the upper hand. The intelligent and prudent adopt this plain
means of protection, while the ignorant and careless suffer.
Thus small-pox operates powerfully in selecting the least val¬
uable lives for its tribute, while the fittest survive, and
the standard of humanity is elevated. At the risk of a
candor which savors more of utilitarianism than humanitarian-
ism (in the ordinary and limited sense of the word,) we will
add that the doctrine of Darwin affords us the only visible con¬
solation in the working of that theory of creole exemption
from yellow fever, which, we are forced to believe, costs many
lives, whenever the disease widely prevails in the city.
OBITUARY.
Ash wood, La.
The late Council at Atlanta having ordered biographical
notices of the physicians who died of yellow fever to be pre¬
pared, some brief account of one of those brave men may not
be unacceptable to your well-known journal.
We refer to the late Dr. Wm. A. L. Potts, of Ashwood, La.,
one of the gallant volunteers who obeyed the memorable tele¬
gram, “ The epidemic is the battle-field of the true physician
and with Norris and seven noble comrades in Vicksburg alone,
“died, because he would not see others die unaided.”
The subject of our notice was the youngest son of Jane Alex¬
ander, of Cumberland, and the late William Potts, of Baltimore,
and grandson of Judge Potts, of Frederick, eminent on the bench
and in the United States Senate. Born in Maryland about
1834, of a family connected with her earliest history, he grad¬
uated with honor in Richmond, and after practising a short
time there and in New York, settled in Tensas, La., where he
286 Obituary. [August
had acquired reputation and a good practice when the war
broke out, and duty called him to another post.
Volunteering in the ranks, his surgical skill shown on the
battle-fields of Port Gibson and Mansfield, secured promotion
unsought; and he was said to have passed the best examina¬
tion of any surgeon in the Trans-Mississippi. Serving with
Majors at Red River and Pleasant Hill, and with Magruder
till the last, he had attained the grade of surgeon of division,
when the surrender closed his military career. Returning to
Tensas, at the last urgent instance of friends, he endeared
himself to all. as well by his personal merits, as skill and
enthusiasm in his profession, which he loved, as was often
said, only next to his mother.
As a surgeon, the cool, steady nerve, firm hand, and gentle
touch that made him the chosen assistant of Dr. Bell Gibson
when a student, rendered him one of the most skilful and suc¬
cessful operators in the South. As a physician, to thorough
knowledge, keen perception and unfailing energy, he added
that rare faculty of inspiring confidence and exerting control
which is often more valuable than medicine. In his general
practice, as among the sick and wounded in his camp and hos¬
pital work, it was often said that, however despondent friends
or patient might be, his presence alone seemed to assure relief
and hope.
Of his private character, moulded by the early intiuence of
parental excellence, and matured by a life of high-toned exer¬
tion and self-reliance, we need only say that it was in keeping
with the noble and unselfish close of that life.
Though somewhat recticent and reserved in general inter¬
course and noted for quiet, but indexible resolution, his temper
had a calm sweetness and equanimity which few things could
disturb, and his manner and bearing showed the unmistakable
stamp of innate and cultivated refinement. A systematic and
earnest student and fond of general reading, he regarded
neither labor nor fatigue in his beloved profession, in which he
conscientiously made interest subordinate to science and be¬
nevolence. Those who knew him best, loved him most ; know¬
ing him of unsullied honor, generous to a fault, kind to the
poor, constant to his friends, in all relations of life a gentle-
1879 j Obituary . 287
man without reproach, ami to his family the best ami dearest
of sons and brother.
When the epidemic became violent, and Vicksburg in panic
and distress called for help from all sides, when telegrams an¬
nounced that hundreds had no medical care, his friends tried
in vain to prevent Dr. Potts from volunteering. Though urgent
that his mother and sisters should leave, he met all remon¬
strances on his own account with the simple words, u If 1 am
a physician, 1 must do the duty of one ; if help is called for, 1
must give what help I can. Don’t you see what Choppin
says,” for to him, as to others, that, fatal telegram was like the
call for volunteers on a forlorn hope; the bravest one first to
respond.
The last half of August proved the most deadly season, and
he came at its worst. It was characteristic of his steadfast
temper that he reported for service, and made all his arrange¬
ments before letting his family know of his arrival. With the
fear of his coming they had delayed leaving until too late ;
and now insisted upon his staying with them instead of at a
hotel, as he proposed, lest he should endanger their safety ;
it would have been a vain precaution for some of the most
violent cases were already in the adjoining houses.
Having brought his own horse and buggy, and giving his
services and life without a thought of recompense, lie began
work under the Howards with a self-devotion and energy that
ensured success in most of the cases under his care.
The volunteer physicians took their place w ith the foremost ;
no special caution was used in assigning their locations or
hours of service, even could such care have availed; and their
experience was among scenes of want, misery and contagion
unknown in country practice. In letters written to friends in
Tensas the night before he was taken ill, Dr. Potts expressed
his deep feeling for the suffering he witnessed, and urged them
to send relief to the Howards, which came in liberal measure.
Coming to the infected city from pure country air, and in
the full prime of health and vigor, he may have been the
more susceptible of these depressing influences ; a brief season
of active and successful practice ended on the 2d of September
in an attack of the prevailing fever. Though at firet pro-
288
Obituary.
[ A ugust
uouneed mild, neither nursing nor medical science could arrest
its course, proving fatal on the lltli, almost before his friends
had realized the danger.
Within the same week, but four days earlier, the youngest
and most beloved sister, Miss Susan C. Potts, fell a victim to
to the same terrible disease, having been taken ill almost at the
same hour, and medicine and care proving equally ineffectual.
None but those who shared them can realize those days of
horror and desolation when death was in every house, and hu¬
man aid powerless ; when in every family the dearest and most
excellent seemed chosen for special victims. Of this family the
brother and sister taken, had both some years previously been
exposed to the fever without taking it, and might have been
considered exempt; the others, though nursing them night and
day did not take it, though the mother was prostrated by long
and severe illness.
We cannot better close this notice, after saying that the fam¬
ily, including a brother (now a civil engineer in Chicago), con¬
template removing both to their family burial place at St.
Paul’s, Baltimore, than with the following from the Louisiana
’Journal of that date :
u Our friend left Ashwood, called by the appeals from Vicks¬
burg, against the wishes of his friends and the prayers of his
family ; giving up a healthy location and lucrative practice, to
do his work as a true physician. Steadfast as a rock in his
sense of duty, he was gentle as a woman, and though the
acknowledged head of his profession in this section, be was as
modest as one. The first report of his illness had spread sym¬
pathy and anxiety through the community, and when the fatal
news was known on Sunday, there was not a dry eye in the
little church ; the colored people stopped every one on the
roads to ask if it could be true ; for all had known and loved
him truly.”
I believe he left none but friends in Tensas, and many a tear
fell for our beloved physician and friend, who like a true sol¬
dier faced the enemy where the battle raged fiercest, and in
the prime of manhood and honor fell bravely in that cause of
humanity
“ Wherein no act is vain
And death bat larger makes the service and the life.”
1879 J
Reviews and Book Notices.
289
Reviews and Book Notices.
Naval Hygiene. Human Health and the Means of Preventing
Disease. By Joseph Wilson, M.D., Medical Director U. S.
Navy. Second edition, with colored lithographs, etc.
Philadelphia : Lindsay & Blakiston ; New Orleans : Ar-
raand Hawkins, 196| Canal street. 8vo., pp. 274.
Dr. Wilson, in his travels, has been a careful student of
nature, and in the capacity of surgeon in the United States
Navy, has had rare opportunities of investigating the best
means of preserving health and procuring the comfort of those
u who go down in ships.” In the work now under considera¬
tion, he has been rather discursive, but in the main, has kept
the one thought in view, and the reader will obtain valuable
information from the study of its pages.
The introductory chapter contains important information in
regard to air and water and the necessity of their purity, and
abruptly ends with observations on hydrophobia, introduced
principally, we think, on account of the opportunity afforded
of showing the extraordinary nerve of the author on an occa¬
sion when he was bitten by a dog that was not mad.
Chapters I to XI Y are full of varied information. We are
taken through the ship ; various defects in naval architecture
are pointed out. The crew is mustered; the characteristics of
the sea described ; sea-sickness, home sickness and the other
ailments of young sailors receive notice ; the best means of
preserving food and water on shipboard are pointed out ; the
subject of vinous and alcoholic drinks is discussed, and a
graphic picture of alcoholic intoxication drawn.
Chapters XV and XYI discuss zoology and botany, and
proper from improper food pointed out.
It is not until the chapter on syphilis is reached that we can
find fault with the author. He considers that the Bible con¬
tains a perfect description of the disease, and in the quotation
from Leviticus, takes undue liberties with King James’s trans¬
lation.
u When a man shall have in the skin of his flesh a [rising]
swelling , a sore, or a [bright] raw spot, and it shall be in the
10
290 Review s and Boole Notices. [August
skin of his flesh like the [plague of leprosy] ulcer of syphilis,
then he shall be brought unto one of the priests. And the
priest shall look on the [plaguej sore in the skin of the flesh ;
and when the [hair]* raised margin in the sore is [turned white]
inverted and white , and the sore [in sight] apparently deeper
than the skin of his flesh ; it is a [plague of leprosy] syphilitic
ulcer (a Hunterian chancre) ; and the priest shall look on him
and pronounce him [unclean] infectious, if the rawr spot be
white in the skin of his flesh, and apparently not deeper than
the skin, and the margin thereof be not inverted or white, then
the priest shall shut him up that hath the sore seven days.”
On page 218 is found the following : “ About the end of
the fifteenth century prodigious havoc was created by a battery
of lewd women in the Austrian army, at that time engaged in
the siege of Naples, and a remnant of the army was saved
only by raising the siege.” [“General Butler, at New
Orleans, in 1862, did better. The police regulation was
that this sort of artillery should be kept in jail ; but this being-
found insufficient, he ordered that pretended ladies, no matter
what their apparent rank, who approached his men with insult¬
ing (?) language or gestures, should be treated in the same way/’]
Now all of us know that it was not to protect the morals of
his soldiers that the notorious order was issued, but to enforce
tacit respect to his men from ladies whose husbands, brothers,
or friends were in the Confederate army, and we have no doubt
in the world that General Butler will be as much surprised as
we are, to see the turn given to his manifesto.
In regard to prophylaxis, he says: “Let us not weaken by
crude experiments the restraints now existing, which every
middle-aged man must understand pretty well, from recollec¬
tion:. of personal experience. Something like the following has
been proposed : have handsome gilt signs attached to the fronts
of houses, so that the old stager may suggest to go in and take
“ something,” while the shy boy who hesitates is to be laughed
at as a “chicken-hearted baby.” Boards of health perhaps
might do more than at present : they have charge of hospitals
for patients suffering under “ contagious diseases ;” a reasona
The part of the body referred to is naturally without hair.
Review* and Book Notices.
291
1879]
ble amount of confinement in the hospital might do the
patients good, without serious harm to the communtty.”
The publishers have spared no pains to present the work in
excellent form.
(1) Posological Table : Including all the officinal and the most
frequently employed unofficinal prepartions. By Charles
Rice, Chemist, Department of Public Charities and Correc¬
tion, N. Y., etc. 18mo., pp. 96. New York: Wm. Wood
& Co. 1879.
(2) The Pharmacopoeia of the British Hospital for Diseases of
the Skin, London. Edited by Balmanno Squire, M.B., Lon¬
don, Senior Surgeon to the Hospital. 18mo., pp. 80. Lon¬
don : J. & A. Churchill. 1879.
These little volumes have the advantage of containing in
small compass, convenient for reference, certain particulars
w hich the prescriber could indeed find in large volumes, but at
a loss of time. Besides, the volumes can be carried in the
pocket, whenever desired.
The Pharmacopoeia could easily have been rendered of much
greater value by the addition of an index of diseases, in addi¬
tion to that of remedies, and it is to be hoped that this omission
will be supplied in a future edition.
Long Life , and hoio to reach it. By Joseph G. Richardson, M.
D., Prof. Hygiene, Univ. Pa., etc. 16mo., pp. 160. Phila¬
delphia: Lindsay & Blakiston. 1879. [Sold by Armand
HaAvkins, 196£ Canal street.]
This is the second of a series of Anerican Health Primers,
now being published under the editorial direction of Dr. W. W.
Keen, of Philadelphia. The object of the enterprise seems to
be to popularize preventive medicine, which is eminently praise¬
worthy, and in this particular volume that intention is admi¬
rably fulfilled.
Written by a physician of high reputation, an expert in hy¬
giene, the use of technical words has been entirely avoided,
so that it is fully adapted to the comprehension of an ordinary
reader. At the same time the selection of subjects for the six¬
teen chapters of the volume is such as to bring into prominence
the most important conditions affecting health and longevity.
U92
Reviews and Book Notices.
[August
It is needless to add that the book is intended ’for lay readers,
rather than medical men, and, though its manifest effect must
be the prevention of disease, no true physician will regard it
with jealousy. While artisans hold an invention which dis¬
penses with their labor as an intruder and an enemy, physi¬
cians must not forget that medicine rests upon science, whose
sphere is not only the discovery but also the dissemination of
truth. S. S. FI.
The Cell-Doctrine : its History and Present State. For the use of
students in Medicine and Dentistry. Also a copious biblio¬
graphy of the subject. By James Tyson, M.D., Prof. Gen.
Pathol, and Morbid Anat., ITniv. Pa., etc. Second edition,
revised, corrected and enlarged. Illustrated. 12mo., pp.
202. Philadelphia : Lindsay & Blakiston. 1878.
This work exhibits great industry and research, embodying
in moderate compass a very complete history of the growth of
the subject, from Aristotle to the living workers in the field of
histology. It is therefore an immense convenience to those in¬
terested in its study ; for, if not satisfied with the synopsis of
different views now and formerly held, the bibliography of 44
pages affords complete reference to all that has been written on
the subject.
The views of the author, in the closing section, form a judi¬
cious summing up of the present state of knowledge on the, cell-
doctrine.
In this day of excessive specialization and over production of
monographs, we are glad to commend a book of this class, at
the same time legitimate in conception and in its substance so
meritorious. S. S. H.
A Tabular Hand-Book of Auscultation and Percussion , for Stu¬
dents and Physicians. By Herbert C. Clapp, A.M., M.D.,
Instructor in Auscultation and Percussion in the Boston
University School of Medicine, etc. With 4 plates. 8vo.,
pp. 97. Boston : Houghton, Osgood & Co. 1879. [Sold by
Eyricli, 130 Canal street.]
An introduction gives some general directions for practicing
auscultation and percussion ; part I contains nine tables, des¬
criptive of the physical signs, both normal and morbid ; part
1879]
Books and Pamphlets Received.
298
II, containing two tables, teaches the physical diagnosis of
diseases of the lungs and of the heart.
This arrangement is convenient by its compactness and its
systematic classification for study and for reference, and will
be found useful for student and practitioner alike. The work
is really to be commended.
Harvey and his Discovery. By J. M. DaOosta, M.D., Professor-
Practice Medicine, Jefferson Medical College, Philadelphia.
Svo., pp. 57. Philadelphia : J . B. Lippincott. 1879. [Sold
by Eyrich, 130 Canal street.]
This volume is an address delivered at the opening of the
course of lectures at Jefferson Medical College in 1878. It is a
sketch, biographical and critical, of the life and labors of the
illustrious discoverer of the circulation of the blood; and renders
due credit, in fitting language, to his genius and his services to
science and mankind.
-* i mm i ♦
Books and Pamphlets Received.
The Hand as a Curette in Post-Partum Hemorrhage. By Henry
C. P. Wilson, M.D., Baltimore, Md. Reprint from Yol. H I Gyne¬
cological Transactions, 1879.
Conclusions from the Study of One Hundred and Twenty-jive
Cases of Writer’s Cramp and Allied Affections. By George M.
Beard, M.D., New York City. Reprint fron the Medical Record,
March 15, 1879.
Other Symptoms of Nervous Exhaustion ( Neurasthenia .) By
George M. Beard, A.M., M.D., Member of the New York Acad¬
emy of Medicine, of the American Academy of Medicine, of
the American Neurological Association, etc. Reprint from the
Journal of Nervous and Mental Disease, April, 1879.
University of Maryland , Seventy -second Annual Circular of the
School of Medicine , Session of 1879- SO.
Ninth Annual Announcement of the Louisville College of Phar¬
macy, Session of 1879-80.
Books and Pamphlets Received.
294
August
First Annual Report of the Proceedings of the Kentucky Phar¬
maceutical Association , 1878.
Twelfth Annual Report of the Board of Health to the City
Council of the City of Dayton, Ohio, for the year ending February
28, 1879.
Thirtieth Annual Announcement of the 14" Oman’s Medical Col¬
lege of Pennsylvania, Philadelphia, Pa., 1879-80.
Fifty -fifth Annual Announcement of the Jefferson Medical Col¬
lege of Philadelphia, Session of 1879-80.
Announcement of the Medical Department of the University of
Pennsylvania for the One Hundred and fourteenth Session,
1879-80.
A Case of Enterocele Vaginalis, Anterior. By G. M. B.
Maughs, M.D., Professor of Obstetrics and Diseases of Women
in the Missouri Medical College. Read before the St. Louis
Medical Society. Reprint from the St. Louis Medical and Sur¬
gical Journal, May, 1879.
A n Argument made before the American Medical Association at
Atlanta, Oa., May 7, 1879. By Edward S. Duuster, M.D.
The American Medical College Association, Third Annual Meet¬
ing, held at A tlanta, Ga., May 3d and 5th, 1879.
A Contribution to the Hcematuric Properties of Dialysed Iron.
Being extracts from communications read before the Boston Society
of the Medical Sciences and the Boston Society for Medical
Observation. By Robert Amory, M.I)., Longwood, Mass. Re¬
print from the Boston Medical Journal, April, 1879.
Minutes of the Meeting of Organization and Proceedings of the
Sanitary Council of the Mississippi Valley, May , 1879.
Pendulum Leverage of the Obstetric Forceps. By Albert H.
Smith, M.D., Philadelphia. Reprint from Vol. III. Gyneco¬
logical Transactions, 1879.
Normal Position and Movements of the Unimpregnated Uterus.
By Ely Van De Warker, M.D., Syracuse, N. Y., Fellow of the
American Gynecological Society. Reprint from the American
Journal of Obstetrics and Diseases of Women and Children,
April and July, 1878.
Books and Pamphlets Received.
295
1879 1
Impotency in Women. By Ely Van De Warker, M.D., Syra¬
cuse, N. Y. Reprint from the American Journal of Obstetrics
and Diseases of Women and Children, January, 1878.
Therapeutischer Almanack for January, 1879. By Dr. G. Beck.
Dyphthonia Paralytica. By Ethelbert 0. Morgan, A.B., M.D.
Late Assistant to Professor Johannes Scknitzler, in the De¬
partment of Diseases of the Throat and Lungs in the Polik-
linik, Vienna, Austria. Reprint from the National Medical
Review, April, 1879.
Annual Catalogue and Announcement of the Columbia Veter¬
inary College and School of Comparative Medicine , New York,
Session i>/1879.
Pharmacopoeia of the British Hospital for Diseases of the Skin.
By Belmanno Squire, M.B., London, Senior Surgeon to the
Hospital.
Posture as a Means of Relief in Strangulated and Incarcerated
Hernia , with a General Consideration of the Mechanism of Re¬
duction. By Frank H. Hamilton, A.M., M.D., Surgeon to
Bellevue Hospital, etc. Reprint from Hospital Gazette, June
7th, 1879.
On Some Points in Connection with the Treatment of Sterility.
By A. Reeves Jackson, A.M., M.D., Chicago, Ill. Reprint from
Volume III Gynecological Transactions, 1879.
Alternating Anterior and Posterior Version of the Uterus. By
Samuel C. Bussy, M.D., Washington, D. C. Reprint from
Volume III, Gynecological Transactions, 1879.
On Nitrogen Iodide. By J. W. Mallett. Reprint from Amer¬
ican Chemical Journal, Vol. I, No. 1.
Memorial Address on the Life , Character and Death of Dr.
John L. Cook , of Henderson , Ky. By J. W. Singleton, M.D.,
Paducah, Ky.
Annual Address on the Relation of Neurasthenia to Diseases of
the Womb. By William Goodell, M.A., M.D., Philadelphia, Pa.
Reprint from Volume III, Gynecological Transactions.
Illinois State Board of Health. Halmeman College Case.
The American Academy of Medicine.
Meteorological and Mortality Tables.
[August
29(1
Meteorological Table — June, 1879.
Day.
Mean
Barometer
Temprrat.nr<
Maximum Minimum
Range.
Mean
Humidity.
Rainfall.
1
30.0t4
80 )
73
7
83
.72
2
30.047
78 j
72
6
76
1.52
3
30.090
75
65
10
51
.00
4
30.079
76
66
li>
52
.00
5
30.094
78 i
69
9
67
.01
6
30.002
79
70
9
75
.03
7
29.964
78 1
72
6
83
.26
8
29.953
85
73
12
75
.14
9
29 915
87
74
13
70
.00
10
29.908
88
75
13
72
.00
11
29.940
86
75
11
75
.00
12
29.945
87
74
13
76
.00
13
29.890
88
74
14
75
.10
14
29.882
89
75
14
68
.00
ir>
29.872
87
75
12
73
.18
10
29.945
88
76
12
69
.00
17
29.992
91
76
15
68
•00
18
29.998
91
76
15
61
.00
19
29 990
90
75
15
o/
.00
20
30 065
85
76
9
60
.00
21
30.120
35
71
14
55
.00
22
30.122
86
70
16
61
.00
23
30.040
87
72
15
67
.00
24
30 002
86
72
14
67
.00
25
30.010
86
73
13
65
00
20
30 047
«7
73
14
7)
.00
27
30.020
86
74
12
65
.00
28
29 887
88
73
15
69
.00
29
29.867
89
76
13
67
.00
30
29.910
87
77
10
69
.00
Mean..
29.887
85.10
73.07
12.03
67.9
2.96
Mortality in New Orleans from June 23, 1879 to July
20, 1879, inclusive.
Week Ending.
Yellow
Fever.
Malarial
Fever.
Consump
tion.
Small¬
pox.
Pneu¬
monia.
Total
Mortality.
June
29..
0
4
11
0
3
116
July
6..
0
4
21
0
4
126
July
13..
0
7
20
0
2
105
July
20..
0
9
15
0
2
83
Totals . . .
0
24
67
0
11
430
1879]
Louisiana /State Medical Society.
297
Louisiana State Medical Society, Annual Session of 1879.
Abstract of Proceedings.— ( Continued.)
Comparative Pathology of Malarial and Yellow
Fevers.
BY JOSEPH JONES, M. D.
Professor of Chemistry and Clinical Medioine, Medical Department University of Louis¬
iana ; Visiting Physician of Charity Hospital, New Orleans.
Malarial Fever.
Yellow Fever.
stage of the disease, an explanation
of the frequent occurrence of albu¬
men casts, detached cells of the epi¬
thelium of the uriniferous tubes,
and oil globules and granular mat¬
ter in the urine of yellow fever.
Urinary Bladder.— As a general Urinary Bladder — Often disteud-
rule the bladder contains little or no ed, with high-colored urine, free
urine in yellow fever. The urine is from albumen and casts. In mala-
of a light yellow color, without any rial haunaturia the urioe contains
crystalline bodies, and loaded with casts and blood-corpuscles, and des-
albumen, granular fibroid matter, quamated cells of the tubuli urin-
urateof ammonia, casts of the tu- iferi. Casts high colored, and often
bull nriuiferi, and excretory cells of contain colored corpuscles,
the kidney. In many cases the urine
is entirely suppressed for as long a
period as 48 hours before death. So
long as the kidneys perform their
functions freely and regularly the
patient may recover, even though
black vomit may have appeared,
but if the action of the kidneys has
been arrested by structural changes,
death is inevitable.
11
A bstraet of Proceedings
[August
29H
The Cure of Oblique Fracture of the Thigh Bone without
Shortening of the Limb.
By M. SCHUPPERT, M.D.
hi simple subcutaneous fractures of the thigh, comprising
the shaft of the bone in its middle, upper, or lower third (ex¬
cepting the neck, the trochanteric region and condyles), the
difficulty of recognizing the character of the injury, whether
transverse or oblique, is so generally admitted, that it is said
“ the age of a person counts more in establishing a diagnosis
than a manipulation. v That this difficulty increases in fleshy
persons, moreover, if traumatic swelling has set in, is obvious.
Yet it strikes me, aside of the fact that in the adult, fractures of
this bone are more frequently oblique, at least in its upper and
lower third, whilst in children the transverse fractures are more
common, that the obliquity of a fracture of the femur might be
easier recognized by the greater shortening of the limb, as well
as by the difficulty of keeping the replaced ends of the frac¬
tured bone in position. These two important symptoms ought
to render the correct diagnosis less difficult. But whatever
the experience of surgeons may be in regard to this question,
there certainly exists less diversity of opinion, that in oblique
fractures of the femur in middle-aged persons, the healing of
the fracture will rarely if ever be accomplished under less than
one inch of shortening ; yea, rather more than less. Such has
beeii the almost universal opinion, from Hippocrates down to
our days. Most all the prominent writers on surgery have
acknowledged this fact. It is true a few surgeons, inventors
mostly of some complicated machineries or certain contrivances,
. have pretended to accomplish the cure of fractures of the thigh
bone without shortening, yet neither was the character of such
fractures al ways distinctly stated, nor was a shortening inside
of a certain extent, which was considered natural, or which
could be compensated by a pelvic inclination, counted as a real
defect. L11 the treatment of fractures of the femur, the inven¬
tive human genius has exhausted its capacities in the con¬
struction of complicated machines and bandages, yet without
much influencing the generally adopted opinion, that such
fractures could not be cured without a considerable shortening.
The celebrated Dessault, who asserted that he could heal any
such fracture without a shortening of the limb, experienced the
most violent assaults of his contemporaneous colleagues ; he
saw his veracity impugned and suffered the loss of confidence
in his teachings, so that even Malgaigne, with all the authority
of his great name, did not succeed in restoring it, though he
stated, what he had witnessed himself, the success of l)essault7s
skillful treatment. Dessault did not keep his method a secret;
any one who wanted to convince himself of it could have done
so, and what is more singular, the splint he made use of is at
1879]
Louisiana State Medical Society.
299
present still in use, after having experienced some slight modi¬
fications, under the name of Pliysick’s or Liston’s splint. For
extension, Dessault made use of the corresponding leg, whilst
for counter-extension he availed himself of the os ieliii. The
majority of American surgeons have adopted this treatment,
applying Physiek’s or Liston’s splint, whilst in fractures com
prising the trochanteric region the double inclined plane of
Amesbury is here and there employed. I)ugus, of Georgia, is
probably one of the few surgeons who advocated the use of
weights in this country, which in Germany is the prevailing
method of causing permanent extension, at the same time
employing gypsum bandages. Such in Germany is almost the
exclusive treatment, foremost in compound fractures, and in
order to apply at the same time Lister’s antiseptic treatment,
openings are made in the plaster bandage.
The historical proofs of Dessault’s successful treatment of
these fractures were of themselves sufficient inducements for
me of a repeated investigation. Professional jealousy and
blindness could not forever keep the field ; yet what induced
me foremost to relinquish the method generally adopted here,
and which brought me to pursue another course, were besides
the unsuccessful, unsatisfactory issues, two instances of simple
fractures of the thigh bone, where at least in one case, from a
careless application of the splint, a man had lost his limb,
whilst in the other, from an injudicious, stupid action, the life
of the patient had been sacrificed. Both cases bear sufficient
interest in more than one respect, and most so to the younger
members of the profession, which induces me to give a short
account of them here. The first case was a sailor, who by fall¬
ing into the hold of his ship fractured the thigh in its lower
third. He had been carried to the pay ward of the Charity
Hospital under the immediate charge of the house surgeon.
(1 will state here, in older to avoid an unjust suspicion, that
this happened during 1858, and that the house surgeon mentioned
here has since died.) Liston’s splint had been applied, but the
sailor’s complaining to his captain over an unbearable pain in
the limb, which complaint the surgeon did not consider justifi¬
able, was the cause of the patient’s removal to a boarding
house in the immediate neighborhood of my residence, and of
my engagement to treat him there. As soon as I had removed
the splint, I found that from the pressure of the rope-like band
with which counter-extension had been made, and which had
shifted from its original position, the femoral artery had
become obliterated, certainly an observation of importance,
and which elsewhere I have never met with in our literature.
The circulation of blood in the extremity had entirely ceased.
Gangrene had set in, and as soon as its limit had been ascer¬
tained, the limb was amputated in its upper third. Of further
mterest in this case were two other incidents worth mention
ing. On the second night after the amputation had been per
formed, I was called upon by the night-watch left with the
300 Abstract of Proceedings [August
man, and informed that the patient was “ bleeding to death.”
It was a fearful dark night, the rain falling in torrents, the
streets overflown. 1 had not taken time to dress : grasping
my case of instruments (which I always keep ready for an emer-
gency after an operation, and more so, when secondary haemor¬
rhage may be expected to take place), I ran over the street,
through the water knee-deep, dressed but in my night-gown,
resembling one of Macbeth’s witches ; and indeed 1 did not
arrive a minute too soon. The man fortunately had fallen into
a syncope from the loss of blood: still 1 was in a singular
plight. The night-watch was a mere boy of 14 summers, and
all the illumination I could command consisted of a diminutive
oil lamp. When 1 lifted up the man’s stump he awoke, but lie
was out of his mind, and bleeding began anew. In compress¬
ing the artery 1 observed the bleeding to stop. It would have
taken too much time to cut the many sutures, wash and clean
the stump, and search for the artery, which under other cir¬
cumstances i certainly would have done. I resolved therefore
to search for the femoral artery in its contiguity as high up as
possible. The cutting down upon the artery, the pulsation of
which could hardly be felt, and ligating it, was nevertheless
the work of a few minutes; it was an operating race between
life and death. Happily it was accomplished, and the man’s
life thereby saved. 1 afterwards found out that in a tit of deli¬
rium the man had pulled on the stump, and unfortunately had
gotten hold of the arterial ligature, pulling it off. A pitcher
tilled with water, which stood on a table by his side, this time
saved the man’s life. In his delirium he got hold of the pitcher,
and smashing it against the wall awoke the sleeping boy, as it
probably would have done with one in a death slumber. By
this accident the bleeding was detected, anil yet in time. This
man, after the wound had healed, suffered for several months
daily attacks of clonic spasms, which at the beginning returned
quite frequently, several times a day, and resisted all medica¬
tion, but they disappeared gradually after having lasted over
two months. When such a spasm came on, the stump took a
perpendicular position, and great force had to be applied
to keep it down. During such an attack the man complained
of pain, which he assigned to different parts of his amputated
leg, anti nothing would give him rest and bring the stump
down to its normal horizontal position, excepting some person
would sit in front of the stump on his imaginary extremity. 1
have often been a witness to this singular idiosyncrasy, and
can therefore vouch for the truth of this statement.
The other case of fracture which ended fatally, happened in
the Third District of this city. A healthy, robust man, 30
years of age, a cooper by occupation, met with the accident
by falling from his cart, by which he fractured his right thigh
bone midway of the shaft, but the greater misfortune which
befell the man consisted in falling in the hands of a careless
and ignorant physician. Being in bed tightly bandaged, the
1879]
Louisiana State Medical Society.
301
man suffered excrutiating pain, as he stated, caused by a part
of the bandage, still the Doctor had refused to remove it.
Another physician was therefore called in, who, by a misapplied
professional etiquette though aware of the real condition of
things, refused to touch the bandage, except a surgeon was
called in consultation. When 1 arrived, several hours later,
this medical Fabiug had just returned and told me what had
happened. Having cut the rope forthwith, to relieve the poor
sufferer, I became horror-stricken by wuat 1 saw. With one
piece of rope the foot had been tied to the lower part of the
bedstead, whilst another piece of rope, which served for coun¬
ter-extension, was carried between the legs and fastened to the
head-piece of the bed. The force which had been made use of to
cause extension, might best be learned irom the fact that the
upper rope had cut into the tissues so deep that I could nearly
bury my list in the hole it made. If the rope had not been
hemmed in by the bone it might probably have cut the man in
two. The abdominal cavity had been laid open by it. All
care taken did not save the poor sufferer’s life; he died on his
wound becoming gangrenous, a few days later. An intelligent
jury appointed by the coroner, a practising physician of this
city, gave the unanimous verdict that the man had died from a
wound caused by malpractice. The inconsolable widow w as
too poor to afford paying the expenses of a criminal prosecu¬
tion, and so the malefactor escaped a deserved punishment.
Enough ! I hope that the interest involved in these two cases
will excuse the time spent in their narration, they certainly con¬
tain several valuable lessons for the younger members of our
noble but, unfortunately, often maltreated and abused pro¬
fession.
I will iiowt proceed with a description of the method I have
adopted in the treatment of fractures of the femur, and small
as the number of cases so treated have been (elev en in all), yet
the invariable unique favorable result of them, even in the
most severe form of a compound fracture, will bear me out in
demonstrating that these fractures may be cured without a
material shortening of the respective extremity. I will first
speak of the treatment of the uncomplicated, subcutaneous, sim¬
ple fracture, transverse as well as oblique. The patient is
placed on a table covered by a mattrass. The latter is doubled,
so that sufficient free space is obtained for the application of
the bandages around the pelvis and the lower portion of
the abdomen. The plate of the table must have a prominent
edge, to which is fastened a wooden vise, such as carpenters
use, or an instrument invented hy the ingenious surgeon, W.
Koser, Professor of Surgery at Marburg, and called by him
Beckenstiitze (meaning a support for the pelvis). This latter
instrument is made of iron, it consists of a staff which is fast¬
ened to the edge of the table by a screw. To the staff' is
attached a small movable triangular plate, which can be fast¬
ened also by a screw, as it glides up and down the staff and
302
A hstraet of Proceedings
[August
can be adjusted accordingly, as each case may require. This
triangular plate has to support the lower end of the sacrum.
Against the staff of the Beckenstutze (pelvic support) which
staff is one foot in length, or against the handle of the wooden
vise, the perimeum of the patient is pulled by an assistant,
whilst the fractured portion of the injured extremity is sup¬
ported ; the other extremity is held by another assistant. The
staff’ serves the purpose of counter-extension during the time
the bandages are applied. The patient being thoroughly narco¬
tized previous to beginning the operation, has to be retained
under the influence of the chloroform and in this position, until
the gypsum bandages of which 1 will soon speak, are all
applied.
After the patient has been brought completely under the in¬
fluence of chloroform, indicated by a complete relaxation of the
muscles, the fractured ends of the bone have to be brought ip
proper position, wherein they have to be retained by a faithful
assistant. This is of great importance. Whilst the perimeum
rests against the staff of the pelvic supporter, the fractured
extremity is pulled by the foot to an equal length with the
other. This has to be superintended by an assistant, who pre¬
viously has drawn a straight line with ink from one anterior
superior spinous process of the illium to the other, and a per¬
pendicular line from the ensiform appendix of the sternum to
the symphisis ossis pubis, whereby two right angles have to be
formed. If the correct equal length of both limbs has been ob¬
tained, then by measuring from each anterior superior spinous
process of the illium to the lower end of each internal mal¬
leolus, both limbs will present equal lengths. This position
obtained, which as 1 said is of the utmost importance,
the bandaging should begin. The limb is first surrounded
with flannel, beginning at the foot, including the same and
going upwards to the pelvic brim, and as high as the umbili¬
cus. The pelvis and abdomen have besides to be well cov¬
ered with batting, which ought to extend as far down as the
knee joint, including the latter. The tuber ossis ischii corres¬
ponding with the fractured limb ought to be well padded with
a thick pad of cotton batting, which has to be secured in its
place by a few tours of a roller of gauze, since here the greatest
pressure is to be exercised, as the point for the counter-
extension. Against this pad I place an ordinary wooden
splint, including and securing it by the gauze roller, by which
the pad is maintained in place. On top of the flannel, at the
seat of the fracture, a few narrow splints of tin , reaching below
the knee, are placed and fastened with the same roller of gauze
of about 8 yards in length and 4 inches in width, which has
served for the pad and wooden splint. Next in order now is
the encasing of these parts with gauze rollers well gypsed,
beginning again with the foot. Three layers of these bandages
covering each other are sufficient. It is advisable, before the
fracture is encased with the gypsed rollers of gauze, to be con.
1879]
Louisiana State Medical Society.
303
vinced that the proper length of the limb has been retained,
which is executed by the assistant who had taken the first
measurement. After the gypsed rollers have been applied, the
whole thereby covered receives a thin coat of gypse, secured
lastly by an ordinary roller of gauze previously dipped in
water. After having given the surface a polishing, by going-
over the whole with the wet palm of the hand, the patient is
pulled back and laid on the mattrass, but without moving any
part out of the horizontal position which had been maintained
during the application of the dressing ; care should also be
taken that the gypsum bandages do not cut into the skin in the
inguinal region, which very frequently happens, and can be
best avoided by placing there some additional batting. The
gypsed gauze bandages are from 34 to 4 inches in width and
4 yards long, and the flannel bandages of the same width with
a length of (> yards. The gypsed rollers are prepared by
spreading the calcined gypsum over the gauze equally. Before
being used these rollers are placed in a basin of water, deep
enough to completely submerge them ; they have to be
thoroughly saturated before being used. The first dressing-
can be permitted to remain on for two or three weeks, before
being exchanged tor another of the same kind. At its first
removal a careful measurement has to be made again to ascer¬
tain the proper length of the extremity, in order to remedy, in
case there should have happened a shortening, which can at
this time still be corrected, the fracture not having become
consolidated. The patient has to be narcotized at each dres¬
sing until the consolidation of the fractured bone lias been
obtained. 1 seldom have had need of more than three dres¬
sings. The last one may remain on four weeks. The time con¬
sumed, from the first application to the last, is from eight to
ten weeks. I have been particular in describing so minutely
the application of this dressing, because I am convinced that
mistakes, thought probably to be trifling, may yet alter the
final result materially.
We ought to wonder why a treatment so simple, which
we might say would promise these admirable results by a
priori reasoning, has not been tried to a greater extent
or become the standard treatment long ago ? Yet this seems
to me only one proof more of a common observation, that
the simplest things are often longest kept from the search¬
ing, investigating eye of even the highest scientific culture.
How has not the inventing mind been tortured with the con¬
struction of complicated machines, in the treatment of club¬
foot for instance ! Looking in one or the other of those pic¬
torial surgical atlasses of olden times, have we not to wonder
at the complicated machines, large magazines could be filled up
with, and did they ever accomplish what we are able to effectuate
to-day, and with the simplest means, a bandage and a handful
of calcined gypsum 1 It is only a few years since that 1 saw,
during the meeting of the American Medical Association in
304 Abstract of Proceedings [August
this city, a surgeon of New York, who occupies a promiueut
position, present to the members assembled a shoe with fixings
which he considered as the ne plus ultra of all similar contrivances
to correct the malformation of a congenital club-foot. Heca¬
tombs of eulogies were offered at the shrine of surgical science
a few decennies since, when Stromeyer introduced into surgical
practice as an invaluable progress in the cure of club-foot, the
subcutaneous dissection of the tendons ; but how rarely need
we to-day have recourse to that operation, provided the
children so affected are taken care of soon after their birth 1
A few bandages of gypsed gauze is all 1 am using for years to
restore to their proper shape the worst cases of congenital club¬
foot; seldom, and exclusively in elder persons, do I have
recourse to the knife.
From what we find in handbooks and journals on surgery as
documentary * evidence, the opinion seems to be generally
adopted in this country, as well as in others, that fractures of
the femur could not be cured without a shortening of the
limb. Siuce the time that 1 began to make use of the calcined
gypsum (or as it is commonly, but improperly called, plaster
of paris), in surgical practice, supplanting therewith all machines
and other mechanical contrivances in the treatment of fractures,
dislocations and in orthopaedics, extending over a time of nearly
two decennies, I have treated 7 cases of simple oblique fractures
of the thigh and 5 cases of compound fractures of the same
bone, and have, with the method described above, with but a
single exception, obtained a complete cure without any shorten¬
ing of the limb. Never did I observe hi the extremity so
treated, in comparing it with the other, a difference in length.
Even that exceptional case was finally cured with a shortening
of only one half an inch. A too early and careless use of the
limb and an unlucky fall by which the bone fractured again, so
that a propel apposition of the fractured ends had become im¬
possible, resulted in this shortening. The result obtained in
those five cases of compound fracture entitles me, I believe, to
recommend a mode of proceeding, which may appear to some,
who are even apt scholars of Lister, a little hazardous, yet if 1
at first hesitated to give it a practical application, I am at pres-
sent no longer doubtful. In compound fractures of the femur
the first eight or ten days are to be exclusively bestowed to the
treatment of the wound. Having readjusted the fractured ends
of the bone as much as possible, after a thorough scrupulous
cleaning and irrigation of the wound with a carbolic or salicylic
acid solution, Lister’s dressing is applied and covered with a
thick layer of cotton batting. The whole dressing is then sur¬
rounded with gypsed rollers of gauze, and upon this a suffici¬
ently thick layer of the calcined gypsum previously made into
a paste, is spread, so that an occlusive , absolute air-tight bandage
is thereby obtained. I have here also, like in other wounds, done
away witli the spray and the drainage tubes. In eight or ten
days after the traumatic swelling has disappeared the proper
Louisiana State Medical Society.
305
1879]
adjustment of the fractured ends has to be attended to, after
which another occlusive bandage is applied. In this manner I
have at present a man under treatment over one of whose legs
the wheel of a cart with 3000 pounds had passed. The bones
were crushed to pieces, and in the gaping wound large enough
to admit a small fist the muscles and tendons were observed
denuded and lacerated. The man, 40 years of age, and much
addicted to whisky, had lost a great deal of blood. After a
thorough cleaning of the extensive wound and an irrigation last¬
ing one-half hour, the leg was dressed in the manner described,
after the edges of the skin had been brought together as near
as possible by the application of nine antiseptic silk sutures.
It is eleven weeks since the accident happened ; on the fourth
day the man suffered an intense ^attack of mania-a-potu, which
lasted a whole day and requiring three men to hold him down,
the bones became displaced again, and in removing the dressing
were met with sticking out of the wound. Notwithstanding
that all this happened, the patient never suffered the least
fever, the pulse and temperature remained all the time station¬
ary normal. The extensive wound has nearly closed, and con
solidation of the crushed bone has taken place. A better and
more convincing example of what we may dare under the aegis
of the occlusive bandage, can hardly be found. An injury of
such frightful character, which under any other circumstances
would call for an immediate amputation, passing away without
any of those symptoms, which in former times we were often apt
to meet with in wounds of even a more trifling' nature, is un¬
heard of in surgical practice. The question arises now, have I
a right based upon such a comparative small number of cases
as I have treated, to claim for my method of treatment
that superiority in practice, which would entitle it for
recommendation, placing myself thereby in opposition to
the judgment rendered by so great a number of intelligent
and experienced surgeons ? I am under the impression that I
have acquired the right to answer the question in the affirma¬
tive, and I believe to be supported in this from the uniform
result 1 have obtained in the treatment of oblique as well as
transverse fractures, to which also the compound fractures form
no small contingent, and which comprise the thigh as well as
the leg and arm.
APPENDIX.
In the report of the progress of Aantomy and Surgery dur¬
ing 1877, Dr. M. Murty, of Danville, Ky., says : u The state¬
ment is justified that with the most approved methods of
treating fractures of the femur, shortening is the rule in
practice.”
In the Archives of Clinical Surgery of February 1877, Dr.
Jarvis S. Wright asserts u that after an examination of many
persons, embracing various nationalities and occupations, he
lias come to the conclusion that the lower limbs of the same
12
306 Abstract of Proceedings [August
person are uot always of the same length. The difference in
length being to V ; ” from which the writer concludes u that
it would be impossible to say how much in a united fracture a
leg or the broken femur has shortened, if the uninjured limb of
the person be made the standard of comparison, and that a
correct and reliable conclusion would only be reached in a case
in which the injured limb had been measured before and after
the injury.” He further states u that in a certain number of
cases of fractures of the femur the injured limb will remain
shorter than the other, no matter what treatment mag have been
used .”
Ln the session of 1877 of the American Medical Association,
in the section on Surgery and Anatomy of which Dr. Hamilton
of New York was chairman, a paper was read by Dr. J. F.
Hodgen of Missouri in which he, in the treatment of fractures
of the femur, “ detailed the advantages of Smith’s Anterior
Suspensary Splint, modified by him, as superior to all other
appliances” and in the same session Dr. Hingston of Canada
offered a resolution, which was modified by Dr. Peck of Iowa
and which, singular to say, was adopted as the standard opin¬
ion of the American Medical Association and published in the
form of a. resolution which reads as follows:
Resolved , u That it is the opinion of this section, that shortening
in cases of fracture of long bones , is the rule in practice , regard
less of any of the plans of treatment now in use.”
The report of the Danville doctor 1 have cited, but, for the
purpose of proving by it the general standard of opinion in
regard to the ultimate result of treatment of fractures of the
thigh.
Of not less interest is the statement of Dr. Wright, regard¬
ing the congenital difference in length of the lower extremities
of man. It is obvious, that if the statement, which, besides I
have never before met with in surgical literature, was based
upon a correct observation, it would be of great importance in
more than one respect. From the time that I first saw that
remark, 1 have not missed an opportunity of measuring the
lower extremities of persons, of different nationalities, race,
sex and age, and have come to the conclusion that, if a disease
had not previously existed, the difference in length which Dr.
Wright asserted, had only an existence in the imagination of
the doctor, being the result of a faulty measurement ; indeed, a
difference in length of one inch, or even half an inch would
certainly cause limping, and if not compensated by a pelvic
inclination, would be recognized without taking a comparative
measurement. It is only in a proper execution of the methods
above described, that such mistakes can be avoided. Unless
the person stands on level ground and upright, and a
plumb extended from the ensiform process of the sternum is
applied, no correct measurement can be obtained, and errors
will occur. By a pelvic inclination one one side, an artificial
shortening can be produced on the other to the extent of even
1879]
Louisiana State Medical Society.
307
two and a half inches. With the defeat of this assertion of
the doctor, his other remarks based upon this statement are,
as a matter of course, worthless. Though in the matter of
shortening', he seems to be more liberal than his confreres of
the American Medical Association, confining his remark to
only a certain number of fractures of the femur, though he
also commits an error in ealculo in taking pars prototo.
A more difficult task I will have in dealing with the
snap judgment (?) contained in the mentioned resolution of
the American Medical Association. Yet l cannot help declar¬
ing the resolution as it stands, lacks a solid foundation. It
grasps far too much at once. It asserts, what can easily be
disproven ; it protects unskilfulness and even excuses mal
practice. All this and more may be anticipated in the forego¬
ing specification of what 1 have stated in the treatment of
fractures of the thigh. Nevertheless, I am fully aware of the
difficult position 1 occupy in a matter supported but by a sin
gle personal experience, where neither immutable laws can be
cited, nor logic assist an assertion, which is in opposition to
the majority of the profession, of men of high standing, of great
scientific attainments. With no witnesses or corpora delicti
available, and with the fate of Dessault on record, what aus¬
pices can be augured under such a constellation? We know in
the treatment of certain injuries how much depends often upon
personal skill, how much upon a proper minute execution of
things apparently of small matter.
In spite of the most minute description, errors in manipula¬
tion may happen. Need 1 refer to the various results
surgeons have obtained with Lister’s antiseptic treat¬
ment ? What would the naked assertion help me, of having
cured eleven fractures of the thigh without a single shortening
of the respective limb, if some surgeons, though by mistakes
of their own, would meet with failures ? might that, not jeopard
ize the method or, upon which I lay more stress, impugn
my veracity ? In this emergency I see but one way to get out of
the dilemma, and this consists in placing the author of this
method on trial ; not till then, if he has signally failed in pro¬
ducing the promised result, ought he to pay forfeit.
This is in equity the right which I can demand ; all else is
but equivocation and not worth further consideration.
Topography of the Parish of Plaquemine and its Medical
History.
By D. K. FOX. M. I).
The parish of Plaquemines is situated in the lowest portion
of the State of Louisiana, latitude 29°, 30' north, longitude
14°, 55' west of Washington.
Abstract of Proceedings
3<>H
[August
It consists of a narrow strip of land, bordering both sides of
the Mississippi river, and extending from the mouths of the
river to within twelve miles of New Orleans — a distance of
about eighty-five miles. The arable land is very narrow ; in
the upper portions of the parish, it averages about ten arpents
in depth, without artificial drainage, and about twenty writh
drainage.
As it approaches the outlets of the river, this gradually nar¬
rows to a strip of one or two arpents in depth.
These lands are low and would be inundated by the annual
rise of the river, were they not protected by artificial embank
ments or levees. These levees vary from one to seven feet in
height. About three miles from the river, in rear of the plan¬
tations there are bayous or natural canals, into which the fields
are drained. To prevent the water from flowing back from these
during high tides, the plantations are protected by low back
levees.
The population of this parish is about thirteen thousand,
one-third white, the remainder colored.
It will be readily inferred from the low and marshy situation
of this that the malarial fevers predominate ; the most com¬
mon being the intermittents, which are generally quotidian or
tertian in type. These fevers are mostly of a mild character,
though a few cases of pernicious fever are met with every year.
Until the last two or three years, the remittent fevers were
also of a mild type, the average duration not being over two or
three days. Within the past few years the cultivation of rice
has been much extended, and the remitting fevers have as¬
sumed a more severe grade, the febrile stage being much longer.
As far as my experience goes, the colored population, before
the war, were more sickly than at present, being more subject
to fever, which I attribute to the different system of labor.
On some of the larger plantations I have frequently met, in a
single day, in one hospital, from fifteen to thirty cases ; while
at present, not one-fifth that number are sick at one time.
Typhoid fever is seldom met with here: — in twenty-five
years, I have not seen more than ten or twelve cases of genu¬
ine typhoid.
Until the summer of 1878, yellow fever was almost unknown
in this locality. In 1853 and 1854, a few cases occurred in one
or tw o families in the Buras settlement and its vicinity, but it
did not spread.
In my own practice, extending over a period of twenty-five
years, only about 12 or 13 cases have occurred.
During the great epidemic in New Orleans in 1853, I had
only two cases here, nothwithstanding the constant intercourse
with the city; there being no quarantine whatever at that time.
In 1854 1 had only six cases, all occurring in one family and all
of whom recovered excepting one, who died with black vomit.
This family wras of the Creole population. In 1867, a young
Creole who had been to the city and spent several days during
Louisiana State Medical Society.
309
1879]
the epidemic, returned home with yellow fever and died, but no
other member of the family had it, neither was there any other
case in the neighborhood. In 1868, a northern gentlem an is
said to have died of this disease, on a neighboring plantation.
As far as I have been able to ascertain, no other cases than
those above mentioned occurred previous to 1878. During
that year, the upper portions of the parish continued remark¬
ably free from fevers of every kind, until the latter part of
August, when many cases of bilious remittent fever and a few
cases of yellow fever occurred. The yellow fever was confined
chiefly to unacclimated persons who were recently from the
.North.
The disease also made its appearance at the jetties, the Buras
settlement, and on several plantations in the lower part of the
parish, and attacked chiefly foreigners, and proved very fatal.
1 mention these facts in regard to yellow fever to show how
peculiarly exempt this parish is from this disease.
Malarial lnematuria is also a very rare disease here; as far
as 1 know, only a few cases, and those within the past few
years.
Exanthematous diseases are rare in this locality; scarlei
fever has never prevailed as an epidemic ; I have met with a
few isolated cases of very mild character. Of measles there
have been but few epidemics, and they were very mild. Small¬
pox , previous to the war, owing to the strict attention paid by
planters to vaccination, was very uncommon. Since 1865, owing
to the great influx of strangers, both white and colored, the
disease has been more frequent and fatal. Large numbers of
negroes have died of it on several plantations. Although the
number of children is very large, diphtheria is very rare here.
In my own long practice, 1 have only met with about six cases.
Dysentery is a disease of frequent occurrence, and prevails on
the plantations, sometimes as an endemic, brought on by vari¬
ous local causes. It approaches more in character the disease
as seen in the tropics, than elsewhere, and is often complicated
with malaria.
Diarrhoeas also prevail during some seasons, and often assume
malarial forms.
Cholera has frequently occurred, prevailing as an endemic
among the colored population. In 1832, it proved very fatal
to both races. In 1853, there were a few isolated cases
(colored) on the Magnolia plantation, and in the Ronquillo
settlement. In 1866, there was a severe endemic among the
colored people on the Scarsdale plantation, in which 18 out of
40 died ; also a few cases occurred on the plantation on the
opposite side of the river.
Char bon, or malignant pustule, is a disease peculiar to this
portion of the State. In 1853 I saw six cases of it, all on one
plantation, supposed to have been produced by a pile of hides,
the skins of animals which had died of charbon the previous
spring. The hostler was the first one attacked ; he had been
310 Abstract of Proceedings [August
cutting ham strings from the hides. Persons living in the
cabins near the hides were next attacked ; no other cases were
observed in any other of the cabins of the plantation.
A disease has frequently occurred here among the domestic
animals, which is called charbou, which appears to me to be
rather a species of epidemic phlebitis or erysipelas, and is very
malignant and fatal. It seems to be brought on by the bites
of the innumerable insects with which the parish is infested —
such as mosquitoes, and a variety of small black fly resembling
the house tty in appearance, and which, like the mosquito,
sucks the blood of animals; it is generated in immense swarms
in decaying rice straw and bagasse.
Syphilis, before the war, was very rare among the colored
race ; which was owing to the strict surveillance and perfect
control of the slave. Whenever a case appeared upon a plan¬
tation every precaution was taken to prevent a spread of the
disease. But at present there is scarcely a plantation or
colored village in which it does not exist.
Before closing my observations on the diseases of the parish,
1 would call attention to a fact worthy of notice and which
sustains the observations of others, viz : that land covered by
water is free from malarial diseases.
In 1858, a portion of the parish oii the right bank of the
river was inundated about fifty miles in extent, by crevasses
above the city, which continued about five months. It was the
most remarkable inundation ever known in this part of the
State; the water reached the base of the levees in a few days
after its appearance in the rear of the plantations ; it gradually
rose until it was from two to four feet deep at the levee, grad¬
ually increasing to a depth of fourteen feet inside the back
levees of the fields, a distance of about fourteen acres from the
front.
About the middle of August, the water began to subside ;
during the time it covered the land there was no sickness what¬
ever, but, after the water had disappeared, in late September
and in October, there were many cases of pernicious fever, and
at the extremes of the inundated district a severe endemic ma¬
larial pneumonia occurred on two plantations, which was ex¬
tremely fatal.
1 must not close the medical history of this district without
mentioning that, in 1875, a parish association was organized
with Drs. J. B. Wilkinson for President; 1). R. Fox, Vice-
President; and Geo. B. Hayes, Secretary, to whom the So¬
ciety owes much for his untiring efforts for its existence.
After a, few meetings, all the regular physicians of the parish
had joined the association ; a resolution was then passed that
the secretary be instructed to communicate with all the other
Medical Associations of the State, inviting them to cooperate
with us in calling a convention of the medical profession of the
State, to organize a State Medical Society. To this invitation
the Shreveport Association promptly responded, and through
1879]
Louisiana State Medical Society.
311
the united efforts of these two societies, a medical convention
was called to meet on the 14th of January, in New Orleans,
which resulted in the establishment of the State Medical Society
of Louisiana.
Magnetism as an Anaesthetic in Surgical Operations.
By DR. E. L. DAY, Hempstead, Texas.
The subject of this article was suggested to me from a case
reported by Dr. C. L. Legreud, of Hempstead, in this State, a
case in which he amputated the great toe while the patient was
under the influence of magnetism, and of which 1 send you a
succinct account, begging the Journal will deliver its opinion
of this interesting case.
Willis Francis, colored man, about 25 years of age, had great
toe badly injured by having heavy iron rollers fall upon it.
About ten days after injury consulted Dr. Legreud, who decided
to amputate, and as an experiment, called upon Mr. James
Armstrong, of this place, who claims the power of magnetiza¬
tion, to exercise this influence on his patient. The magnetizer
commenced by passing his hands slowly and steadily in front
of patient’s face for a period of five minutes, when he closed
his eyes as though in sleep. The doctor then performed the
operation, the patient remaining all the while in a state of com¬
plete anaesthesia. By simply snapping his fingers sharply in
the patient’s face, the influence was removed.
[The above phenomenon is commonly called Mesmerism, and
is fully described and explained by Dr. W. B. Carpenter, in his
work on Human Physiology, being entitled by him Artificial
Hypnotism. — Ed.]
T R EASUR E R’S R E 1 >ORT.
New Orleans, La., July 2<S, 1879.
Treasurer in account with the Louisiana State Medical So¬
ciety from April 14, 1879, to date :
DR.
To balance brought forward from last year . 8152 45
To cash received from 51 members, present year.. . 255 00
To balance due by delinquent members
$407 45
$310 00
312 Abstract of Proceedings [August
OK.
By expenses to July 12, 1871) . $110 00
By expenses for printing as per bill rendered by L.
Graham, on July 14, 1879 . 200 00
$310 00
Balance on hand July 28, 1879 . $ 90 85
Balance due by members . 310 00
Geo. K. Pratt, M.D., Treasurer.
SEC 1 BBT ART’S REPORT.
New Orleans, April 7th, 1879.
It having been made the duty of the Corresponding Secretary
to keep a record of all the local medical societies in the State, and
also a list of the practising physicians, classified as regular,
irregular, and unknown or doubtful, 1 would respectfully sub¬
mit the following report in compliance therewith :
The Bienville Medical Society was organized by a meeting of
the physicians of Bienville parish at Sparta on May 2oth, 1878.
Seven medical men affected the organization by adopting a
constitution and electing Dr. F. Courtney, president; I)r. W.
C. Patterson, vice-president; and Dr. T. J. Fouts, recording
and corresponding secretary and treasurer. The meetings
take place at Sparta on the second Saturday of June, Septem
ber, December and March.
The Shreveport Medical Association was formed in January,
I860. The officers for the present year are Dr. D. M. Clay,
president; Dr. A. A. Lyon, vice-president; Dr. D. H. Billieu,
corresponding secretary ; and Dr. Walter Hilliard, recording
secretary and treasurer.
There is a medical society at Baton Rouge, of which 1 have
no returns.
A medical society was organized in Grant parish near the
close of 1877, but 1 am not informed of its further progress.
The Lafayette Medical Society was organized in June, 1877,
and holds its meetings at the Court House in Vermilion ville,
on the last Saturday of each month. The officers, at present,
are as follows : Dr. ,1. 1). Trahan, president ; Dr. H. D. Guidry,
vice-president; Dr. W. H. Cunningham, secretary; Dr. A.
Gladne, treasurer. There are six other members.
The Orleans Parish Medical Society was organized in April,
1878, and has at present about 45 actual members. Meetings
occur on the last Monday of each month. The lately elected
officers are as follows : Dr. S. S. Herrick, president ; Dr. Geo.
tv. Pratt, first vice-president (for First and Fifth Districts) ;
Dr. E. S. Lewis, second vice-president, (for Second and Third
Districts) ; Dr. J. P. Davidson, third -vice-president (for Fourth
Louisiana State Medical Society.
313
1879J
Sixth and Seventh Districts) ; Dr. D. Jamison, corresponding-
secretary ; Dr. A. B. Miles, recording secretary and treasurer.
Another organization, known as the New Orleans Medical
and Surgical Association, was founded in December, 1873, by
the junior members of the profession. It has had a very suc¬
cessful career, and now includes, in about 40 active members,
some of the oldest practitioners in the city. A considerable
number of its members belong also to the Orleans Parish
Society. Its meetings occur every Saturday evening, except
during the summer months, when they take place monthly.
As this association has not adopted the Code of Ethics of the
American Medical Association, it can have no affiliation with
that body nor with the State organization.
The Plaquemine Parish Medical and Surgical Association
was organized November 15, 1875. The present officers are Dr.
J. B. Wilkinson, president; Dr. 1). R. Fox, vice-president; Dr.
Geo. A. B. Hays, secretary and treasurer. It has nine members
(all the regular physicians in the parish), and meets at Pointe
a la Hache at irregular intervals, from four to eight times a
year.
I am informed that a medical society exist in Pointe Coupee
parish, but have no particulars of its organization.
The Medical Association of the parish of St. Landry was
organized in 1861, with a charter from the Legislature. Dr.
Alexander Donald was secretary in January, 1878. No report
has been rendered to me.
The above constitutes all that I have learned of the local
medical societies in Louisiana, though I have made inquiries of
physicians in all parishes where sncli bodies were said to exist.
Addendum. — April 8, 1879. — Since the above was written, I
have been informed of the recent organization of the New
Iberia Medical Association, in the parish of Iberia. The offi¬
cers elected are : Dr. Alfred Duperrier, president ; 1 )r. G. J.
Colgin, vice-president; Dr. J. G. Mestayer, treasurer; Dr. L.
G. Blanchet, secretary.
Also of the Medical Society of Ascension, organized in March,
1879, with Dr. John E. Duffel as president, Dr. Vaudergriff as .
vice-president, and Dr. John E. Duffel, Jr., as secretary.
The Iberville Medical Society was organized in March, 1878.
The present officers are J. P. R. Stone, president ; A. B. Snell,
secretary. Members : S. D. Schwing, R. Schlater, P. S. Pos¬
ted, M. J. Lehman.
The fellowing classified table of medical practitioners in
Louisiana has been compiled from the best sources of informa¬
tion at my command, and at best is only an approximation to
completeness and correctness. The arrangement is by parishes.
13
314
A bstract of Proceedings
[August
PARI8H.
Total No.
Regular.
Irregular
Unknown
or
Doubtful.
Died in
1878.
Remarks.
Ascension .
14
10
12
v 16
11
12
29
6
4
3
1
2
9
6
1
1
Assumption ....
14
25
Avoyelles .
Bienville .
17
Bossier .
12
32
8
Caddo .
Calcasieu .
2
1
2
6
Caldwell .
10
Cameron _
Carroll .
No Report.
No Report .
Catahoula .
18
9
17
g
1
1
Claiborne .
1
2
2
Concordia .
6
4
De Soto . .
East Baton Rouge.
East Feliciana . . . .
Franklin .
14
23
26
14
14
23
26
12
5
i
Grant .
10
13
11
8
Iberia .
12
It
6
16
11
13
5
12
16
18
195
i
Iberville .
Jackson .
Jefferson .
1
.. |No Report.
Lafayette .
19
13
17
5
13
18
19
287
2
Lafourche .
Lincoln . . .
Livingston .
Madison . . .
2
2
i
1
2
Natchitoches . .
1
Orleans _
Ouachita .
No Report.
Removed 1.
Plaquemines- .
Pointe Coupee . . .
Rapides .
13
16
16
8
9
15
16
4
1
l
1
2
Richland .
Sabine .
1 2
7
12
5
1
St. Bernard .
i
i
9
o
l
St Charles .
St. Helena. .
1
8
2
--
1
St. James .
St. John Baptist.
St.- Landry .
No Report.
No Report.
No Report.
St. Martin .
15
5
n
12
22
5
8
10
10
4
15
3
8
11
13
5
4
1
3
St. Tammany .
Tangipahoa. .
Tensas . .
Terrebonne .
Union .
2
2
1
6
1
3
1
No Report-
Vernon .
3
Washington . .
Webster . ...
West Baton Rouge.
West Febciaua. ...
"l
10
4
1
No Report.
No Report.
Grand Total...
862
677
98
87
23
S. S. Herrick, M.D.,
Corresponding Secretary.
1879J
Louisiana /State Medical Society.
315
Note. — Committee on Scientific Essays. — Dr. C. J. Biekham,
chairman of the above committee, announces that, in addition
to the papers already mentioned in the Transactions, as having-
been promised for the next annual meeting, the gentlemen
whose names are given below have also promised contributions
upon the following subjects :
Dr. M. Schuppert, u On Morbus Coxarius.”
Dr. A. B. Snell, 1st, “ On the Conservative Influence of Dis¬
ease 2d, u The Medical Profession and the Public ; Where
the Obligation Rests.”
Dr. Thos. Layton, u Contribution to the Study of Glossitis.”
Explanatory Remarks of the Committee on Permanent
Organization.
These regulations are the result of the study of the Consti¬
tution and By-Laws of more than twenty (20) State Medina]
Societies, especially of those which are the oldest and most
successful.
The great length of these regulations is deemed objectiona¬
ble, but was found unavoidable in accomplishing the following-
objects, viz : to embrace in these regulations all points which
were frequently repeated in other societies, or which seemed to
be manifestly desirable. Great brevity is usually followed by
frequent repeals, amendments and changes leading to confu¬
sion. Further, great explicitness seemed eminently proper in
the regulations of a society which is to meet only once a year,
and to be composed of members not familiarized by frequent
meetings with their duties.
Effort has been made (apparently for the first time) to estab¬
lish an easily understood connection between a Constitution
and its By-Laws, and to subject these to a simple system, in
such manner that the Constitution should express the funda¬
mental requirements, while the By-Laws should contain the
detailed regulations for the execution of these requirements,
and also all such regulations as expediency may require should
be easily altered. Hence, a full knowledge of each subject
requires that the corresponding Articles in the Constitution and
in the By-Laws should both be read one after the other. This
arrangement facilitates reference to special subjects, and pro¬
vides a proper place for the interpolation of all future changes.
Among other points worthy of note are the following, viz :
The duties of officers and committees are detailed at unusual
length, so as to guide the inexperienced in the proper discharge
of their duties.
The objects of the Society are specified at length, and stand¬
ing committees established especially to promote these objects.
Proper prominence is for the first time given to the para¬
mount object of a State Society, viz : To State medicine, which
cannot be promoted except through efficient organization of
.‘310 Abstract of Proceedings [August
the entire profession of the State. Henee great prominence is
given to the organization of the profession, by a standing com¬
mittee on this subject, and by regulations for organizing affili¬
ated societies, and for the recognition of their members by the
State Society.
A State Society should be exclusively representative ; as this
is, at present, unpracticable, permanent members are pro¬
vided for, but only for such time as delegates may become suffi¬
ciently numerous to sustain the society.
An attempt is made to render each newly elected president
responsible for the work to be done during the session he is to
preside over.
An attempt is made to render vice-presidents responsible and
actively useful officers, instead of being idle recipients of
honors.
An attempt is made to protect the funds of the society from
waste, and the transactions from discredit, by strictly regula¬
ting the articles to be published. The experience of all other
societies proves that strict regulations of some kind on this
subject are indispensable.
To the regulations of the Louisiana State Medical Society
are appended a code of regulations recommended by said
society for adoption by parish societies.
The committee recommends that the regulations now sub¬
mitted be adopted temporarily, and be published for the care¬
ful criticism of the members, but not be finally acted upon be¬
fore the next annual session. In the mean time special atten¬
tion is solicited to the regulations of the Medical Association
of the State of Alabama, and to consideration of the question
whether these regulations should be engrafted upon or substi¬
tuted for those now presented by this committee. The Ala¬
bama society is the most prosperous and efficient one in the
Southern States, and its success is attributed in a large degree
to its Constitution of 1873. The peculiarities of this Constitu¬
tion are as follows :
There are four classes of members, viz : Counsellors, dele¬
gates, members, and corresponding members. The last are
more usually designated honorary members, and present no¬
thing peculiar. The remaining three classes of members
deserve consideration.
The counsellors constitute the greatest peculiarity and are
the sustaining strength of the society. They possess all rights,
except that they can never serve as delegates ; they alone can
be elected to office ; they are limited to one hundred in number ;
they are elected for life by the counsellors, and the delegates ;
they must promptly pay $10 annually , and attend at least one
annual session in every three years ; and in case of failure or
neglect to discharge their duties to the society, their names
are at once stricken from the rolls. Thus, this society must
prosper as long as there cau be found in Alabama one hundred
physicians with sufficient pride in their profession and in their
Louisiana State Medical Society.
317
18791
State, to contribute $10 each per annum, and to otherwise sus¬
tain a State Medical Society.
Delegates. — Two are allowed from each county society;
they have all rights, except that they cannot hold office ;
they pay a fee of $5 each ; and must bring from the society
represented a fee of $1 for each member thereof foi »the treas¬
ury of the State Society.
Members. — Every member of a county society is a member
of the State Society ; with a right to a seat and to discussion,
but he can neither vote nor hold office.
A board of ten censors constitute a committee on the organ¬
ization and general welfare of the society ; it is a court of im¬
peachment for all offenses ; it examines the annual official
accounts, and makes an annual report. Under the State laws
it is a State Medical Examining Board, and a State Board of
Health. Two are annually elected to serve for five years, and
the one elected chairman serves as such throughout his term.
The number present at an annual session constitutes a quorum.
All officers are elected annually, except the censors, secretary
and treasurer, who are elected for live years. All officers are
elected by ballot, and without nomination.
“The president shall submit to the Association at every an¬
nual session an annual message devoted to the discussion of the
interests, objects, and business of the Association.”
“ He shall, every year, appoint regular reporters on the dis¬
eases, surgery, topography and climatology of the different parts
of the State ; and on such other matters of professional interest
as may, in his judgment, require investigation. The same
person shall not be eligible for the presidency for two successive
terms.”
The secretary is ex-officio chairman of the Publishing Com¬
mittee, and the society pays the necessary expenses of both
the secretary and the treasurer, in attending the annual
sessions.
County societies are organized under the general control of
the State Association. Each county society must contribute
annually $1 for each member ; must forward an annual report ;
inust^submit any specially meritorious essay or paper reported to
it, and must have a Board of three Censors. This county
Board of Censors is required to register and publish the names
of all reputable physicians in the county, and members are
prohibited from consultation with any others — to examine on
their preliminary education all persons who propose to study
medicine, and members are prohibited from accepting, as a
medical student, any person who has not been thus satisfac¬
torily examined ; and also to examine every person who comes
in the county to practice medicine, and members are prohibited
from recognizing, as physicians, any persons who have not
passed a satisfactory examination before either the County or
the State Board of Censors.
The State Association has appellate jurisdiction in all trials
before county societies.
Abstract of Proceedings
[August
318
REGULATIONS
OF THE
LOUISIANA STATE MEDICAL SOCIETY.
CONSTITUTION.
PREAMBLE, TITLE AND OBJECTS.
The Louisiana State Medical Society, reorganized January
15, 1878, shall have for its objects :
(1) The union in this Society of all the reputable members
of the regular medical profession in the State, and cooperation
with the medical profession throughout the United States, in
sustaining the American Medical Association ;
(2) The advancement of State Medicine, i. e., of Public
Hygiene (or Preventive Medicine), of Medical Education, of
Medical Jurisprudence, and of Public Institutions for the sick,
and the infirm ;
(3) The cultivation of medical knowledge, and particularly
of such parts thereof as may be of special importance to this
State ;
(4) The elevation of professional character and attainments,
and the promotion of the welfare, in all matters relating to
medical science, of the profession, and of the public.
ARTICLE I.
Mode of Government.
Section 1. This society shall be governed by such regula¬
tions as shall be specified in its Constitution, By-Laws and
Ordinances (or Resolutions ;) and, as to matters not so speci¬
fied, it adopts the Common Parliamentary Law and the Code
of Ethics of the American Medical Association.
Sec. 2. Any suspension or alteration of the Constitution
shall require a unanimous vote, unless proposed in writing at a
preceding annual session, in which case a vote of two-thirds of
the voting members present shall be required; provided that an
amendment, germane to the subject, shall be in order, and may
be adopted, though not submitted, at a preceding annual
session.
The By-Laws may be suspended or altered by a vote of two-
thirds, and the ordinances by the vote of a majority at any reg¬
ular meeting.
ARTICLE II.
Members.
Section 1. (Qualifications.) Every physician to be a mem¬
ber of this Society, must be (1) a graduate of a reputable med-
1879]
Louisiana State Medical Society.
319
ical college, (2) socially and professionally in good repute, (3)
obedient to the Code of Ethics, and (4) a subscriber to the
regulations of this Society.
Sec. 2. Men of worth and culture, occupied in pursuits cal¬
culated to directly promote the objects of this Society, may,
though not graduates in medicine, be elected members of this
Society.
Sec. 3. There may be five classes of members, viz : (1) Dele¬
gates, (2) Permanent Members, (3) Associate Members, (4)
Honorary Members, and (5) Members by Invitation ; provided
that whenever more than one-half of the parishes of this State
shall each have an Affiliated Medical Society, and shall be rep¬
resented in this society by not less than one hundred delegates
present at the annual session. A majority of said delegates shall
have the power to prohibit the election of any additional per¬
manent members.
Sec. 4. All members shall have the right to take part in the
proceedings, but only delegates and permanent members shall
have the right to vote.
Honorary members and members by invitation shall not be
assessed.
Sec. 5. (Delegates.) Every Affiliated Medical Society, State
Medical College, and State Medical Institution — in this State
and in good standing — shall have the privilege of appointing
one delegate, and one additional delegate for every live phy¬
sicians, regular members of said society, or of the medical staff
of said public institutions.
No delegate shall be received unless the dues, of his society
or institution, to this society shall have been paid; and the sum
total to be paid for a delegate shall be equal to the amount an¬
nually assessed on each permanent member.
Sec. <>. (Permanent members.) (1) Delegates and such other
persons as possess fully the qualifications for membership in
this society, may be elected permanent members.
(2) Permanent members, resident in parishes having no affil¬
iated medical society, are charged with the paramount duty of
aiding to organize such a society ; and, no physician shall be a
permanent member, who has been refused membership in the
affiliated society of his parish, unless there be satisfactory evi¬
dence that such refusal has not been due to his disqualification
t o be a member of this Society.
Sec. 7. A delegate, who may be a permanent member, or
vice versa, shall cast but one vote.
Sec. 8. (Associate Members.) Every member of an affiliated
medical society, which has paid its dues to this Society, shall *
be an associate member thereof.
Sec. 9. (Honorary Members.) Honorary Members shall
never exceed twenty in number, and shall require the ballots
of three-fourths of the voting members present at an Annual
Session.
320 Abstract of Proceedings [August
Sec. 10. (Members by Invitation.) Members by Invitation
may be elected, to hold connection with this Society only dur¬
ing the session at which they were elected, on the recommend¬
ation of the Committee of Arrangements.
ARTICLE III.
Officers.
Section 1. The officers of this Society shall be, one presi¬
dent, a vice-president for each Congressional District of Louis¬
iana, provided that each of such districts be represented by a
delegate, or a permanent member, whom this Society may deem
it advisable to elect to the office, one recording secretary, one
corresponding secretary, and one treasurer, who shall also be
librarian, until such time as the Society, by a vote of two-thirds
of the voting members present at an annual session, may deter¬
mine to elect a librarian, as well as a treasurer.
Sec. 2. Only physicians who are delegates or permanent
members shall be elected officers ; and the president, the secre¬
taries, and the treasurer must be chosen from those in attend¬
ance at the annual session.
Sec. 3. The president and the vice-president shall serve for
the term of one year ; the secretaries, and the treasurer and
the librarian shall serve for the term of three years. But every
officer shall continue in office until his successor is duly elected
aud installed.
Sec. 4. The election of officers shall be on a day preceding
the last day of each annual session, but their term of office
shall not begin until the close of the last day, except, so far as
the cooperative action of the president elect may be required
for the transaction of business at the ensuing annual session,
such as in the appointment of the committees.
ARTICLE IV.
Committees.
Section 1. Such Standing and Special Committees may be
appointed as this society may deem necessary, for the purpose
of preparing and arranging business for the annual sessions,
and for carrying into effect the orders of the society not other¬
wise assigned.
Sec. 2. The following Standing Committees shall be ap¬
pointed at each annual session, viz :
1. Committee of Arrangements.
2. Committee on the Organization of the Medical Profession.
3. Committee on Necrology.
4. Committee on State Medicine and Legislation.
5. Committee on Scientific Essays, Reports, Original Papers.
(i. Committee on Publication.
7. Judiciary Committee.
Sec. 3. Committees shall be appointed as follows:
The chairman, by the president, with the approval of the
president elect or of the society ; and the remaining members
1879J Louisiana State Medical Society. 321
by the president, the president elect, and the chairman ; except
in the cases following, viz :
(1) The Committee on Organization shall consist of the presi¬
dent (as chairman,) the vice-presidents and the corresponding-
secretary ;
(2) The recording secretary, the corresponding secretary and
the treasurer and librarian, shall be members of the Committee
on Publication ;
(3) And said committee shall have power to appoint sub¬
committees of experts ;
(4) The president shall have power to appoint members on
sub committees of the Judiciary Committee, and to till all
vacancies on committees.
Sec. 4. Members of a committee shall be responsible for
the work assigned it in the order each name on the list is an¬
nounced ; and inaction of the chairman shall not justify the in¬
action of other members of the committee.
ARTICLE V.
Annual Orator.
Section 1. The society shall elect annually au orator, whose
duty it shall be to deliver at the ensuing annual session a pub¬
lic address designed to interest a non-professional audience in
the objects of this society.
ARTICLE VI.
Delegates from this Society.
Section 1. Delegates to the American Medical Association,
and those State Medical Societies and other scientific bodies in
which this society may deem it advisable to be represented,
shall be elected annually ; or otherwise shall be appointed by
the president.
ARTICLE VII.
Funds and Appropriations.
Section 1. Funds shall be raised by the society for meeting
its current expenses and awards, 'these funds may be obtained
by an equal assessment upon each of the permanent members,
and by the assessment of a like sum upon every affiliated society
and medical institution for each delegate to which said society
and institution is entitled, by an equal assessment on all the
members of affiliated societies; by fines; by the sale of its
publications; and by voluntary contributions.
Sec. 2. The funds may be appropriated (1) for defraying the
expenses of the meetings, (2) for enabling the officers and the
committees to fulfill their respective duties, conduct their cor¬
respondence, and procure the materials necessary for their cor-
14
322 Abstract of Proceedings [August
respondence and reports ; (3) for publishing the proceedings,
memoirs and transactions of the society ; (4) for the salaries of
officers ; (5) for the establishment and support of a library ; (6)
lor the encouragement of scientific investigations by prizes and
awards; and (7) for defraying the expenses incidental to scien¬
tific investigations under the instruction of the society, where
such investigations have been accompanied with an order on
the treasurer to supply the funds necessary for carrying them
into effect.
ARTICLE VIII.
Affiliated Societies.
Section 1 . While it is deemed advisable that there should
be only one Parish Medical Society, for the purpose of uniting
in a single organization, all reputable physicians resident in
each parish ; there may, none the less, be established several
societies in one parish, each society to be composed of members
residing in a political subdivision of the parish ; and there
may be established one society for physicians resident in sev¬
eral adjacent parishes ( i . e., district societies), or in subdivisions
of two or more adjacent parishes.
Sec. 2. (1) No physicians shall be members of affiliated
societies, except those qualified to be members of this society.
(2) Any physician refused admission to, suspended or ex¬
pelled from an affiliated society of his parish, shall have the
right to appeal to the State Medical Society, but he shall
neither become nor continue to be a member of said society,
unless the facts in the case have been duly investigated by the
Judiciary Committee of said society, and favorably decided by
said society.
Sec. 3. An affiliated society may adopt any regulations
which contain the provisions required by the State Medical
Society, and do not contravene any of its regulations.
Sec. 4. Every affiliated society and institution shall pay to
the State Medical Society its assessment, which shall not ex¬
ceed for each delegate, to which said affiliated society or insti¬
tution is entitled, the amount assessed on each permanent
member of the State Medical Society.
ARTICLE IX.
Meetings.
Section 1. A regular annual session shall be held at such
time and place as the society may select, and the president
may call a special meeting for the transaction of business of
paramount importance.
Sec. 2. The Society shall adopt an u Order of Business” and
such “ Rules ” as may be necessary to conduct the proceed¬
ings of the meetings.
1879]
Louisiana State Medical Society.
323
B Y-L A W S.
ARTICLE I.
Mode of Government.
Section 1. (Quorum.)
Fifteen members entitled to vote shall constitute a quorum.
Sec. 2. (Mode of voting.)
Permanent members, members by invitation and officers,
shall be elected by the ballots of a majority of the voting mem¬
bers present. The mode of voting in all other cases — except
where differently specified in the Constitution — shall be by the
viva voice vote of a majority ; provided that one-third of the
voting members present, shall have the right to demand the
record of the yeas and nays.
ARTICLE II.
Members.
Section 1. Every member, in attendance at the annual ses¬
sions, shall, prior to the permanent organization of the session,
or before taking part in the proceedings after the session has
been organized, sign the regulations of the society, inscribing
his name and address in full, the title of the medical institution
by which and the year when graduated ; and, if a delegate, the
title of the affiliated society or institution from which he re¬
ceived his appointment, and shall pay all sums due to this
society.
Sec. 2. Every delegate must present a written appointment
from the affiliated society or institution which he represents.
Sec. 3. No person shall be elected a member of this Society
unless recommended by two members as possessing fully the
qualifications for membership ; and, at the request of two mem¬
bers, a recommendation to membership shall be submitted to
the Judiciary Committee for investigation and report, before
action shall be taken thereon by the Society.
Sec. 4. Any member may resign, provided that lie has paid
all dues, and that there be no charges against him. Any mem¬
ber neglecting two successive years official notifications to pay
his dues shall forfeit membership, and shall not be re-elected
until said dues shall have been paid.
Sec. 5. No voting member present shall be excused from
voting, except by a majority of those present.
Sec. 0. No member shall be required to read his own manu¬
script ; provided that a member k.,own to be a good reader, be
ready to act as his substitute.
Sec. 7. Medical men, or men learned in the collateral
branches of science, on a visit to the place of the Annual Ses¬
sion, may be permitted to attend meetings, on being introduced
by a member of this Society.
324
Abstract of Proceedings
[August
Sec. 8. Any person desiring to become a member, during the
interval between the Annual Sessions, shall forward his appli¬
cation, indorsed with the recommendation of two members, and
accompanied with the annual fee, to the liecording Secretary,
who shall record the name on a special list for “temporary
members.” All privileges of the Society shall be granted to
such temporary members until the first meeting of the Society,
when tlie Constitution and sections 1 and 3, Article II, of these
By-Laws sliall be enforced.
ARTICLE III— DUTIES OF
President.
Section 1. (1) The President shall a, preside (assisted by the
Vice-Presidents) at all meetings ; b , appoint all committees as
provided in sec. 3, Art. IV, of the Constitution ; c, suspend un¬
til the next meeting any officer guilty of flagrant malfeasance
or neglect of duty, and fill ad interim any such, and all other,
vacancies tliat may occur; d, call special meetings; e, approve
or disapprove all requisitions on tlie funds of the treasury ; /,
give a casting vote when necessary ; g, act as chairman on the
committee for the efficient organization of the medical pro¬
fession cf the State in this society ; /<, direct and control, dur¬
ing the intervals between the Annual Sessions, the general
policy and business of this society, transmitting to officers and
members such information and documents in his possession as
may be needful for the discharge of the duties of each, and
requiring reports of progress from nil those appointed to do
any special work for the ensuing session, to the end that he
may if needful take such action that the Society shall not be
deprived of this special work because of the inaction of any
member; i , deliver at the Annual Session an address designed
to promote the objects of this society, and report what has
been, and is likely to be, accomplished during his presidency
to promote these objects ; and, k, perform all such other duties
as this society, custom and parliamentary usage may require.
(2; The President shall have power to delegate his authority
in whole or in part to one of the Vice-Presidents.
Vice-Presidents.
Sec. 2. (1) Such Vice-President, as the President or the so¬
ciety may select, shall in the absence of the President from the
meeting or from the chair, discharge his duties ; but, in the
event of his death, resignation or disability, the Vice-Presi¬
dents in their order of number by congressional districts shall
discharge all the duties of the President. In the event of the
absence of the President and of the Vice-Presidents, the society
shall elect a President pro tempore.
(2) Each Vice-President shall be a member of the committee
on the efficient organization of the medical profession in this
State, charged with the special duty of aiding in the orgauiza-
325
1879] Louisiana State Medical Society.
tion and in promoting the efficiency of an affiliated medical
society in every parish of his district ; and also a member of
the Committee on Necrology.
(3) Each Vice-President shall report to the President an¬
nually in the month of February, the following facts as they
existed on the last day of December, as to every affiliated society
in his district, viz : the title; regulations; place of meeting ;
names of officers and members, alphabetically arranged, to¬
gether with the postoffice address of each, the title of the med¬
ical institution in which and the year when graduated.
(4) Each Vice-President shall also report to the President
at the same time and for the same date, a register of all the
practitioners of medicine in his district , recording in said reg¬
ister, as to each one of said practitioners, the name (alphabeti¬
cally arranged) ; the postoffice ; the place and date of gradua¬
tion (if a graduate) ; and shall arrange the names of said
practitioners in three classes, viz : 1st, practitioners of unques¬
tionable good standing; 2d, practitioners of doubtful or ofun-
, know n repute, stating which ; 3d, irregular practitioners,
specifying whether homoeopathic, eclectic, Thompsonian, etc.,
and to this register shall be added a list of all practitioners
who, during the year, may have died, removed from their pre-
vions postoffice addresses, or come to reside in the congres¬
sional district reported upon.
(5) It shall be the duty of the Vice-President of the Congres¬
sional District in which the records, archives, etc., of the soci¬
ety may be kept by the Recording Secretary, the Treasurer and
Librarian to inspect said records, archives, etc., and to report
annually any inaccuracies and delinquencies therein.
Recording Secretary.
Sec. 3. (1) The Recording Secretary shall keep not less than
three books of record (A) for the regulations of this society and
any future changes thereof ajranged for ready reference thereto,
together with the inscription of the names of members to said
regulations as required in Section 1, Article II of the By-Laws,
and with a register of the members of this society alphabeti¬
cally arranged, (B) for the minutes of the proceedings of this
society, and (C) for the minutes of the proceedings of the Com¬
mittee on Publication, of which he shall be a member.
(2) For two days prior to and during each day of the annual
session he shall have notified office hours, during which he, or
the Corresponding Secretary, or the Treasurer, acting as his as¬
sistants, shall register members and collect for the Treasurer,
the assessment on each member as registered.
He shall refuse to register any person whose status or cre¬
dentials are unknown or questionable, and shall refer all doubt¬
ful questions of this nature to the Judiciary Committee.
(3) He shall, when necessary, give notice of meetings, of any
special duty imposed on a member, and of the election to mem -
bership with the fee due by such member.
320 Abstract of Proceedings [August
(4) He shall distribute the annual volume of Transactions,
(a)toall members who, by the Treasurer’s report, have paid their
fees, (b) to such State Medical and other societies as exchanges
with would be desirable, and (c) to Medical Journals and
Libraries.
Corresponding Secretary.
Sec. 4. The Corresponding Secretary shall keep not less than
three books of record, viz : (d) for the copy or for the minutes
of all the correspondence of the society ; (e) for the record of
the regulations, of the names, etc., of the officers and members
of every affiliated society and institution as directed in (3) See.
2, Art. Ill, of the By-Laws; and (f) for the registration of all
practitioners of medicine in this State, as directed in (4) of Sec.
2, Art III, of these By-Laws. The facts lor the two last books
of record, (e) and (f) should be furnished by affiliated societies
to the Vice-Presidents, and by these to t he President, who should
transmit them to the Corresponding Secretary ; but the Corre¬
sponding Secretary is required, independently of these societies
and of these officers, to render these records as complete as may
be in his power ; and shall recommend to the Vice-Presidents a
blank form for the uniform registration in each district of prac¬
titioners of medicine.
(2) The Corresponding Secretary shall be a member of the
Committees on Organization and on Publication.
(3) He shall present an annual report.
Treasurer and Librarian.
Sec. 5. (1) This officer shall have custody of all moneys,
books, and other property not assigned to the charge of any
other officer; and he shall keep two books of record; one (g)
for receipts, expenses, debts and credits, and one (h) for the
ca alogue of all books and other prorerty of the society.
(2) He shall collect all fees and other sums due to the society,
notify delinquents, within thirty days after each annual session,
of the necessity of prompt payment, and shall report the
names of persistent delinquents to the society.
(3) He shall within sixty days after each annual session fur¬
nish the Recording Secretary with a list of the names of all
members, affiliated societies, and institutions which have paid
their dues, as a guide to siad officer in the distribution of the
Transactions.
(4) lie shall disburse no money except on the written order
of a member, approved either by the President, or by a Vice-
President to whom the President has delegated this authority.
(5) He shall lend no books or other property for more than
one month, and to no one except a member who has given a
written Receipt for the same and such other reasonable secur¬
ity as may be required.
(0) He shall permanently retain in the library not less than
live, copies of the Transactions of each year, ami shall take pos¬
session of copies for exchange and for sale.
1879J
Louisiana State Medical Society.
321
(7) He shall be a member of the Committee on Publication.
(8) lie shall give security for the property in his custody,
and for the faithful discharge of his duties, whenever the
society shall judge this requiste.
(9) He shall at each annual session report the condition of
the library, and of the finances of the society, stating its
receipts, expenses and debts due to and by it, and the number
of deceased and delinquent members as well as of those who
have paid their dues ; and he shall add to his report an esti¬
mate of the receipts and expenses of the society for the ensu¬
ing year, and recommend such measures as he may deem neces¬
sary to raise the funds needed to meet the estimated expenses.
t
ARTICLE IV —COMMITTEES.
6' o m in it tee o f A r r a n y e in ent s .
Section 1. (1) This committee shall consist of not less than
three members, who shall, if no sufficient reasons prevent, be
residents in the place where the annual session is to be held
(2) It shall provide suitable accommodation, and make all
necessary arrangements for the annual session. It shall pro¬
vide a suitable hall for the delivery of the President’s address,
and of the annual oration, and invite thereto the public, and
especially those learned and interested in medical science.
it shall supervise the introduction of all business, and pre¬
pare, in accord with the order of business, Sec. 2, Art. IX,
By-Laws, a programme of the proceedings. For this purpose,
it shall require from each officer, committee and member having
business for the society’s attention, the nature of said business
and the probable time required for its transaction.
(3) it shall, at the opening of the session, report its action
and a programme of the proceedings as arranged by it, subject
to the pleasure of the society. It shall post, in the hall, when
the meetings are held, a notice of any arrangements important
for the information of the members.
(4) it shall have the privilege of inviting any distinguished
medical or scientific men to attend the session, and of recom¬
mending them to the society as members by invitation.
Committee on Organization.
Sec. 2. (1) This committee shall consist of the President, the
Vice-Presidents and the Corresponding Secretary, and three
members shall be sufficient to constitute a quorum.
(2) It shall be its duty to use all practicable means to organ¬
ize the medical profession in local societies throughout this
State, and to increase the efficiency of this society; and it shall
be guided in its action by these regulations as specified in Art.
VIII, of the Constitution, and in (3), (4) Sec. 2, Art. ill; (1)
Sec. 4, Art. Ill, By-Laws.
(3) it shall present an annual report of what has been done
during the year, and recommend such measures as it may deem
32<S Abstract of Proceedings [August
necessary, to promote the more efficient organization of the
medical profession throughout this State.
Committee on Necrology. •
Sec. 3. This committee shall consist of the Vice-Presidents.
It shall report annually brief biographical notices of deceased
members of this society. Each member of the committee shall
report to the chairman at least thirty days prior the annual
session.
Committee on State Medicine and Legislation.
Sec. 4. (1) This committee shall consist of not less than five
members. The chairman shall assign not less than one mem¬
ber to investigate, and report to him upon the condition, needs
and prospects in this State of each one of the four branches of
State Medicine ; and the chairman shall present an annual
report to the society on all of these branches.
(2) It shall consider propositions to repeal, modify or enact
any law relating to medical interests, provided that such pro¬
positions be presented in proper language and form for legisla¬
tive action.
(3) It shall be its duty to recommend to this society its influ¬
ence in behalf of the enactment of such laws as it may deem
desirable, and shall accompany its recommendations with the
words and form of the law proposed to be enacted ; for this
purpose, this committee shall have authority, with the
President’s written approval, to employ, if this be indispensa¬
ble, a competent lawyer.
Committee on Scientific Essays , Reports , etc.
Section 5. (1) This committee shall consist of not less than
five members. It shall be its duty to appoint from the members
of the society a list of essayists and reporters, and to recom¬
mend subjects for their consideration.
(2) It shall particularly encourage scientific essays, reports,
and original papers upon the following subjects, and if practi¬
cable limit them thereto, viz :
a. Subjects peculiar to, or of special importance to this State ;
b. Positively new facts, modes of practice, or principles of
real value ;
c. The results of well devised original experimental researchss ;
d. Reviews, so complete, of the facts on any particular sub¬
ject, as to enable the writer to deduce therefrom legitimate con¬
clusions of importance.
(3) All scientific essays, reports, and original papers, whether
from appointees of this committee, from affiliated societies, or
from volunteers, shall be presented to the society through this
committee, which shall have authority to require that all such
manuscripts shall be submitted to it at a definite date prior to
the annual session.
i £(4) All manuscripts submitted to this committee shall be dis¬
posed of as follows : Those which the committee does not deem
1879 J Louisiana State Medical Society. 329
it desirable to submit to the consideration of the society, shall
be returned to the author, provided the attending expense be
paid by him. Those deemed suitable for the consideration of
the society, shall be assigned the order in which they shall be
read; provided that none requiring over thirty minutes for
the reading, shall be so assigned, unless recommended as par¬
ticularly meritorious, or unless summaries of, or abstracts from,
manuscripts exceeding thirty minutes for the reading shall be
so prepared that these summaries or abstracts can be read in
thirty minutes. All manuscripts deemed suitable for the con¬
sideration of the society shall, whether assigned for reading or
not, be finally referred in full to the Committee on Publication.
(5) This committee, as also the Committee on Publication is
prohibited from giving publicity to the names of authors of re¬
jected papers.
Committee on Publication.
Sec. 6. (1) This committee shall consist of not less than three
members, and the Recording Secretary, the Corresponding Sec¬
retary, and the Treasurer and Librarian, shall be members
thereof.
(2) It shall supervise all publications of this society, and
shall publish an annual volume of Transactions, which, so
far as the funds of the society may permit, shall consist of the
following contents, viz :
' a A disclaimer of the society’s responsibility for the opin¬
ions, theories, criticisms, and alleged facts contained in the
published papers of its members.
[u The society, in publishing papers, does not thereby en¬
dorse their contents.”]
b A table of contents, and an alphabetical index.
c Regulations of this society, and the Code of Ethics.
d A list of the officers and members of this society and of all
affiliated societies.
e A register or list of all practitioners of medicine in Louisi¬
ana on the preceding 31st of December, arranged as directed
in (4) Sec. 2, Art. Ill, of the By-Laws.
/ The minutes of the daily proceedings of the annaal session,
or a summary thereof.
y The annual official reports, or summaries thereof.
h All such scientific essays, reports, and original papers re¬
ferred to it by the Committee on Scientific Essays and Reports,
as a Committee of Experts may decide should be published.
i Advertisements admitted at the discretion of the committee.
k The permanent address of the society, with request to ex-
chanye , to occupy a prominent place in the cover.
(3) The Committee of Publication is authorized, at its discre¬
tion, to appoint a Committee of Experts on the subject matter
of any scientific address, essay, report or paper ; and of these,
it shall publish only such as a Committee of Experts — whose
names shall not be disclosed — shall recommend for publication.
15
330 Abstract of Proceedings [August
(4) The society may order the publication of any such papers,
provided that a two-third vote by ballot be cast in its favor.
(5) All papers which are not placed by their authors complete
in the hands of the Committee on Publication within thirty
days after the close of the annual session, may be excluded
from the annual volume of Transactions.
(0) No paper printed by the society shall be otherwise pub¬
lished, unless the author obtains the consent of the Committee
on Publication.
(7) This committee shall report annually, through the Treas¬
urer and Librarian, and shall present an estimate of expenses
for the ensuing year.
Judiciary Committee.
Sec. 7. (1) This com mittee shall consist of not less than as many
members as there may be Congressional Districts in this State.
It may apportion itself in sub-committees, one for each Con¬
gressional District, and the President may, at any time, appoint
additional members on any sub-committee which may be called
upon to investigate a case of serious importance.
(2) It shall take cognizance of and report upon all questions
of an ethical or judicial character that may arise in connection
with this society; it shall, when desired by the society, investi¬
gate the status of any member, or of any person proposed for
membership, and it shall consider all questions of a personal
character, including complaints, protests and questions on cre¬
dentials.
(3) A charge against a member of this society must be made
in writing (and may be made and investigated while the society
is not in session), to the President, or to the Yice-President of
the Congressional District in which the accused member resides.
This officer shall refer the charge to the Corresponding Secre¬
tary, who shall forthwith notify thereof the accused member, and
the members of the Judiciary Committee. This committee, or
with the President’s approval a sub-committee thereof, shall
then proceed, after due no'tice to the accused member, to inves¬
tigate the charge ; shall keep an accurate written record of the
facts and evidence in the case ; and shall prepare a written
summary of the chief facts — agreed to by both parties — and of
those in dispute with the evidence pro and con thereon, adding
thereto the recommendation of each member of the committee
or to the sub committee, which recommendation shall be to dis¬
miss the charge against, to exonerate, to fine, to censure, to
suspend, or to expel the accused member. All the proceedings
of a sub committee shall be referred to the Judiciary Commit¬
tee for its action thereon, and this committee shall refer all the
proceedings to this society for final action at the annual ses¬
sion. A vote of two-thirds (by ballot or by yeas and nays) of
all members present shall be required to expel a member ; and
the vote of a majority by recorded yeas and nays shall effect
the decision, if expulsion be not the question for decision.
1879 1
331
Louisiana State Medical Society.
(4) Three members of this committee, or of a sub committee
thereof, shall be necessary to constitute a quorum.
(5) If, after due notification, an accused member fail to ap¬
pear at the time and place of trial, he shall, unless satisfactory
excuse be rendered at the time, be considered as admitting the
truth of the charges against him, and shall be liable to sentence
accordingly.
(6) Any member convicted of crime by a court of law may
• be sentenced, without trial, by this society.
ARTICLE V.
Annual Orator.
Section 1. The Annual Orator may be chosen from any one
of the five classes of members.
ARTICLE VI.
Delegates from the Society.
Section 1. Any Delegate from this society shall, if unable
to discharge the duty, give the President prompt notice there¬
of, and otherwise aid the President to appoint a substitute.
ARTICLE VII.
Funds and Appropriations.
Section 1. The annual assessment on each permanent mem¬
ber, shall be, until otherwise ordered by a two-thirds vote at an
annual session, five ($5) ; dollars ; and on each member of an
affiliated society one ($1) dollar, provided that the sum due
for each delegate to which an affiliated society or institution is
entitled shall not be less than five ($5) dollars. See section 4,
Article II, By-Laws.
Sec. 2. Funds may be disbursed by the Treasurer, upon a
requisition signed by a member and approved by the President
or by a Vice-President duly authorized, for the necessary ex¬
penses (1) of the meetings ; (2) of officers and committees ; (3)
of publication. Funds shall not be disbursed for other pur
poses unless ordered by a vote of the society.
ARTICLE VIII.
Affiliated Societies.
Section 1. Three physicians shall suffice to organize an affil¬
iated society, provided that all qualified physicians (see Art. II,
sec. 1, Const.) residents of the same parish, or of the same
neighborhood, shall have been invited to unite in said organ¬
ization.
Sec. 2. A medical society seeking affiliation with this so¬
ciety must submit, to the Vice- President of the congressional
district in which it is located for reference to the President, or
332
Abstract of Proceedings
[August
if there be no such Vice-President then directly to the Presi¬
dent of this society, two copies of its regulations with a list of
its officers and members ; and when one of these copies is
returned approved by the President and Corresponding Secre¬
tary of this society, thereupon the aforesaid society shall be
affiliated to the Louisiana State Medical Society, and entitled
to delegates, to the Transactions, and all other privileges, so
long as said affiliated society conforms to the regulations of this
society.
Sec. 3. An affiliated society, failing for two successive
years to pay the fees due this society, shall after due official
notification be denied all the privileges of this society until
said fees have been paid.
Sec. 4. Every affiliated society shall meet at least once
annually, and whenever notified by the President of this so¬
ciety, or by the Vice-President of its congressional district.
Every affiliated society is recommended to hold an annual
meeting in January to choose delegates to, and otherwise aid
this society; and to appoint one standing committee on State
Medicine and Legislation, and one on the efficient organization
of the medical profession.
Sec. 5. Every affiliated society shall report annually in
January to the Vice-President of its district (or if there be no
such officer then directly to the President of this society), the
following tacts as they existed on the preceding last day of
December, viz: 1st, any changes in its regulations, its general
condition, the names alphabetically arranged, of its officers and
members, their postoffice addresses, institution, where and
year when graduated, and cessation and refusal of mem¬
bership during the year with the causes thereof ; and 2d, a
register of all practitioners of medicine of the parish or of the
political sub division in which said affiliated society is located,
in accordance with the directions in (4) sec. 2, Art. Ill, of these
By-Laws. These reports shall be forwarded by Vice-Presidents
to the President, and by him to the Corresponding Secretary.
Sec. 0. Every affiliated society shall forward to the Record¬
ing Secretary (for reference to the Committee on Scientific
Essays and Reports), thirty days before the annual session,
any such original papers as it may deem worthy of the consid¬
eration of this society, and of publication in its annual Trans¬
actions, and shall also forward to the Recording Secretary,
prior to the annual session, a list of its Delegates to this
society.
Sec. 7. Affiliated societies, through their Delegates, or
otherwise, shall have the privilege of nominating the Vice-
President of this society for the Congressional District in
which said affiliated societies are located.
H. B. — Recommend Constitution for Parish Societies, and
form for Annual Reports.
1879 j
Louisiana State Medical Society.
333
ARTICLE IX.
Meetings.
Section 1. The annual session shall begin on the
, and shall continue from day to day,
until all of its business be transacted. During the session
there shall be two meetings daily, one at 11 A. M., and one at
74 P. M.
Order of Business.
Sec. 2. The Order of Business shall at all times be subject
to the vote of two-thirds of all the voting members present ;
and until permanently altered, except when for a time sus¬
pended, it shall be as follows :
(1) Call to order.
(2) Announcement of the members in attendance by the
Recording Secretary.
(3) Reading and correction of the daily minutes.
(4) Reading the notes of absentees, provided these contain
any facts of importance.
(5) Election and registration of new members.
(6) Report of the Committee of Arrangements.
(7) Any business, requiring early attention, may, by permis¬
sion, be introduced.
(8) Address of the President, and the annual oration at the
time and place recommended by the Committee of Arrange¬
ments.
(9) Reading and consideration of, with action on, the reports
of officers ; of Standing and of Special Committees ; of Affiliated
Societies, and of delegates from this society.
(10) Election of officers, delegates, etc., and selection of the
next place of meeting.
(11) Appointment of the Chairmen of committees.
(12) Reading and consideration of scientific essays, reports,
and original papers.
(13) Unfinished business.
(14) New business.
(15) Announcement of committees.
(16) Reading rough minutes of the session about to dose.
(17) Adjournment.
Rules.
Sec. 3. (D The reading of no report, original paper, etc.,
shall, in its delivery, exceed thirty minutes, unless by special
permission of the society; provided that summaries of, and ab¬
stracts from such manuscripts as would exceed thirty minutes
in the reading, may be read, and that such manuscripts shall
be referred in whole to the Committee on Publication. The
opportunity for debate shall be furnished immediately after the
reading of every paper, but the time for debate shall be limited
to thirty minutes, unless extended by vote of the society.
-534 Abstract of Proceedings [August
(2) No member shall be permitted to address the society un¬
til his name and residence have been distinctly announced, and
any such member may be required to speak from the stand.
No speaker in the debate of any one subject, shall, unless by
permission of the society, exceed ten minutes, nor speak more
than once, until every member choosing to speak shall have
spoken, nor shall he speak more than twice without the permis¬
sion of the society.
(3) A member shall not interrupt another while speaking,
unless to call him to order or to correct a mistake ; and such
interruptions shall not be considered as speaking in debate, to
the violation of the above rule (2).
(4) A vote shall not be reconsidered at the same meeting by
a smaller number than was present at its passing.
(o) When a question is before the society no other motion
shall be received; except, (a) to adjourn, (b) to lay on the table,
(c) to postpone indefinitely, (d) the previous question, (e) to
postpone to a definite time, (f) to commit, (g) to amend, or (h)
the main question ; which several motions shall have prece¬
dence in the order they are arranged. A motion to adjourn, to
lay on the table, and to postpone indefinitely are not debatable.
(fi) When the previous question is demanded, it shall take
five members to second it; and when the main question is put,
under the force of the previous question, and negatived, the
question shall remain under consideration the same as if the
previous question had not been enforced.
(7) When a report is read, it is thereby received ; and when
received. , it may at any time be considered, and in whole or in
part, may by vote of the society be accepted , and it is thereby
adopted.
REGULATIONS
OF THE
PARISH MEDICAL, SOCIETY.
CONSTITUTION.
PREAMBLE, TITLE AND OBJECT.
The . . . Parish Medical Society, organized _
shall have for its objects :
(1) The union in this society of all the reputable members of
the regular medical profession, residing in this parish, and co¬
operation with the medical profession throughout the State in
sustaining the Louisiana State Medical Society.
(2) The advancement of State Medicine — i. e., of Public
Hygiene (or Preventive Medicine,) of Medical Education, of
1879] Louisiana State Medical Society. 335
Medical Jurisprudence, and of Public Institutions for the sick
and the infirm ;
(3) The cultivation of medical knowledge, and particularly
of such parts thereof as may be of special importance to this
parish and State ;
(4) The elevation of professional character and attainments,
and the promotion of the welfare in all matters relating to med¬
ical science of the profession and of the public.
, ARTICLE I.
Mode of Government.
Section 1. This society shall be governed by such Regula-
tions as may be specified in its Constitution, By-Laws and Or¬
dinances (or Resolutions;) and, as to matters not so specified,
it adopts the Common Parliamentary Law and the Code of
Ethics of the American Medical Association.
Sec. 2. Any suspension or alteration of the Constitution
shall require a unanimous vote unless proposed in writing at a
preceding regular meeting, iu which case a vote of two-thirds
of the voting members present shall be required ; provided
that an amendment germain to the subject shall be iu order,
and may be adopted, though not submitted, at a previous
meeting. The By-Laws may be suspended or altered by a vote
of two-thirds, and the Ordinances by a majority at any regular
meeting.
* ARTICLE II.
Members.
Section 1. (Qualifications.) Every physician, to be a mem¬
ber of this society, must be (1) a graduate of a reputable medi¬
cal college, (2) socially and professionally in good repute, (3)
obedient to the Code of Ethics, and (4) a subscriber to the
Kegulations of this society.
Sec. 2. Men of worth and culture, occupied in pursuits cal¬
culated to directly promote the objects of this society, may,
though not graduates in medicine, be elected members.
Sec. 3. There may be two classes of members, (1) .Regular
Members, and (2) Honorary Members. Honorary Members
shall not be assessed, shall not have the right to vote, and
shall require, for election, the ballots of three-fourths of the
members present at a regular meeting, succeeding a regular
meeting at which they have been proposed for Honorary
Membership.
ARTICLE III.
Officers.
Section 1. The Officers of this society shall be, one Presi¬
dent; . Vice-Presidents; one Recording Secretary who
shall also be Treasurer, and one Corresponding Secretary who
shall also be Librarian.
330 A bstract of Proceedings [August
Sec. 2. Only physicians, who are regular members, shall be
elected officers.
Sec. 3. The President and Vice-Presidents shall serve for
the terms of one year, and the Secretaries for three years, said
terms to expire at the annual meeting ; but in no case shall an
officer vacate his place until his successor has been chosen.
ARTICLE IV.
Committees. %
Section 1. Standing Committees shall be appointed on (1)
The efficient organization of this society; (2) Judiciary; (3)
State Medicine and Legislation ; (4) Scientific Essays, Reports
and Discussions ; (5) Publication.
Sec. 2. Special Committees, and additional Standing Com¬
mittees may be appointed at the discretion of the society.
Sec. 3. The chairman of any committee shall- be appointed
by the President, and the remaining members by the Presi¬
dent, with the consent of the chairman, or of the society ; ex¬
cept, as to the Committee on Efficient Organization, which
shall be composed of the President, the Vice-Presidents, and
the Corresponding Secretary ; and as to the Judiciary Com¬
mittee, the members of which may be increased at the discre¬
tion of the society, by the election of additional members.
ARTICLE V.
»
Annual Orator.
Section 1. The society shall elect annually an orator, whose
duty it shall be to deliver a public address designed to interest,
in the objects of this society, a non-professional audience.
ARTICLE VI.
Delegates.
Section 1. Delegates to the Louisiana State Medical Asso¬
ciation, to the American Medical Association, and to such
other scientific bodies, as this society may deem advisable that
it should be represented in, shall be elected annually, or in
default thereof, be appointed by the President.
ARTICLE VII.
Funds and Appropriations.
Section 1. Funds shall be raised by this society for meeting
its current expenses and awards, by an equal assessment on
each of its regular members.
Sec. 2. Funds may be appropriated, (1 ) for defraying the
expenses of the meetings, (2) for enabling the officers and the
committees to fulfill their respective duties, conduct their cor¬
respondence, and procure the materials necessary for their
Louisiana State Medical Society.
337
1879]
records and reports, (3) for the payment of such equal assess¬
ments as may be imposed on affiliated societies by the State
Medieal Association for its support, (4) for publishing the pro¬
ceedings and transactions of this society, (5) for establishing a
library, and (6) for the encouragement of scientific investiga¬
tions.
ARTICLE VIII.
Meetings.
Section 1. There shall be not less than one regular meeting
. ; one of which shall be the annual meeting, for the
election of officers, the presentation of annual reports, the an¬
nual oration, and for such other proceedings as may be directed.
Sec. 2. The President shall call a special meeting whenever
he may deem proper.
Sec. 3. The society shall adopt an “ Order of Business ” and
such other “ Rules ” as it may deem necessary to conduct pro¬
perly the proceedings of the meetings.
BY-LAWS.
ARTICLE I.
Mode of Government.
Section 1. (Quorum.) _ regular members shall constitute
a quorum.
Sec. 2. (Mode of Voting.) Regular members and officers
shall be elected by the ballots of a majority of the regular
members present. The mode of voting in all other cases, ex¬
cept when otherwise specified in the Constitution, or when
otherwise determined by the society, shall be by viva voce vote
of a majority ; provided , that one-third of the regular members
present shall have the right to demand the record of the yeas
and nays.
ARTICLE II.
Members.
Section 1. Every member must, before taking part in the
proceedings, sign the regulations of this society, inscribing his
name and address in full, and the title of the institution by
which, with the year when, graduated ; and must pay all sums
due by him to the society.
Sec. 2. No person shall be elected a member of this society
at the same meeting wheu his name may be proposed, nor un¬
less recommeuded by two members as possessing fully the
qualifications for membership. In any case, at the request of
two members present, such proposal for membership shall be
16
338 Abstract of Proceedings [August
submitted to the Judiciary Committee for report at the follow¬
ing meeting.
Sec. 3. Any member may resign, provided that he has paid
all dues, and that there be no charges against him. Any mem¬
ber neglecting two official notifications to pay his dues, shall
forfeit membership and shall not be re-elected until said dues
shall have been paid.
Sec. 4. No member present shall be excused from voting,
except by a majority of those present.
Sec. 5. No member shall be required to read his own address,
report, essay, or other paper ; provided that a member, well
known to be a good reader, be ready to act as bis substitute.
Sec. (>. Medical men or men learned iu the collateral
branches of science, on a visit to . Parish, may be
permitted to attend meetings on being introduced by a member
of this society.
ARTICLE III— OFFICERS, DUTIES OF—
President.
Section 1. The President shall (a) preside, with the assist¬
ance of the Vice-Presidents, at all meetings ; (b) appoint all
committees, as provided in Section 3, Article 10, of the Consti¬
tution ; (c) fill ad interim all vacancies that may occur , (d) call
special meetings ; (e) inspect the records and archives of the
society and report any inaccuracies and delinquencies in refer¬
ence thereto ; (f) approve or disapprove all requisitions on the
funds of the treasury; (g) give a casting vote when necessary;
(h) act as chairman of the Committee on the efficient organiza¬
tion of this society ; (i) report, at the close of his term of office,
what has been accomplished to promote the objects of this
society, recommending such measures as he may deem neces¬
sary to promote these objects more effectively : (j) and perform
all such other duties as this society, custom and parliamentary
usage may require.
Vice-Presidents.
Sec. 2. (a) Such Vice-President as the President or the society
may select shall, in the absence of the President from the meet¬
ing or from the chair, discharge his duties, and if all these
officers be absent, the society shall elect a President pro tern ;
(b) each Vice-President is charged with the special duty of
promoting the efficient organization of the society, and shall
be a member of the committee for this purpose.
Recording Secretary and Treasurer.
Sec. 3. (a) This officer shall keep one or more books for the
record of (1) the regulations of this society (with any further
changes thereof arranged for ready reference), the names of
members subscribed thereto (see Section 1, Article II, By-
1879]
Louisiana State Medical Society.
339
Laws), and a list of officers and members alphabetically ar¬
ranged ; (2) the minutes of the proceedings ; (3) the receipts,
expenses, debts, credits, and property of the society, (b) He
shall give notice, when necessary, of meetings, of any special
duty imposed on a member, of the fees due by each, and of
election to membership in the society, (c) He shall collect all
fees and other sums due, notify delinquents of the necessity for
prompt payment, and report the names of persistent delin¬
quents to the society, (d) He shall report annually the finan¬
cial condition of the society, recommending such measures as
he may deem necessary.
Corresponding Secretary and Librarian.
Sec. 4. (a) This officer shall keep one or more books for the
record of (1) the correspondence of the society ; (2) the cata¬
logue of its books and scientific property, and (3) the alpha¬
betical registration of all practitioners of medicine in .
Parish, on December 31st, of every year. This alphabetical
list shall, as far as practicable, record the names, residence, in¬
stitution by which, and year when graduated, of every prac¬
titioner in . Parish, dividing these into three classes, viz :
Practitioners of unquestionable good standing ; practitioners of
unknown or doubtful repute, designating which ; and irregular
practitioners, designating whether homoeopaths, eclecties,
Thompsonians, etc.
(b) He shall be a member of the Committee on the Efficient
Organization of this society.
(c) He shall present an annual report, which shall contain,
among other things, a list of deaths, removals, and arrivals (for
permanent residence) of practitioners in . Parish during
the year, closing with the last day of the year.
ARTICLE IV.
COMMITTEES —DUTIES, ETC.
Standing Committee on the Efficient Organization of this Society.
Section 1. This committee, composed of the President (as
chairman,) of the Vice-Presidents, and of the Corresponding-
Secretary, shall devise and recommend measures to promote
the efficiency of this society; and shall report annually all
measures necessary to be adopted, in order to support the State
Medical Association, and to maintain affiliation therewith.
Judiciary Committee.
Sec. 2. (a) This committee shall consist of not less than five
members.
(b) It shall take cognizance of, and report upon, questions of
an ethical or judicial character that may arise in connection
with this society ; shall investigate the status, if questionable,
of any member, or of any person proposed for membership, and
340 Abstract of Proceedings [August
shall consider all questions of a personal character, such as
complaints, protests, etc.
(c.) A charge against a member of this society, must be made
in writing to the President, who shall report the charge to the
society, as also to the accused member, and refer it to the Ju¬
diciary Committee — the members of which may be increased at
the discretion of the society. The Judiciary Committee shall,
after due notice to the accused member, investigate the charge ;
shall keep an accurate written record of the facts and evidence
in the case; shall prepare a summary of the chief facts agreed
to by both parties, and of those in dispute with the evidence pro
and con thereon, adding thereto the recommendation of each
member of the committee ; which recommendation shall be to
dismiss the charge, to exonorate, to hue, to reprimand, to sus¬
pend, or to expel the accused member. All the proceedings of
the committee shall be referred to the society for final action
thereon, at a meeting to which all the members have been sum¬
moned, with notice of the special business to be disposed of.
A vote of two-thirds by ballot, of all members present, shall be
required to expel a member ; a majority, by recorded yeas and
nays, shall effect the decision of any issue involved, other than
expulsion.
(d) If, after due notification, an accused member fail to ap¬
pear at the time and place of trial, he shall, unless satisfactory
excuse be rendered at the time, be considered as admitting the
truth of the charges against him, and shall be liable to sentence
accordingly.
Committee on State Medicine and Legislation.
Sec. 3. (a) This committee shall consist of not less than ....
members, and shall, from time to time, report to the society
upon the condition, needs and prospects in . parish of
each one of the four branches of State Medicine.
(b) It shall recommend the enactment, repeal, or modifica¬
tion of such State laws and parish ordinances, relating to
medical interests as it may deem advisable, presenting these
recommendations in the form and words, which it is proposed
shall be enacted.
Committee on Scientific Essays , Reports , Discussions.
Sec. 4. (a) This committee shall consist of not less than
. members, (b) It shall make provision for and have
general supervision over the scientific proceedings of the meet¬
ings ; select a list of essayists, aud reporters, and of subjects
for discussion, to the end that each meeting of the society may
be made instructive and attractive to the members, (c) It
shall particularly encourage the consideration of all medical
subjects of special importance to the parish, aud to this State.
1879J Louisiana State Medical Society. 341
Committee on Publication.
Sec. 5. This committee shall consist of not less than .
members, and the chairman of the Committee on Scientific
Essays, etc., the Recording Secretary and Treasurer, and the
Corresponding Secretary and Librarian shall be members of
said committee, with the Recording Secretary and Treasurer, as
chairman thereof. It shall discharge the duties usually as¬
signed such a committee ; and in the discharge of these duties
it shall require that there shall be attached to the published
reports and original papers belonging to this society the follow¬
ing : “ The . Parish Medical Society, although publishing or
recommending for publication the reports of committees, orig¬
inal papers of its members, etc., holds itself irresponsible for
the opinions, theories, and criticisms therein contained, except
when otherwise decided by special resolution.” It may refer to
the Louisiana State Medical Society any specially meritorious
report, essay, or paper.
ARTICLE V.
Annual Orator.
Section 1. An orator shall be elected at a regular meeting
to deliver an address at the succeeding annual meeting. He
need not be a member of this society.
ARTICLE VI.
Delegates.
Section 1. The Committee on Organization shall recommend
to the society at appropriate times members for election or
appointment as delegates ; notifying the society of the num¬
ber, which this society is entitled to, of delegates to the State
Medical Society, and to the American Medical Association.
ARTICLE VII.
Funds and Appropriations.
Section 1. The annual fee due by each regular member shall
be, until otherwise ordered by the society, .
Sec. 2. Funds may be disbursed by the Treasurer for the
payment of (1) the necessary expenses of the meetings ; (2) the
necessary expenses of officers and committees ; and (3) the as¬
sessment of the State Medical Association — upon a requisition
signed by a member and approved by the President. Funds
shall not be disbursed for other purposes unless approved by
vote of the society.
ARTICLE VIII.
Meetings.
Section 1. The regular meetings shall be held, until other-
342
Abstract of Proceedings
[August
wise ordered by a majority of the society, in the .
. , on the
. The annual meeting
shall be the regular meeting in the month of .
Order of Business.
Sec. 2. The order of business shall at all times be subject to
the vote of two-thirds of all the members present ; and until
permanently altered, except when for a time suspended, it
shall be as follows :
(1) Call to order; (2) reading and consideration of the min¬
utes ; (3) reading of communications ; (4) proposals for mem¬
bership ; (5) report of officers and of committees and action
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relation of cases and of medical news ; (12) arrangement and
announcement of scientific work for the following meeting ;
(13) adjournment.
Rules.
Sec. 3. (1) The reading of no report, essay, or original paper
shall in its delivery exceed thirty minutes, unless by special
permission of the society, and no speaker shall, in debate on
any one subject, exceed ten minutes, nor speak more than once,
until every member, choosing to speak, shall have spoken — nor
shall he speak more than twice without leave of the society.
(2) A member shall not interrupt another, while speaking,
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(3) A vote shall not be reconsidered at the same meeting by
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(4) When a report is read it is thereby received : and when
it may at any time be considered, and in whole or in part may,
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NEW ORLEANS
Medical js nd Surgic/l Journal.
SEPTEMBER, 1879.
PAGINAL
UNICATIONS.
Treatment of Yellow Fever.
BY JOSEPH JONES, M. D.,
Professor of Chemistry and Clinical Medicine, Medical Department University of Louis¬
iana; Visiting Physician of Charity Hospital, New Orleans.
{Extracts from, Clinical Lecture delivered in the Amphitheatre of the Charity
Hospital , February oth, 1879. Reported for the New Orleans Medical and
Surgical Journal.)
LECTURE Y.
TREATMENT OF YELLOW FEVER, AND CLINICAL LECTURES ON
THE YELLOW FEVER EPIDEMIC OF 1878.
Concluded from August No.
Of late years, tlie view held by Hippocrates, Aselepiades,
Campanella, Van Helmont, Sydenham, Stahl, Boerhaave, So-
bernheim, and many others, that fever was salutary in that it
removes from the system the existing products of disease, and
was a conscious and voluntary effort on the part of Nature to
free herself from the detrimental substances which had forced
themselves into the system, lias receded into the back ground,
and the conviction has been steadily gaining ground that, quite
apart from the fundamental disease, fever (increase of heat), of
itself , causes great danger to the patient, in fact that in many
febrile disorders the majority of the patients who die, die not,
of the disease proper, but of the accompanying fever. In typhus
d44
Original Communications. [September
and similar diseases, many physicians of learning and experi¬
ence regard the fever as the essential danger, and have been
naturally led to find in the fever the essential object of treatment.
The experience of the present day has shown that under the
action of a long continued high fever-temperature, the cell
elements of a large number of organs degenerate, and are at
length destroyed ; in the liver the cells are abnormally filled
with granules and fat-globules, the nuclei become invisible, the
sharp contours of the cells disappear, and they are represented
only by loose conglomerations of granular debris ; in the kid¬
neys similar alterations are found, chiefly in the epithelium of
the cortical substance ; in the heart the transverse strife of the
primitive fibres are indistinct and obliterated, and the fibres
filled with abundant fat-globules, the color of the heart is much
paler, of a greyish and brownish yellow, and the whole muscle
is strikingly soft and easily torn; in the voluntary muscles
there is the same indistinctness of the primitive fibres caused
by granular and fatty parenchymatous degeneration ; and even
in the blood vessels of the brain similar alterations are found.
As the cause of the febrile rise in temperature is increased
combustion, and as the appetite and digestion are generally so
affected as to prevent the replacement of the loss of the corporeal
substance by the increased combustion, it is evident that every
fever is attended by loss of substance, and wasting ; and it is
farther evident that such consumption in protracted or chronic
febrile complaints may be the final cause of death. Whilst
on the other hand, in such an acute febrile complaint as yellow
fever, there is without doubt during the active stages, a rapid
decrease of substance, this wasting is neither the greatest nor
the most important symptom, nor can it be considered as the
cause of the great fatality of this disease. Countless human
beings have died of yellow fever before any appreciable degree
of wasting has been occasioned ; and we must refer the exceed¬
ingly rapid and fatal nature of the disease to the celerity with
which its poison induces profound changes in the blood, heart,
liver and kidneys and nervous system, and to the conse¬
quent high temperature. After a careful examination of the
symptoms during life, and the lesions after death, I have-
been unable to establish any connection between the tissue
Jones — Treatment of Yellow Fever.
345
1879J
changes and the degree of heat during the febrile stage;
but that such relationship exists may be inferred from
the facts that in almost all cases of yellow fever, where
the temperature does not exceed 102° F., or even 103°, the
symptoms are comparatively mild, and the tendency is to
recovery.
Whilst we cannot fully subscribe to the dogma that the essen¬
tial danger in yellow fever consists in the deleterious influence of
a high temperature on the tissues ; at the same time we freely ad¬
mit that the material changes lead to functional disturbances
of all the organs, which lead to disorganization of the blood,
uraemic poisoning, convulsions, and finally to cardiac and cere¬
bral paralysis.
If it be held that in yellow fever the greatest danger is to be
looked for in the height of the temperature of the body, and
that the raising of the temperature beyond a certain point is in
a large number of cases the direct or indirect cause of death ;
then the essential problem in the treatment is to lower the tem¬
perature, to cool the patient. The most efficient remedies for
this purpose are, 1st. Active purgation and large doses of
quinine in the first twenty-four hours of the fever. 2d. The
employment at regular intervals from the inception of the fever,
of such measures and agents as promote free perspiration and
diuresis, as the hot mustard foot bath, frictions with fresh
olive oil, orange leaf tea, sage tea, and spirits of nitric ether.
3d. The employment at regular intervals from the inception of
the fever, of those agents which control the action of the heart
and arteries, quiet the nervous system and reduce animal heat,
as aconite, veratrum viride, and gelsemium semper virens ; 4th,
local and general blood-letting ; 5th, the free employment at
regular intervals from the inception of the fever, of the so-
called antizymotic remedies, carbolic acid, sulpho carbolate of
sodium, sulphide of sodium, and black sulphuret of mercury.
6th. Sponging the surface with water, diluted acetic acid, di¬
luted alcohol, sedative water, and greatly diluted aqua ammo¬
nia. 7th. The cold or tepid water bath, and cold or tepid water
sprinkling in cots or beds specially prepared for this purpose.
In other words those antipyretic and autithermal remedies
and measures should be instituted which reduce the action of
346 Original Communications. [September
the heart and arteries, promote free perspiration, control exces¬
sive chemical action in the blood, by their antiseptic and anti-
zymotic properties, and directly reduce the heat of the surface.
Nothing apparently could be simpler than the fulfillment of
the seventh method indicated above, namely, the plunging of
the hot yellow fever patient into cold water ; rubbing his sur¬
face with blocks of ice, or placing him upon a cot properly con¬
structed, in irrigating his body with either warm or cold water,
thus abstracting the heat directly and by evaporation from the
surface. From the time of Hippocrates to the present day,
efforts have been made to conquer fever heat with cold water,
but the English physician, Dr. James Currie, who more than
seventy years ago frequently employed the thermometer in the
diagnosis and treatment of diseases, and who strenuously advo¬
cated the use of water warm and cold as a remedy in fevers and
other diseases, should be regarded as the true founder of modern
Hydropathy, notwithstanding that his method gradually fell
out of use and was almost forgotten, in the treatment of fevers
until 1861, when Ernest Brand, of Stettin, published his book
about the hydropathic treatment of typhus. The work of Ernest
Brand did good service in stimulating other physicians to make
trial of this method and probably led to the energetic and experi¬
mental researches of the Kiel observers. Bartels and Jurgensen,
of Kiel, have shown that in the majority of patients thor¬
oughly cold baths may be used without danger as often as may
be necessary, that is as often as the temperature in the interior
of the body may again have risen beyond a certain limit. The
great results of the cold water treatment date from the publi¬
cation of these experiences in 1866. It was throughout shown
that such results could only be attained by controlling the
temperature of the patient by day and night, and using the
cold bath as often as the bodily temperature required it. It
is usually necessary to give from six or eight cold baths in the
twenty-four hours. In severe cases it happens that the bath
has to be given twelve times in the twenty-four hours. Profes¬
sor C. Liebermeister, of Tubingen, who has recorded his exten¬
sive and valuale experience with this method of treatment,
has used as many as two hundred baths in the treatment of an
obstinate case of typhus.
Jones — Treatment of Yellow Fever.
347
1879J
In the Kiel Hospital, from 1850-1861, out of 330 typhus pa¬
tients, 51 died under ordinary treatment, that is 15.4 per cent.
On the other hand, from 1863, out of 160 cases which were
consistently treated with cold water, only 5 died, that is 3.1 per¬
cent.
In the hospital at Basle, where abdominal typhus is ex¬
tremely common and very virulent, until the year 1865, the
treatment was of the ordinary symptomatic and expectant
kind. When, in 1865, Professor C. Liebermeister undertook
the direction of the department of Basle, baths were given
more regularly, but still generally only once or twice a day,
rarely twice. At the same time, in order to aid the antipy-
resis, quinine or digitalis was used, but not in so energetic a
manner, nor according to such established indications as later.
At length, however, from September, 1866, after Professor 0.
Liebermeister had seen the convincing communications of Jiir-
gensen, of the results obtained at Kiel, baths were employed in
gradually increasing frequency, and by degrees somewhat
colder, until at last, near the commencement of the year 1868,
the method of treatment has been fairly settled.
Professor C. Liebermeister has given the following valuable
statistics as the effects of different modes of treatment of ab¬
dominal typhus, in the hospital at Basle.
I. With ordinary treatment , 1843-1853, cases of typhus fever
444 ; deaths 135 ; mortality 30.4 per cent. 1854 to 1859, cases
643 ; deaths 173 ; mortality 20.7 per cent. 1860 to 1864, cases
631 ; deaths 162 ; mortality 25.7 per cent.
II. With imperjeet antipyretic treatmen', January, 1865, to
September, 1866, cases 982 ; deaths 159 ; mortality 16.2 per
cent.
III. With consistent antipyretic treatment, September, 1866-
1870, 845 cases ; 64 deaths; mortality 7.6 per cent.
Favorable reports of the antipyretic treatment of abdominal
typhus came also from numerous hospitals, as those in Munich,
Erlangen, Wurzburg, Nuremberg, Griefswald, Jena, and Halle.
According to Professor C. Liebermeister, this mode of treat¬
ment is not alone useful in abdominal typhus, but generally it
is of value in every other disease accompanied by fever, in
which the rise of temperature of the body brings danger by its
348 Original Communications. [September
height or duration ; and the region of these diseases is now
proved to be much greater than had formerly been anticipated ;
all complaints belonging directly to it which, as a rule, are ac¬
companied by somewhat severe and continued fever. According
to Professor Liebermeister, the most brilliant results are natur¬
ally to be expected in those diseases in which the danger chiefiy
or exclusively depends on the fever ; but only slightly on the
local disturbances, as, for instance, in abdominal typhus, exan-
thematic typhus, scarlet fever, etc. But much is gained even
in those diseases in which severe and dangerous local lesions
exist, if we can succeed in allaying the danger arising from
the fever. For instance, Professor Liebermeister affirms that
very favorable results are furnished by the consistent use of
the cold water treatment in those severe forms of pneumonia
which are usually called typhoid, bilious or asthenic. Professor
Liebermeister has treated more than 200 eases of pneumonia in
this manner, and has employed cold baths in scarlatina, measles,
in the primary fever of small pox, in pleurisy, in puerperal fever,
and in meningitis cerebro spinal epidemica.
The temperature of the baths employed by Professor Lieber¬
meister is generally 20° 0. (08° F.), and only in hot summer
weather, or when from particular circumstances, a lower tem¬
perature is required, it may be restored by putting in pieces of
ice. The length of the bath amounts, as a rule, to ten minutes,
a much longer time is disagreeable to the patients and possibly
might be productive of injurious consequences. If a weak per¬
son be so affected by the bath that he continues shivering for a
long time afterward, or even collapses, it is advisable to limit
the duration to live or seven minutes. Such a short cold bath
is always more effective than a far longer continued bath.
Directly after the bath the patient must rest, for that purpose,
without being first dried, he must be wrapped up in a dry blan¬
ket, laid in bed, which may be somewhat warmed at its foot
end, lightly covered up, and, under certain circumstances,
should have a glass of wine given him, and only after some¬
time has elapsed should his night dress be put on. Cold
douches, as direct calometric examination shows, have much
less effect than cold baths of equal temperature and duration,
and are much more unpleasant to the patient. Cold packings
1870J
Jones — Treatment of Yellow Fever.
340
are generally well borne, even by the weakest patient, particu¬
larly if the feet and legs are left free. A series of three or
*0111' consecutive packings of from ten to twenty minutes each,
have about the same effect in cooling the body as a cold bath
of ten minutes duration. Local abstractions of heat by cold
applications, ice-bladders, etc., appear to have an essential in¬
fluence on the temperature of distant parts of the body. In a
healthy man, the bodily temperature becomes reduced by cold
drinks, swallowing ice, and by cold enemata, etc., and about
as much as corresponds to the quantity of warmth required for
warming the introduced material ; a regulated increase in
the production of heat does not take place, as in the cooling of
the external skin. This is a circumstance of essential significa¬
tion ; and if the general effect of such abstractions be not very
great, there is this advantage that there is no opposition to be
overcome, and no great demand is made on the system. If it
were possible to abstract large quantities of heat from the in¬
ternal organs, without causing much irritation, this would be
theoretically the most commendable form of refrigeration. The
proposition to wash out the intestinal mucous membrane for a
length of time with a constant stream of cold water, by means
of a double-action (esophageal tube carried far up the rectum,
one pipe of which should be put in communication with the
reservoir, appears worthy of trial.
Professor Liebermeister, whilst strenuously advocating the
preceding method of treating fevers, at the same time admits
that the extreme obstinacy of fever in many cases, which is
occasionally not to be overcome by the most persistent use of
baths, as well as the circumstance that many patients will not
bear a sufficiently frequent employment of them, renders it
necessary to use freely such remedies as quinine, digitalis, and
veratrurn, for the reduction of the temperature of the body.
During the yellow fever epidemic of 1.37.3, the effort was made
by several physicians to reduce the fever heat by cold water
baths, cold packings, and cold water sprinkling. We have no
reliable statistics, of the results of these imitations of the experi¬
ments of Currie and of the German hydropathists ; but as far
as my knowledge extends, they were not attended with favor-
350
Original Communications.
[September
able issues in comparison with other modes of treatment, and
were not to any extent adopted by the most experienced and
intelligent physicians. The heralding of some of these hydro¬
pathic experiments in the daily newspapers, as well as the
death of the New York physician, Ur. Kibbee, on his own fever
cot, under the process of water sprinkling , did not convince
either the profession or the public as to the value of such mea¬
sures in the treatment of yellow fever.
The objections to the employment of the hydropathic treat¬
ment in yellow fever are briefly these :
1st. The yellow fever poison induces rapid and profound alter¬
ations in the ultimate muscular fibres of the heart, causing
obliteration of the transverse striae, and granular and fatty
degeneration.
The pulse at the commencement of the attack is rapid and
full. The frequency of the pulse does not, however, as a gene¬
ral rule, continue to correspond with the elevation and oscilla¬
tions of temperature, as in many other febrile diseases ; and in
many cases of yellow fever, the remarkable phenomenon is wit¬
nessed of the pulse progressively decreasing in frequency, and
even descending below the normal standard, while the tempera¬
ture is maintained at an elevated degree; and on the other
hand, the pulse frequently increases in frequency, but diminishes
in force, near the fatal issue. The occurrence of copious haemor¬
rhage from the stomach or bowels may be attended with sudden
depression of temperature, and increase in frequency but dimin¬
ution in the force and fullness of the pulse. I have observed
cases in which, even in young persons, the pulse upon the 5th,
6th and 7th days of severe cases of yellow fever, has not ex¬
ceeded 36 beats per minute. I have also observed many cases
in which the pulse was intermittent, both during the active
stages and during the period of depression.
The remarkable progressive decrease in the beats of the
pulse after the first stage of yellow fever, appears to be due to
several causes ; as the anatomical changes in the heart (acute
fatty degeneration), and the retention in the blood of the bile
and urinary constituents.
1879 J Jones — Treatment of Yellow Fever. 351
It is well known that absolute rest in the recumbent position
is one of the most important indications in the treatment of
yellow fever ; it is also known to the experienced physician,
that rapid rises in temperature, sudden collapse, fatal syncope,
and profuse haemorrhage from the stomach and bowels and
wild delirium, coma and death, may be caused by the mere
removal of the patient from a private residence to the hospital,
or by the injudicious rising of the patient and getting out of
bed.
It appears, therefore, from these conditions of the heart, and
circulatory and nervous systems, that the cold water or hydro¬
pathic treatment is inappropriate and dangerous in yellow fever,
in that it necessitates frequent change of position and frequent
exertion.
2d. The kidneys are profoundly altered in many cases of
yellow fever, and many deaths are caused by the structural
alterations of these organs ; and in every case of yellow fever
there is a greater or less tendency to congestion of these organs
desquamation of the excretory cells, and the exudation of
albuminoid and granular matter.
The cold water, or hydropathic treatment, therefore, is inap¬
propriate and dangerous in yellow fever, in that it tends to in¬
duce fatal congestions of the kidneys.
I have seen some good results accomplished both in my
private and hospital practice, in cases of urinary suppression,
by the injection of large quantities of ice-cold water into the
rectum ; and this method, as well as swallowing fragments of
ice and sponging the surface of the body with cooling evapo¬
rating lotions, appear to be the measures best adopted to cool
the fever heat in yellow fever.
In order to reduce and control the febrile heat in yellow
fever, I relied chiefly upon early and free purgation, and the use
of quinine internally and externally (chiefly by the latter
method) veratrum viride, aconite, gelsemium sempervirens,
cold water and fragments of ice (ice-cold carbonic acid water,
Apollinaris water), frictions with olive oil, and such antizy-
motic agents as sulpho-carbolate of sodium.
2
352
Original Communications.
[September
10. ANTIZYMOTIC REMEDIES (SULPHO-CARBOLATE OF SODIUM,
ETC.) IN THE TREATMENT OF YELLOW FEVER.
The employment of such antiseptic remedies as sulphuret
(black sulphuret) of mercury, salicylic acid, creasote, carbolic
acid and sulpho-carbolate of sodium, should engage the atten¬
tion of the medical profession in the treatment of yellow fever.
1 shall coniine my observations to the last-named remedy. In
1873, I treated over 50 cases of yellow fever, and have the de¬
tails of the cases in which I employed the sulpho-carbolate of
sodium with apparent benelit.
From direct clinical observation, and from experiments on
animals, I was led to believe that the black vomit might, by its
decomposition in the stomach and re-absorption into the blood,
be one cause of death by septicaemia. I endeavored, therefore,
to modify and prevent these changes by the use of the sulpho-
carbolate of sodium ; and at that time (1873), three cases of
yellow fever attended with high temperature (105.5-107.5°)
and black vomit recovered under the use of this agent. The
sulpho-carbolate of sodium was employed in scruple and half
drachm doses every 4 to 0 or 8 hours. This treatment 1 found
to be especially adapted to severe cases, when the first stage
has been attended with high fever, and in which we infer from
the nausea and vomiting that black vomit will be an inevitable
result. During the recent epidemic of 1878, 1 employed the
sulpho-carbolate in near two hundred cases of yellow fever with
satisfactory results. It was administered in from 10 to 20 grains
in orange leaf tea every 4 hours, during the active febrile
stage. It is almost wholly tasteless, and in uo instance did I
observe it to produce any irritation of the stomach. The objec¬
tions to carbolic acid, that it has an unpleasant taste, and is
often irritating to the gastric mucous membrane, and that it
can be administered only in small doses, do not apply to the
sulpho-carbolate of sodium.
Dr. Sansom, by a series of well devised and carefully exe¬
cuted experiments, has established the fact that large doses of
the sodium sulpho-carbolate may be administered with impu¬
nity to both animals and man.
Dr. Sansom found that 20 grain doses of sodium sulpho-
carbolate could be readily administered to adults. So free
1879J
Jokes — Treatment of Yellow Ferer.
353
from taste was the solution, that many said that it seemed only
like water itself. The dose was increased in several cases to
<>() grains, administered every 4 hours. The only direct effect
noted, was a slight tendency to vertigo or dizziness. The odor
of carbolic acid could be readily detected in the breath. The
urine of a patient who had taken 300 grains of sodium sulpho-
carbolate in twenty-four hours, was collected and examined.
It presented no evidence of the presence of carbolic acid, but
contained a considerable quantity of sodium-sulphate. It
showed a marked tendency to resist putrefaction.
It would appear, therefore, that sodium sulpho-carbolate
administered to a living animal is rapidly absorbed and pro¬
jected throughout the system. In the blood, or the tissues, the
double salt is decomposed, the sodium sulphate being set free
in the tissues, and ultimately excreted by the kidneys: the
carbolic acid also liberated in the textures, eventually for the
most part escaping by the lungs. It is probable, also, that
some portion of the carbolic acid is eliminated by the urine. It
follows that the administration of sodium sulpho-carbolate is an
indirect means of administering carbolic acid; and inasmuch
as at least one-fourth of the weight of the sulpho-carbolate
employed consists of carbolic acid, we find that an amount
equalling from 15 to 90 grains per diem can be administered of
the latter. It is obvious that the direct administration of this
amount of carbolic acid would, from its nauseous character and
its difficulty of manipulation, be not readily accomplished ; and
there would be a danger of the toxic action of the latter being
manifest, a result which does not occur when the sulpho-carbo¬
late is administered. It is probable that in this latter case,
there is a gradual evolution of carbolic acid, which at no time
is in sufficient amount to manifest its poisonous action It is
possible that the sulpho-carbolate of sodium, administered in 5
grain doses (dissolved in water) three times a day, may prove
an efficient and valuable prophylactic during the prevalence of
yellow fever. Sodium sulpho-carbolate has been also adminis¬
tered with marked benefit in the treatment of ulcerative tonsil¬
litis, sloughing ulceration of the tonsils, scarlatina, erysipelas,
enteric fever and tuberculosis.
.”>54 Original Communications. [September
In 1857, Professor Polli, of Milan, introduced sulphurous
acid, and the sulphites and hyposulphites of the alkalies, and
alkaline earths, with the avowed object of withstanding the
internal decomposition occurring in zymotic diseases. These
agencies were regarded not as influencing septic agencies, but
as opposing the catalytic changes supposed to occur according
to Liebig’s theory of fermentation and zymosis. According to
Professor Polli, these salts do not act as poisons towards the
several morbific ferments. They do not kill the catalytic germs
of the organic poisons, but they re-act on the material compo¬
nents of our organism, rendering it by their presence incapable
of being acted on by these catalytic germs. The sulphite of
sodium was used during the epidemic yellow fever of 1878, as
a prophylactic, and also by some physicians in the direct treat¬
ment of the disease, but we have no data to show the relative
value of these measures.
It has also been proposed to employ in the treatment of yel¬
low fever, the Ethiop’s mineral (black sulphuret of mercury),
holding two agents, sulphur and mercury, which, since the
time of Valisneri, have always been regarded as the most
potent of parasiticides and germ destroyers, whether used in¬
ternally or applied externally. The black sulphuret of mer¬
cury may be given in doses' of from 12 to 50 grains, without
causing salivation, and as a prophylactic against cholera
plague and other contagious diseases the Italian physicians
recommend the Ethiop’s mineral daily, in the following doses :
for children 2 years, 1£ grains; 2 to 5 years, 2 grains ; 5 to 12
years, 3 grains ; 12 to 20 years, 3£ grains ; 20 years and up¬
wards, 4i grains.
11th. While local blood-letting may be beneficial in the first
stage, when practiced chiefly for the relief of local congestions
of the stomach and kidneys, general blood-letting is injurious
on account of its depressing effects upon the heart and nervous
system. Cut cups should be employed with caution, and in the
majority of cases they are unnecessary. I have, however, used
them with signal benefit in several cases after the supervention
of black vomit. In three cases of children during the epi¬
demic of 1878, in which I abstracted blood from the epigas¬
trium by cut cups, after the supervention of black vomit,
Jones — Treatment of Yellow Fever.
355
1879J
recovery took place; and I attributed the favorable issue
largely to the local abstraction of blood. In like manner the
local abstraction of blood has proved beneficial in congestions
of the kidneys and brain ; in the former case the cut cups or
leeches are applied to the back over the region of the kidneys,
and in the latter to the temples and back of the neck. During
the epidemic I always carried my cupping instruments with
me and applied them immediately with my own hands when
their use was indicated. The delay of one or more hours in
securing the services of a “ professional cupper f may prove
fatal. In most cases the circulation will best be influenced by
dry cups, sinapisms, and hot mustard foot baths.
Blood-letting, either in large or small quantities repeated at
intervals, is injurious, because it permanently reduces the
pulse, prostrates the powers of life, and quickens the fatal
termination.
12th. The employment of the mineral acids internally, as the
nitro-muriatic, from its supposed beneficial effects upon the
jaundice, as well as of the tincture of the sesquichloride of iron,
from its supposed power of arresting or preventing black vomit,
is of very doubtful propriety. If the view be correct that black
vomit is intimately associated with and even dependent upon
impairment, if not complete suppression of the functions of the
kidneys, and if, to a certain extent, it be an effort of nature to
relieve the blood of certain poisonous constituents, such agents
can have little or no remedial power, and they are in many
cases directly injurious by their irritant action upon the con¬
gested, irritated and softened gastric mucous membrane.
13th. Such stimulating diuretics as oil of turpentine, whether
used internally or externally, are dangerous, in that they may
cause fatal congestion of the kidneys, followed by uraemic
poisoning. On the other hand the spirits of nitric ether, and
the mild saline diuretics (we have already pointed out the value
of certain mineral waters), will prove in most cases beneficial.
A pleasant effervescing draught may be extemporaneously pre¬
pared as follows : If — Potassi bicarb., 3iij.; aquae destillatae, f ^iij.
b — Acidi citrici, 3ij.; aquae destillatae, f^iij. One tablespoonful
of each mixture, with two tablespoonfuls of ice cold water,
mingled together, every two, three or four hours.
356 Original Comnivnicaiions. [September
14th. Cantharides (blisters), should be used with judgment,
on account of their irritant effects (that is of the absorbed
cantharidin) upon the kidneys and urinary apparatus. In some
cases of black vomit, unaccompanied by urinary suppression, I
have derived benefit from blisters to the epigastrium; and also
in cases of great cerebral disturbance, they appeared to accom¬
plished some good when applied to the back of the neck.
L5th. The sudden fatal termination of many cases of yellow
fever, is to be referred chiefly to the suddeu arrest of the func¬
tion of the kidney; complete suppression of urine in yellow
fever, is of more fatal import, even than black vomit, which it
accompanies and precedes. In cases of suppression of urine
in yellow fever, the malpighian corpuscles and tubuli uriniferi
are filled with granular albuminoid matter, oil globules, and
detached epithelial cells. If the cassation of the excretion of
the urine was due simply to capillary congestion or defective
inervation, it might be met by appropriate remedies ; but the
results of my chemical and microscopical examinations have
placed in a clear light the reason of the impotency of all
measures heretofore proposed for the relief of this fatal
symptom.
I have in several cases of temporary suppression of urine in
yellow fever, restored the excretion by throwing large quan¬
tities of ice-cold water into the rectum. Ergot, either in the
form of the tincture or fluid extract, has been said to have
restored the excretion of urine, but this powerful agent has
failed in my hands. The subcutaneous injection of ergot and
ergotine, has been employed by several physicians for the
arrest of black vomit, and cases thus treated have been pub¬
lished in the daily newspapers and in the medical journals, and
recovery in these cases was referred to the effects of ergot, used
by subcutaneous injection. It is well known that iu this epi¬
demic as in preceding epidemics, numbers of cases of yellow
fever, with black vomit, have recovered under various modes of
treatment. Thus, I have seen the black vomit arrested in some
cases by cut cups, in others by the ice bag to the epigastrium ;
iu others again by the following prescriptions: li. Calcis carb.
precip. 3iij.; pulv. gum aeaei;e3ij.; aquae destillatae f^iij. Mix.:
tablespoonful every half hour. ft. Calcis carb. precip. 3iij ;
Jones — Treatment of Yellow Fever.
357
1879]
kreasote Til xxx j emulsion gum acaciae ffiv. Mix. Sig. Table¬
spoonful every two or three hours.
We frequently observe the change in the color of the black
vomit from the dark brown and black to the florid hue, from
the neutralization of the acid of the gastric juice by the car¬
bonate of lime.
16th. The maintenance of free ventilation, and at the same
time, the avoidance by proper coverings of sudden changes of
temperature.
1 have shown by numerous careful analysis of the urine, and
by microscopical examinations of the kidneys after death, that
in fatal cases, the lesion of these organs is profound. The
results of these investigations afford an explanation of the
fact that sudden changes or depressions of temperature often
cause sudden and fatal changes in cases of yellow fever.
By sudden depressions of temperature, the function of the skin
is diminished or arrested, internal congestions promoted and
augmented in the enfeebled state of the circulatory and ner¬
vous systems which characterize the second stage of calm and
depression, and the already crippled kidneys have an addi¬
tional amount of work thrown upon them, while at the same
time they are still further incapacitated for the performance of
this work by the increased congestion.
17th. While opium and its preparations may in certain cases
attended with sleeplessness and great restlessness in the first
stage, produce fa vorable results, at the same time they possess
no power of arresting or curing the disease, and should be
used with great caution, as they may act with great energy and
even poisonous effects when the function of the kidneys is
impaired or arrested. This observation applies equally whether
opiates be administered by the mouth or by subeutaneons in¬
jection. The effect of yellow fever on the system is to make it
sensitive to narcotics. Even when yellow fever attacks those
who are suffering with delirium tremens, they lose their toler¬
ance for narcotics. Daniel Blair has well said that the injury
frequently arising from the use of morphia is chiefly due to its
action on the. secretions of the kidneys; it impairs their func¬
tion, *ud when the march of symptoms is already verging on
that of uremic suppression, although the tranquilizing effects
358 Original Communications. [September
of the drug may be pleasant for the time and well marked, it
indirectly induces head symptoms and adds to the uremic poi
soiling, 'flie rule therefore would be not to give it where there
is suppression or tendency to suppression.
As a general rule, suppression of the urinary secretion is
speedily followed by restlessness, delirium and coma, and, in
some cases, convulsions. It is folly to expect any good results
from sedatives and the various preparations of opium in such
cases. Counter irritants to the surface, cut cups and the pro¬
longed use of warm baths are the measures which promise the
most good.
18th. Transf usion of blood suggests itself as a measure to be
considered in the second stage of yellow fever in extreme cases,
where the issue appears to depend mainly upon the prolonga¬
tion of the struggle.
When we consider the history of trausfusion of blood and
saline solutions, the doubtful nature of the results, and the
dangers of the operation; and farther, that favorable cases of
yellow fever recover rapidly; no one would feel justified in per¬
forming transfusion, except in extreme cases.
When we consider still farther the nature of the lesions in
severe cases, the dilated and enfeebled capillaries, the weak
circulation, degenerated, flabby, feeble acting heart, the con¬
gested gastric mucous membrane, the fatty degeneration of the
liver, the congested and altered condition of the kidneys, the
defibrinated blood, loaded with urea and bile, and the passive
haemorrhages resulting from capillary congestion and defibrin¬
ation of the blood, it is impossible to conceive in what manner
any benefit could arise from the injection into the blood vessel
system of saline solutions or of fresh blood.
19th. The maintenance, as far as possible, of absolute rest
in the recumbent posture. This precaution appears to be indi¬
cated by the results of experience, as well as by the lesions of
the heart, which L have shown by careful post-mortem exami¬
nations to be characteristic of this disease.
The central organ of the circulation is structurally altered and
enfeebled in yellow fever. The muscular structures of the heart
present alterations similar to those observed in the liver and
kidneys.
1879J Jones — Treatment of Yellow Fever. 359
Oil and granular albuminoid matter is deposited within and
around the muscular fibril lee. and the organ after death pre¬
sents a yellow, flabby appearance. In some cases, time is re¬
quired for the restoration of its free and vigorous action, and
this result is impossible without absolute and continuous rest
in the recumbent position.
Every case of yellow fever should be regarded as serious , however
slight the symptoms may appear ; and on account of the profound
structural alterations of the heart , liver and kidneys, and the pro-
found alterations of the blood , the closest medical attendance and
the most caref ul nursing are demanded.
20th. After the subsidence of the fever, the diet and drink
should still be restricted to articles of the blandest and lightest
description, administered at regular intervals in small quan¬
tities. A careful guard should be kept against the commission
of any indiscretion in eating or drinking, or sitting up in bed,
on the part of the patient, and against the officious interference
of friends in such matters. The food should consist chiefly of
beef tea, chicken tea, arrow root, sago, milk and barley water,
and when the stomach is at all irritable these should be taken
in minute quantities at a time. The same rule applies to drinks
of all kinds, as the patients are generally greedy for large-
draughts of fluids. By sucking liquids through a glass tube
of small bore, or by administering them by tea or tablespoons-
ful, they are much more likely to be retained.
When wines, or brandy or whisky are used, the greatest
care should be exercised as to their freedom from impurities.
Moderate quantities of the best hock, champagne, or weak
brandy and water, well cooled, may be used with benefit in
some cases.
If the disease ceases with this stage, the same carefulness
must be extended to the period of convalescence. If aperients
are required, the effervescing powder, the carbonate and sul¬
phates of magnesia, separately or in combination, may be
administered internally, or the bowels may be kept open by
saline enema. When there is evidence of excess of acid
in the stomach, the bicarbonate of soda in combination with ni¬
trate of potash, may be used in from five to ten grains at a
3
360 Original Communications. [September
dose, and the practitioner should be careful not to introduce
an excess of alkali.
When the mucous surfaces, as indicated by the tongue, are
denuded of epithelium, the use of gum-water may be beneficial
by lubricating and soothing the raw surfaces.
Even when black vomit appears, although the chances of
life are fearfully diminished, the physician must not abandon
his patient, and even in this stage the disease may be curable.
This has been accomplished in some cases by vigilantly watch¬
ing the symptoms and mitigating them, and by sustaining and
husbanding the general powers of life. I have seen a mitiga¬
tion of the emesis by the internal use of the sulpho-carbolate
of sodium, creasote and carbonate of bine in mucilage. Dry
cups, sinipisms, and the ice-bag have proved useful for the re¬
lief of epigastric tenderness and vomiting. Blisters, leeches,
and cut cups should be avoided in this stage, as they tend to
depress the already exhausted powers.
21st. If intermittent or remittent fever supervenes, as it
does in many cases of yellow fever occurring in highly malarious
regions, the remedies applicable to paroxysmal fevers, espe¬
cially quinine, bark, iron and arsenic, and strychnia should be
employed.
If swellings and abscesses and carbuncles arise after the
cessation of the active stages of the disease, and thus continue
the febrile excitement ; as soon as the stomach regains sufii-
cient power, the bitter tonics and tincture of iron and quinine
should be freely used internally, and iodine and carbolic acid
and tannic acid applied locally. In these cases, which are often
protracted for weeks and months, the diet should be of the
most nutritious character, with a liberal supply of porter and
ale. The contents of abscesses should be discharged at the
earliest moment.
The following is a brief outline of the plan of treatment
based upon the preceding principles, which I carried out dur¬
ing the epidemic yellow fever of 1878, in New Orleans :
The total number of cases treated in my private practice was
256; total deaths 18. One death in 14.2 cases. Mortality 7.0
per cent. Of 256 cases 238 recovered, giving a per cent, of
93.35 recoveries.
1879] Jones — Treatment of Yellow Fever. 30i
1st. If there was any reason to suppose that the stomach
contained undigested food, it was immediately evacuated by an
emetic. Powdered ipecacuanha root, mixed with warm water,
was most generally employed.
2d. The bowels were freely evacuated as early as possible.
To accomplish this end, and also at the same time to induce an
impression upon the system by quinine, from 10 to 20 grains
each of quinine and calomel were administered to adults, and
followed with a full dose of castor oil (oleum ricini), in doses
of from half an ounce to one ounce for an adult.
3d. The action of the skin was excited by the use of the hot
mustard foot bath, and mild diuretics as orange leaf tea and
by frictions of fresh olive oil.
4th. The function of the kidneys was maintained by the
regular use of cold water and Apollinaris water ; by attention
to the covering of the patient and avoidance of cold draughts.
5th. Absolute rest, in a well ventilated room, with absence
of noise and excitement, and with careful nursing night and
day.
6th. The patients were confined to barley water duringjjthe
period of febrile excitement.
7th. The patients were not allowed to rise from the bed upon
any pretext whatever. The medicines and drinks and nourish¬
ment were administered by means of the sick cup. Whether
the case was mild or severe, the patient was required to remain
quietly in bed from eight to fourteen days, and even longer in
severe cases.
8th. In many cases, especially in adult natives of New Or¬
leans, these measures rigidly enforced were sufficient.
9th. When the initial temperature was high and the pulse
rapid, such antipyretic and antizymotic remedies were used as
tincture veratrum viride, 2 to 4 drops In orange leaf tea, every
two or four hours; frictions with quinine liniment, composed
of from one to two drachms of the sulphate of quinia, mixed
with three fluid ounces each of soap linament and olive oil ;
sulpho-carbolate of sodium, 10 grains in orange leaf tea every
4 hours.
10th. Cold applications to the head, sedative water, vinegar
and water, whisky and water, and cloths saturated in cold
362 Original Communications. [September
water, were freely used when there was heat about the head
and nervous irritability.
11th. Gastric irritation was treated by sinapisms to the epi¬
gastrium, cold applications, and in some cases cut cups, and
carbonate of lime (precipitated) administered internally.
12th. As a general rule, the use of opiates and chloral was
discarded. In some cases, however, attended with great nerv¬
ous excitement, and unattended by urinary suppression, these
agents were employed, and apparently with benefit.
13th. When the kidneys were involved seriously, and the
urine diminished in amount, cut cups were applied to the loins,
followed by flaxseed poultices. Bromide of potassium in such
cases appeared to increase the flow of urine, and at the same
time to quiet the nervous system.
14th. After the subsidence of the febrile excitement, iced
champagne and beef tea were administered in small quantities
at regular intervals.
In typhoid cases attended with tympanitic bowels, ice cold
enemas, containing small quantities of tincture of assafcetida
and oil of turpentine, were found to be beneficial. It was also
found that in some cases large enema of ice cold water not
merely reduced the febrile heat, stimulated the bowels to expel
the gaseous accumulations, but also promoted the action of the
kidneys.
15th. When secondary fever ensued, and presented an inter¬
mittent or remittent type, the sulphate and bromide of quinia
were freely used, and when the stomach would tolerate nourish¬
ment and stimulants, beef tea, chicken tea, and tender beef
steak, and good port wine and brandy, and whisky were
administered.
16th. When carbuncles and abscesses supervened, and pro¬
longed convalescence and endangered the life of the patient,
the tincture of iron, quinine, the mineral acids and bitter tonics,
with alcoholic stimulants, were freely used, together with nutri¬
tious diet, and the local application of carbolic acid, tincture of
iodine, tannic acid and tincture of opium.
17th. Be lapses were avoided by confining the patient to bed
until the heart had regained its usual vigor, and by strict
attention to diet of a simple but nutritious kind.
363
1879] Friedrichs — Influence of Diseased Teeth.
18th. Each case was carefully studied ; accurate records of
the temperature and pulse, aud of the symptoms and treatment,
were preserved, and the treatment directed accordingly. It
was my experience that the careful recording of the symptoms,
once, twice, and even three times daily, not merely aided the
physician in the most effective manner, but also established a
quiet and most valuable confidence on the part of the patient
and his attendants.
In concluding these Clinical Lectures on the Yellow Fever
Epidemic of 1878, whilst expressing my appreciation of the
diligent attention of the students of the Medical Department of
the University of Louisiana, 1 desire also to express to my pu¬
pils, my thanks to my kind friends and skillful physicians and
surgeons, Dr. A. Foster Axson, Dr. Joseph T. Scott, and Pro¬
fessor Samuel Logan, M.D., of New Orleans, Louisiana, and
Professor Henry F. Campbell, M.D., Professor L. A. Dugas,
M.D., L.L.D., and Professor Lewis I). Foard, M.D., L.L.I)., of
Augusta, Georgia.
The Influence of Diseased Teeth Upon the General System.
By A. G. FRIEDRICHS, M.D.
1 have chosen the above subject because, in the practice of
my specialty, I have frequently come across cases of aggravated
diseases, arising from neglect due to the ignorance of medical
advice ; and believe that the time has now arrived when prac¬
titioners of medicine should fully comprehend the importance
of the teeth, and appreciate their influence, when diseased,
upon the adjacent parts, and upon the general system.
Teeth should not be looked upon as mere pegs or nails in¬
serted into living structure, but as organs having the most im¬
portant relationship to the whole system; there hardly being a
period in life that a knowledge concerning their growth and
development would not be of some service to us in our practice,
and I think if we, professional men, would devote a very small
portion of our time to their study, we would thereby be render¬
ing ourselves a future benefit.
304 Original Communications. [September
Consider with me, for an instant, liow they are supplied with
nerves, their attendant ganglia and plexuses, their position in
the maxillary bones (on each side of the oral cavity), their re¬
lationship to the antrum which is again in contiguity to the
nasal fossae. The posterior lower molars are but little removed
from the tonsils, Eustachian tubes, the parotid region and the
external and internal ear. The roots of the upper back teeth
are near to the orbit and its important contents ; more poste¬
riorly they approach the spheno-m axillary fossa and fissure, all
of whicli are frequently the seats of dental disease.
The gums and teeth, very often, are valuable aids as a
means of diagnosis in hereditary sylphilis, scrofula and the
various pathological conditions of the gastro-intestinal-mucous
canal.
During dentition, a period so fraught with danger, that seven
per cent, of the deaths are ascribed to teething. We can fully
appreciate this, when we consider at this epoch, how much the
spinal predominates over the cerebral system, when the slight¬
est irritation could produce the most fatal results ; for, that
which causes a shudder in man, would very likely throw an
infant into convulsions.
The symptoms of dental irritation may then be and fre¬
quently are confounded with congestion or inflamation of the
brain ; and full well we know what would likely be the result
of a failure in a correct diagnosis.
1 will mention a few of the maladies which are dependent
upon or synchronous with the eruptive period, to-wit : cholera
infantum, diarrhoea, constipation, increase or decraase of urine,
convulsions, transient palsy of the arms and legs, insomnia,
marasmus, etc.
The foregoing suggests to me the propriety of drawing your
attention to that favorite method of treatment for actual or
supposed dental irritation. I mean that of gum lancing. There
is no doubt that the gums have been frequently lanced during
the period of repose which characterizes evolution or when the
osseous structure of the maxilla still remains unabsorbed
over the advancing tooth. A great many physicians perform
this operation indiscriminately, simply because they happened
to stumble over a case where the relief of tension in the con-
1870] Friedrichs — Influence of Diseased Teeth. 365
gested tissue sufficed to relieve an attack of convulsions. The
only time when the incision of the parts can be productive of
any benefit is when the tooth is just beneath the gum and there
is a manifest congestion ; otherwise it is a procedure not only
useless, but barbaric.
Retardation in the development of teeth is also a means of
indicating future disease. For example, when their eruption
is delayed beyond nine months, there is every reason to sus¬
pect that the child is suffering from rickets — a valuable means
of diagnosing that disease, for which we are indebted to Sir
William Jenner.
1 will now mention some of those diseases connected with the
teeth which occur at a latter period of life.
There is no affection that is of greater importance to us than
neuralgia ; certainly none more annoying to our patients.
Suppose we call to mind the extensive sympathetic connec¬
tions of the tri-geminal nerve ; it will not be strange to us that
any portion of the face, neck, throat, or any of the associated
parts that are supplied by the nerve itself or any of its related
nerves, should be the seat of reflex trouble from a diseased
tooth.
But recently a gentleman came to my office, who was suffer¬
ing from a most agonizing pain shooting from the orbit of one
side, across the forehead, to the other.
This neuralgia had continued for two months, during which
time lie had had hardly any rest, had eaten hardly anything,
and when T saw him, was quite emaciated. Tie had been under
the treatment of physicians, quacks, homoeopaths and a hydro-
path, but with no relief. Tie never complained of the slightest
pain from his teeth; but however, in examining his mouth for
a cause, I discovered a semi decayed dead posterior superior
bicuspid, with no connection between the cavity of decay and
the pulp cavity. With a spear-shaped drill I established a con¬
nection between the two cavities, and relief instantly followed.
The cause of this neuralgia was the compression of the gases
evolved from the decomposing pulp upon the dental nerve.
Dr. Johnston speaks of a case of a well known physician who
was forced to relinquish an extensive practice, as a consequence
366 Original Communications. [September
of a tie, douloureux caused by an osseous excrescence growing
from the dental wall.
Dr. Emmeuch reports a case wherein a man consulted him
on account of a painful affection of his eye, which had lasted
fourteen years and occasioned great suffering. There was con¬
siderable vascularity of the conjunctiva and scloritica, espe¬
cially around the cornea, which structure itself was somewhat
opaque and spotted. There was a cbntinual flow of tears with
pain and intolerance to light. All these symptoms were
aggravated by any indiscretion in diet, or by the use of the
slightest stimulant, such as a glass of wine. All kinds of reme¬
dies had been tried iu vain at different times, and the affliction
seemed incurable.
Dr. E. upon examining the upper jaw, discovered an ex¬
tremely sensitive carious tooth in the side corresponding to the
afflicted eye. The tooth was extracted, and immediately after¬
wards the eye-symptoms subsided.
The affection of the eye evidently was the result of sympathy
between the second and third branches of the fifth pair of
nerves.
Dr. Trudeau, of Paris, mentions an instance where insanity
was caused by a diseased tooth. He says : u Mr. Equirol told
me he had cured a young lady who was insane, of her mania, by
the extraction of a second molar tooth which was preventing
the growth of a wisdom tooth.”
Epilepsy has resulted from dental irritation.
u Sometime in the year 1801,” says Dr. Rush, u 1 was consulted
by the father of a young geutleman in Baltimore, who had
been affected with epilepsy. I inquired into the state of his
teeth, and was informed that several of them in his upper jaw
were very much decayed.
“ 1 directed them to be extracted, and’ad vised him, after¬
wards, to lose a few ounces of blood at any time when he felt
the premonitory symptoms of a recurrence of his fits. He fol¬
lowed my advice, and, in consequence of which, I had, lately,
the pleasure of hearing from his brother, that he was com¬
pletely cured.”
Likewise, general paralysis has been brought on by the same
Friedrichs — Influence of Diseased Teeth.
307
1879 1
cause. I will cite a case reported in the London Lancet , by J.
L. Levison, of Brighton.
A young lady was broughr to his residence, in a carriage, to
have her mouth examined. On being removed, site was sup¬
ported on one side by a lady ami on the other by a man-ser¬
vant. Her entire muscular system seemed paralyzed. Her
legs trailed on the ground like useless appendages. Her arms,
when raised, fell powerless immediately when unsupported.
Even the muscles of her tongue were paralyzed, and in her
effort to speak this important organ remained in a quiescent
state.
On examining the mouth a dens sapientiie of the lower jaw,
very carious and deeply imbedded in the temporal muscle just
below eoronoid process, was perceived, and in which locality
there was an extensive inflammation.
Extraction was suggested, and though some advantage was
anticipated, the actual result was surprising.
She instantly obtained the free use of her tongue which she
immediately used to communicate the important fact that ever
since the extracted tooth had been forcing its way through the
gums she could date the gradual loss of power over her limbs.
One month after the complete use of her limbs was restored.
About two months ago, a case similar to the above came
under my observation presenting all the paralytic symptoms
except that of the tongue. She had likewise been a sufferer
for sevejal years, during which time, being a lady of means,
she had availed herself of the services of gentlemen of recog
nized ability, both of this city and elsewhere, whose* efforts,
however, failed to afford any relief or arrest the progress of
the malady.
Upon an examination of the mouth, the teeth were diagnosed
as the source of the trouble. All of those organs in the supe¬
rior maxilla were found in a very carious condition and the
gums surrounding them were very much inflamed. Puss ex¬
uded from them, upon the slightest pressure.
Extraction was recommended, which operation performed,
recovery, both rapid and complete ensued.
. 4 •... ... # . . , . .
368 Original Communication a. [ September
Sir Asliley Cooper speaks of hemiplegia being cured by the
extraction of a tooth.
Catalepsy has resulted from toothache. A ploughboy, who
had complained of toothache in the morning, half an hour
after commencing work, was found lying a short distance from
his plough, apparently dead. He was carried home and a
physician sent for, who, after a careful examination, concluded
that the affection must have been produced through the dental
nerve. The tooth was extracted and the boy immediately got
up and expressed himself as well as ever.
Dental abscesses have frequently been mistaken for scrofula.
L positively kuow.of a case of this kind being diagnosed as a
cancer by a prominent surgeon of this city. This gentleman
referred this patient to live other surgeons, so positive was he
in this belief. All but one confirmed his diagnosis. The dis¬
senting one advised her to see her dentist and ask his advice.
The patient’s mouth was examined. An impacted root was
found, which was extracted. In one month, all vestiges of this
supposed cancer had entirely disappeared.
There is a case of pyienna caused by dental abscess, which is
very interesting, and I will report it in detail.
“M. C. W.,aged four years and a half, was admitted to Guy’s
hospital, under the care of Mr. Howse, on September 30, 1874.
“ The family history was good, except that there was some
account of a tumor in the grandmother. The child had been a
healthy boy till six weeks before his admission, when he came
home from school with a bad attack of diarrhoea. A few days
subsequently, he was much frightened by a fire, and it was
within a short time of this that his left eye was noticed to
swell. In a fortnight the other eye did the same, but no notice
was taken of it. He gradually grew worse, and for three
weeks prior to his admission, he was in a drowsy state.
u On admission, he was delicate and vacant looking. The left
eye was much more prominent than the right, with thickening
along the upper margin of the orbit. Beneath the edge, under
the eyelid, was a hard, cartilaginous, freely-movable body,
which reached backwards apparently into the orbital cavity
above the eyeball, while it extended downwards into the eyelid.
The movements of the eyeballs were perfect, and sight was uu-
Fkiedrichs — Influence of Diseased Teeth.
309
1879J
affected. The temperature was 104.5° in the morning, and
102.7° in the evening ; pulse 100.
“He was seen by Dr. Fagge, who could discover no cause for
the elevation of temperature. Dr. Fagge thought, however,
that as the roof of each orbit was evidently affected, and the
boy tottered as he walked, and was peculiarly torpid, the dis¬
ease, whatever it was, had extended from the orbital fossae’ to
the cerebral hemisphere. The ophthalmoscope revealed only
large and tortuous veins, with a small haemorrhage on the
outer margin of the right optic disc. The temperature re¬
mained high, and he rapidly became much worse, losing con¬
trol over his evacuations, and he died nine days after admission.
“The autopsy being held, the eyeballs were hardly prominent,
but the left upper lid was full, and a hard, movable mass could
be felt along the orbital ridge. The scalp was normal, and
nothing wrong was noticed till, on the removal of the vault of
the skull, the dura mater in its frontal part, and the longitudi¬
nal sinus for half its length, were rough and of an olive green
color from purulent infiltration of the membrane. The corres¬
ponding inner surface of the skull was of the same greenish
tint and rough all over, partly from the deposition of a layer of
new bone, partly from an irregularly excavating caries. Con¬
fining the description still to the bones of the skull, nothing
further was noticed till the roof of each orbit had been removed,
and then a thick layer of similar green-colored pus was exposed,
lying, of course, between the bone and the orbital periosteum.
The orbital cavities (muscles, etc.) were quite healthy. On the
right side the pus extended all over the outer side forwards, and
appeared externally over the superciliary ridge, while it passed
backward through the optic foramen and sphenoidal fissure
underneath the cavernous sinus, across the stella sturcica and
grooves for the optic commissure, through the right optic for¬
amen and right sphenoidal fissure, all this benentli the dura
mater of the base of the skull, the bone itself being rough and
carious, and part of the body of sphenoid infiltrated with a
gruinous, chocolate colored pus. Thus it appeared the right
orbit had become affected after the left. On the outer side of
the left orbit pus was traced into the spheno-m axillary fossa,
and thence to the condyle of the lower jaw. The articulation
370 Original Communications. [September
was free, but the whole of the condyle and much of the ascend¬
ing ramus on this side was bared of its periosteum, and pus
lined the inferior dental canal as far as the first molar tooth,
which was decayed, lying loose in its socket, and with carious
bone about it. It should also be said that, though the pus so
closely surrounded the cavernous sinus on each side, yet these
sinuses were quite unobstructed. So also was the longitudinal
sinus, though its walls were very much thickened. The frontal
sinuses were normal. The lump felt during life over the left
superciliary ridge consisted of a tough, opaque, yellow mass,
very much like some lymphomata as seen in the neck, or like a
gummatous mass. It certainly had all the microscopic appear¬
ances of some new growth, but, after further examination, it
was evidently of an inflammatory nature. Its precise situtaion
was from the lachrymal externally to the inner margin of the
orbital ring, and it lay half protruding from and half within
the orbit, and adherent to the bone, which on its removal was
bare of periosteum.
The brain weighed forty-eight ounces, and lymph was found
at its base, and a dot or two of pus was found beneath the
arachnoid on the left side, about an inch from the longitudinal
fissure. None of the veins contained any coagula. The brain was
exceedingly soft, and the number of small cavities formed by
softened substance scattered throughout it was remarkable.
The whole brain, cerebrum and cerebellum, was studded. Most
of them were small — mere pin-points— but one or two were
larger; and they had this peculiarity: that their walls were
sufficiently well defined and hard to show that they were not
formed by a general softening of the brain, more advanced at
some parts than others, but that they were really due to num¬
berless local spots of disease, very probably embolic. Ecchy-
moses were found in the aretinie, on the plurse and in the sub¬
stance of the lungs, heart and kidneys ; but no emboli could be
found in the vessels. The lungs contained early pyjemic infarcts,
and there were early abscesses in the heart and kidneys.”
u There can be no doubt, from the post-mortem appearances,
that the source or all this mischief was a decayed tooth. It
had led to caries of the bone, to suppuration in the inferior
dental canal, and thence the pus had followed the course
1S7DJ Friedrichs — Influence of Diseased Teeth. 37i
which has been described. It is a good illustration of the bad
results which may follow a slight amount of mischief in an un¬
healthy subject, and is remarkable in that there is no history
of toothache, swelling or other trouble about the jaws. Ex¬
cepting a bad attack of diarrhoea, the first symptoms noticed
was swelling, first of one eye, and then of the other. Notwith¬
standing that, by the time the second eye was effected, as
shown by the inspection, there must have been considerable
suppuration at the base of the skull, about pituitary fossa, and
very probably about the vault also, the disease at its onset
must have been peculiarly insiduous, and the pyannia of late
accession, within a few days of his admission.
In one of the numbers of the “ Bibliotheque Germanica
Schurgical,” there is an account by Dr. Seibold of a young
woman who had been affected for several months with great
inflammation, pain and ulcers in her right upper and lower jaws
at the usual time for the appearance of her catemenia, which
were always deficient in quantity. On inspecting the seat of
trouble, the doctor found two decayed molar teeth, which he
directed to have drawn, in consequence of which, the patient
was relieved of the monthly disease of the mouth, and ever
afterwards had a regular discharge of her catemenia.
Amaurosis has been known to have been produced by the
over-crowding of teeth in the maxilla*.
Even sciatica has been said to have been cured by the ex¬
traction of a tooth.
A great many of the tumors of the maxillae, from a simple
absess to an odontome, have their origin in a diseased or im¬
pacted root which, if only recognized in their incipiency, how
easily could the remedy be applied and the disease cured !
These facts, though but little attended to, should not sur¬
prise us when we recollect how often the most distressing dis¬
eases are brought, by very inconsiderable inlets of morbid ex¬
citement, into the system. A small tumor, concealed in the
fleshy part of the leg, has been known to bring on epilepsy. A
trifling wound with a splinter or a nail, even after it has
healed, has often induced a fatal tetanus. Stone in the kidney
has excited the most violent commotions in every part of the
system. Certain mental states affect certain functions in cer-
372 Original Communications. [September
tain definite ways. Sudden anxiety may cause increase of
peristaltic action, and joy diminish the gastric secretions, and
cause a loss of appetite.
Hundreds of facts of a similar nature are to be found in the
medical records.
Is it surprising then that the teeth should often be the un¬
suspected cause of general and particularly of nervous dis¬
eases ? Consider how often the teeth are exposed to irritation
from hot and cold drinks and ailments of all kinds. What mor¬
bid effects would likely arise from the putrid and acrid dis¬
charges from decayed teeth and diseased gums, when intro¬
duced into the stomach. I may also add what influence these
organs have upon perfect mastication, when in a pathological
condition ; and, again, the connection of mastication with good
health !
Imperfect digestion must follow, and you rarely find a person
whose teeth are in a diseased condition who is not a sufferer
from dyspepsia — a disease which daily baffles the efforts of the
doctor to cure, and few there are who have not experienced the
sensations so graphically described by Cowper :
“I awake like a toad out of Acheron,
Covered with the ooze and slime of melancholy.”
It is not strange that diseased teeth should produce dys¬
pepsia. It is easily accounted for. In the first place, the food
is improperly prepared for the stomach ; secondly, the fluids of
the mouth, constantly trickling into the stomach, impair its
tone and vitiate its solvent secretions ; and thirdly, a continual
demand made upon the system by the vain efforts which nature
makes to cure the diseases of the teeth, and also the frequent
and severe pain diminish the nervous influence which the
stomach receives, and impairs its powers.
Now I have no doubt that our success in the treatment of a
great many, if not all chronic diseases, would be greatly pro¬
moted if we would only direct our inquiries to the condition of
our patient’s teeth — advising their treatment when diseased.
It is not necessary that there should be the slightest pain, or
even one symptom that would attract our attention to the
offending organ. Splinters and tumors and other irritations
have caused disease and death, and were unsuspected as the
373
1879] Friedrichs — Influence of Diseased Teeth.
cause. Translation of sensation and motion from parts affected
to parts remote seems to be an original law in the animal
economy.
All this is not an issue of yesterday. Tissot, who wrote
nearly a century ago, was fully aware, from observation and
clinical experience, of the great importance of diseased teeth to
the general health. He described toothache as resulting from
gout and rheumatism — as producing disorders of the stomach
and noxious matters, which, according to the pathology of his
time, was the mode of expressing what we mean by constitu¬
tional disorders.
It also must not be forgotten that the teeth are often made
the fools for the other organs. They are just as liable to be
the objects of sympathetic irritation, and in the absence of
adequate knowledge as to the cause of pain, have been con¬
demned for the faults of their fellow-organs.
Toothache has resulted from constipation of the bowels.
Grout is frequently ushered in with the most terrific dental
suffering. Dr. Cartwright speaks of a gentleman suffering
from hemorrhoids, wiio always had au acute pain in his upper
molar teeth, but which invariably ceased when a hemorrhage
relieved the engorged vessels.
The foregoing cases are but a few of the great number that
might be collected, showing the importance of the teeth, in
healthy and unhealthy conditions, to the welfare of the whole
system.
They will certainly be sufficient to arouse the physician to
the necessity of regarding the agency of these organs when
diseased, in the production and continuance of disease.
It is nevertheless strange that physicians have paid so little
attention to so important a subject, when such men as Hunter,
liusli, Darwin, Halford, Chapman, Grandson, and many others
have taken special pains to call the attention to its importance ;
but more than that, they have gone unheeded.
In our recent text-books, this subject is barely mentioned.
I can see no other reason than that the teeth are objects that
are visible to the naked eye, and on that account were consid¬
ered as undeserving of notice. Were they but microscopical
374 Original Communications. [September
objects, they doubtlessly would have received their due con¬
sideration.
Unfortunately it has become the fashion to study pathology
more in the dead-house upon the cadaver, than in the sick
room at the bed-side.
While I am upon this subject, 1 cannot refrain, before con¬
cluding, from mentioning what stupidity some medical men
display when asked by their patients to select for them a dental
operator. They must consider one man as equally as capable
as another, or they do not fully comprehend wliat irreparable
damage may be done by an ignoramus. 1 frequently see, at
my office, patients who have been recommended to well-known
quacks who had put the former’s teeth in the most deplorable
condition, and, in some instance, beyond redemption.
Certainly cases of this kind reflect most increditably upon the
intelligence of medical men who should hav e known better.
They not only have betrayed the trust confided to their judg¬
ment, but caused unnecessary pain to be indicted ; had the
system put in a condition less resistable to disease and aggra¬
vated existing maladies conspired, in a manner to rob the un¬
suspecting one both of time and money, and finally lowered
themselves in the estimation of their clients, of their confreres,
and of all men who have any appreciation of decency and self-
respect.
Allow me to ask, would any respectable physician think — ay,
ever dream of sending their patients to any but a competent
and reliable oculist or surgeon ? Then, with due defference to
suffering humanity, the physician should consider it his
bounded duty to select none but proficient, trustworthy and
skillful oral surgeons.
In conclusion I fully coincide with Dr. Fitch, who rightly and
ably remarks : u We are not to contemn the diseases of the
teeth, because they seem insignificant. Many persons are
formed of a fibre so fragile as to be broken by the slightest
shock; of a stamina so delicate, as to be affected by the slight¬
est impression. Disease in its steps at first is, as it were, soft and
hesitating, weak in its powers, and slow in it progress. But
every instance of indulgence, and each succeeding advantage
gained, confirms its step, increases -powers and hastens its
1879] Holt — Yellow Fever in New Orleans during 1879. 375
progress, and what but a moment ago seemed a thing too insig¬
nificant to mention, now rises a monster that derides human
effort and whose sting is the arrow of death.
“Almost inappreciable are the beginnings of many fatal
diseases ; and could the grave reveal its secrets, I have not a
doubt, when I consider the number of diseases produced by
diseased teeth, that it would be found that thousands are there
in whom the first fatal impulse was given by a diseased state
of these organs ; and could I raise my voice so as to be heard
by every medical man in America, I would say to them : attend
to your patient’s teeeth, and if they are diseased, direct such
remedies as shall restore them to health ; and if in health, such
means as shall keep them so.”
The Chain of Circumstances connected with the Appear¬
ance of Yellow Fever in New Orleans during the
Summer of 1879.
By JOSEPH HOLT, M.D., New Orleans, La., August 2, 1879.
Mr. President and Gentlemen of the New Orleans Medical and
Surgical Association :
Impressed with the peculiar and unfortunate experience,
almost invariably associated with the history of the many out¬
breaks of yellow fever in this city, the uncertainty concerning
the locality of the first cases and precise date of their occur¬
rence, the source or origin of the disease, whether imported
or indigenous, and remembering with regret the diversity of
opinion in relation to these particular points which has repeat¬
edly given rise to protracted and wearying discussions, some¬
times unamiable, even rancorous, and seldom profitable, the
whole question becoming finally involved in hopeless entangle¬
ment and abiding in doubt, this Asssociation has deemed it of
paramount importance to mark out for its members a
plan whereby they may guide themselves in an earnest
endeavor to elicit the truth, while avoiding controversy
as at all times useless. Recognizing as principle among
5
370
Origin a I Com m unications.
[September
the obstructions to knowledge concerning the origin or
apparent beginning of the infection, certain faults on
the part of practitioners themselves, such as carelessness in
observation, negligence in the immediate recording of partic¬
ulars, a strong bias in favor of some special theory, and, in a
few instances, the over-riding method of maintaining a point
by positive and vehement assertion, when not assured of the facts,
the New Orleans Medical and Surgical Association, warning
its members, has charged them, while observing the utmost
prudence in speech and caution in pronouncing an opinion, to
take instant cognizance of all facts and circumstances asso¬
ciated with the tirst cases, suspicious or assured, immediately
to record the same and so to report them, to the end that this
Association may furnish itself with data, from which to draw
conclusions of practical value, in advancing knowledge con¬
cerning the origin and possible prevention of yellow fever.
In accordance with the spirit of my instructions, T present
the following serie;. of cases, giving the evidence without com¬
ment, just as T received it, and above all, without intruding my
personal opinion :
AN EPITOME OE THE TESTIMONY OF ME. AND MRS. STOUT.
The family of Mr. John S. Stout, consisting of himself, wife,
live children and Louisa Creel (servant), arrived in New Or¬
leans, from their summer residence on the lake shore near Mis¬
sissippi City, December 2d, 1878. They occupied as their
residence the house No. 184 Third street, between Constance
and Magazine streets.
They had never spent a summer in New Orleans, and were
unacclimated.
They found the premises very cleau, except the privy vault,
which was foul and had not been cleaned for at least a year
previous. With the advent of warm weather the privy became
horribly offensive, and was cleaned June 8th.
Several cases of yellow fever, with a death, occurred in this
house during the epidemic of last year.
The health of the family remained perfectly good until —
Case 1. — John Stout, white, age 0 years, native of New Or¬
leans. He awoke about six o’clock, the morning of June 16th,
1879] Holt — Yellow Fever in New Orleans during 1879. 377
complaining of feeling ill, of headache, pains in the limbs, and
was found to have fever. During the day his condition con¬
tinuing to grow worse, Dr. Souchon was sent for. The fever
continued, with slight remissions, for four days. During its
continuance his eyes were red and face flushed. Repeated haemor¬
rhages from the nose, to which he was subject, occurring day
and night during the fever, peculiarly characterized the attack.
Fever subsided on the 20tli, leaving him very weak. Conva¬
lescence rapidly established.
Case 2. — Eleanor Stout, age 3 years, native of New Orleans.
She awoke from a noonday sleep about 2, P. M., June 17th,
with fever, which lasted four days ; at no time very high, the
paroxysm characterized by marked remissions. Recovered.
Case 3. — William Stout, age 5 years, native of New Orleans.
Was taken ill Sunday, June 22d. He awoke early in the morn¬
ing with fever and other symptoms, as iu case 1. Fever of one
paroxysm of about four days. Both cases, 1 and 3, had irrit¬
able stomachs, with frequent gaging and occasional vomiting
of water taken. Haemorrhage from the nose, as in case 1.
Recovered.
Case 4. — Jennie Stout, age 4 years, native of New Orleans.
Awoke about 3 o’clock, P. M., June 27th, with fever, which
lasted in one paroxysm, with a marked daily remission, three
days. Haemorrhage from nose slight during night of second
day. All the symptoms mild. Rapid convalescence.
Case 5. — Mr. Joseph Oswald — brother of Mrs. Stout, and re¬
cently staying at her house — age 36 years, native of Missis¬
sippi, had never had yellow fever.
Was taken Saturday, July 12th, about 3 P. M., with a violent
headache and nausea. He retired early in the evening, and
awoke the following morning with these symptoms aggra¬
vated, severe pain in the back and fever. The attack con¬
tinued as a fever of one paroxysm of forty-eight hours.
Convalescence slow but continuous.
Case 6. — Lucy Stout, age 7 years, native of New Orleans.
Was taken Monday, July 14th, awaking at an early hour
with fever. She dressed herself and attempted to walk about,
378 Original Communications. [September
but complained of being so hot and feeling so badly that she
again laid down, and slept for the greater part of the day.
During the night the fever became intense, and lasted in one
paroxysm nearly five days.
Stomach irritable during the attack. Nose bled one night in
latter stage of the fever. She was sicker than the other chil¬
dren had been, and convalesced more slowly.
Case 7. — Mr. John S. Stout, age 40 years, native of Ken¬
tucky. Occupation pilot on board the Thompson Dean, in the
Vicksburg trade. Was taken ill Thursday, July 17th, at 11
o’clock P. M. with pain in head, back and limbs.
He was then on board of the boat about twenty miles this
side of Vicksburg. At 1 o’clock in the morning he was seized
with a chill, and had to be relieved from duty at the wheel. A
high fever followed, which lasted until Sunday morning —about
fifty hours. During its continuance he suffered intense pains
in the back and limbs. The fever left him greatly prostrated.
Convalescence slow but regular.
Cases 1 and 3 having quite recovered, left the city July Cth,
on a visit to their relatives over the lake in company with
Louisa Creel who was going into the same neighborhood to see
her mother. This girl had been perfectly well during her stay
in the family of Mr. Stout.
Case 8. — Testimony of Dr. J. J. Harry.
Handsboro, Miss., July 31, 1879.
Dr. Joseph Holt. — Bear Sir : In reply to your communi¬
cation of the 29th instant, I present the following :
Louisa Creel, white, age 16 years, native of Perry county,
Mississippi, had never had yellow fever, was recently employed
in the family of Mr. Stout, New Orleans. Arrived at her
home, mid-day July 6th. About 3 o’clock, P. M., of the same
day, was seized with a chill, pains in head and limbs, nausea.
I was called to see her at 4 o’clock, A. M., July 8th. She was
delirious and continued so until her death. Face dark brown
or bronze color ; eyes, injected red ; tongue, furred in centre
and red at edges and tip ; gums, spongy and red ; excessive
nausea; suppression of urine. Second visit, eveniug of the
same day, symptoms same, except symptoms of uremic poison-
1879 J Holt — Yellow Fever in New Orleans during 1879. 379
ing with threatened convulsions. High fever continued to
within a few hours of her death.
July 9th. Patient in articulo mortis; eapillary congestion
and stasis. I saw no haemorrhage from gums or nose, but was
told she had black vomit before death. Suppression of urine
beginning three days before death. Black vomit from mouth.
No urine could be obtained to test. Hied in convulsions on the
morning of the 10th July. She was not seen by any other
physician.
ADDITIONAL EVIDENCE OBTAINED BY DR. KILPATRICK OF THE
NATIONAL BOARD OF HEALTH.
u She threw up largely of black vomit and purged the same
matter just before death. She died in the fourth day of her
illness.”
Dr. Kilpatrick continues :
Case 9. — Thomas Creel, white, male, aged 21, born in the
vicinity, brother of Louisa, was taken sick eight days after her
death, or on Friday, July l>tli, 1879. He had a chill and an
indescribable sensation of pain and restlessness. Dr. Pelaez
saw him; pulse 108; temperature 103; tongue coated, red at
tip and edges; no nausea then; not much thirst; eyes red,
conjunctive intensely injected. There was no suppression of
urine, but it was highly albuminous. There was also slight
delirium ; great tenderness of the epigastrium. On Monday,
21st, he passed, per rectum, considerable quantities of dark fluid
usually called black vomit, and on Monday night, 21st, he began
to throw up black vomit, which he continued to do at frequent
periods till death. About 72 hours after the attack came on,
the fever subsided. Suppression of urine came on, Tuesday,
22d. He discharged mine at 4 o’clock that morning, but no
more afterward. At 10 o’clock, A. M., Tuesday, the catheter
was introduced, but no urine could be procured for analysis or
testing. I saw him at this time, and noted the pulse was 72 ;
temperature 101° ; tongue furred, edges and tip red ; gums red
and spongy. He gradually sank, and died at 5 o’clock, A. M.,
Thursday, July 25th.
Autopsy. — Dr. Pelaez made the autopsy, with my assistance.
Five hours after death there was intense rigor mortis ; cadaver
380 Original Communications. [September
was extremely yellow, ami the ears, ueek, and all depending
parts highly eccliymosed. The subcutaneous adipose tissue
was highly tinged yellow, and the abdominal viscera were all
tinged in the same way, as was the tunica adnata. The liver
was firm, pale straw or boxwood color. On being cut, no blood
issued from it at first. The spleen was a little enlarged, but no
abnormal appearances. The kidneys were nearly double the
normal size, and highly congested. They were soft and flaccid,
and the capsules were easily detached. The stomach was dis¬
tended with gas, and on being opened a considerable quantity
of black vomit was seen. The coats were softened. All the
colon was contracted to the size of the jejunum. The urinary
bladder was found empty. The serum in the pericardium was
of a pale straw color. The heart was nearly twice the normal
size, soft and flaccid, and when one auricle was opened a large
quantity of dark-colored fl uid blood ran out.
Case 10. — Caroline, aged 12, sister of Louisa, was taken sick
on Friday, the 18th, about three hours after her brother Thomas
began to complain.
Cases 11 and 12. — Arabella, ;et. 6 years, and Samantha, ait. 8
years, were taken sick on the 10th, the day after Thomas and
Caroline came down with the fever. Arabella had suppression
of urine some hours on the 22d, and was delirious, but they
both recovered.
Case 13. — Edward, brother of Louisa, aged about 20 years,
was taken sick on Sunday, the 20th, having the same symp¬
toms in a milder form. On the 22d his pulse was 00, and tem¬
perature 103 3|5 °, at L0 o’clock, A. M. He recovered. Of the
six cases, two died. They were all yellow, had furred tongues
with red edges and tips, and eyes intensely injected and yellow.
Case 14. — Dr. Joseph Holt — Dear /Sir : The following out¬
line of the case of Mr. W. B. Heyward’s son, aged 8 or 10 years,
who was attacked with yellow fever near the Creel house, two
and a half miles from Mississippi City, were given to me
verbally by Dr. Pelaez, the attending physician.
Shortly after the death of Thomas Creel (which took place on
the 25th of July), Mr. Heyward’s son fell ill with the fever.
His attack was ushered in by a chdl in the evening, followed
1879] Holt — Yellow Fever in New Orleans during 1879. 381
by high fever with severe cephalalgia, pains in the back and
limbs, pulse frequent and temperature 105°. His tongue was
furred in the centre, and the tip and edges quite red. He
evinced uneasiness of the epigastrium on pressure, had some
nausea and great thirst. His eyes were also injected and adnata
discolored.
In sixty hours from the beginning of the fever, he threw
up black vomit freely, and passed it in quantity from the
bowels.
His urine was tested and found to be loaded with albumen.
Suppression of urinary secretion occurred, lasting sixteen
hours, the catheter having been passed without finding any
urine in the bladder. The secretion was restored and the vom¬
iting controlled.
The case went on improving to convalescence. The day of
my interview with Dr. Pelaez was the fourteenth of the little
boy’s illness. He was then quite prostrate, deeply jaundiced,
and his body covered with furunculi.
It is interesting to know how far the attack of this case may
be traced to the focus of infection at the Creel house. Mr.
Heyward, when interrogated by me, furnished the following-
facts : u My son was in almost daily association with the eldest
Creel boy, Thomas — who afterwards died of yellow fever — and
a younger one. These two boys came every day to my house
at meal-time to obtain food for Mrs. Creel and family.
My sou was also greatly interested in the building of a boat
on the beach by these Creel boys, and spent some time every¬
day with them while engaged in this work.
“ During the sickness of Louisa Creel, he was in the habit o*
going to the gap in the fence, opening at a point not more than
eight or ten yards from the Creel house, lingering there and
conversing with the children.”
Mr. Heyward, when asked, could not say that he knew of his
son’s having ever passed beyond the gap, or of his haviug
entered the Creel house while there was sickness there.
The distance between Mr. Heyward’s premises and the Creel
house, is about two hundred yards.
3815 Original Communications. [September
Regretting that I cannot give you a more satisfactory detail
of the above case, 1 am, yours,
Very respectfully,
J. P. Davidson, M.D.
Case 15. — Viucenza Spano, aged 10 years, native of Italy;
in Hew Orleans two years. Residence, corner Second and Con¬
stance streets, about three hundred feet from the family of Mr.
John Stout Was not in the city during the epidemic, but
encamped near it. Had never had yellow fever. Was taken
ill, Wednesday, July 23d, about 8 o’clock, P. M., with severe
headache, pains in back and limbs, and fever, not preceded by
a perceptible chill. Dr. Mainegra was called at 9 o’clock the
next morning. Temperature 105£°. Tongue heavily coated
with white fur, pointed, edges cherry red, gums and mucous
membrane of mouth red. Eyes much injected, face flushed a
dusky red. Stomach irritable and exquisitely tender on pres¬
sure ; vomiting frequently of fluids taken.
Her condition continued the same with slight variations of
temperature of one-half of a degree morning and evening,
until Sunday morning, the beginning of the fourth day, when
the temperature declined to 103°, and pulse to 89. Her state
was then one of great depression, tongue and gums angry red.
Capillary stasis. Yellow suffusion of skin strongly pronounced.
Eyes yellow and somewhat congested. Stomach irritable, with
a frequent desire to vomit. Urine scanty, almost completely
suppressed and highly albuminous. Ho delirium, but a lethar¬
gic calmness.
Was seen during the evening of the same day, Sunday, 27th,
by Dr. R. Bailey, Sanitary Inspector of the Fourth District,
Drs. Bemiss, White, A. C. and Joseph Holt. These gentlemen,
with one accord, pronounced the case one of yellow fever.
During the night she became wildly delirious, purged blood
from the bowels and threw up a small quantity of black blood.
She died at 5 o’clock Monday morning.
The corpse presented those appearances strongly marked
so characteristic to an experienced eye.
Case 10. — Caroline Mainegra, aged 2 years, .native of Hew
Orleans. Unacclimated. Residence, corner Washington and
1879J Holt — Yellow Fever in New Orleans during 1879. 383
Magazine streets, two squares and a half from the house of
Mr. Stout.
Was taken July 21st, at 8 o’clock, P. M., with fever, which
continued with slight variations of temperature 72 hours, and
accompanied by great stupor. Tongue, gums and mucous
membrane of mouth of a decided red color. Fever subsided
on the fourth day, and convalescence rapidly established. Her
father, Dr. Mainegra, was the attending physician.
Case 17. — John Knoph, age 33 years, native of Norway. In
the United States nine years, in New Orleans eight months.
Residence 123 Seventh street, between Constance and Laurel
streets. Was taken ill July 25th, at 9 o’clock, A. M., with
slight chill, followed by high fever, pains in head and limbs.
Was seen on the morning of the third day by Dr. Mainegra,
the attending physician, accompanied by Dr. Joseph Holt.
High fever ; eyes congested and yellow ; skin dusky aed with
yellow tinge; tongue furred and red at edges ; gums and mucous
membrane of mouth red. Stomach irritable ; patient restless.
On the following day seen by Dr. M. General symptoms the
same. Urine highly albuminous, and almost suppressed. This
symptom continued the same on the fourth and fifth days and
the urine very bloody. Great irritability of the stomach.
Fever lasted in one paroxysm of 120 hours. Temperature
sustained at 104° A. M., and 105° P. M.
Dr. C. B. White saw him with Dr. Mainegra, and concurred
in the diagnosis — yellow fever.
Convalescing slowly.
Case 18. — Bernard S. Berkson, white, age M years, native of
New Orleans, but absent heretofore during the summer, and
unacclimated. Residence 217 Third street, between Magazine
ami Camp streets, within 350 feet of the family of Mr. Stout.
Was taken Saturday, July 26th, at 10 o’clock, A. M., with a
fever rapidly ascending to 105°. Dr. Bickham was called im¬
mediately.
The high grade of the fever was sustained until the morning
of the third day wheu it declined to 103°.
Tongue and mucous membrane of mouth red ; gums red and
swollen. In the latter stage of the attack haemorrhage occured
6
384
Original Communications. [September
from two small boils, one on the neck, the other on the back of
the head. The blood presented that peculiar character of hav¬
ing lost its plasticity. Stomach irritable. Urine from the third
day heavily albuminous, no suppression. Skin quite yellow.
Died at 4 o’clock, P. M., July 31st; sick 126 hours. Conges¬
tion of the brain characterized the case. The last three days
of its illness the child was constantly in a state of restless
delirium. Convulsions threatened during the last two days,
and occurred a few hours preceding dissolution.
Having proceeded thus far in a chain of evidence, as shown
in the recital of the particulars in relation to the foregoing
series of cases, it only remains for me to state that in doing so,
I have presented all the testimony that seems to have any bear¬
ing upon the subject of this investigation from the beginning
to the present moment.
To the personal friendship and professional courtesy of Dr-
Souchon, but above all, to the high regard which that gentle¬
man entertains for this Association, am I largely indebted for
information concerning the first apparent links in this chain.
As presented to him, the cases, taken by themselves, their
comparative mildness, irregular course, and uniform recovery,
were so equivocal as to have necessitated his pursuing that
prudential course so strongly enjoined upon the members of
this organization. Subsequent events — an experience common
to us all — aroused suspicions, and furnished ground for an
opinion to which the cases in the family of Mr. Stout, by them¬
selves, would not have given rise.
Resuscitation of Still-Born Infants. — McDauiel’s
Method.— A Case.
[Read before the Bullock County Medical Society at its Monthly Meeting, June 2, 1879.]
By C. H. FRANKLIN, M.D., Union Springs, Ala.
Gentlemen :
Those of us who were present at the State Medical Associa¬
tion in Selma, last April, will, I am sure, recollect with pleasure
the very interesting and exhaustive paper, read by Dr. E. D.
1879] Franklin — Resuscitation of Still-Born Infants. 385
McDaniel, of Camden, Ala., on the above subject. The
doctor claims to be the originator of the method, and expresses
some surprise, as well as mortification, that some European
authorities have adopted the plan without giving him the
honor of its origination.
It may be in place to mention that he read a monograph on
the same subject, in which most of the points of interest were
embodied, before the American Medical Association at its ses¬
sion in New Orleans, in 1809, and that through the transac¬
tions of that body, knowledge of it may have been obtained in
Europe.
As, however, we will soon have an opportunity of reading
the entire plan in our State Medical Transactions, it is hardly
necessary to say more of the method than that it consists in
subjecting the still-born babe, with about the frequency of or¬
dinary respiration, to the alternate prone and supine position,
that is the thorax is to be inclined to the abdomen to an angle
of about 45° and back again to the line, the diaphragm thus
playing the part of a piston, and the thorax a cylinder as it
were, in alternately diminishing and increasing the chest capac¬
ity. The relative difference between this and the method
usually employed, was shown by the spirometer to be consid¬
erably in favor of McDaniel’s plan.
My case was, I think, a most happy one to test the efficacy
of the method. The woman was a white primipera, with shal¬
low pelvis, and otherwise fair development. I visited her
April 21st. She had been in labor, she said, fourteen hours.
On examination, found the womb tolerably well dilated, vertex
presentation with pains feeble and long intervals. The soft
parts were satisfactorily soft and dilatable. The labor con¬
tinued tedious for some hours. Hoping to increase the
efficiency of the pains, the womb now being appar¬
ently fully dilated, with pains rather more of an ex¬
pulsive character, I ruptured the membranes. Only a
few ounces of anmiotic fluid escaped, and with it a pro¬
lapsus of the cord became manifest. Several ineft'ecual efforts
were made to replace the cord. The head soon engaged fully
in the strait, notwithstanding the partial uterine inertia, and
thus precluded all hope of its reintroduction. Fearing the
380 Original Communications. [September
continued pressure upon the cord would destroy the child, ergot
was given to hasten the delivery. A protracted pain gave
birth to the head, but the interval that followed, we thought,
was of full seven minutes duration, during which time two
small doses of ergot were given, the patient being exhorted to
bear down, uuphilosophical as it was, it being manifestly cer¬
tain that no woman can bear down effectively without the
co-operative influence of a uterine contraction. During this
unnatural confinement of the child, we did what we could to
enable it to breathe by forcing fresh air under the cover, and
placing and sustaining its mouth in the most easy and exposed
position. There was no pulsation in the cord and when,
finally, a pain occurred, and by aid of gentle traction the sec¬
ond stage of labor was complete, there supervened, or rather
there was existing that relaxed or inelastic feel in the child
that an educated touch would readily recognize as death. I
noticed, also, that the meconium had passed. I hastened to
lay him on his right side, with his shoulders slightly elevated,
and arranged the cord immediately, so as to protect it from
further compression, hoping that the blood might resume its
course through the foetal circulation. He made no effort to
breathe, there was no gasp, he was completely relaxed — he was
apparently dead.
I at once determined to test Dr. McDaniel’s method alone,
believing at the time I heard him read his paper that it em¬
bodied the most philosophical plan that I had yet read, and
accordingly began, the little fellow being still inclined on his
right side. After subjecting him to the alternate prone and
supine positions five or six times, in frequency about equal to
the natural respirations in the child, I noticed that bronchial
rales were produced, thus proving that the air did enter at least
the larger tubes. I had no means of definitely determining the
time, though 1 thought it was full ten minutes that this rythmi¬
cal movement was kept up before manifestations of returning
vitality made their appearance — first by a gasp, two or three
movements, the large rales continuing and deepening appar¬
ently, and another gasp. Soon the lungs showed more
marked evidence of expansion and contraction, and by and by
a feeble cry.
Correspondence.
387
1879]
The recovery was slow, the child continuing quite feeble for
more than an hour, not crying, but for the most part of the
time merely whining, but it was breathing. He is since doing-
well, his parents and friends feeling that his life is due to the
persistent efforts at resuscitation.
I do not recollect whether Dr. McDaniel referred to position
in his method, though I believe, considering the anatomical
peculiarities of the fcetal heart, that some advantage may be
obtained by placing the child on the right side, as the force of
gravity might thus have some influence in closing the foramen
Botalli, and favoring the course of the blood along the pulmo¬
nary veins to the lungs. I believe this idea was original with
the late Professor Meigs as far back as 1832, and though it has
been subjected to some criticism, I nevertheless think it will
have an auxiliary influence, it is, moreover, the most conve¬
nient position for the accoucheur to practice this particular
method of resuscitation. I am aware that Meigs employed it
in Morbus Ceruleus, but I think, after a little consideration of
the foetal peculiarities of the circulation, that any one will see
that it is quite as applicable to cases of suspended animation in
still-born infants.
Montecello, Ark., May 15, 1879.
Editor of the New Orleans Medical Journal:
Dear Sir — I have read with much interest the various causes
that produce yellow fever as promulgated by the many writers
on this very grave question, and it seems to be a settled fact that
the fever is produced by aniinalcula or bacteria, and they
produced by stagnated pools in warm climates and in stagnated
waters in the hulls of ships. But it seems to be a mooted
point yet, as to whether it is imported into this country from
some distant seaport or island.
The last and most grave question that now seems to be occu¬
pying the mind of the profession is, as to how the ravages of
this fell-destroyer can be checkmated.
388 Correspondence. [September
Some think that national, state and municipal quarantine
will put a stop to it; others seem to think it can be frozen out
in ships and houses where it has prevailed ; all of which I
think is an mpossibility and an absurdity.
First. History has established the fact beyond contradiction,
that quarantine has never checked its ravages in any country
where there was a cause, and where there was heat enough to
develop that cause and disseminate the same through the air,
to be wafted over the country in the form of a cyclone.
Second. Freezing it out in ships or houses in a few days is ab¬
surd, from the tact that in all places in-doors, there are crevices
or places where these insects can secret themselves and the
cold (however intense it maybe) cannot reach them, and just
so soon as the cold is withdrawn and heat applied the insects
come forth again, as they can only breed in a heated
atmosphere. Nothing can starve them out, only a long
continued season of cold weather. Just as soon as the heat
is commenced to be withdrawn, just so soon does the ani¬
malcule begin to cease to germinate and to produce its ravages,
and so long as the cold coutiuues there is no danger of yellow
fever, and if the season of cold is long enough and intense
enough there is a hope that the cause has died out. But with
a short time of cold, however intense it may be, it will still
leave the seed in places that the cold has failed to reach, and
so soon as heat is applied, just so soon will they commence to
germinate, and the same results will follow as did before the
cold was applied or when the cause first made its appearance.
My opinion is that nothing but proper drainage and cleanli¬
ness of cities, houses and the premises about the same, will do
any good in stopping the ravages of yellow fever, and if the
Government and States would spend as much money in trying to
produce cleanliness among ourselves as they have spent in
looking abroad for the cause and trying to fence it out, they
would do far more good in the premises. Here is a thought
for the wise ones to think about.
J. N. Slemond, M.D.
[Dr. S. is certainly wrong in his first proposition. There is
no reason to suppose that Arkansas and Texas owed their
escape, from the ravages of yellow fever in 1878, to any climatic
1879J
Current Medical Literature.
389
or sanitary advantages over Mississippi and Tennessee, or to
any other advantage than more effectual exclusion of the
specific infection. If this infection were “ wafted over the
country in the form of a cyclone ” through the atmosphere, it
would have extended over the whole country within a month ;
whereas, we know that the disease is neither spread nor re¬
tarded by winds.
As to local sanitary conditions, observation amply proves
that yellow fever is not mitigated by good nor aggravated by
bad sanitation. The three conditions needed for a prevalence
of the disease are subjects susceptible to its specific cause, the
presence of this cause, and a temperature high enough to ren¬
der it active. Eliminate one, and the other two fail. — S. S. H.]
J-
ED1CAL
ITERATURE.
H J3 MATIN’ I (J PROPERTIES OF DIALYZED IRON.
13r. Robert Amory, in the Boston Medical and Surgical Journal,
contributes a very interesting series of observations on the
hsematinic properties of dialyzed iron. After desciibing the
instrument used and the method of computing the richness of
the blood in corpuscles, he takes up and compares the dia¬
lyzed with other preparations of iron, and reports his obser¬
vations on five cases of ancemid, and shows “ that, under the
continued use of ninety drops of solution of dialyzed iron per
diem this condition of impoverished blood was replaced by an
increase in the number of corpuscles” * * * “and the
symptoms of ill-health simultaneously disappeared with this im¬
provement.”
“ Dialyzed iron may increase the globular richness of blood,
but it may have no effect in bringing about the chemical com¬
bination of oxy-luemoglobin. If the supposition be true that
there is a state of ill-health in which the corpuscles may be
numerically normal, but may simultaneously be deficient in
coloring matter, we may conceive of an anaemic or chlorotic
patient who may require some therapeutical means for im-
390 Current Medical Literature. [September
proving this deficiency other than simple iron. I may have
been extremely fortunate in selecting just those cases in which
a simple form of iron was indicated, and it may not be impossi¬
ble that another form would have benefited my eases as much
as the dialyzed iron ; yet the latter is preferable to the more
astringent iron salts, because it does not impair the digestion,
nor produce constipation.
“ Now, one final word about the various solutions of dialyzed
iron. Many of these solutions are valueless, some are very
dilute, and a few are of pretty uniform standard, and contain
only the products of dialysis from a salt of iron and distilled
water. If physicians use a worthless preparation, they need not
expect an improvement in the anaemia ; if they use a dilute
solution, they must prescribe a larger amount of the solution.
In the preparation I used for these experiments the solution
had a specific gravity of 1042, and had no free acid.”
[The dialyzed iron used in making the experiments was from
Messrs. John Wyeth & Bro., manufacturing chemists, Phila¬
delphia. — Eds.]
A CASE OF HYDROPHOBIA CURED BY KURARA.
\ [Translation.]
Dr. Offenberg, of Wickrath, Germany, has, in 1874, had a
case of this disease under treatment at the hospital in Munster,
and lately published a very detailed description of it. The his¬
tory of the case is too voluminous here to be given in extenso,
and we will have to content ourselves with giving a synopsis
of the same.
An autopsy of the dog who had bit the patient was not
made. According to a description of the condition of the dog,
a veterinary surgeon pronounced it suffering from hydrophobia,
and caused it to be killed the same day it bit the girl. It
appears to us, however, that many points in connection with
the late disease of the patient justify the diagnosis, and that
haidly any doubt as to its correctness can be maintained, in
spite "of the missing autopsy. The dog had been chained for
19 days when it attacked the patient. The proprietor of the
dog states that it was not usually snappish, and knew especi¬
ally well the patient, who several times daily passed the dog,
and favored it occasionally with food. The assault was entirely
unfounded, and was followed immediately after by a striking-
change in the habits of the animal, which became very turbu¬
lent. There had previously been noticed several cases of hydro¬
phobia in that part of the country, and a dog on a neighboring
farm had undoubtedly been attacked by this disease in the
latter part of June; it had bit several animals and persons —
among others its master, who, July 29tli, was suddenly
attacked by hydrophobia and died July 31st. Some days later
a donkey on the same farm, and which had been bit by the,
Current Medical Literature.
391
1879]
dog, became strikingly turbulent and snappish, assaulted
especially calves, and had to be killed. It is highly probable
that this dog, in which the disease in the beginning manifested
itself, by roaming about at that time had been together with
the dog on the neighboring farm, where the patient was bit.
The patient, a girl, 24 years of age, was bit, July 28th, in the
heel, and July 30th she went to the neighboring farm to see
the physician attending the gentleman who had also been bit,
as above mentioned. They prescribed a concentrated solution
of potash, and advised her to cauterize the wound with it ; she
did so, dipping pieces of linen in the liquid and applying them,
and she produced by this method an extended and quite dry
cauterization about the size of the palm of the hand on and
about the wound. She was persuaded to stay and nurse the
sick man and witnessed consequently his violent attacks of
spasms, raving and finally his death. She used also an arca¬
num consisting principally of a concentrated solution of cook¬
ing salt, which produced pain in her throat when she drank ;
she therefore refused drinks, which was supposed to be symp¬
toms of hydrophobia. The physician who was summoned did
not examine the mouth nor the throat, and was not told the
real state of the case, but prescribed a solution of morphia.
She was perfectly well four or five days later, and returned to
her parents. The wound was dressed with a solution of car¬
bolic acid, later with basilic ointment, the physician wishing to
keep it suppurating for three months at least.
This treatment, however, did not satisfy the parties, and the
girl was sent to the hospital October 8th. She has never been
seriously ill and there is no disposition to nervous diseases in her
iamily ; she is plethoric, of a very healthy appearance and of a
lively character ; she states that she is continually afraid of the
breaking out of hydrophobia, and that during night, she often
awakens in fear; upon admission she seems, however, to be quiet.
The wound was red, granulating, and considerably decreased in
size October loth. Menses appeared October 10th, and were
about ceasing the 10th (80 days after she had been bit) ; she
was on that day as usual out of bed, had taken supper at
0 o’clock, and nobody had noticed anything extraordinary in
her. At 7 o’clock, her temper was irritable, trying to calm her
made her cry, as she stated herself later, without any reason ;
at 8 o’clock she suddenly had an attack of suffocation, when
drinking water, which she could not swallow, but had to spit
out. With short intervals she now had repeated attacks of
convulsions, which roused the supposition of approaching
hydrophobia.
I)r. O. sawT her at 10:15 o’clock, and found her excited, anxious,
crying, satisfied that she was suffering from hydrophobia and
that she was going to die. She (cmplains of pains in the
upper part of the chest and front part of the neck, especially
around larnyx and os byoideum ; in the throat she also feels
7
392 Current Medical Literature. [September
pain, but nothing abnormal is to be seen; the secretion of
saliva is not increased, no Marochetti vesicles ; the tempera¬
ture is but slightly increased ; she states that she feels pain in
the wound now and then, extending towards the knee; the
appearance of the wound is unchanged. The muscles, espe¬
cially on the limbs, show slight spasms incessantly on the
flexor-side of the forearm, so much so that the pulse cannot be
counted. At the interval of 1 to 2 minutes, inspiratory spasms
appear, accompanied by general clonic convulsions. They
commence with some short, sighing sounds, produced by the
entering of air thorough the narrow glottis. The chest rises
and expands, the inspiratory muscles are very prominent, the
whole body is shaken by clonic spasms, she beats furiously, or
catches hold of the proffered hand ; she has a sensation of
suffocation and constriction of the throat, also pain in the
limbs. Previous to the attack, she feels it coming by in¬
creased fear. When the attack is over, respiration becomes
superficial and frequent, later more quiet.
In attempting to drink, spasms of the throat appear, and
she swollows only a little with great difficulty, and a few sec¬
onds later she gets inspiratory spasms. The attacks increased
in violence and frequency. At 10:45 o’clock an attempt to drink
failed for the first time entirely in spite of her thirst. An in¬
jection of morphia (gr. £) had no effect, while inhalation of
chloroform continued until narcotism gave great relief; the
first inspiration produced, however, every time a spasm ; she
presented now the symptoms of hydrophobia very decidedly ;
she was, besides, much afraid of light, greatly alarmed, nearly
out of her mind, the hearing extraordinarily sharp.
As there could no more be any doubt about the diagnosis,
Dr. O. decided to make use of kurara. There was a solution of
this drug at the hospital, 50 ceutigr. in 10 grammes of water
(gr. 10 in 3iij of water), the effect of which he had tried in frogs,
and a year previous in two cases of tetanus ; as these had both
turned out fatal, Dr. O. felt himself justified in giving quite
large doses. At 10 o’clock, about three hours after the sudden
breaking out of the disease, he injected 2 centigr. (c. gr. J), and
repeated the dose at 11 o’clock, when the muscular turbulence
in the intervals commenced to decrease ; he felt thereby encour¬
aged to continue the hypodermic injections, administering 3
centigr. at the time, and became more and more convinced of
the utility of the drug. At 1 o’clock the intervals were of 3 to
5 minutes’ duration ; the convulsions were, however, yet as vio¬
lent as before. Finally, at 3:15 o’clock, when 18 centigrammes
(c. 3 grains) of kurara had been given, an attack of much less
force and shorter dura' ion than any one previous was noticed.
A little later, the patient stated that she felt paralyzed in all
her limbs, and a very considerable paralysis was developed in
the course of a minute. The attacks of spasms now became
scarce and weak, and at 4:30 o’clock she had a last, very weak,
attack — a spasmodic inspiration. After the last attack of
1879]
Current Medical Literature.
393
spasms, a complete suspension of the respiration hail appeared,
which, however, was easily brought on again by a few rythmi¬
cal compressions of the chest and abdomen. As the spasms
had ceased, the nearly complete paralysis continued, and im¬
paired even the speech; respiration became weaker, though
uninterrupted ; the patient had difficulty in opening the eyes ;
to be touched was painful to her ; she felt headache and weak¬
ness, but was not sleepy. Towards morning the skin became
moist, and she was brought into perspiration through the
agency of bottles filled with hot water.
October 17th, at 7:30 o’clock, A. M, the paralysis commenced
to disappear; she swallowed a glass of water easily. In course
of day the paralysis ceased entirely; the headache and the
hyperesthesia, especially in the arms, continued yet. Towards
evening, some slight spasmodic contractions appeared in the
arm and other muscles, and having taken a glass of water, a
spasmodic inspiration took place in the same manner as the
previous night. This repeated itself several times, but ceased
without treatment, and at 9 o’clock she fell into a deep and
quiet sleep. She awoke at 1 o’clock with a severe chill, which
lasted three-quarter of an hour. She did not sleep any more,
but there was no paralysis nor spasms during the rest of the
night.
October 18th. On that morning a few spasmodic contrac¬
tions appeared in the arm; the patient had headache and pho¬
tophobia ; at 11 o’clock she suddenly became totally parayzed,
could not move a finger, hardly speak, but recognized visitors.
In an hour the paralysis commenced to vanish and disappeared
entirely in the course of the evening. Towards night, spasms
appeared again, and, in attempting to drink, an inspiratory
spasm ; as those were repeated at intervals of 2 to 3 minutes,
and the patient besides became restless, thirsty and shy of
light, a hypodermatic injection of 3 centigr. of kurara was
administered, which in 15 minutes displayed its effect. At
midnight, she had another inspiratory spasm, followed by par¬
alysis and superficial respiration as in the forenoon ; towards
morning she was quiet for several hours.
October 19th. Some headache and photophobia ; a few
spasmodic contractions ; a few times slight spasm of the throat
in attempting to drink, once followed by considerable paralysis.
October 20th. In the morning still some slight contractions.
Since October 16th, she had taken only water and a little wine ;
in the evening, for the first time, she took some milk and bread
with a good appetite.
December 3d. The wound in the foot is healed. She is dis¬
missed from the hospital.
December 19th. She feels pretty well, but is yet very weak.
She now continued improving slowly ; she became anaemic ;
menstruation, which had appeared in November, now ceased
for 6 months, and the inconsiderate talk of some of the patient’s
394 Current Medical Literature. [September
.surroundings, created fears that reappearance of the disease
might take place.
Ln January, 1877, she informed Dr. O. that she had been well
for many months.
This case hardly leaves any doubt as to the correctness of the
diagnosis : lysa hurnana, as well as the curative effect of kurara
in this case. The remedy is, however, looked upon with a cer¬
tain distrust on account of the danger of the paralysis it pro¬
duces, and because its composition and effect is so inconsistent
that it is not easy to calculate the exact dose to be given, with¬
out exposing the life of the patient; the dose must, therefore,
be established by experimenting. Kurarin would have a great
advantage over kurara, but is at present very expensive. Used
cautiously, and by observing the patient closely also, several
days after its use, it is, howevar, hardly more dangerous than
many other remedies, e. g. atropia. It is preferable to give it
early in the disease, and the author concludes with the follow¬
ing propositions :
1st. Besides the surgical treatment of a wound inflicted by
an animal suffering from hydrophobia, the patient must be kept
under observation for several months. As soon as symptoms
of threatening breaking out of spasms appear, the use of hypo¬
dermic injections of kurara is immediately resorted to.
2d. The physician in attendance must be prepared with a
solution of kurara ( 50 centigr. to 10 grammes of water [ gr. 10
to 3iij.] ), which should be tried on frogs, and 1-10 milligrammes
(1-600 gr.) must paralyse these rapidly without producing any
spasm.
3d. The quantity of kurara used for injection should corre¬
spond with the violence of the convulsions, and ought to be
continued until positive symptoms of paralysis appear. As
kurara may kill by paralysing the respiration, every thing
needed for artificial respiration should be ready.
4tli. When the spasms have apparently ceased, or in threat¬
ening paralysis, it is also necessary for some days to watch the
eventual re appearance of these symptoms. — TJzeskrift fur Cieger.
UTERO-OVARIAN AMPUTATION8.
[Translation.]
In one of the last numbers of the Independente of Turin, we
l ead a very long and detailed account of Dr. Joseph Berruti,
of the case of utero-ovarian amputation, lately performed by
him, ot which we have already spoken in the July Number of
our Journal.
The woman has recovered. On the 25th day after the opera¬
tion, she was able to leave bed, and a few days afterwards
to attend to her household duties.
In order to correct some erroneous statements incurred in
the compilation of the statistics of this operation, published
in several medical journals, Prof. Berruti presents the follow
Current Medical Literature.
395
1879]
in# table, as drawn from the reliable sources of the operators
themselves, in which all the cases of this operation performed
since 1870 to the present date (5th July, 1879,) are resumed:
1 . . 1870 . .
. Prof. Torro, .
. Pavia, . . .
. . Recovery. .
2..L877. .
. Prof. Spaeth, _
.Vienna,..
. . Recovery. .
.
3 1877 . .
.Prof. Hegar, .
. Friburg,.
. Death.
4.. 1877..
.Prof. Braun C., . .
Vienna,. .
5.. 1877..
.Prof. Spaeth,. ..
. Vienna, . .
. Death.
0. . 1877..
. Prof. Chiara, . . . .
. Milauo,
. Death.
7.. 1877
Prof. Tuzani,
. Parma,.
.Death.
8.. 1877. .
.Prof. Previtali, ..
. Bergamo,
• • ......
Death.
9.. 1878 .
.Prof. Miiller, .
. Berne, . . .
10.. 1878 .
Prof. Franzoliui,. .
. Udine, . .
.Death.
11.. 1878.
. Prof. W asseige, .
. Liege, . . .
. . Recovery.
12.. 1878..
. Prof. Chiara, .
.Milano, . .
Death.
13.. 1878..
. Prof. Tibone, _
Turin, . .
.Vienna, .
. Death.
14.. 1878..
. Prof. Brauu C., . . .
. . Recovery. .
15.. 1878..
.Prof. Litzmaun,.. .
. Kiel, .
16.. 1878..
.Prof. Wasseige,. . .
. Liege, . .
L7..L878 .
. Prof. Riedinger,. .
Briiuu, . .
. .Recovery. .
18.. 1878..
.Prof. Breisky, ...
. Prague,. .
. . Recovery. .
19.. 1878...
Prof. Perolio, . . . .
. Brescia, .
. . . Recovery. .
20. .1878..
.Prof. Chiara .
.Milano, .
. . Recovery. .
.
21.. 1878..
. Prof. Fehling, . . . .
. Stockard,
Death.
22 . . 1879 . .
.Prof. Braun G., ..
. Vienna, .
.Death.
23 . . 1879 . .
. Prof. Tibone, .
. Turin, . .
. Cremona,
. .Recovery.,
24 . . 1879 . .
. Prof. Coggi, .
. Death.
25 . . 1879 . .
.Prof. Braun C., . . .
. Vienna, . .
. . Recovery. .
26 .1879..
. Prof. Tibone, . . . .
Turin, . . .
. Death.
27 . . 1879 .
. Lying-in-hospital, .
..Turin,. .
. Death.
28. ..1879..
. Prof. Berruti, .
. Recovery.
29 . . 1879 . .
Prof. Maugiagalli
. .Milano, .
. . Recovery. .
Result-
— Recoveries .
. .13
Deaths .
. . 16
Total .
..29
If we consider, says Dr. Beiruti, that the cases of Doctors
Hegar, Tuzani, Previtali and Franzoliui, J7os. 3, 7, 8 and 10,
were operated ou women in articulo mortis , we may conclude,
that the cures surpass 50 per cent.
CHAULMOOGRA OIL IN LEPROSY.
By WYNDHAM COTTLE, M.A , M.B. Oxon., F.R.C.S. Eng., etc. Senior Assistant
Surgeon to the Hospital for Diseases of the Skiu, Blackfriars.
The following cases are, I think, especially interesting on two
grounds : that they illustrate the use of a comparatively little
known remedy, and are a record of an early stage of elephanti¬
asis Grsecorum occurring in England.
Current, Medical Literature.
396
[September
Case I. — T. W. is now eighteen years of age. His father, an
Englishman born in England, went to India. His mother was
born in that country of English parents. I le affirms that his
parents and his three brothers, with whom he lives in London,
are free from disease ; and that there is no history of skin-affec¬
tion in his family. Born in Calcutta, he resided and traveled
in India until November, 1875, when with his family he moved
to London, where he has since remained in comfortable circum¬
stances. In England, he has always lived well; and he tells
me that in India his food was much the same, with no excess
of fish.
The first symptom of the disease showed itself in June, 1877,
as a spot as large as a sixpence over the angle of the jaw on
the left side, the site of which was marked by a dark stain .
Previously to this, his health had been excellent. The devel¬
opment of this spot was followed by pains in the limbs that
lasted about two months. He then noticed that the right fore¬
arm on its outer aspect had become marked with a brown dis¬
coloration. From August to October, 1877, small round tuber¬
cles, dark colored, about the size of split peas, with somewhat
depressed centres, appeared on the backs of the hands. Simi¬
lar tubercles showed themselves over the face ; but in these the
central depression was absent, and the color lighter. Conjunc¬
tival injection took place from the first attack. These symp¬
toms persisted and increased. Tubercles of like character
developed on the feet; and, in May, 1878, patches of brown
staining, which at first were of a dull red color, swollen and
hyperiemic, were visible on both arm and legs. The back of
the right hand and portions of the right leg were also distinctly
anaesthetic.
In October, 1878, his condition was as follows. He had tuber¬
cles, as described, on the face, the back of the hands and feet,
and the inner surface of the lower lip, with one on the left con¬
junctiva. The limbs, especially on their outer aspects, were
deeply pigmented, dry and scaly, most marked' on the right
side. The back of the right hand and outer surface of the right
leg were anaesthetic. The finger points were also uniformly
enlarged. There was no loss of hair, and the ears were un¬
affected.
At the end of March, 1879, all these symptoms had passed
away, except a more limited and less pronounced anaesthesia in
the above mentioned parts, and somewhat raised dark spots on
the face and backs of the hands, corresponding to the positions
occupied by the tubercles, with some thickening of the finger-
joints.
From March 11th till September 18th, 1878, all the ordinary
remedies were employed, but the disease steadily advanced ;
when I administered chaulmoogra oil in five-minim doses twice
daily. The patient experiencing no inconvenience, I succes¬
sively increased the dose to ten and twenty minims three times
daily, then to forty and sixty minims thrice a day, which he is
1879 J Current Medical Literature. 397
now taking. The disease began to mend from the time the
chanlmoogra oil was given, and very much more rapidly with
the larger doses, the improvement being noticeable week by
week during tbe last six weeks, while he has been taking the
oil in drachm-doses. 1 also directed him to apply daily to the
affected parts an ointment of twenty grains of cliaulmoogra
oil to an ounce of lard.
Case II. — T. M. was born and spent his youth in England.
After residing twenty-seven years in Jamaica, he returned to
London in November, 1877. He noticed the first symptoms of
his disease in May, 1878, when large patches of discoloration
appeared on his legs, followed by similar spots on the face and
arms. A tonie treatment was first employed ; and in September,
1878, ehaulmoogra oil in small doses was given, which was in¬
creased to twenty minims three times daily. This he continued
to take till March 10th, 1879, when I first saw him. He stated
that his condition improved when he commenced to take the oil,
but the complaint recurred in a more marked degree.
On March 10th, 1879, he presented the following appearance.
He was hale and well nourished. There were dusky red raised
patches, two or three inches in diameter, scattered over the
face, neck, body, and limbs, with the characteristic leonine
expression of countenance and thickening of the ears and of
the tissues in the positions occupied by the spots. A superfi¬
cial ulcer existed on the outside of the left leg, and one spot
on the right thigh ; and the insides of the feet from the great
toes to the heels were anaesthetic.
I directed him to take ehaulmoogra oil in drachm-doses thrice
daily. The only ineonveuience he experienced was slight con¬
stipation, which an occasional mild purgative removed. He
has continued the same treatment. The ulcer on the leg rapidly
healed. When I saw him a week ago, the spots had faded in
color and lost some of their thickening, while some had disap¬
peared ; and the anaesthesia was less marked, and his general
health had improved.
1 cannot but rega d these as encouraging results, and per¬
haps an indication of a more hopeful means of combating this
intractable malady.
I have found that there are some points of clinical impor¬
tance to be observed in the administration of ehaulmoogra oil.
It should be given at first in small doses of three or four mi¬
nims, which, as the stomach becomes more tolerant of it, may
be increased to a drachm. It should always be taken after
food. It is apt to produce constipation and sickness. I have
found this is best combatted by administering some mild purga¬
tive to ensure the regular action of the bowels, when the ten¬
dency to nausea generally disappears. In leprosy, at least, I
am led to think that a much larger dose than that ordinarily
given ig required. 1 am in the habit of prescribing the oil as a
mixture suspended in gum, or as an emulsion. It may be
more elegantly administered in perlers or capsules ; and I have
,'598 Current Medical Literature. [September
had some made containing fifteen minims each, which I find
useful and convenieut.
Chaulmoogra is the oil expressed from the seeds of the Gyno-
cardia odorata. Its melting point being high, it is semi-solid
at the ordinary temperature. Its taste and odor are not dis¬
agreeable, and it comes to us with a high Indian reputation
as a remedy for scrofula, skin-diseases, and leprosy. I am
making trial of chaulmoogra oil in lupus and late forms of
syphilis and, in cases where cod-liver oil is not well borne, I
have found patients improve materially while taking it .—British
Medical Journal , June 28.
KLEBS ON THE CONTAGIUM OF SYPHILIS.*
This is an experimental study of the inoculation of syphilis
upon some of the lower animals. Certain patients were sub¬
jected to removal of Hunterian chancres by antiseptic means,
and parts of each chancre were preserved in hermetically sealed
tubes, and from these the inoculations were made, either
directly or after cultivation. Under certain conditions syph¬
ilitic indurations are not infective, or, more probably, they have
ceased to be so at the time of inoculation ; and, inasmuch as
these show the same histological elements as those which do
infect, it is concluded that the cells are not the carriers of the
virus, these being present in both cases. Klebs believes that
the various stages of development of a fungus correspond with
the various grades of iufectiveness, and this is corroborated
by another observation of his, that the extirpated masses were
more active when they had been preserved for some days in
glass tubes prior to their insertion.
The parts removed were all examined, both in the first state
and after the usual hardening processes and staining. By the
latter, appearances were observed in the morbid material which
were suggestive of the presence of micrococci, but they were
to some extent equivocal, isot so with the fresh specimens, in
which organisms were indubitably recognizable as active mo¬
bile grains and short rods.
The first experiment was on this wise. On April 15, 1875, a
Hunterian chancre was removed antiseptically and transferred
to a glass tube heated to a red heat and closed by cotton¬
wool. During three days its surface showed no trace of putre¬
faction. The tube was opened on April 18th under salicylic
acid spray, and pieces of the mass transferred to two cultiva¬
tors. Within two or three days changes were observed in them,
and, at the end of twenty-two days, microscopical investiga¬
tion showed micrococci aud rods. From this material a small
black rabbit was inoculated in the anterior chamber of each
eye. The inoculation excited considerable inflammation of the
eyes, and rapid wasting, and death took place in nineteen days.
Archiv fiir Experiment I’athologie n. Pharmakokigie, Band x.
1879] Current Medical Literature. 399
The inspection did not show very much, but the left side of
the liver contained a small circumscribed yellowish- white
deposit, with gristly thickening' of the neighboring serosa.
The left cornea, also, showed morbid changes.
The second experiment was upon an ape. Three injections
were made — one into the prepuce, another under the right
nipple, the third under the left; all on July 8th. Nothing was
noticed, except that an abscess formed at the seat of one of the
punctures, till seven weeks after inoculation. By that time
the animal was very ill, and a granulation tumor had formed
in the gum of the upper jaw. It died on August 31st. The
lung contained extensive tough yellow masses with cheesy
centre, the peripheral parts of which were rich in spindle cell
forms, and, therefore, unlike tubercle. Moreover, these
changes were in direct communication with a caseous abscess
under the left breast ; one of the spots at which an injection
had been made. Extensive changes were also found in the
skull, in the shape of caseous deposits and bare bone. The
deposits presented the same microscopical appearances as those
in the lung ; they were very vascular, and their softer parts con¬
tained rods in threads, in clusters, and groups which corres¬
ponded with those found in the cultivation apparatus.
The next series was not carried out till May, 1877. The mate¬
rial was afforded by a hard chancre removed by Professor
Weiss half an hour previously. The surface of the ulcer
showed a thick layer of micrococci, which exhibited lively
movement in a mixture of glycerine water and common salt.
Three rabbits and a dog were inoculated from the fresh chancre
in the submucous tissue ol the genitals. No noticeable changes
resulted ; neither induration nor ulceration. Two guinea pigs
were inoculated by injection into the peritoneal cavity ; and in
these, as in former experiments, continuous wasting set in, and
the animals died. No changes were found in the viscera, but
actively moving bodies were found in the urine, pericardium,
and bile of one animal.
Pieces of the same chancre were transferred to a cultivator,
and, after twelve days, from the resulting growth of rods,
grains, etc., a guinea pig was inoculated. On the following
day, the part was somewhat swollen, and, within three days,
the animal was dead. The organs were healthy, but in the
blood were a few moving rods and micrococci.
Some of the material in another cultivator was left for a
month, and, when examined, no longer contained rods, but only
micrococci. With this, and with some material obtained by
cultivation from the bile of the recently dead guinea pig, two
parallel series of observations were made with guinea pigs,
rabbits, dogs, and a goat. The inoculations were made on
June 8th ; on the 12th, the goat and one dog showed some
swelling at the seat of puncture, and the dog some subsequent
swelling of the inguinal glands, the inoculation being made on
8 . .
400 Current Medical Literature. [September
the penis. But these early changes disappeared, and the ex¬
periments appeared to have failed. On July 5th, however, one
of the rabbits died unexpectedly, and a quantity of fluid was
found in the peritoneum containing micrococci ; their being no
trace of peritoneal inflammation. No other disease was found.
On October 1st, a guinea pig died, and it also had ascites ; the
peritoneum being free from inflammation. This case is thought
by Klebs to be similar possibly to a case recorded by Dr. E.
Schiitz (Frag. Med. Woch ., 1878) of a new-born syphilitic in¬
fant with ascites, the condition being associated with an ex¬
tensive narrowing of the small arteries, but the arteries were
not examined in these animals.
Of the two dogs, one died on August 22d ; it had lost
weight continuously. Some rather equivocal appearances in
the cranial bones were found. The other being quite w ell some
months after, it was devoted to other purposes. When it w as
examined, the spongy substance of the long bones in the w hole
extent of the epiphysis and part of the diaphysis was converted
into compact tissue, and no trace of the epiphysial line
remained. In the cranial bones eroded and carious patches
were found.
A fourth series was conducted upon a pair of monkeys. The
male was inoculated immediately from an extirpated chancre.
The latter being removed, a small piece w as deposited under
the skin of the scrotum. The small wound healed at once, and
no ill results followed. From the same chancre two pieces
were taken and cultivated. The material became yellowish-
grey and black, very offensive, and, on the sixth day, it con¬
tained a sporulating bacillus with active movements. The
female w as inoculated by subcutaneous injection. Suppuration
occurred, and the part healed without any further ill result.
The male was again inoculated from a fresh chancre, but only
with a like result. The female was subsequently inoculated
from another extirpated chancre. For six w eeks it appeared
quite well ; then it began to shiver. The temperature rose to
104°, and an eruption appeared on its face. It died on May
L7 th, having been inoculated on December 29th. Characteristic
changes were found in various parts, particularly in the lung,
cranial bones, and kidney. In the lung there appears to have
been a very characteristic gumma. The changes were distin¬
guished from tubercle by being entirely interstitial, and by
being composed of spindle-cells and other elements in a glassy¬
looking protoplasm. Similar appearances are found in the
indurations of a fresh chancre.
By cultivation of the blood of this animal, masses of fungus
were procured, consisting of spirally twisted masses of elon¬
gated rods, arranged in colonies and chains, to which the name
Helicomonads is applied. The results of his observations
Klebs sums up in the following three conclusions.
J. Syphilis in man can be communicated to animals by inoc¬
ulating them with peitions el the sy j liilit ic new tom ations
Current Medical Literature.
401
1879]
But tlie course of the disease is uot the same for each genus.
With apes, the disease is quite the same as in man ; rabbits
have given other results which, if not striking, nevertheless
will not allow any mistake as to their similarity with the dis¬
ease in mau.
2. In syphilitic new formations in man, certain low fungoid
organisms are found, which develop into peculiar forms — Heli-
comonads.
3. By the transference of these to selected animals, changes
are set going which correspond not only with those of genuine
syphilis in man, but also with those of the inoculated syphilis
of animals. — James F. Goodhart, M.D. — London Medical Record ,
July 15.
THE PROPOSED PHARMACY LAW AND PROPRIETARY MEDICINES.
Fr. Eberlein.
The Legislature of this State passed a law, about a year ago,
for the suppression of charlatans and quack doctors. This law
has been followed by good results, and if the Pharmacy law is
passed, it will do about as much good in remedying the existing
evil in the pliarmacal branch of medicine.
But both laws are inadequate, in their present shape, to pro¬
tect the public and the professions for which they are intended
against another class of impostors. It is the case in all civilized
countries ; for as long as a charlatan or any other unscrupulous
person is permitted to make and recommend as a u sure cure” for
any disease known, or yet to be discovered, any kind of mixture
invented by and known only to himself, which is legally pro¬
tected by patents and trade marks, and is assiduously aided
by a docile press, so long will neither the purse nor the life of
men be out of danger.
There are now in the market a vast number of so-called patent
medicines, which, by analysis, have been proven to contain
poisonous ingredients, alike detrimental to man and beast, and
which are bought and consumed by an ignorant public, deluded
by mostly false statements, made in news and other papers.
Is it not, for instance, a well known fact that all the so-called
u soothing syrups,” intended for sucklings only, contain opium
or its active principle ? When the new-born babe makes
use of its first and only sign of life furnished by nature to make
known its pleasures and pains by crying, it is instantly drugged
with a dose of soothing syrup ; aud who can tell how many
poor little creatures are thus annually soothed to eternal rest,
who otherwise might have become useful and happy citizens of
this great u free ” country ?
If our State is ever blessed with a Pharmacy law, who shall
examine all the boys and girls as to their competency to dispense
soothing syrup, etc.? Whereby is any man forbidden to offer
for sale under any high sounding title a mixture containing any
quantity of strychnia, croton oil, etc., assuring the public that
402 Current Medical. Literature. [September
they would feel the beneficial effects after taking the first dose.
The climax, however, in this kind of confidence game, is
reached by a certain firm in B - , by its daring announcement
in the German papers a few weeks ago. The readers were in¬
formed that they would certainly curtail their doctors’ bills by
taking their u unfailing health drops,” and that their liniment
was a certain cure for neuralgia in the most delicate lady or the
worst case of colic in a horse or bull. “ The Great German
Remedy for Man and Beast,” as is printed on the label, is a
direct gift of a merciful God for all suffering beings.
In order to show the reader how well a humbug of this kind
will pay its proprietors — the press being judiciously managed —
I will give a few facts concerning this liniment, thinking that
the same will prove interesting to many druggists who now only
know the preparation by name or by sight. St. Jacob’s oil is
the name by which it is known and extensively advertised in
all of our German publications. On the label is made the state¬
ment that this substance is distilled in Germany, from the leaves
of the fir; that in fact it is fir leaf oil. Few druggists know
that this an officinal preparation.* Mention of it, however,
may be found in the TJ. S. D., under the heading u Fir Wool
Oil,” and in the N. D. (National Dispensatory), under Fichten-
nadelol ; and in New Remedies , January, 1878, p. 9, may be found
the following note : “The Pharmacopoeia of the Throat Hos¬
pital, London, contains, among the list of materia medica, oleum
Piui Sylvestris. From this it may be seen that the oil of the
Pinus Sylvestrist is a well known remedy in England as well
as Germany.” Being acquainted with the article, I imported
some pro bono publico , and of course in the interest of my busi¬
ness, the first consignment reaching me about eight years ago.
Upon its arrival 1 advertised the fact in the papers, and soon
disposed of my stock to people who had employed the oil while
visiting the old country. Since then I have frequently replen¬
ished my stock.
Not very long ago I noticed that a firm in Baltimore was
advertising the same article under the name of “ St. Jacob’s
oil,” (said to be a popular name in some parts of Germany,)
but was not a little surprised upon discovering that the bottle
they sold for fifty cents contained at least four times as much
as I could possibly sell for an equal sum. Subsequently 1
opened one of these bottles, and found it to contain a brownish
colored liquid possessing the odor of camphor, oil of turpentine
and ether, while a closer examination revealed the presence of
alcohol. The conviction dawned upon my mind that such a
concoction might b.* readily sold at $3 per dozen, and still yield
a handsome profit to the manufacturer ; making a pint of the mix¬
ture of the ingredients first mentioned, and adding this to one gal¬
lon of the oil of turpentine at thirty cents, would make for eighty
* Oleum Terebinthinte,— Editor.
t Scotch Fir. — Editok.
Current Medical Literature.
403
1879]
cents sufficient to till three dozen bottles — the main expense
being labels, circulars, wrappers, bottles, and Uncle Sam’s two
cents’ worth of interest in the patent humbug — altogether-
making a cost of about $2 or $2 50 for three dozen, say 75 cents
a dozen, for which they receive about $3 per dozen by the
gross, aud the arcanum , almost dirt cheap, is ready. But to
place it where it would do the most good consumes vast sums
of money ; but for money the press will willingly open its
columns to the greatest charlatan, even when convinced that
the article is an unmitigated humbug. Newspapers are insti¬
tutions created for the purpose of making money ; nevertheless
they obtain a certain induence over their readers, and as it
costs more to run a newspaper than the editor gets from his
subscribers, they use their influence in preying upon the cre¬
dulity of the readers. They offer their columns to speculative
merchants, charging sometimes as high as a dollar a line, and
then without inquiring into the virtue of the article to be adver¬
tised. This point is being well appreciated by compounders of
patent medicines, who, to a great extent, support the daily
press.
It is really a novel species of confidence game, for, through
all manner of promises aud representations, the people are
deluded into investing a certain amount, for which they expect
to receive an equivalent with which to restore their lost health,
frequently, however, without obtaining that which has been
promised by the announcements. Probably the reader is ex¬
pected to consider this investment as part payment for his
newspaper, which he received too cheap in the first place, for
stockholders must make a living.
Ln order to give a superficial idea how plentiful the return is
from the seed of humbug sown on the acre of popular ignor¬
ance, I will state some of the results of my investigations with
the St. .Jacob’s oil business : Here in Cgicago our wholesale
druggists handle from 15U0 to 2000 gross per annum, for which
they pay the manufacturers from $50,000 to $60,000; advertis¬
ing in the German papers of Chicago and vicinity possiby
amounts to $6000 to $12,000 a year; the cost of preparing the
stuff — $9 a gross — is equal to about $13,000 to $18,000. All
expeneses combined possibly amount to $20,000 or $30,000,
against $50,000 to $60,000 receipts ; from which it will be seen
that Chicago alone affords the small, but honest (?), margin of
$30,000 a year.
The moral to be derived seems to be plainly this : Instead of
working hard as a physician or pharmacist for the benefit of
mankind, barely eking out a decent livelihood, it would be
rather more practical to cure the people by means of St. Jacob’s
oil, or something similar, thereby securing one’s self an inde¬
pendent place in society, as is the case with the Baltimore
firm.
Such an idea, however, is repugnant to all respectable pro¬
fessional men, and, as a consequence, we must content ourselves
404 Current Medical Literature. [September
by trying to promote our own interests and those of the public
by arresting the patent medicine humbug now raging in this
country. I am of the opinion that Germany’s laws would serve
us a good purpose. There they have no secret medicines, be¬
cause it is forbidden to make any.
One of the members of the Bancroft-Davis embassy told me
that during the time our Government was inquiring through
them, “ how many patent medicines exist and how large are
the sales of the same in Germany?” the German Government
answered in a very polite manner that Germany was a civilized
country, where no such preparations were allowed. Now, we,
also citizens of a civilized country, should unite and have a
similar law passed, which would create for us a healthier busi¬
ness and at the same time protect the people. — The Pharma¬
cist and Chemist , June.
NOTES ON INTRA UTERINE MEDICATION.
By G. Granville Bantock, M.D., F.R.O.S., Edinburgh.
Senior Surgeon to the Samaritan Free Hospital for Women and Children.
The discussion which has been going on in the Obstetrical
Journal , on this subject, is one of very great importance, and
it is high time that the results of, at least, one of the methods
employed should see the light. Ever since the practice of
applying fuming nitric acid was advocated for the treatment
of chronic uterine catarrh, I have looked forward, in confident
anticipation, to the time when we should hear of the dire
consequences of such heroic treatment. Now my expectations
are realized. Holding these views, it will not be expected that
I can afford any direct evidence, for 1 have never employed the
pure acid, and it will be readily understood with what horror
and amazement 1 have listened to gentlemen declaring that
they had used it in hundreds of cases.
Now I, for one, cannot but regret that a method of treat¬
ment — viz., intra uterine medication — which yields such satis¬
factory results, when judiciously employed, should be thus
brought into discredit ; for I can fully confirm the statements
of Drs. Playfair and Sloan on this subject, seeing that I am
almost daily witnessing the beneficial results of this treat¬
ment.
When I first began the study of the diseases of women,
about fifteeu years ago, 1 was in the habit of employing the
nitrate of silver, according to the method then practiced — viz.,
by passing the solid stick as far up the cervix as possible; but
T soon found that this was a clumsy and inefficient method,
and often produced a greater local effect than was desirable,
more of the agent being used than was necessary. This led
me to employ the mild, hard, and less soluble caustic points
used by oculists. But this did not satisfy me, and I had re¬
course to a more accurate mode. I fused the solid nitrate in a
Current Medical Literature.
405
1879]
platinum crucible,* and then dipped into it a platinum probe,
two inches and a half long, and of the size of a No. 1 catheter.
By repeated dippings 1 got as much as l thought necessary,
and I was thus able to apply the agent to the whole length of
the cervical canal, and, if necessary, to the uterine cavity, as
high as the fundus. In this way I could make sure, not only
of the amount of the nitrate used, but also of the extent to
which it was applied, and 1 obtained excellent results.
This did not, however, prevent me from experimenting
largely. For this purpose 1 had a wide field in the out-patient
department of the Samaritan Free Hospital, where I had sev¬
eral thousand of x>atients pass under my hands — in one year as
many as a thousand. 1 experimented with other agents, such
as carbolic acid, iodine liniment, sulphate' of zinc, styptic col¬
loid, and a solution of sixty grains of nitrate of silver in half
an ounce each ot nitric acid and distilled water ; but I could
not bring myself to try the nitric acid alone. I found the zinc
and colloid of little or no value, and the solution I reserved for
special cases, which came “few and far between.”
The result of this experimentation is the practice 1 now
adopt, which is as follows :
When the secretion of mucus or muco-pus, is very ex¬
cessive — and in some cases as much as a small teaspoonful can
be obtained from the vagina and cervical canal — and, as is
usually the case, the cervical canal is very large, the calibre
generally corresponding with the amount of discharge. I first
apply the above solution, a few days after a menstrual
period. At the end of a week the visible effects have passed
off and the discharge is thiner and less abundant, and I then
apply the carbolic acid (nineteen of the crystals to one of
water), repeating it at intervals of a week, except when inter¬
rupted by a period, and taken care not to apply it within a
week of an approaching one, until a cure is effected. In milder
cases I employ the nitrate of silver first, and if, after a time,
the carbolic acid appears insufficient, and in the convalescent
stage of the more .severe cases, I have recourse to it again, but
only just after a period. In the earlier years of my practice 1
observed rather more contraction of the os and cervical canal
than L considered desirable, after using the solid nitrate, and
in one very severe, long-standing and obstinate case, in which
I applied my solution three or four times, but in no case to an
inconvenient extent. In a few cases I still find the nitrate of
silver alone sufficient, in one or two applications, but for the
most part I use the carbolic acid. But I cannot say that I
have obtained the wonderful results we ought to expect if Dr.
Playfair be correct when he says, “ practically I find that two
applications, at an interval of three or four days from each
other .... are all that is required.” I cannot imagine
* The platinum crucible and aluminium probe can be i btained of Messrs. Krohne and
Seseman n, 8, Duke Street, Manchester Square.
40() Current Medical Literature. [September
that Dr. Playfair has in view the severe cases to which I refer,
nor have 1 found any advantage from the more frequent appli¬
cations — viz., at intervals of three or four days instead of six
or seven.
But there is another method of treatment which has yielded
still better results in my hands. This consists in the dilatation
of the cervical canal by means of a sponge tent, as the first
step.* The tent must be left in for twenty-four hours. By
this time, what with the compression of the swollen mucous
membrane, and what with the removal of exuberant granula¬
tions to which the sponge adapts itself, and which are torn off
as the sponge is withdrawn, a clean surface is obtained. A
strip of lint, saturated with glycerine containing iodine lini¬
ment, in proportions varying with the circumstances of the
case, is substituted for the sponge. The lint is to be renewed
daily for ten or fourteen days. The iodine, however, is not to
be used every day, and its subsequent applications, which
should not be oftener than every third day, should be in more
diluted form. At the end of the period above named the case
will probably be well. Anyhow the treatment must be stopped
two or three days before and during the next menstrual period,
if after this anything more should be required the carbolic
acid will be found the appropriate agent, and probably the
“ two applications” of which Dr. Playfair speaks will be all
that is required. In this way cases may be cured in one or
two months, instead of three to six months, or even more.
The cases in which this treatment can be employed are few
and far between, as it requires that the patient should be
within easy reach. Nor is it always easy to persuade a patient,
who perhaps only complains of “such a discharge” with a
little backache or bearing-down, or othar indefinable and vary¬
ing symptoms, to submit to enforced rest in bed for a fortnight.
The principle of the treatment is the very obvious and com¬
mon-sense one, daily acted upon by surgeons in the treatment
of indolent granulating wounds — viz., first the destruction of
exuberant granulations, and then daily dressing. A surgeon
would not dream of treating, on the surface of the body, a state
of things such as the mucous membrane of a uterus affected
with chronic catarrh, presents to the gynaecologist, by applying
something to it once a week, or even at a shorter interval of
three or four days, and leaving it in the interval to take its
chance. Why should not the gynaecologist do likewise ?
But in practice it is more difficult; and in this the gynaecologist
is at a disadvantage.
One great advantage of this method is this — viz., that we
need not fear subsequent contraction of the canal ; and when
* Sponge tenia should not be covered with greeae, except at the tip, and should be pre¬
pared without gum, aa they have been for some time made by Krohne and Seseman ac¬
cording to my instructions. It is well to charge the tent afresh with two or three drops
of the strong liquid carbolic acid or iodine liniment, by means of a large vaccine tube,
before using.
1870 J
Current Medical Literature.
407
the condition is a sequence of a bad “getting about” after a
confinement, with subinvolution of the organ, we kill two birds
with one stone — we cure the unhealthy condition of the mucous
membrane and the subinvolution at the same time.
A word or two about the mode of applying liquids to the in¬
terior of the uterus. When a probe covered with cotton -wool
is dipped into a liquid it is apt to take up more than is re¬
quired. The consequence is, that as the probe is pushed up
into the uterus the excess is squeezed out and runs over the
cervix into the vagina, where it is not required. The ordinary
(so-called) medicated wool is very inconvenient, because its
capillary properties are interfered with by the presence of oily
matter used in its preparation. Von Bran’s preparation,
which is free from oil, is much to be preferred, and the quantity
of liquid can be better regulated.
Dr. Playfair recommends a probe with a bulbous point-
This is a mistake ; or, at least, an inconvenience. Long
before the publication of his lecture on this subject I
had been in the habit of using a pointed (not too sharp) instru¬
ment. This form is much more convenient. I have never-
known the cotton wool come off. The probe — aluminium is
undoubtedly the most convenient metal — must be wrapped
with the wool for two-thirds of its length, or more, and it
should not be straight, but very slightly curved. Nor is it at
all necessary to roughen it, as Dr. Sloan recommends. 1
always remove the wool with the ordinary gynaecological for¬
ceps, and my difficulty is to prevent the metal getting too
rough from contact with the toothed surfaces of the forceps.
The trouble of getting the wool off' a bulbous-pointed probe is
very irritating. It is all very well in the wards of a hospital
where you have a nurse to do this for you, but it is an intoler¬
able nuisance in private practice.
It is not within the scope of these notes to enter upon a dis¬
cussion of the other conditions requiring intra uterine medica¬
tion. I have limited myself to the question of the treatment
of chronic catarrh as the most frequent, and, in the experience
of some, one of the most obstinate affections coming under the
notice of the gynaecologist, and 1 trust the result of this dis¬
cussion will be that we shall hear less of the hundreds of cases
in which the heroic treatment by fuming nitric acid is employ¬
ed, and that intra uterine medication will be established on a
safe and scientific basis. — Obstetrical Journal , Mai/, 1879.
COMPARATIVE DANGER OF FIRST LABORS.
I)r. J. G. Swayne has recently read before a branch of the
British Medical Association a valuable paper*, in which heen-
*Obatetrical Journal of Oroat Britain, May,
9
408 Current Medical Literature. [September
deavors to answer the question whether first labors are more
dangerous than others. His opinions are based upon a careful
examination of ten hundred and twenty-two cases which have
occurred in his own private practice. Of these two hundred
and thirty-one were primiparse, and seven hundred and ninety-
one multipart. Ho mother died among the former, while five
of the multipart were lost. The causes of death were as fol¬
lows : In one it was heart disease, which existed previous to the
labor, which became worse after delivery, and terminated fa¬
tally on the twenty-seventh day ; in another it was puerperal
scarlatina, proving fatal on the fifth day ; in another ruptured
uterus ; in another pneumonia, commencing two days before
labor, and ending in death six days afterwards ; and in the
fifth convulsions, which proved fatal a few hours after delivery.
Thus the proportion of maternal deaths in the multiparse was
about one in one hundred and fifty-eight, whilst in the primi¬
parse there was no death in two hundred and thirty-one cases,
a difference greatly to the advantage of first labors.
As regards the children, however, the difference was slightly
the other way : in the two hundred and thirty-one first labors
the deaths of eighteen infants are recorded, or about 7.8 per
cent., whilst in the seven hundred and ninety -one multipart
forty-seven infants died, or about 5.1) per cent.
A careful examination of the cases in detail show some inter¬
esting facts which characterize first from other labors. In
primiparse, owing to a prolonged first stage, the uterus is more
exhausted, and forceps are more frequently demanded. Thus in
two hundred and thirty-one primiparse Dr. Swayne used forceps
fifty-two times, or nearly one in four, whilst iu the seven hun¬
dred and ninety-one multiparse they were employed only twen¬
ty-five times, or nearly one in thirty-one. Hence come a larger
number of deaths of infants from the pressure during prolonged
labor. In first labors the rigidity of the soft parts of the
mother gives rise to an increased danger iu cases of presenta¬
tions of the inferior extremities. In the two hundred and
thirty-one primiparse there were six breech presentations, in
four of which the child was still-born, whereas in the seven
hundred and ninety-one multiparse there Avere fourteen such
cases, and only two children lost. Among the multiparse the
greatest cause of infant mortality was premature birth, from
which cause there Avere eighteen deaths ; among the primiparse
there were only three. Post partum haemorrhage occurred
about equally in both classes, but the amount of blood lost
was far greater iu the multiparse. There were eleven cases of
twins among the multiparse, and only one among the primiparse.
There is unquestionably much greater suffering among primi¬
parse than among multiparse ; on the other hand, the former
are, as a rule, younger and in better health and stronger. Rup¬
ture of the uterus occurs much more frequently among the mul¬
tiparae. Dr. Swayne closes hi paper Avith the conclusion that
Current Medical Literature,
1S79]
409
first labors are less dangerous than others to the mother, but
slightly more so to the infant. — Boston Medical and Surgical
Journal, July 3.
IODIDE AND BROMIDE OF POTASSIUM IN ALBUMINURIA.
By J. W. Compton, M.D., of Evansville, Ind.
Many good remedies may have a much wider range of thera¬
peutic usefulness than is usually accorded them. The iodide of
potassium has, for the past ten years, in my hands, exhibited
well-marked good effects in the treatment of albuminous
nephritis.
I n 1809, E. S., age thirty-five, presented himself to me for treat¬
ment for a chronic renal trouble. At this time he exhibited well-
marked cederna ; much swelling from effusion in the cellular tis¬
sues, particularly of the lower limbs and face. Obtaining some of
his urine, and submitting it to the usual tests of heat and nitric
acid, it became almost solid albumen, and having but slight
hope of anything more than mere temporary relief from the
ordinary course of diuretics recommended in such cases, and
having my attention about this time called to the successful
treatment of Bright’s disease by iodide of potassium, I deter¬
mined to try this old remedy in a new role.
The patient was directed to take, in solution, ten grains
iodide of potassium four times per day, and to increase this dose
daily, up to the largest amount tolerated by the stomach and
mucous membranes. The patient proved to be a good subject for
the free admistration of the remedy. The quantity taken per day
was gradually increased, until it reached the unusual amount
of three drachms daily, and before he ceased taking the remedy
he informs me that the renewals of the prescription had cost
him over one hundred dollars. These large doses brought out,
to almost a troublesome extent, the characteristic red eruption
on the skin, particularly on the lower extremities. At this
stage 1 had the pleasure of seeing the dropsical effusion dis¬
appear, and the patient restored to perfect health. He is an
active business man to-day, and his recovery can, with much
certainty, be traced to the remedy in question, as lie took no
other medicine during the time. For the first year or two he
had occasional returns of swellings of the extremities, which
were in a short time relieved by resorting again to the remedy.
More recently there appeared under my observation similar
good results from the administration of bromide of potassium
in albuminous urine. Bromide of potassium possesses altera¬
tive and resolvent properties similar to those of the iodide, and
in many forms of disease complicated with albuminuria will be
found preferable to its congener. In addition to its acknowl¬
edged strong eliminative powers, it possesses physiological
properties similar to those of other potassium salts ; yet its
410
Current Medical Literature.
[September
action on the nervous system and upon the circulation are so
far diverse as to give to it some entirely different therapeutic
properties. Its quieting control over cerebral excitement, and
under certain forms of nervous excitement constituting unrest
and other forms of nervous derangement, often render it a valu¬
able substitute for the iodide. These various forms of nervous
conditions are familiar to the profession, need not be repeated
here, and not wishing to occupy space unnecessarily, I deem it
quite sufficient to call the attention of practitioners of medi¬
cine to the therapeutic indications of two valuable agents in
the treatment of a disease in which I am led to believe these
remedies are not generally administered, and which so fre¬
quently battles our best efforts as to make it desirable for us to
have access to all therapeutic agents that promise permanent
benefit. — Medical and Surgical Reporter, July “6.
TREATMENT OF OBSTINATE VOMITING BY SMALL DOSES OF
IODIDE OF POTASSIUM.
By GEORGE HUNTINGTON, M.D.
Having noticed in the Record of March 15th, under the above
heading, an article taken irorn a statement made by Dr. For¬
mica Corsi in the “Gazette Obstetricale,” and having a patient
suffering from obstinate and intractable vomiting arising from
spinal inflammation, and having exhausted all the remediesordi-
narily employed as anti-emetics, without the least amelioration in
the symptoms, I determined to try the iodide in the minute doses
recommended by Dr. Corsi. The vomiting had occurred imme¬
diately after taking food of any description, quantity and qual¬
ity making no apparent difference. Vomiting occurred with
very little effort, nausea persisting for only a short time after
the contents of the stomach had been entirely rejected.
This state of things had existed for at least two months, in
which time she had retained only an occasional mouthful of food.
After the use of injections of beef-tea and egg for several
days, during which time nothing but a little drink was allowed
by the stomach, one or two meals were retained, but the vomit¬
ing commenced again, and continued up to the time of the
administration of the iodide. I gave it in solution, in doses of
1-30 grain, repeated every hour and a half; and since then —
now fourteen days — she has retained everything she has taken,
excepting one or two meals, when she had omitted the drug for
a few doses, at my request, as a test. — The Medical Record.
1879 1
Editorial.
41 1
DITOI\IAL.
When “old Salt Kiver” Snyder came to die, he admonished
his sons never to become “too intimate” with the bottle.
However erroneous the rhetoric, the moral designed to be con¬
veyed is not a subject for just criticism. Perhaps a paraphrase
of the advice, making it applicable to the medical profession,
may be pardonable, even if the bad language is literally quoted.
The un-dictionary, but yet phonetic spelling of Josh Billings
gives point and endurance to his quaint witticisms.
Suppose, now, we make the venerable Snyder’s dying charge
apply with especial pertinency to the medical profession, by
substituting for “ bottle ” — newspaper reporters.
No one can deny that intimacy with that craft is a growing
evil in the profession in our section of the Union.
A surgeon has an operation to perform : the editors of his
pet Daily hear of it, and one of its reporters is sent to wntuess
it, even though it may be upon a respectable female and for
ovarian tumor, or lacerated perineum — decency is outraged and
feminine delicacy overridden, in order that the reporter may
give a “ good notice,” that is a sensational notice, which is to
benefit the operator.
In all this the newspaper people consider themselves the
benefactors, and naturally enough, because the newspaper ac¬
counts of the operations are generally Haring putt's of the
operators. It is, therefore, natural again, that the papers con¬
ferring these supposed benefits should demand something in
the shape of a return. It then occurs that as often as a medi¬
cal question puzzles the editorial corps, a reporter is dispatched
and their pet Medicus is solicited to furnish a solution. This
he generally holds himself competent to do. Is he not a man
who possesses enough of the fat of wisdom to lard all the lean
hills of science in his community ? If he is not, his pet news¬
paper has lied, for it has put him forth as precisely such a phe¬
nomenon. He can give certificates which clearly define the
412 Editorial. [September
diseases people have died of, into whose sick rooms he was
never permitted to enter. He knows ali the unraveled mys
teries of those destroyers of mankind which devastate nations
in the darkness of night or in the broad glare of noontide.
The saddest result from this state of things in New Orleans is
that one of the daily papers contains from day to day bulletins
of cases of sickness in private families, citing the names and
residences of the sick, and embellished by such gossip as the
reporter may choose to add. The family circle has no privacy
and grief no sacred retreat which these unfeeling and indelicate
wretches do not seek to lay bare to the public in the columns
of a political newspaper, sometimes with their pet doctors to
aid them.
If the delicate and altogether sacred relations which shoidd
subsist between physician and patient are worthy of being pre¬
served, then must the whole honorable mass of the profession
as one man, move breast to breast in breaking down these des¬
picable alliances between certain practitioners of medicine and
newspaper reporters, and in expressing in unmistakable, terms
their condemnation of all newspapers so ignoble and insensible
to right as to attempt such practices.
“ Absorbing Cotton” prepared by Messrs. I lance Brothers
& White, Philadelphia.
While it is very difficult to make ordinary cotton absorb any
not-alcoliolic liquid, on accou t of the oil, which cotton in its
natural condition contains, this u absorbing cotton ” is readily
saturated with any fluid, almost as easy as a sponge. It is
excellent for dressing purposes, whether it be from the surface
of the body or from any of the natural cavities — vagina, ear,
etc. — that secretion has to be removed. On account of its
absorbing quality, it is equally available in the application of
external remedies, for instance, perchloride of iron in lnernor-
rhages.
1879]
Reviews and Book Notices.
413
Reviews and Book Notices.
The Principles and Practice of Surgery , being a Treatise on Sur¬
gical Diseases and Injuries. By D. Hayes Agnew,
L.L.D., Professor of Surgery in the Medical Department
of the University of Pennsylvania. Profusely illustrated.
Vol. I, imp. 8 vo., pp. 1062. Philadelphia: J. B. Lippen-
cott & Co.; New Orleans : Eyrich’s Book Store, 131 Canal
street.
The surgical magnates of America are rivals of their English
confreres, and the work before us will undoubtedly take its
place high in the estimation of the profession.
The handsome volume under consideration, from the begin¬
ning to the close, bears evidence of great experience and care¬
ful study. The introductory chapter is one of the most elabor¬
ate treatises on methods of examination we have ever read.
Chapter I takes up the study of inflammation, and the
investigation of the nature, cause, history, and results of this
process is essentially modern, and the treatment of the subject
complete.
Chapter II is devoted to wounds, their nature and variety,
including those caused by specific infection, and their treat¬
ment is carefully considered. We wonder that when the author
dwells on the subject of hemorrhage the apparatus of Esmarch
found no place in the catalogue of tourniquettes.
Chapters III, IV and V are exceedingly interesting and treat
of injuries of the head, chest and extremities.
Chapter VI relates to diseases of the abdomen.
Chapter VII treats of diseases and injuries of the blood¬
vessels.
Chapter VIII is a practical treatise on the ligation of
arteries.
Chapter IX is an explanation of the various surgical dress¬
ings.
Chapter X is highly satisfactory, and is devoted to the study
of iq juries and diseases of the osseous system. The statistical
414
Reviews and Boole Notices. [September
information contained in it is valuable but too extensive to in¬
terest the general practitioner.
We look forward to tlie second volume with much pleasure.
Epitome of Skin Diseases, with formula), for Students and Prac¬
titioners. By Tilbury Fox, M.I)., F.R.C.P., Physician to
the Department for Skin Diseases in University College
Hospital, etc., and T. C. Fox, B.A. (Cantab), Physician to
St. George’s and St. James’s Dispensary. Second Ameri¬
can Edition, enlarged and revised by the authors. Phila¬
delphia: Henry C. Lea. New Orleans: Arinaud Hawkins,
196^ Canal street, pp. 210.
The name of the lamented Tilbury Fox will long live in the
medical profession as one of the most devoted workers in his
specialty, and his systematic studies in skin diseases have won
for him golden opinions on both sides of the Atlantic.
The work now under consideration is the combined labor of
himself and Doctor T. C. Fox, and, as expressed by its title,
gives within its pages those essential details requisite to the
study of the subject.
The work is divided into three parts.
Part I treats of general observations on skin diseases.
Part II the description and treatment ot skin diseases, and
Part 111 contains the cutaneous pharmacopoeia.
Part II of the work is especially planned so as to be easy for
reference. The diseases are taken up alphabetically, and the
formulae and observations on diet in the third part of the work
are practical and thorough.
The work is printed on good paper with clear type, and is cor¬
dially recommended.
An Atlas of Human A natomy , Illustrating most of the ordinary
Dissections and many not usually practiced by the Stu¬
dent, accompanied by an Explanatory Text. By Rickman
John Godlee, M.S.F.R., C.S., Fellow of University Col¬
lege — Part I. Philadelphia : Lindsay & Blakiston. New
Orleans; Armaud Hawkins, 1904 Canal street. Price,
$2 50.
The purpose of this excellent atlas is fully explained by its
1879]
Reviews and Book Notices.
415
title. The first part contains four artistically executed plates,
illustrating the superficial and deep dissections of the neck.
Muscles, arteries, veins and nerves are displayed with re
markable distinctness. Other parts of this atlas will soon
appear, and afford the student an opportunity of learning-
anatomy practically and agreeably.
Diseases of the Intestines and Peritoneum. By John Syer Bris-
towe, M.D., J. R. Wardell, M.D., S. O. Habershon, M.D.,
J. W. Begbee, M.D., T. B. Curling, F.R.S., and W. H. Ran¬
som, M.D. u Woods’ Library of Standard Medical Au¬
thors.” Wru. Wood & Co., New York. New Orleans ;
Arman d Hawkins.
The enterprising publishers are determined to let merit be
the claim to positions in this valuable i{ Library,” and in the
present volume have won new laurels. The work before us is
the combined effort of five distinguished authors, and while of
necessity, compressed in small compass, contains an admirable
study of the following diseases :
Enteralgia, Enteritis, Obstruction of the Bowels, Ulceration
of the Bowels, Cancerous and other Growths of the Intestines.
Diseases of the Caecum, Colic Colitis, Diarrhoea Dysentery.
Disease of the Duodenum. Diseases of Rectum and Anus. In¬
testinal Worms, Peritonitis, Tubercle of the Peritoneum, Car¬
cinoma of the Peritoneum, Affections of the Abdominal Lym¬
phatic Glands, Ascites and Abdominal Tumors. Surely a
goodly array of most interesting subjects. The work cannot
fad to find its way to the medical library, and, as a work of
reference, is practical and convenient.
The Pathological Anatomy of the Bar. By Herman Schwartze,
M.D., Professor in the University of Halle. Translated by
.1. Orne Green, A.M., M.D. Boston : Houghton, Osgood &
Co., The Riverside Press, Cambridge, 187b'.
This is a work the want of which has been much felt, since it
brings together for the student of otology in a small space ma¬
terial which otherwise had to be sought for scattered, and
uuarranged throughout the literature of the subject.
10
41(5
Reviews and Boole Notices.
[September
The name of the author is a sufficient guarantee that the
work has been carefully performed, and that it will take a
prominent place in the literature of the diseases of the ear.
The careful citation of authorities is one of the best features
of the work with reference to its practical usefulness.
While it abounds in facts for which we must in part, at least,
give credit to the author ; yet the nature of the work renders it
impossible that it should be other than largely a compilation,
for no part of the human body demands for its study more
labor and time than does the ear, on account of its anatomical
position and surgical relations.
This work shows what wonderful progress has been made in
the science of otology in the last fifteen or twenty years, and
the number of distinguished workers in this specialty.
Before Toynbee’s great works appeared, it could be truly
said that there was no true science of otology. To-day, how¬
ever, there are numerous professorships devoted to this
specialty throughout the civilized world.
To Toynbee we in a great measure owe this revolution which
took this important department out of the hands of charlatans
and placed it upon an anatomical basis, thus laying the foun¬
dation of modern otology.
Since that time the German school (and in this probably
that of Vienna) has done the most to advance the science so well
founded by the illustrious Englishman.
Otherwise the translation published in Boston does great
credit to the translators and the publishers, and shows the
great progress made in this species of work in America within
a comparatively short period. B. A. P.
The Laws of Therapeutics or the /Science and Art of Medicine. By
Joseph Kidd, M.D.; Published by Lindsay & Blakiston, of
Philadelphia. Kew Orleans : Armand Hawkins, 1964 Canal
street.
In this little volume of 196 pages, the author presents a his¬
tory of medicine from the fourteenth century (B. C.) noting the
origin and development of the various theories and schools
which existed for a time, and, in turn, give place to new
systems.
Reviews and Bool' Notices.
417
1879]
in Egypt, about the eleventh century 13. C., there was a col¬
lege of physicians who belonged to the sacerdotal class, and
women as well as men practiced medicine. In fact medicine
had attained so high a degree of perfection in Egypt that there
were specialists in the different branches of the art.
The Babylonians and Assyrians alone among the great na¬
tions of antiquity had no physicians.
Hippocrates, born 400 years B. C., was for 23 centuries with¬
out a rival. The first well-marked schism in medicine occurred
about 250 years B. C., and arose, according to the author,
from the mistake made by Hippocrates in leaving the region
of pure observation for that of speculation — hence the origin of
the sect known as Empirics. These were followed by the
Dogmatists, and these latter by the Eclectics, who professed
to select the good, and avoided the evil of all the other systems.
According to the author, of all the sects those known as Eclec¬
tics were the worst. “ Eclecticism in medicine, like the mule
in creation, is essentially barren.”
For six centuries — that is, from the time of Hippocrates to
the time of Galen, all is vague and contradictory in Therapeu¬
tics. Galen was born in Pegamas, in A. D. 131. While Hip¬
pocrates founded his treatment on his own opinion of the na¬
ture of disease, Galen founded his system on his] idea of the
nature of medicine. Haller, in the eighteenth century, was
the first to teach that the true guide to the treatment of dis¬
ease must be sought for in the accurate knowledge of the
action of medicinal agents in the human body. From this the
system of Homocepathy became gradually evolved, and so on
are we able to trace the origin of the various theories and
schools to the present.
The work is exceedingly interesting and instructive as well
as valuable, on account of the thorough investigation into the
merits of the different theories — the study of the natural his¬
tory of disease, the art of medicine, and a well-written article
on “ the obstacles to the action of medicines.” The sugges¬
tions and views of the author as expressed are plausible, prac¬
tical and calculated to lead to a more correct comprehension
of the laws on which the science of Therapeutics is based.
«T. M. W.
418 Hooka and Pamphlet s Received. [September
Manual of the Principle s and Practice of Operative Surgery. By
Stephen Smith, A.M., M.D., Surgeon to Bellevue and St.
Vincent Hospitals, New York. 12mo., pp. 089. Boston :
Houghton, Osgood & Co., 1879.
This work is an enlargement of a hand-book of Su gical
Operations, prepared by the same author in 1802, with special
reference to military practice, and includes the general opera¬
tions in surgery, with the exception of those pertaining to the
special senses. The book consists of sixty chapters, classified
under eleven general heads, as follows: I, The Principles; II,
The Oseous System; Ill, The Muscular System; IV, The Cir¬
culatory System ; V, The Nervous System ; VI, The Tegumen-
tary System ; VII, The Digestive Organs ; VIII, The Respira¬
tory Organs; IX, The Urinary Organs; X, The Generative
Organs; XI, The Extremities.
The scope of this manual is immense, and it is rather to be
regretted that Dr. Smith should have attempted to include so
much matter in so little space. What he says is almost inva¬
riably correct and excellently expressed ; but on many impor¬
tant subjects and operations his extreme brevity is unsatisfac¬
tory, his terseness of expression leaving matters sometimes
obscure. It is certainly to be hoped that another edition will
be prepared, of octavo size and not less than 1000 pages.
This will give room for some amplitude of explanation and
greater variety in methods of operation.
The book is abundantly illustrated with wood cuts, is sup¬
plied with an index, and its mechanical execution is altogether
excellent. ’ S. S. H.
Books and Pamphlets Received.
Announcement Memphis Hospital , Medical College and Medical
Department of Southwestern University , Session of 1879-80.
The Radical Cure of Hernia By the Antiseptic Use of the Car-
holized Catgut Ligature. By Henry O. Marcy, A.M., M.D.,
Cambridge, Mass., Member of the Massachusetts Medical So-
1879] Books and Pamphlets Received. 419
ciety, American Medical Association, etc., etc. Reprint from
Transactions of the American Medical Association, 1878.
An Account of the Perineosinuexereeinator — A New Instrument
for the Exploration of Sinuses. Especially Adopted to Gynecolog¬
ical Practice. By Jacques Robinson, A.M., M.D., Surgeon to
the Hospital for Ruptured Vesicles, Member of the Antever-
sion Society and the Round Ligament Club, etc., etc. Reprint
from Louisville Medical News, May 13 and June 7, 1879.
The Pith of the Pried Cornstalk as a Uterine Tent , and General
Remarks Upon the use of Uterine Tents in Gynecological Practice
with Cases. By W. T. Goldsmith, M.D., Atlanta. Reprint
from the Transactions of the Medical Association of Georgia.
A Conspectus of the Different Forms of Phthisis , Intended as
an Aid to Differential Diagnosis. By Roswell Park, A.M., M.D.,
Demonstrator of Anatomy, Woman’s Medical College, Surgeon
to the South-Side Dispensary. Reprint from Chicago Medical
Journal and Examiner, September, 1878.
McGill University , Montreal , Canada , Forty-seventh Annual
Announcement of the Faculty of Medicine- , Session of 1879-80.
A Series of A merican Clinical Lectures. Edited by E. C. Seguin
M.D., Yol. Ill , No. IX. Operation for Closure of Cleft of the Hard
and Soft Palate. By A. Vanderveer, M.D., Professor of the
Principles and Practice of Surgery, Albany Medical College ;
Attending Surgeon at the Albany Hospital and St. Peters
Hospital.
University of the City of New York, Medical Department. A n-
nual Anouncement of Lectures and Catalogue, Session 1879-80.
The Casual Lesions of Puerperal Convulsions. A Paper Read
Before the Pathological Society of Philadelphia, April 28, 1878.
By James Tyson, M.D., Professor of General Pathology and
Morbid Anatomy in the University of Pennsylvania; One of
the Physicians to the Philadelphia Hospital, etc.
Case of Sarcoma of the Kidneys in a Negro Child. By W. H.
Geddings, M.D., Aiken, S. C. Reprint from Vol. IT, Gynaeco¬
logical Transactions, 1878.
Memorial Exercises State Medical Association at the Twelfth
Annual Session.
420
Books and Pamphlet* Received. [September
The Future Influence of the John Hoplcins Hospital on the Medi
cal Profession of Baltimore. I»y Jolm Van Bibber, M.l).
Manual of the Principles and Practice of Operative Burger)/.
By Stephen Smith, A.M., M.l)., Surgeon to Bellevue Hos¬
pital and St. Vincent’s Hospital, New York Oity. Houghton,
Osgood & Co., Boston, Publishers.
Transactions of the Pathological Society of Philadelphia , Vol.
VIII. Edited by J. Henry C. Simes, M.D., Lecturer on His¬
tology in the University of Pennsylvania, Recorder of the
Society.
Formula Booh of Gelatine-Coated Pills and Granules , Fluid
Extracts , etc., etc. By McKesson & Bobbins, New York.
Pocket Therapeutics and Dose Book with Glassification and Ex¬
planation of the Actions of Medicines. By Morse Stewart, Jr.,
B.A. and M.A., Detroit, Mich.
First Annual Announcement of the Medical Department of the
Arkansas Industrial University , Session of 1879-80.
Medical Heroism of 1878. By J. W. Singleton, M.D., of Pa¬
ducah, Ky. Reprint from the St. Louis Medical and Surgical
Journal, 1879.
A Description of the Medical Books and Periodicals , published
by D. G. Briuton, M.D., Philadelphia.
Valedictory Address to the Graduating Class of Jefferson Medi¬
cal College at the oAth Annual Commencement, March 12, 1879. By
J. Aitken Meigs, M.l)., Professor of the Institutes of Medicine
and Medical Jurisprudence, Philadelphia, Pa.
Ringworm in Public Institutions. Extracted from the Trans¬
actions of the American Medical Association.
Rosacea. Extracted from the Transactions of the Medical
Society of the State of Pennsylvania. By John V. Shoemaker,
A.M., M.D., Lecturer on Dermatology at the Philadelphia
School of Anatomy, Surgeon to the Pennsylvania Free Dispen.
sary for Skin Diseases, Lecturer on Practical Anatomy in the
Jefferson Medical Association, etc., etc.
Forty-third Annual Announcement of the Medical Department of
the University of Louisville, Session of 1879-80.
Books and Pamphlets Received.
421
1879 1
Tenth Annual Announcement of the Woman's Medical College of
Chicago , Session of 1879-80.
Pocket Therapeutics and Dose Book. By Morse Stewart, Jr.,
BA., M.D., Detroit, Mich.
Transactions of the Pathological Society of Philadelphia , Volume
VII. Edited by J. Henry C. Simes, M.D., Lecturer of Histology
in the University of Pennsylvania.
The Demand for a Woman's Medical College, in the West. An
address delivered at the Commencement of the Seventh An¬
nual Course of Lectures and Dedication of the Woman’s Medi¬
cal College, Chicago, Ill. By C has. Warrington Earle, M.D.,
Professor of Diseases of Children.
American Nervousness : Its Philosophy and Treatment. By
George M. Beard, M.D., New York. An address delivered be¬
fore the Baltimore Medical and Chirurgical Society, February,
1879. Reprint from Virginia Medical Monthly, July, 1879.
Announcement of the Dental Department of Vanderbilt Uni¬
versity , Nashville , Tenn.
Medical Department of University of Nashville and of Vander¬
bilt University. Announcement of Lectures for Session of 1879-8°.
Laryngeal Tumors and Tuberculous Laryngitis. By E. Fletcher
Ingalls, A.M., M.D., Lecturer on diseases of the chest and
Physical Diagnosis, and on Laryngology in the Post Graduate
Course, Rush Medical College. Reprint from the Chicago
Medical Journal and Examiner for July, 1879.
Sixteenth Annual Report of the New York Society for the Relief
of the Ruptured and Crippled, for May, 1879.
The Death Rate of St Louis. An inquiry into the causes of
its being less than that of any other large city of the United
States. By Charles A. Todd, M. I)., Professor of Physiology,
etc., Missouri Medical College, St. Louis, Mo.
Atlas of Skin Diseases. By Louis A. Duhring, M.D., Pro¬
fessor of Skin Diseases in the Hospital of the University of
Pennsylvania, etc. Part IV.
The Detroit Medical College, Detroit, Mich., Twelfth Annual
Commencement and Catalogue Session of 1879-80.
422
Meteorological and Mortality Tables. [September
Meteorological Table— July, 1879.
Day.
Mean
Barometer
•
Temperature.
Maximum Minimum. Range.
Mean
Humidity.
Rainfall.
1
30.005
88
76
12
75
.08
2
30.090
87
76
11
74
.66
3
30.107
8(5
75
11
31
1.37
4
30.153
8(5
73
13
64
.00
5
30.152
87
73
14
(51
.00
f>
30.080
89
76
13
64
.00
7
30.100
87
74
13
64
* .00
8
30.150
88
74
14
66
.00
9
30 120
89
75
14
59
.00
10
30.055
90
75
15
65
.00
11
29.970
91
76
15
(57
.00
12
29.935
90
77
13
(54
.oo
13
29.957
91
76
15
64
.00
14
29.995
91
76
15
66
.00
15
30.020
91
78
13
67
.00
1(5
30.035
87
78
9
71
.00
17
30.010
87
76
11
75
.19
18
29.980
89
74
15
71
.17
19
29 988
89
76
13
71
.37
20
29.997
89
74
15
73
1.38
21
30.002
8(5
75
11
73
.00
22
29.910
87
77
10
74
.13
23
29.863
85
77
8
79
1.01
24
29 940
35
76
11
74
.07
25
29.985
87
76
11
76
.00
2(5
29 987
87
76
11
75
.08
27
29.992
87
77
10
72
.00
28
30 000
88
77
11
73
.00
29
30.005
89
77
12
67
.07
30
30.002
87
75
12
73
.06
31
30.008
85
75
10
73
1.39
Mean..
30.018
87.9
75.6
12.3
70.1
8.95
Mortality in New Orleans from July 20, 1879 to August
24, 1879, INCLUSIVE.
Week Ending.
Yellow
Fever.
Malarial
Fever.
Con sump
tion.
Small¬
pox.
Pneu-
u onia.
Total
Mortality.
July
27..
0
9
1(5
0
3
103
August
4__
3
3
24
0
1
96
August
11..
0
8
7
0
1
84
August
18..
0
4
8
0
1
68
August
24..
1
7
14
0
l
87
Totals .. .
4
31
. 69-
0
■ 7
. 438
NEW ORLEANS
Medical jlnd Su^gic>l Jourhal
OCTOBER, 1879.
PAGINAL pOJAJ&XJ
NIC ATIONS.
Gunshot Wound of Uterus ; Bullet traversing six months’
Foetus ; Recovery of Patient in four weeks.
By GEO. A. B. HAYS, M.D.
The late Professor Paul F. Eve, in his work entitled u Re¬
markable Cases in Surgery,” on page 581, under the heading
“ Remarkable Wounds and Injuries,” quotes from the Boston
Medical arid Surgical Journal , 1853, a case reported by Dr.
Palmer, of the East India Company’s service, in which a Bur¬
mese woman received a u bullet wound of the bladder and
womb,” and “ recovered in three weeks.” As Dr. Palmer’s
patient received the wound in an unimpregnated uterus, and
the case was cited as an instance of great recuperative power
and recovery from wounds ordinarily fatal, 1 would like to
place upon record a very similar case which recently came
under my observation, in which the complications were far
more grave, and which also resulted in a complete recovery.
June 20th, 1879. Was summoned hurriedly to Magnolia
Plantation, six miles distant, to see Mary Washington, colored,
aged 18, married, six months pregnant, primipara, who was
reported as suffering from a gunshot wound of abdomen
received that morning. Reached the place at 9, A. M., and
learned that about three hours previous the assistant overseer
had fired a pistol shot at some hogs in the cane field ; the ball
had ricochetted from the hard, dry field road, and wounded the
424 Original Communications. [October
woman, who was standing concealed behind a clump of tall
alder bushes sixty yards distant from where the shot was fired.
Upon examination 1 found the patient beginning to react from
the shock, and complaining of severe pains in the abdomen.
The ball (oiie from the same cartridge box weighed 130 grains)
had penetrated the abdominal cavity at the left side, about two
inches diagonally in front and above the anterior superior spin¬
ous process of the ileum, ranging upwards — confirming the
statement that it had first struck the ground, the shot having
been fired from on horseback — and had lodged within the
abdominal cavity.
There had been but very little haemorrhage externally at the
first, and 1 found a portion of omentum an inch in length pro¬
truding from the wound; completely plugging it. The woman
had not menstruated since December, and stated she was six
months advanced in pregnancy. It was evident the abdominal
wall was cut through, and furthermore, if the projectile had
sufficient velocity at the moment of impact, the uterus and con¬
tents would be involved in the injury, but the distance from
which the shot was fired, and the fact of the ball first striking
the ground, prevented a positive diagnosis at the moment,
probing of course being inadmissible. 1 reduced the protruded
omentum and turned the woman upon her left side, in order to
allow drainage in the event of internal haemorrhage or effused
liquor amnii in the abdominal cavity. Prescribed full doses of
sulph. morphia, and ordered large, warm linseed poultices,
abundantly saturated with laudanum, to be constantly applied
to the abdomen.
June 21st. Visited patient at 10, A. M. She had well
marked labor pains which had begun to come on about sun¬
rise, as stated by the nurse. She had rested badly all night,
scarcely slept at all. Entire abdomen extremely tender and
distended. Could not bear light percussion. During a pain
would by an effort of will control and arrest the contrac¬
tion of the abdominal muscles, thereby throwing all the work
upon the uterus. Shortly after 11, A. M., the contractions
being stimulated by fluid extract ergot, the foetus, placenta and
membranes were expelled simultaneously with very slight gush
of waters when the membranes were ruptured. Some coagula
1879J Hays — Gunshot Wound of Uterus 425
escaped with the foetus. After delivery the uterus contracted
beautifully, not more than two ounces of blood being lost.
Administered alcoholic stimulants and beef-tea, the patient
being very much exhausted. Continued the poultices and fas¬
tened the bandage over them. Examined the foetus for the
pistol ball and found it had penetrated beneath the left
scapula, ranged diagonally through the trunk a distance of
about three inches, and made its exit in the right hip. Careful
search could not find the ball either in the placenta or among
the coagula, and I was forced to the conclusion that it had en¬
tirely traversed the uterus, and as it could not be felt exter¬
nally on the right side that its course had been arrested just
as it attained the inner surface of the abdominal parietes on
that side. The child was a female, ten inches in length, well
developed, nails formed, eyelids adherent. Evidently a six or
six and a half months foetus.
Puerperal fever set in, accompanied by peritonitis. Opium,
quinine and calomel were the remedial agents principally re¬
lied upon, and the poultices before mentioned were continued
until recovery. Laxative enemas were sometimes resorted to.
For the first few days of her illness I had no expectation of
her recovery, and in fact more than once carried with me on
my visit the necessary instruments to make an autopsy, expect¬
ing to find her moribund. In my treatment I was actuated
greatly by the motto Dum anima est, spes est , and placed a deal
of reliance upon the vis medicatrix natural.
From the 27th of June, her general condition underwent a
change for the better and she steadily continued to improve.
The opium, quinine and calomel were persisted in until her
gums became touched, when the latter was discontinued, and
a solution of chlorate of potash used as a mouth- wash. A
strong camphor ointment relieved the inflamed breasts. She
had very little lochial discharge, it lasting only two or three
days. There was no drainage from the external wound at all,
and it was closed with a strip of plaster and subsequently,
when it suppurated a little, dressed with oxide of zinc ointment.
July 17th, she began menstruating with but little pain or
discomfort; she ceased on the 19th, and the following day,
July 20th, just one month from the date of the injury, she was
426 Original Communications. [October
dismissed, well. It is proper to state here that the manager
of the plantation kept an experienced nurse at the bedside day
and night, and kept the patient supplied with everything
necessary for her welfare, which undoubtedly contributed very
greatly towards her recovery. She is now, August 9th, walk¬
ing about, feels well, sleeps well, has the appetite of a tramp
and suffers no inconvenience from the presence of the ball in
her internal economy.
It would be interesting to know exactly by what physiolog¬
ical process the liquor amnii that escaped into the cavity of the
abdomen became so readily absorbed, while the entire cavity
was in such an altered and abnormal condition.
Plaquemines Parish, La.
Remarks on Skull Fracture.
WITH REPORT OF TWO CASES, ONE SUCCESSFULLY TREPHINED.
By WILEY K. FORT, M.D., New Orleans, Louisiana.
Before proceeding to a report of the following cases of skull
fracture, I should premisingly state, that I have intentionally
delayed this report, that I might the more correctly be able to
give a fair and correct statement of the results attending the
case in which the trephine was used.
Four years ago, the 27 th of this past June, I was called to
see Mr. Gideon Folger, aged thirty-two years, who had half
hour prior to my seeing him, received a severe scalp wound
complicated by — comminuted fracture of the skull, with
depression. The injury inflicted was caused by the breaking
of a large cast-iron wheel, which was situated on the fifth floor
of a hardware store, and was part of a patent elevator. Mr.
Folger was at the time s anding in the car of the elevator,
which had only ascended a few feet from the first floor, when
the crash of iron came down. Several pieces of the broken
wheel fell perpendicularly to the car of the elevator, which was
about fifty feet. The weight of the pieces varied from two to
eight pounds. I could not with accuracy decide which piece
struck him.
1879] Fort — Remarks on Skull Fracture. 427
I found the gentleman quietly, sitting in a chair, and appar¬
ently in a more composed condition than 1 subsequently found
to be natural with him. Upon examination, I found a horse¬
shoe shaped incision, with one of the parallel lines much
shorter than the other. The point of the shoe-shaped wound,
pointing towards os frontis, the heel or base toward the occiput.
Just beneath the scalp wound, was a comminuted depressed
fracture, of the anterior superior angle of the right parietal
bone, just above the parietal ridge. The scalp wound was
divided quite down to the calvaria, about two and a half inches
in length. The skull was gradually depressed from both sides
of the fracture to the centre, camerated, imparting to the
sense of touch, a sharply defined groove in the centre of the
depression, of about an inch and a half long, in a parallel
line with the scalp wound and parietal ridge. Although the
finger met with considerable resistance, yet I could feel, upon
decided pressure, such questionable resistance as to decide my
diagnosis to be fracture of both tables of the skull, with com¬
pression of the cerebrum, and great probability of extravasa¬
tion of blood from rupture of its superficies. I informed his
family of his perilous condition and of my decision to trephine.
Requesting consultation, Drs. Chastant and J. T. Scott
agreed with me upon the line of action I proposed. Both of
these physicians kindly offered their valued assistance in the
operation. These gentlemen having thoroughly put the patient
under the influence of a mixture of two parts of pure sulphuric
ether to one of chloroform, which I always prefer when the
operation requires a prolonged amesthesia, I proceeded to widen
and extend back toward the occiput, the flap which had first
been carefully raised by dissection from the cranium, with as
much of the pericranium as possible. Having fairly turned
back such a flap as to give ample room for unembarrassed
manipulation, \ felt my way through the skull bone with the
trephine cautiously, just outside the line of fracture ; first, with
a trephine one inch across the circle, then nearly diagonally
across the fractured depression with a three-quarter inch tre¬
phine. This enabled me to lift the major portion of the
depressed bone with greater ease with the elevator, and with
far less disturbance and injury to the subjacent tissues and
428 Original Communications. [October
brain, than simply with one trephine perforation. The bone
came away in irregular-shaped pieces, varying in size from a
.grain of Indian corn to that of a silver coin quarter of a dollar,
together with a eoagula, formed by the bleeding, lacerated
superfices. Carefully detaching and removing all the frag¬
ments, 1 applied my huger to the dura mater and found, about
the centre of the skull opening, a perforation of the dura mater,
pia mater and arachnoid. Pressing my finger down upon the
perforation, I distinctly felt a detached spicula of bone, which
had been driven down into the cerebral pulp and fairly beneath
the investing tissues of the brain. This spicula of bone I
extracted with a small forceps, and which proved to be lance-
lated in shape and a portion of the internal table of about half
inch in length. I took more than a dozen pieces of bone away
of the comminuted mass. Sponging the blood from the wound,
1 returned the flap to its proper position, which was then cov¬
ered with a piece of old soft linen saturated with sweet oil,
and over this a cloth which was kept constantly renewed with
ice water. The patient rallied remarkably well from a pro¬
longed anaesthesia, having been under the operation over an
hour. Brandy and ice water was given ; an hour or two later,
I gave him half grain morphia hypodermically. The wound was
given a free drainage. In fact, all encouragement was given to
facilitate drainage ; no pressure or weight was allowed on the
wound ; light dressings only. The wound was kept constantly
cleansed, and a continuation of the above described dressing
continued, except substituting simple cerate for the sweet oil,
and adding a sufficient amount of carbolized oil for disinfecting
and antiseptic purposes. The patient suffered but little pain
from the time of operation, and had but little fever. The
wound cicatrized kindly, and the patient began to get about in
two months after the operation. Four years have elapsed, and
Folger is in good health. I would furthermore state, that the
space from which the skull was taken is protected by an exceed¬
ingly hard and strong covering, and which I am disposed to
attribute much to the preservation of the pericranium when
the flap was dissected up from the calvaria.
Case 2d. — On the night of the 9th December, 1876, George
Fiegel, age 20 years, was decoyed by false statements from his
1879] Fort — Remarks on Slmll Fracture. 429
place of residence corner of Louisiana Avenue and St. Charles
street, into Delachaise green, and was there struck several
times about the front and top of the head with some blunt or
spherically shaped weapon, which at the time was thought to
be a slung-shot. A passing cartman was attracted by the
moans of the wounded man, whom he found in an insensible
condition, but he soon became sufficiently conscious to direct
the cartman’s way to his residence. I was probably by the
wounded man’s bedside in two hours after the injury was sus¬
tained. I found that he had lost a considerable amount of
blood. Reaction had commenced. Stimulants had been given.
Pulse was sixty-five and compressible. Five scalp wounds ex¬
isted, which were more than half circular in form and about an
inch in diameter. Two of the wounds were on the os frontis,
just within the line of hair ; two to the left and one just to the
right and near to the occipital protuberance. The scalp was
divided completely to the bone, which was abruptly depressed
about the third of an inch. The circular margins of the skull
depressions were about the same size as those of the scalp and
quite sharply defined. That which 1 desire to express compre¬
hensively is, that the skull depression did not begin with a
gentle or gradual declivity, but abruptly, which I shall again
have occasion to refer to, as it is in my opinion a valuable indi¬
cator to a correct diagnosis. I removed the hair and attempted
no operative interference, simply applying the sweet oil dres¬
sing anti cold water application. Gave him three compound
cathartic pills and a solution of twenty gr. of chloral, and
instructions to give Rochelle salts if the pills had not the
desired effect by morning. The patient had a temperature
of 103.4 degrees Farenheit for nearly three days, when the
fever began to decline. 1 shall not tediously describe
this case from day to day, but briefly state, that the
cold water application, free drainage and carefully cleans¬
ing the wounds were the chief points in treatment. My
diagnosis in this case was scalp wounds, concussion with
depressed fractures of the external table. I should state, that
the scalp wounds continued opeu with a slow fistulous-like dis¬
charge for some weeks, when the depressed button-like parts
of the external table came away like exfoliated sequestra. This
430 Original Communications. [October
case had a good recovery and has had no trouble from the in¬
jury ; his health is good at this time.
To form something like a correct estimate of the importance
with which the operation of trephining has and is still invested
in the minds of surgeons, it is only necessary to take a retro¬
spective view oi the operation within the last two centuries.
In the existing and warmly contested views which have been
taken from time to time, both for and against it, are to be
found the names of many of the great and most illustrious
masters in surgery. Among the former list, I may mention
those of Prescott, Hewitt, Percival, Pott, and his world-
renowned pupil, John Hunter, who went so far as to declare,
that u there was no harm in the trephine.” To the above names
we may add the immortal Guthrie, Brodie and Velpeau. Stand¬
ing in the line of those wrlio discouraged the operation are to
be found names equally as distinguished — such as Dessault,
Rose, Henen, John Bell, Abernathy, Lawrence, Robert Liston,
Samuel and Sir Astly Cooper, MacCormac and Neadrofer.
The few recoveries and the high authority who have discour¬
aged this operation lias undoubtedly deterred too often the use
of the trephine. Leon le Fort lias carefully examined
trephine operations, both in France and England, from 1855
to 1800. He found 157 in England and only 4 cases in
France. The French surgeons are little in favor of tre¬
phining and the German less. Neadrofer’s conclusions after
the Franco-German war was against the trephine. Our late
war of the States offered a large field for observation. No
less than 12,980 cases of injuries to the head from all causes,
are reported alone on the Northern side, in “ The Medical and
Surgical History of the War, from 1861 to 1865.” Besides the
large number which should have been collated from the Con¬
federate Records, which have been shamefully entombed in
Washington City for the last fourteen years, although gentle¬
men from the South, with commendable spirit, lifting them,
selves nobly above pride and prejudice for the cause of science,
history and truth, and have unavailingly made laudable efforts
to have the Confederate Records exhumed from their long
sepulchral rest. Since writing this, 1 am informed, the Con-
431
1879 j Fort — Remarks on Shull Fracture.
federate Records will be exhumed. Scientific data and records
and truth, are like the highly valued and brilliant diamond,
they glow and they sparkle like the true gem, whenever light
is given them, whatever surroundings may befall them. But
to return from digression to the subject under consideration.
I will copy from the valuable “ Medical and Surgical History”
above referred to, table viii. Although the eutire report of
head injuries, is replete with interest, yet 1 can only in the
brevity of this paper give this table and a few remarks :
“TABLE VIII.
“ Results of Nine Hundred Cases of Injuries of the Skull in ichieh Operations
were Performed.
Operations.
OQ
©
d
o
Recovered.
Deaths.
u
V ©
© 3
^ *3
d a
'p
Ratio of
Mortality.
Remarks.
Extraction of Missiles _ .. _
175
33
89 83
3
48.3
The missiles ex-
Ligation . . . . . .....
21 12
36.3
tracted from be-
Removal of bone splinters or ?
elevation of depressed bone. $
Formal Trepanning _ _ _ _
456
220
275 176
95 124
3
1
39.0
56.6
neath the skull or
soft parts are not
recorded in this
Operation for Hernia Cerebri.. .
29
71 22
75.8
table.
'This report continues :
u Abstracting from the twenty-nine hundred and eleven cases
of fracture without known depression the eighteen hundred and
twenty-six fatal cases, there remains one thousand and eighty-
five cases, of which two hundred and sixty-two were subjected
to some form of operative interference, and eight hundred and
twenty-three were treated without a resort to such measures.
Of these eight hundred and twenty-three cases, two hundred
and sixty-nine returned to duty, fifty-seven went to modified
duty in the Veteran Reserve Corps, two hundred and seven
were discharged, one hundred and thirty-five either exchanged,
paroled, retired, furloughed or released, thirty deserted, and in
one hundred and twenty-five instances the ultimate result could
not be ascertained. Of two hundred and sixty-nine cases of
patients returned to duty, the names of two hundred and thirty-
2
432 Original Communications. [October
four do not appear on tlie pension rolls.” If the latter number
were living, I think a fair inference is that they would have
applied for pension.
A century ago trephining and elevating was the rule in all skull
fractures with depression, and 1 may say, at the present time, the
preponderance is still held in its favor in this country where
the scalp injury is considerable and involved with great depres¬
sion and complicated, threatening brain perverted functions.
The progress of opinion, however, in Europe, is committed to
non-interference till the brain irregularities are unquestionably
established.
So universally does this opinion sway the line of action
usually pursued (which is expectant), that it is in my opinion
one of the chief factors, giving cause for the popular odium
which rests upon the operation. The golden moment of action
if deferred, is lost. When the only chance for the patient’s
salvation is gone, and after active inflammatory excitement is
thoroughly set in, and uot till these very grave conditions exist,
does that capricious arbiter — popular sanction — accept the situa¬
tion as justifying the trephine and elevator. When the unfor¬
tunate patient is most usually doomed, the trephine then is
only accepted as a dernier or forlorn hope. To decide the
merits of the operation based upon the results of such cases is,
beyond doubt, uufair. The question of propriety or impro¬
priety of the trephine resolves itself as does all other questions
in surgery, viz : upon a correct and sound diagnosis. When
the scalp is divided and separated from the skull, which is
broken and unmistakably driven down upon and pressing the
brain, the surgeon is undoubtedly left without, as yet, any
known method of relieving the subjacent part of braiu from that
pressure if he discard the trephine and elevator. Moreover, if
the concave or internal brittle surface be spiculated by the
fracture and some of the spiculae be driven into and absolutely
invade the brain substance, as was the condition in my tre¬
phine case, death almost inevitably would be the result. Suck
a complication, beyond peradventure, if not rectified would
vastly enhance the danger of life, if not immediately, by wound¬
ing the blood carriers or by puncturing the brain ventricles, it
1879] Fort — Bern arks on Skull Fracture. 433
would by the inflammatory excitement which all foreign bodies
of organic substances would set up by its disintengrating
process when thus embeded in the brain substance. It
is true we are creditably informed, that metalic sub¬
stances have remained for an iudefinie time in the brain.
But it is not possible, that a detached organic substance
can ever become incysted in its normal state in any living
human tissue. I would then ask, how the surgeon is to possi¬
bly be able to determine whether this very grave and perilous
condition exists and will prove his patient’s destruction if he
neglect or procrastinate the use of the trephine ? It is true,
Henen gives his Waterloo case, where the skull was driven for
an inch and a quarter into the brain from the surface of the
bone. No operation, we are instructed, was performed, and
yet the man was discharged, cured in a few weeks. Henen
certainly intended to be understood thus, that the calvaria was
pressed down from its spherical position one and a quarter
inches and not that a detached piece of bone was driven into
the brain. For if he intended to express the latter, how else
could he determine such a result without having recourse
to at least the operation of elevation. I hold, there is great
difference in life risk, in a mere depression of the skull bone
and a spicula of detached, sharp and rugged bone, which
is driven through the investing membranes and into the brain
pulp, added to depression with blood clots.
Certainly, no symptoms are so infallibly described, or in fact
do exist, by which the surgeon can unerringly determine, that
bone has been detached and driven into the brain, or that the
amount of depression, compression, or blood clot exist, which
is sufficient to destroy the patient. For many days may elapse
before its effects (inflammation), may be set up. Nevertheless,
I apprehend that such guiding circumstances often may be
ascertained when judiciously and soundly considered which would
throw such guiding and valuable light upon the nature of this
fracture as to enable the surgeon, to wisely determine his line
of action, as to whether he will operate or persue a non-inter¬
fering course. For instance, the application of the laws of
physics are to be practically taken in consideration in this con-
434
Original Communications.
[October
nection. To properly apprehend the effect of a force applied
to a substance, the form, both of the body : trikingand struck,
must be philosophically considered as well as their density and
thickness.
Anatomically viewed, the differences which exist between
the young and old man’s skull, is decided and marked, as well
as that between the juvenile and adult, and plays an im¬
portant part surgically considered. The diploe in the adult
skull, between the ages of twenty and thirty, is considerable,
making a wide and marked separation between the external
and internal tables. These anatomical variations being taken
in account, in producing the differences in the character and
results of such fractures, it is quite unnecessary and would be
superfluous to tediously dwell upon their importance, con-
siderered surgically.
Contrastingly compared, the material and physical injury
received by the brain of the aged man who presents no more
evidence of injury sustained, judged by external appearances,
than the young man presents, would lead the unwary surgeon
in grave error. For this most obvious reason, that the aged
man’s skull bone is not only decidedly thinner but denser, con¬
sequently much more fragile. The abrupt and decided depres¬
sion in the vault of the aged person’s skull could not exist, if in
normal condition, without displacement and with an entire solu¬
tion of continuity through the diameter of the cranium. While
this is true in the aged, we find widely different conditions in the
young adult, whose cranial tables are considerably separated
by canecli or an ethmoid-like organization which exists and
materially assists in preventing fracture of the internal table,
as well as concussion of the brain. Again, another important
diagnostic clue to the injury done the internal table, in my opin¬
ion, is to be looked for in the physical characteristics of the
osseous wound. The deep camerated wound in the middle
aged and older persons if connected with an elastic resistance
to pressure suddenly made upon the depressed bone, would
very strongly influence my diagnosis to one of grave injury of
the subjacent meninges and brain substance from the shattered
internal table, though no very marked brain symptoms be
1879J Fort — Remarks on Skull Fracture. 435
present. But it' 1 find the convexity of the external table in
the young adult, even though considerably driven down, pre¬
senting sharply defined edges such as described in 1113* second
case I should require the further evidence of a yielding to pres¬
sure made on the depressed part before deciding that T had a case
to deal with which demanded the consideration of instrumental
interference. My conviction clearly and frankly expressed is,
that in all cases of skull fracture of both old and young is, that
when the scalp is separated or divided to the bone and complicated
unm istakably with commin uted depressed fracture, that the eleva¬
tion of the depressed bone is imperatively and immediately demanded.
The earlier the trephine is used after reaction (if concussion exist)
the better will be the chance for recovery. Where the surgeon can
satisfy himself that such conditions as I have just described do
exist, I unhesitatingly accept John Hunter’s dictum “ that
when the operation of trepanning is artistically performed no
harm is done.” 1 can not refrain saying in this connection that
1 think very much is due in successful operations to applying
the trephine more upon the outside of the fractured line than
upon the portion of the skull involved in the fracture. For
this reason, that the to and fro motion of the same is commu¬
nicated to the injured parts beneath the fracture and which
are aggravated by further disturbing the molicular arrange¬
ment of nerve cells. I prefer that two-tliirds of the circumfer-.
ence of the circular trephine saw should rest on the firm bone
contiguous to the broken mass which is to be lifted, carefully
observing in doing so that the duromater be gently detached
by carefully applied strokes of the knife closely made to the
bone. Too much care can not be taken to perform the opera¬
tion carefully, quietly, gently, so as to do no violence to the
brain and its snperfices.
The brain and investing membranes should by all means be
left free and unembarrassed by stitches, sutures, bandages, or
pressure from any source, under the mistaken idea of prevent¬
ing hernia cerebri, which disorder is the legitimate offspring of
inflammation. The brain and its superfices do not become too
large for their natural encasement, unless it be the result of
436 Original Communications. [October
haemorrhage, or inflammation, in which case sound pathology
would acquiesce.
My views of the inflammatory conditions of the brain and its
effects on the meninges were given in a paper on Cerebro-Spinal
Meningitis, published in the New Or team Medical and Surgical Re¬
porter, vol. iv., 1877. Embolism, thrombosis and, in fact, lesions
of the cerebro- vascular system, play the most important part in
the pathology of skull injury, to duly dwell upon which would
extend this paper to too great a length.
With regard to sudden death, which occurs nearly and
remotely after skull fractures, and also the cause of liver
abscess, very much may be said. For instance, encephelo-
spinal fluid tightly confined in the ventricles or blood clot
pressed upon the floor of the fourth ventricle, would produce
functional influences corresponding to the length of time sus¬
tained, in consequence of haemorrhage in the pathways of trans¬
mission of motor and sensory impulses thereby disturbing secon¬
darily circulation, resulting in cardiac, pulmonary, hepatic and
renal disorders. It is claimed by high English authority, that
a clot of blood extending from the anterior commissure of the
cerebrum in the third ventricle, through the chambers and
passing through the entire narrow prolongation of the
iter a tertio ad quartern ventriculum , through the cerebro¬
spinal opening, caused instant death, by clot pressure upon
the origin of the pneumogastric nerve originating from the
floor of the fourth ventricle, causing paralysis of the nerves
of respiration. This fact would justify the conclusion, that clo¬
sure of the passway of the cerebro spinal fluid upon the corpus
collosum or striata, by pressure or from whatsoever cause,
would be sufficient to cause fatal termination. Not only as
occurred in the English surgeon’s case, instantly, by paralyzing
the pavagum nerve and stopping respiration, but also by inter¬
fering with functional action ; setting up a hyperemic condition
of the cerebrum, cerebellum and their meninges, eventuating in an
inflammatory action of either acute, passive or chronic character,
or possibly by resulting in a hernia cerebri. It is most likely
that in this manner, that functional perverted influence is brought
about resulting in abscess of the liver, as was long since
1879] Fort — Remarks on Skull Fracture. 437
observed as a sequel of head injuries by Bertrandi, Andonilli
Klein, and others. Another perilous complication which is
quite probable in depressed fracture, is that which 1 have
already described in the case of Folger, in which a lancelated
spicula of bone from the internal table was extracted, which
piece of bone was directly beneath the depressed mass and
deeply imbedded in the cerebral texture. Had this spicula of
bone penetrated the ventricle, thus giving exit to the cerebro¬
spinal fluid, I think I am justified upon sound pathological
ground in concluding, that a sufficient cause in such event is
established to set up a dangerous excitement and turgescence
of the veins ; such a condition as is induced by suddenly letting
out the cerebro spinal fluid by puncturing the saculated accu¬
mulation about the region of the sacrum.
Most surgeons agree that a large number of chronic disorders
are the result of local injury of the brain. Sudden death often
occurs a long time after concussion. The removal of the local
disturbing cause is the only rational method of avoiding such
results. The very complex and delicate structure of the brain
requires longer time for reparation of injury sustained than
other tissues and structures. Unlike the cerebrum, cerebellum
or nerve tissue, the scalp reparative ability is something won¬
derful when compared with any other part of the body. This
is forcibly illustrated in the plastic operation for artificial nose.
Although it may be a considerable portion of the scalp which
is dissected up and twisted over from the forehead and fulfills
a good end, yet little or no cicatrix is left. In the month of
May, in the year 1854, I saw a girl fourteen years of age, who
was taken to the Pennsylvania Hospital in Philadelphia, and
who, in attempting to caress a large Bengal tiger, was seized
suddenly back of her head with both paws thrust through the iron
bars of his cage, clawing the girl so forcibly to the cage that
her scalp was literally torn from the occipital bone, entirely
across the head to the superciliary ridge of the os froutis. The
scalp was lifted like a mask from her face and adjusted. Yet
this girl made a good recovery, with no horrible and unsightly
scar as might be supposed.
I apprehend that very much of the odium which exists in
438
Original Communications.
[October
the mind of the profession concerning the trephine and eleva¬
tor, should more properly belong to the sutures, stitches, ban¬
dages and such contrivances, as different ones may have had
predilections in favor of, for the purpose of coaptatiug and
firmly holding the lips of the scalp wounds in situ. I have
seen the heads of patients, with scalp and head injuries very
artistically, but exceedingly unscientifically bandaged so
tightly as to cause great pain for (the not only useless, but
unwise purpose of) restraining and holding the lips of the
wounds together, as well as for the double purpose in skull dis¬
placement with a durameter rent, to repress and prevent hernia
cerebri. All such contrivances are not only useless, but they
are exceedingly prejudicial and positively injurious by the
pressure, by the heating, by the irritation, and by painfully
arresting free discharge of offending and often unhealthy
detrita. Scalp wouuds are almost always attended with some
discharge, which finds a nidus or lodgement in some hidden
recess or pocket, underneath the wounded integuments. Should
vent to such accumulated plathoras be unfortunately closed up
or retarded in exit, thereby arresting natural drainage, the
consequences are sometimes dire and calamitous.
Even the transuding, coagulated and disorganizing blood
thus confined by the irritating sutures, is sufficient to often set
up an evil train of complicated conditions, resulting frequently
in traumatic or erysipelatous fatalities. These are but a part
of the unfortunate concomitants which have so long, so unfor¬
tunately and so unjustly contributed fruitful cause for throw¬
ing odium upon one of the most meritorious operations in
surgery.
Remarks on the After-Treatment of Bronchotomy.
(Read before the New Orleans Medical and Surgical Association, August 2, 1879.)
By ALBERT B. MILES, M.D.
Demonstrator of Anatomy, Medical Department, University of Louisiana.
Mr. President and Gentlemen : — Since our last meeting, when
I was appointed to prepare a paper, I have gathered some facts
upon a subject which should be of equal interest to us all ; for
1879] Miles — After-Treatment of Bronchotomy. 439
physicians, as often as surgeons, are called to perform the oper¬
ations on the windpipe and conduct the after-treatment.
The points presented for discussion may seem at first glance to
be minor matters in surgery. However, the object of this paper
is to emphasize their clinical importance, for in no class of
cases does success depend more upon a careful attention to the
minutiae of surgical therapeutics. We will discuss in order:
I. Suggestions in the selection of suitable tracheal tubes.
II. The simple indications in the after-treatment, and the
importance of their careful observance.
III. An account of some of the accidents and diseases which
complicate the after-treatment ; and how their frequency may
be lessened and the fatality of operations on the windpipe
reduced.
The first question to be settled is : Why not use the simple
retractors to hold open the incision in the windpipe rather than
insert any canula ? Some operators, renowned as authorities, dis¬
card altogether the use of the canula, in the belief that the
presence of an instrument inserted immediately after opening
the windpipe, irritates, excites inflammation and ulceration,
and favors the development of pulmonary diseases. They pre¬
fer the retractors. I have had no experience in this practice.
The procedure seems primitive, but certainly better than the
use of imperfect tubes, the bad results of which no doubt
originally suggested the plan of treatment. In view of the
constant tendency of the opening to contract, 1 would hardly
expect the retractors to answer the purpose, unless the neck
bands were made uncomfortably tight. Most of the advocates
of this plan find it necessary to cut an elliptical piece from the
windpipe, that the retractors may the better serve their purpose ;
and, strange to say, they have never observed narrowing of
the passage as the result. Anyhow, we have learned a lesson,
which we may utilize in an emergency, or even practice in cer¬
tain cases where the retractors are to serve for only a short
time. But I must think that the instances are exceedingly
rare, when a suitable canula would not be preferable, especially
if the artificial opening is to be maintained for any length of
time.
3
440 Original Communications. [October
I. SUGGESTIONS IN THE SELECTION OF SUITABLE TUBES.
As we have seen, a very simple device may serve for awhile
to keep the incision in the windpipe open. Some years ago, a
resident student in the Charity Hospital saved his patient by
incising the larynx and inserting his toothpick. Only a few
years since, a man from one of the country parishes came into
the Hospital breathing through a section of reed-cane inserted
into the trachea several weeks previously. Now, I do not pro¬
pose to write up ail the instruments which the genius of inven¬
tion has given to the profession ; will only examine those in
common use which our markets now supply. Nearly all tubes
are now made, as they should be, with a double canula, and
with the neck-plate movable upon the tubular portion ; but it is
not too much to say that most of them are faulty in several im¬
portant particulars.
1. Relative length of the inner and outer canula. Some tubes,
even to this day, have the outer canula longer, around which a
ring of gummy mucus may form in the trachea. The inner
canula should also project in front, that it may be easily closed
when the patient speaks. Some silver tubes have the staples
for fastening the neck bands so projecting in front of the open¬
ing as to allow its closure with difficulty. (See the pattern.)
2. The curve of the canula. Some of the tubes now made are
too straight, so that, when inserted, the end presses unduly
against the posterior wall of the trachea and oesophagus.
Others are curved too much, so that in an ordinary case the
convexity would bear against the posterior wall of the trachea,
while the end would press the anterior. Some of these short
curved tubes are made too long, and the greater is the danger
in their use. Now, even after making due allowance for swel¬
ling and thickening of the tissues, see the greater risk attend¬
ing the use of such tubes in persons of slim necks. The articu¬
lated canula, which adapts itself to tit the windpipe, was
introduced into the Children’s Hospital ot Paris, to obviate
the difficulty just mentioned; and afterward, erosion of the
mucous membrane and ulceration of the trachea were much
less frequently observed. But the joiuted canula is hard to
clean, easily gets out of fix, and may break and drop into the
1879] Miles — After-Treatment of Bronehotomy. 441
trachea. If the catmla be single, the grea ter is the objection
to its use. The ordinary double canula, of gutta percha or
silver, is best, if simply altered. The inner part of the canula,
from its point of entrance into the trachea, should be made
straight, while the outer portion should bear the proper
curve.
3. The breathing calibre of the canula. This, of course, should
be selected in each case f o accord as nearly as possible with the
size of the windpipe. Trousseau was the first to urge the use of
large canulse — as large as possible to be introduced with ease
and fit comfortably. Most of the tubes for adults have a
calibre too small ; some are only 3-16ths of an inch in diameter,
scarcely one half as large as the rima glottidis, while the size
of a few offered for sale is inadequate to the maintenance
of life.
Let us take a hurried glance at the anatomy of the windpipe
in the male adult. The narrowest part of the air passage is in
the laryngeal cavity, at tne rima glottidis. Here is a chink,
contracting in expiration by the recoil of its elastic tissue,
dilating iu inspiration, like the chest, by the action of its
muscles. In expiration it is triangular in shape, with sides
measuring about one inch in length ; base, one-third of an inch.
In females this measurement is a little less. In inspiration this
triangle is widened into a pear-shaped aperture, varying in
width, at its widest part, from one-third to half an inch Just
below is the cricoid cartilage, which is larger than the rima,
even in inspiration. The trachea is still larger than the cricoid,
and varies in diameter from five to seven lines (5-12tlis to
7-12ths of an inch). Any narrowing of this natural channel
proportionally impairs respiration. Then, the breathing calibre
of tubes for adults should range from four to five lines in dia¬
meter ; ordinary size 3-8ths of an inch.
Operations on the windpipe are required far more frequently
in children than adults, and their after-treatment imposes a
much greater tax upon our care. A few words, then, in regard
to the anatomy of their windpipe and the measurements which
have been made. In the first place, it is next to impossible to
get correct measurements of the rima glottidis iu an infant by
442 Original Communications. [October
any examination (luring life. Most of the measurements are
made after death, when, by the recoil of the elastic structure of
the larynx, the aperture is at its very smallest size. We see at
once the dangerous fallacy of some of the measurements, that
of Mr. Holmes, for instance, who gives the long diameter of
the elliptical opening of the rima, at the age of two years and
eight months, at l-6th of an inch. Furthermore, in taking the
dimensions of the rima, in view of the selection of suitable
tubes, it is well to bear in mind that the opening is not station¬
ary, like a canula, but dilates in inspiration, and may
also yield in expiration. The trachea varies in diame¬
ter, between the ages of one and twelve years, from
one quarter (below one year it is but little less) to
half an inch. Then, between the ages of one and twelve years,
the breathing calibre of the canula should range from two and
a half to four lines in diameter.
The anatomy of the neck of a child is on a very small scale;
the crico thyroid space is small ; the thyroid body situated
high up, extending in many cases right up to the cricoid car¬
tilage; the front of the trachea is covered by the plexus of
vessels and the thymus gland, which often reaches the thyroid ;
but a place can always be made for inserting a tube of suffi¬
cient size. The tubes made nowadays are large enough, as a
rule, in their outer circumference ; but most of them are made
of gutta-percha, and the material is such that the walls of the
double canula have to be made thick. This is done at the
expense of the breathing calibre, which, in some tubes, is too
small to sustain life long. In this connection one fact more is
worth mentioning. The windpipe begins to grow very rapidly
from the age of twelve years, as evidenced by the change of
voice in youths. The size of the air passage soon attains
nearly that of adults, and such cases will, then, require canulse
ranging from one-third of an inch to the size for adults.
To recapitulate, we may say for practical purposes, between
the ages of one and twelve years, the calibre of the canula
should range from 2|„ to £ of an inch in diameter ; in youths
from £ to f of an inch ; in adults from £ to 4 an inch ; ordinary
size | of an inch, the maximum to be used in persons of great
stature.
1879] Milks-*- After- Treatment of Bronchotomy. 443
II. THE SIMPLE INDICATIONS IN THE AFTER-TREATMENT, AND
THE IMPORTANCE OF THEIR CAREFUL OBSERVANCE.
The general management of cases should, of course, be con¬
ducted upon the general principles of practice. We pass over
the special treatment of particular cases to speak only of such
directious as are applicable in all cases.
1. Procure for the patient breathing air (a) of the same tem¬
perature, and (b) the same degree of moisture as that inspired
through the natural channel.
(a) The air of the patient’s chamber should be fresh, and
maintained at a temperature of about 80° Fah. Patients have
complained to me of a sense of cold and constriction in the
chest upon exposure in an air draft.
(b) The benefit of breathing a saturated atmosphere, such as
some patients are made to live in, is not apparent. The benefit
of air moderately moist is evident. It prevents the formation
of dry crusts of mucus on the walls of the canula, which, be¬
coming detached, are apt to be sucked into the windpipe ; it
also prevents the formation of these crusts in the bronchial
tubes, which irritate and inflame the mucous surface, and in¬
crease the risk of pulmonary diseases. Statistics show that a
close observance of the points just mentioned has very materi¬
ally lessened the frequency of catarrhal or broncho pneumonia.
All sorts of contrivances are devised to warm and moisten the
air around the patient. Here is room for the exercise of inge¬
nuity. The simplest, and perhaps the most efficient expedi¬
ent, is to wrap the neck in a gauze or woolen material. Trous¬
seau’s “knitted comforter” answers the purpose well. Into
this the patient breathes, and through this he inspires air
filteied of many of its floating particles, and made warm and
moist by the vapor exhaled from his own lungs. This expedi¬
ent, although efficient, should be adopted and practiced with
the utmost caution. Every one knows the sensation of suffo¬
cation in lying in bed with the head covered. The effect is the
same in confining the canula too closely. Especially do I im¬
press the caution in the management of little children, who,
unable to tell their complaints, may be smothered with the
greatest ease.
444 Original Communications. [October
2. The inner canula should be removed and cleansed as often
as necessary. In some cases a viscid mucus is secreted from
the bronchial tubes, and the cough to force it out is harrassing
and painful. In most canulrn there is no breathing room to
waste, and this tenacious mucus, choking the canal, is the occa¬
sion of great distress. Inhalation of the spray of lime-water is
often useful in facilitating its expectoration. At the risk of
taxing you with details, I must tell how tubes are often
cleaned — by being threaded on a tape, and slipped back and
forward from one end to the other. By this means, some
mucus always remains in the convexity of the canula. I once
knew of a case in which, after the death of the child, the canula
was returned choked with gummy mucus. The tube can be
best cleaned with hot water, or a weak solution of potash, by
pushing wads of lint through on the point of a probe.
Such are the simple indications in the after-treatment —
modify the air which the patient breathes to make it like that
inspired in health, and keep the canula clean. In carrying out
these directions, constant vigilance on the part of the attendant
is the price of the patient’s life. I would simply add, let us be
sure to remove the canula as soon as the patient can go with
safety without it.
III. AN ACCOUNT OF SOME OF THE ACCIDENTS AND DISEASES
WHICH COMPLICATE THE AFTER-TREATMENT.
A tube to be worn for a long time, should be removed from
time to time, to guard against wear and corosion of the mate¬
rial. Cases are recorded in which the tubular part became
detached from the neck-plate and dropped into the trachea.
For long use, the vulcanite tube is preferable. Even a silver
canula is liable to wear and break. About two years ago, at
the Saturday Surgical Clinic, I assisted Prof. Samuel Logan in
a cricotomy for a gunshot wound of the larynx. A silver
canula was temporarily inserted. Later, it was proposed to
introduce a gutta perclia tube. Lest he should be the loser in
the swap, the patient deserted the Hospital. After a time he
lost the inner canula, but continued to wear the other until
misfortune overtook him. One morning, about eighteen months
after the operation, he returned, a penitent, and came to me,
1879J Miles — After-Treatment of Bronchotomy. 445
with one half of the canula in his hand, the other in his trachea,
doing bnt little harm. While preparing for its removal, a
paroxysm of coughing came on, and the broken tube was ex¬
pelled through the mouth. The deserter had, of course, worn
the canula longer than was necessary; and besides, suffered of
an accident which never would have happened under the oper-
tor’s care.
I would call special attention to the accidents and diseases
which follow the use of imperfect tubes.
In the first place, of wearing tubes too straight or too much
curved, pain in swallowing and coughing, erosions of the mu¬
cous membrane, occasional hemorrhages into the trachea, with
expectoration of blood through the tube, and ulceration, are
the usual minor consequences. The last has been commonly
observed, more frequently of the anterior tracheal wall, a fact
evidently due to the pressure of the end of the canula. The
ulceration may be attended with necrosis of the tracheal car¬
tilages. Cases are recorded where the ulceration has even ex¬
tended through the anterior wall of the trachea, two of which,
in Guy’s Hospital, resulted in an opening of the innominate
artery.
Bronchitis may be the direct result of the extension of inflam¬
mation from an ulcerated patch, or from a spot irritated by the
pressure of the canula. This disease may lead to catarrhal or
broncho pneumonia, a complication of rather frequent occur¬
rence in past years. Abscess, the formation of pus sinuses,
which, in some instances, have been known to burrow even
into the anterior mediastnum, and pyaemia, with its train of
symptoms, may also occur.
Secondly, I wish to draw particular attention to the diseases
which may arise from the use of eauulae too small in calibre.
Pneumonia is one of the most frequent, as it is one of the
most fatal, of the diseases which complicate the after-treat¬
ment. When, on any account, the air passage is obstructed,
this disease may result. The lungs are not fully inflated, and
parts of the organs must remain inactive, collapsed. The cap¬
illaries in the walls of the unexpanded air cells offer resistance
to the circulation, a compensatory liypenemia is the result,
and this state of congestion is the potent predisposing cause of
* ■
446
Original Communications.
[October
pneumonia. The disease may, as it not unfrequently does,
occur before the windpipe is opened for the relief of the obstruc¬
tion. If, after bronehotoray, a canula too small be inserted,
the respiration remains imperfect, the congestion of the organs
is prolonged, and the chances for the occurrence of pneumonia
are the most favorable that can be procured. If what has gone
before be true, its occurrence, in many instances, no doubt, may
be averted by the use of canula; of sufficient breathing calibre.
Pulmonary consumption may follow respiration permanently
impaired on any account. Long continued mechanical hyper* -
mia of the lungs, from imperfect expansion, impairs their func¬
tion, lowers their vitality and prepares a place for tubercular
deposit. If, now, a patient should escape pneumonia, we see the
remote danger of wearing a canula too small. I have seen two
cases contract pulmonary consumption, while wearing gutta¬
percha tracheal tubes of the ordinary size now made, and die
within six months after the operation.
It may not be out of place to mention here the symptoms,
which sooner or later ensue, if by mistake, or in any emergency,
a canula too small in calibre be inserted. In the first place,
the respiratory acts are prolonged, one following another with
scarcely an interval. Secondly, the whistling sound through a
cauida too small is ominous. Natural respiration, at a short
distance, is nearly noiseless ; so is respiration through a tube
large enough. Thirdly, the patient feels fatigued. He has to
call into service the auxiliary muscles of respiration to over¬
come the difficulty, and breathing becomes a tiresome task.
Sleep comes to the relief of the wearied muscles, and the
patient, when not asleep, is nearly always drowsy. Fourthly,
the patient may feel oppressed for want of breath, and the
slightest exertion increases the difficulty. Such symptoms can
scarcely be mistaken in adults, nor in children, if they be at¬
tended with proper care.
Nearly two years ago, I performed laryngotomy on a woman
now in ward 38, Charity Hospital. She is the subject of lep¬
rosy. The invasion of the mucous membrane of the mouth
and larynx demanded the relief. I inserted a gutta-percha
canula, with a calibre of one-third of an inch in diameter. A
short time since, I replaced this tube with -a smaller one,
1879 J Richardson — Recurrent Calculus of the Bladder. 447
3-ltJths of an inch in diameter, the largest gutta-percha tube
at the time in the New Orleans market. At the end of six
hours, she informed me that “she had to breathe with such an
effort that she felt tired and oppressed.” The old canula was
repaired and reinserted and again she was comfortable.
We have now shown the imperfections in many of the
tracheal tubes now made, and pointed the risks attending their
use ; we have offered some suggestions in the selection of suit¬
able tubes, and urged the necessity of carrying out, with the
utmost care, the simple indications in the after-treatment.
The more judicious management of latter years has already
reduced the death rate. The object of this paper looks to a
continued improvement in the after-treatment, by which many
more of the accidents may be averted, and the pulmonary dis¬
eases occur still less frequently. The clinical importance of
the facts we have gathered, deserves a second thought. The
art of medicine is made up of little things, attention to which
makes the physician perfect in his profession.
Singular Case of Recurrent Calculus of the Bladder.
By PROFESSOR T. G. RICHARDSON. M.D.
[Reported to the Orleans Parish Medical Society, July 28, 1879.1
In the year 1865, 1 cut a gentleman for stone in the bladder,
resulting from gunshot wound. The case was one of peculiar
interest, and was published in detail in the New Orleans Med¬
ical and Surgical Journal for September, 1866. An
abstract of the history there recorded is necessary for the
proper understanding of the sequel :
“ D. J. B., of Missisippi, set. 27, admitted to private infir¬
mary November 24, 1865 ; was wounded three years previously
at the battle of Sharpsburg, by a minnie ball, which entered
the pelvis in front, about an inch to the left of the pubic sym¬
physis, shattered the pubic bone, traversed the bladder and
rectum and escaped at the right sacro-sciatic notch. Urine
escaped through the wound in front and the rectum for several
months. The wounds finally healed, but patient had no con¬
trol over his bladder. Several fragments of bone passed
4
448
Original Communications.
[October
the urethra, but without affording relief. Later on, the com¬
munication with the rectum reopened, and at the time of his
admission into the infirmary, all the urine had been passing by
that route for several months. Patient was reduced to a mere
skeleton and never free from suffering.
Upon attempting to pass a bougie the prostatic urethra was
found to be blocked up by calculi or fragments of bone, and
with the finger in the rectum a mass of similar material was
felt projecting through the fistula. As it was necessary that
the patient should be relieved as soon as possible, the follow¬
ing day a grooved metallic bougie was passed into the urethra
and forced alongside of the obstructions into the bladder, and
the usual lateral operation of lithotomy performed. Two cal¬
culi, each weighing If ounces were removed from the bladder
and two of smaller size from the prostatic urethra, all of a
phosphatie nature. Contrary to my expectation, they did not
contain fragments of bone or other foreign substance as nuclei,
but the central portion of each of the larger ones was soft,
resembling freshly mixed mortar. The incision was kept open
for four weeks by means of a canula, to enable the vesico rectal
fistula to close, which having been accomplished, the instru¬
ment was withdrawn and the wound healed up rapidly. Slight
incontinence followed, but this soon subsided and the patient
rapidly regained a lair state of health.”
Nothing more was heard of the case until June 1st, 1879 —
nearly fourteen years after the first operation — when the patient
presented himself again with symptoms of stone, which he said
came on about four months previously. Upon introducing a
sound, a small calculus was readily detected, and two days sub¬
sequently I performed lithotomy. The stone was phosphatie,
and among the fragments discharged I discovered a coarse
woollen thread, about two inches long, doubled upon itself and
encrusted with calculous deposit. The thread had evidently
been the nucleus of the stone, and must have been carried in
by the ball at the time the wound was received. The only way
to account for its long retention, is to suppose that it became
entangled in the cicatrix, and only recently made its way into
the cavity of the bladder. This explanation is partly confirmed
by the fact that the patient has never been entirely free from
slight vesicular irritation since the first operation.
Upon sounding the bladder carefully a few days afterwards,
no remains of the calculus could be discovered, a single crash¬
ing having sufficed for its entire discharge.
1879 J
Malarial Hematuria.
Bv J. D. HAMMONDS, M.D., Lind Grov.-, La
I f AMMONDS — Malarial Kama l a via.
419
In presenting this subject, I will not enter into the discus¬
sion whether an haemorrhagic tendency can exist, caused by
malarial poison, without the presence of haematuria, but I will
treat of haematuria as found in our part of the country and
the way it came under my observation.
Malarial haematuria is, as its name implies, a haemorrhage in
the urine, but we mean to convey the idea of a haemorrhage
from the kidneys, when we speak of malarial haematuria, and
the same caused by malarial poison. I will not enter into a
long and uninteresting search after the origin of this disease,
but will confine myself to stating, that it was only about thirty
years ago that it was discovered to be a separate and distinct
disease from contagious epidemic yellow fever, while I am sat¬
isfied that this disease existed in the strongly malarial dis¬
tricts of the Southern States prior to the time I mentioned.
For, if we concede that it is caused by malaria, we must admit
that there was just as much malaria in the Southern States
one hundred years ago, as there is to-day, and there is nothing
to prove that its power to prostrate the human system is any
greater to-day than it was then ; but, the disease prevailing
during the latter part of the summer and the autumnal
months, at the very time when yellow fever usually makes its
appearance in our climate, it is easy to understand how the
practitioner would readily pronounce it a case of epidemic
yellow fever, or erroneously call it by the name of malignant bil¬
ious fever ; and so in my opinion it has thus existed and been
treated ever since the settlement of this country.
Malarial haematuria is met with in three distinct forms, viz.,
intermittent, remittent, and continued or inflammatory, which
for practical purposes I will treat separately, but will try to
give the general symptoms first, and afterwards notice each
type and its special symptoms separately.
The most important symptoms which are met with in every
form of the disease are three : 1st, Bloody Urine ; 2d, Nausea
and Vomiting; 3d, Discoloration.
1st, Bloody Urine. When the mine is first voided in this
450 Original Communications. [October
disease, it is of a red color, and to the eye of the observer
resembles blood in every respect, except that it will not coagu¬
late, and is too dark for arterial and too light for venous blood.
2d, Nausea and Vomiting. There is usually considerable
nausea and vomiting, sometimes of a dark green matter, at
other times it may resemble bile, or again it may consist of
nothing else than the secretions of the stomach and its con¬
tents, during the whole course of the disease; and in rare
cases, as the disease advances, the ejecta will be the contents
of the stomach mixed with what is usually called coffee grounds
or black vomit. There is a general feeling of prostration
accompanying the nausea and vomiting, which is increased
upon the least exertion, and the patient is tossing from one
side of the bed to the other, whilst he complains of being
extremely faint.
3d, Discoloration . The skin and conjunctiva, after the dura¬
tion of from 4 to 12 hours of the luematuria, assume what 1
would call a dark lemon color, whilst the perspiration and the
serum exuding from blistered surfaces appear to be charged
with the same coloring matter.
The luematurie condition is ordinarily preceded by a rigor,
which resembles more the shock to the nervous system mani¬
fested by one who receives a sudden and severe injury than a
common ague.
Having given an outline of the disease in general, I will pro¬
ceed to the special types, their special symptoms, and the treat¬
ment 1 am usually pursuing.
THE INTERMITTENT TYPE OF MALARIAL ILEMATURIA.
This form of the disease sets in by a severe rigor, as men¬
tioned heretofore, followed by a fever, haematuria, nausea and
vomiting, prostration and discoloration, all of which symptoms
disappear simultaneously with the subsidence of the exacerba¬
tion of fever, leaving the patient somewhat prostrated with a very
slight discoloration, but in a comparatively easy condition until
the next paroxysm, which like a simple intermittent may be of
the quotidian, tertian, or double- tertian type. The pulse iu
1879] Hammonds — Malarial Hcematuria. 451
this form of the disease does not differ from what we find the
same to be in simple intermittent, being excited during the hot
stage, reaching frequently as high as 130 or 140 per minute,
and falling gradually as the fever is leaving and the sweating-
stage is progressing, becoming entirely normal during the in¬
termissions. The tongue is slightly coated with a white film
during the feverish excitement, as in any other intermittent;
and frequently the case, like any other interim itent, if not checked
by proper treatment, will sooner or later assume one or the
other of the more severe types of the disease.
The treatment that I usually pursue in this form of the dis¬
ease is as follows : To allay the excitement by diuretics, dia¬
phoretics, etc., and mercurials in purgative doses to arouse the
secretions and relieve the engorgement that may exist in the
portal circulation, followed during the intermission with de¬
cided doses of antipei iodics, the sulphate of quinine of course
having the preference, if attainable.
THE REMITTENT TYPE OF MALARIAL HCEMATURIA.
In this form of the disease the patient is usually attacked
with what would seem to be a simple remittent fever. After
a few remissions have taken place, the characteristic rigor with
all the symptoms uccompauying haematuria set in, and in a far
more aggravated form than in the intermittent type, though
cases are met with wherein the lmnnaturia and other symptoms
have presented themselves from the onset of the disease, pre¬
ceded by that characteristic rigor above mentioned. After the
haematuria hns once set in, it never disappears altogether. It
may assume a lighter color, but it still retains a sanguineous
appearance, though during the remission it frequently happens
that the urine, after having been voided for some time, becomes
apparently clear with a dark sediment settling to the bottom
of the urinal. The quantity of urine voided in this type is
usually larger than in the preceding type, and the prostration
seems to keep pace with the amount voided, which during the
remission becomes somewhat less frequent and less copious.
Should the disease terminate favorably, we notice a diminu¬
tion in the quantity voided, the urine getting clearer from
452 Original Communications. [October
time to time, which is a favorable symptom as regards prog¬
nosis. Upon the other hand, should the quantity continue to
increase it augurs ill, as the patient may die from actual pros¬
tration consequent upon loss of the vital fluid, whilst we flatter
ourselves with having stopped the paroxysm and expect a re¬
covery. Again, should the quantity diminish but become
darker every time it is voided, though the paroxysm fail to
recur, as long as nausea and vomiting still continue, we may
expect suppression to set in, and uremia, coma and death to
follow as a result.
THE CONTINUED TYPE OF MALARIAL HvEMATURIA.
From what we have seen during the progress of the two
types of the disease heretofore mentioned, there is quite a
resemblance between this disease and common malarial fever,
and in fact the cause is the same. There are localities where
a certain poison is by some means or other generated, which,
acting upon and enfeebling the nervous system of man, causes,
secondarily the weakening of the vis a tergo of the heart’s
action, thereby allowing congestions to take place generally in
some one of the organs connected with the portal circulation,
and giving rise to the different types of malarial rigors, fevers,
reactions, etc.
This poison, whether palpable or not, we call by the name
of malaria. It is vague indeed, yet it expresses an idea, and
leads us, if not into the nature of that particular poison, at
least into the mode of its manifestation. Now, in all malarial
fevers the congestion thus produced may remain in the
passive stage, but may also increase and enter an in¬
flammatory stage, in which case we have to treat a remit¬
tent connected with inflammation of some organ, or a continued
fever connected with some inflammation. That the same may
be the case in malarial lnematuria is quite obvious to my mind,
as I do pathologically distinguish this disease from simple mala¬
rial fever, by its having a congestion or inflammation of the
kidney connected with it. Whether it is the idiosyncracy of
the individual which makes him more liable , to suffer from a
congestion of an organ connected with the systeunie circula-
18791 Hammonds — Malarial Hcematuria. 453
tion. than anybody else, or the same is caused by certain cli¬
matic influences, it would not make any material difference in
the treatment. Suffice it to say that 1 believe the intermittent
and remittent types of hamiaturia to be a congestion of the
kidueys, whilst 1 take the continued form to be an active in¬
flammation of the organ.
With this preface 1 am ready to give an outline of the dis¬
ease, and the treatment 1 always follow, which will prove my
assertion regarding its pathology.
In the disease now under consideration, the peculiar rigor
heretofore mentioned generally precedes the haematuric con¬
dition, but sometimes the hamiaturia manifests itself before the
rigor, which, however, immediately follows the haematuric
appearance. The rigor lasts for a longer or shorter period, and
is followed by a reactionary fever, which does not range so
high as in the other types of the disease, the pulse, according
to my observation, rarely exceeding 110 to the minute — in fact,
showing very little of the severe disturbance which the economy
is undergoing. Frequently during the progress of the fever
there is a recurrence of rigors, which have no influence what¬
ever upon the pulse, and seem to be more a manifestation of
shock that the nervous system has received than common
rigors, having no special period and no influence upon the tem¬
perature as far as I could observe. The haematuria may remain
the same in appearance, but becomes usually more and more
copious during the first 24 hours. As the disease advances,
the urine diminishes in quantity, but at the same time turns
more grumous and darker. If it keeps on in that way, sooner
or later complete suppression takes place, and the patient di»*s
comatose; on the other hand, the urine may continue to be
voided in larger quantities, until the patient dies in an exhausted
condition, remaining conscious to the very last. Now and then,
however, the urine becomes less in quantity, losing the san¬
guineous hue, clearing up more and more from time to time, and
the patient escapes with his life, but remains with a weak kid¬
ney for some time, which may now and then take on Bright’s
disease or diabetes, and terminate in death with hamiaturia as
its primary cause.
The nausea and vomiting are very excessive in this type, very
454
Original Communications.
[ October
distressing to the patient and perplexing to the physician, on
account of being often at a loss how to proceed in administer¬
ing medicines when the stomach is not in a condition to retain
anything whatever.
The discoloration of the skin, conjunctiva, etc., sets in shortly
after the luematuric condition is established, and retains or
deepens its hue, often even assuming a bronze color, especially
when tending to a fatal termination.
Complications, such as congestions or inflammations of other
internal organs, are frequently observed, and the whole surface
will sometimes be bathed with a perspiration during the entire
course of the disease.
The diagnosis of this form of the disease is very simple, yet
must be attended with great care, as it is essential not to con¬
found it with the other two types, for the treatment of the
latter forms would not only be unavailing, but would even
increase the danger.
TREATMENT.
Whilst describing the remittent type, 1 omitted the treat¬
ment with the purpose of showing the difference to be observed
between the remittent and continued types, and when it be¬
comes advisable to treat the former the same way as the latter.
From the pathological view I have taken in describing these
two types, it is obvious to every one that, whilst quinine during
an intermission or remission would be sound and logical treat¬
ment, it would not only be useless, but even contra-indicated,
in the treatment of an active inflammation of the kidney.
Quinine is to a certain exteut an irritant to the kidney, and
would, therefore, not be admissable. The object to attain in
this type of the disease is to allay the inflammation and pro¬
mote absorption, and with this view I usually prescribe mer¬
cury in alterative doses, not minding a slight ptyalism ; also
saline diuretics, unless the discharge from the kidney is too
free, in which case 1 substitute a general stimulant to support
the system. 1 also use counter-irritants, in the form of sina¬
pisms, to be followed by a blister in case of the least suspicion
that suppression may set in. If I succeed in bringing tne in-
1879]
Hammonds — Malarial Hcematuria.
455
dam matiou to a favorable result, my patient is saved, as far as
immediate danger is concerned.
1 find it necessary to keep the bowels open by gentle purga¬
tives, and also prescribe fluid extract of gelsiminum, which
may be combined with sweet spirits of nitre, in the proportion
of four parts of the latter to one part of the former, with the
aim of equalizing the nervous system and acting gently upon
the kidney. In cases where debility has set in, 1 use spirits of
turpentine and discontinue the nitre, but watch its effect upon
the kidney.
In the remittent type quinine may be administered during
the remissions, but as soon as the paroxysms cease, whilst the
urine becomes diminished and darker from time to time, there
is danger of suppression. The quinine treatment must be
stopped at once and substituted by the active antiphlogistic
treatment above mentioned.
Such is the substance of my treatment of the disease, and it
is my opinion that the failure to make the proper distinction
between the different types has been, and is, the great cause of
the diversity of opinion among eminent members of the profes¬
sion with regard to the use of quinine and mercury in its
treatment.
Whilst some exalt quinine and undervalue mercury, there
are others, equally able, who consider mercury as a sine qua
non, and charge quinine as being a poison in the treatment of
hiematuria. The trulh is, the difference of type makes the dif¬
ference of the treatment best adapted to meet the indications.
Lack of time has prevented me from treating the subject as
fully ami extensively as it deserves, but 1 hope that my feeble
efforts will serve to direct the attention of the profession to a
closer observation of this disease, and if not correct, 1 may
thereby be instrumental in causing someone more learned than
myself in the healing art to give to the profession a true and
exhaustive treatise on this much dreaded destroyer of human
life. In any case, 1 promise to continue my observation in the
future as 1 have in the past.
5
( Original Communications.
J October
45<!
Twenty Caesarean Operations with Fifteen Women Saved in
Louisiana.
By ROBERT P. HARRIS, M.D., 713 Locust street, Philadelphia.
1 have received the twentieth case of gastro-liysterotomy tor
Louisiana’s record — the operation was performed upon a black
dwarf, with success, in 1873, in the Parish of Assumption, near
Napoleouville, by Drs. Charles and Gaston Bordis. The child
was lost. The woman made a good recovery, but died undeliv¬
ered a year later, having refused assistance until beyond hope.
1 am indebted for the case to Dr. Thomas B. Pugh, of Bertie.
Number of operations in the State . 20
Published by operators or others . 9
Communicated by letters to me . 11
Operations twice on 3 women, all saved . 0
Children delivered alive . 12
Children died soon afterward . 2
Women saved . 15
Chronic Inversion of the Uterus of Five Months Duration
Reduced by Emmett’s Method.
(Case reported to Medical and Surgical Association ,)
By E. S. LEWIS, M.D., Prof. Obstetrics and Diseases of Worneu, Univ. La.
Annie McM., a native of New Orleans, aged twenty-two
years, entered ward 35, in the Charity Hospital, on March 0th,
1879. She was pale and wasted, and gave a history of frequent
uterine haemorrhages since the fitli December, 1878, when her
tirst child was born. The labor was conducted by a midwife
and lasted five hours, proving moderately severe. The pla¬
centa was expelled naturally, but was followed by so profuse
a flooding as to cause syncope. A physician was sent for, but
finding the flow arrested on his arrival, merely left a prescrip¬
tion and withdrew, without making an examination. Vaginal
exploration revealed a pediculated pyriform tumor, resting on
the perineum. Traced upwards, it appeared to spring from the
roof of the vagina. The os could not be detected, nor any
I
1879J Lewis — Chronic Inversion of the Uterus. 457
structure which could be identified with the infra vaginal por¬
tion of the cervix. Compression of the tumor occasioned pain,
and when exposed by a Simms speculum, was of a dark red
color, smeared with mucous and blood.
By abdominal palpation the uterus could uot be detected,
but when the tumor was pushed upwards and forwards, a hard
rounded body was felt, somewhat flattened on its upper sur¬
face, and with a slight central depression. The tumor was
then drawn out of the vagina, and two fingers of the right
hand introduced in the rectum were pressed toward the blad¬
der, meeting with no resistance, but on crooking the fingers,
and pressing them forwards in the axis of the vagina towards
the ostium, there was no difficulty in recognizing the body dis¬
covered by abdominal palpation. The case was clearly one of
chronic inversion, dating from the expulsion of the placenta.
It was judged advisable, to attempt reposition by sustained
elastic pressure. A rubber bag was inserted in the vagina
and distended with water. It served also as a tampon in ar¬
resting the flow which was quite free during and immediately
following the examination. This was well borne by the patient
and worn until the 12th, six days, being only removed every
second day to cleanse the vagina with carbolized water, and
replaced. The 12th March, chloroform was administered, and
an attempt at reduction was made by Courtey’s method. After
drawing the tumor to the vaginal outlet, two fingers of
the left hand were introduced iu the rectum, hooked and
separated, so as to press on each side of the inverted
cervix. The uterus was then restored to the vagina the
fundus pushed in the hollow of the sacrum, and the body
seized and pressed obliquely upwards towards the bladder, but
whenever the necessary force was exerted, the cervix would
slide past the two fingers, steadying it through the rectum so
that it was impossible to fix it. Noeggerath’s method was next
tried, but the uterus proved too unyielding to allow any inden¬
tation of its structure. Elastic pressure with the bag was
again continued until the 18th, when Courty’s method was a
second time tried under chloroform, with no better results.
The inverted cervix remained firmly contracted, and through
458
Orif/ina l Com munications.
[October
the rectum the index finger could not be wedged in
the external os t* » facilitate its expansion. A larger rub¬
ber bag was now introduced, but proved so painful, its
removal became necessary in a few hours. As no bleeding fol¬
lowed, it was thought best to let the patient rest, as too con¬
tinued pressure might produce inflammation. Her condition
remained unchanged till April 9th, when she was found much
prostrated from a severe haemorrhage which had occurred in
the night. She was anaesthetized with ether, and the repos-
itor of Prof. White, of Buffalo, employed to restore the uterus.
Over an hour was spent with this instrument without making
the slightest impression on the uterus. To arrest the haemor¬
rhage the first rubber bag used was again introduced with
directions to remove it occasionally, for the purpose of cleans¬
ing the vagina. Producing no irritation, its use was continued
till the 27tli, a period of ten days. The arrest of haemorrhage
had led to marked general improvement. The pulse was
stronger and the appetite better. On the 28th, she was anaes¬
thetized for the fourth time, and Kmmett’s method practised.
The right hand introduced in the vagina grasped the uterus
about the cervix and body, the fundus resting in the palm. It
was then directed forwards and upwards a little ab >ve the
symphysis and steadied by counterpressure with the left hand.
The fingers of the right hand were then slid along the uterus
to the vaginal junction and separated, and the fundus pushed
up with the palm. The abdominal walls were at the same time
made to slide over the inverted cervix, alternating with efforts
to dilate the os and roll out the cervix by wedgeng the thumb
and forefinger in the depression. This manoeuvre was kept up
for an hour and a half, alternating with the left hand in the
vagina to rest the right, when the cervix yielded, and a partial
reduction took place, to about the internal os.
It was decided to postpone any further efforts tor the pres¬
ent. An elastic bag was introduced in the vagina to maintain
the advantage obtained. Leaving for Atlanta two days after,
1 did not again see my patient until the 11th of May. She
was much improved and had regained strength. Sustained
pressure had been kept up in my absence and had produced
1879]
Current Medical Literature.
459
but little irritation. On the 13th of May she was chloroformed
for the last time. On removing the bag, no change had
occurred beyond a greater softness of the uterus. After fully
two hours of hard work by Emmett’s method, the uterus was
reduced, excepting a part of the fundus which formed a pro¬
jection in the cavity opposite the left cornea. This was finally
reduced by a cup-shaped stem pessary introduced iu the uterus
and fastened by elastic tubing to an abdominal belt. It was
removed the next day and the uterus measured, showed a
length of three inches. From that moment all haemorrhage
ceased, the strength of my patient rapidly returned and she
left the hospital on the 31st May, and has been well ever since.
INTERMITTENT FEVER IN FINLAND.
By Otto Hjkt.t, Professor University of Helsingfors.
[Translated by Dr. ,J. P. LEHDE, N-w Orleans, La.]
In consideration of the marked favor with which at present
the general laws for the appearance of diseases are viewed, the
restless energy now shown in the investigation of their causes
and origin, the active interest exhibited in all that surrounds
epidemiology, together with many zealous efforts science now
evolves in the search for correct knowledge concerning the
natures and relations all diseases may assume, even in the
remotest regions, permit the hope to lend a degree of interest
in rendering a description of a peculiar process of disease pre¬
valent in that distant and but little known country — our Fin¬
land. This country, situated between lat. 59° 48' and 75.5°
and long. 37° 20' and 50° 30', on account of its isolation,
sparceness of population, scattered over a relatively extensive
surface area, its little towns and systematic political adminis¬
tration, may offer not a few important items which might lend
definite information towards a knowledge concerning the ex¬
tension of its epidemics, their peculiarities and relations they
hold with those prevailing upon the adjacent continent.
Finland, environed by the waters of the Baltic Sea, Gulfs of
Finland and Bothnia, maintains its southern and eastern con
nection with Russia, by means of a narrow tract of land, situ¬
ated between the Gulf of Finland and Ladoga Lake. It is
Current Medical Literature.
[October
460
over this slender neck of land that the diseases of the conti¬
nent have effected entrance into our sequestered country. This
has beefi the route selected by cholera, relapsing fever, small¬
pox and epizootic,. In contrast with this, malarial fever in its
advance northward, has pursued another and possibly the more
direct route across the Baltic Sea. Not only has the southern
coast of this country, together with Aland, long been known
to have proved fruitful fields for the devastations of malarial
fever, but likewise have always been particularly the sections
which have suffered the attacks of this fever, in preference,
and indeed primarily by every outbreaking epidemic, yet in the
southeastern portion bordering Russia, sporadic cases only of
intermittent fever have been known, and even during the exist¬
ence of general epidemics of this disorder, it never there
acquires that universality of extension peculiar to the remain¬
ing parts of the country. Hence, we are justified in accepting
the conclusion that the course of ingress of malarial miasmata
toward the interior of our country, proceeds either from the
south or west, i. e., it proceeds from Germany or Sweden.
It cannot be affirmed that malarial fever is strictly endemic
in Finland, since a series of years may elapse without the
occurrence of a single case, even in such localities seem¬
ingly most exposed to its influences. Yet the fever, in its in¬
tercurrent manifestations, at all times assumes an epidemic
character of less or greater extension. Upon nearer investi¬
gation of malarial epidemic phenomena in our country, we find,
moreover, that Germany, and to a certain extent Sweden, had
in every instance previously endured the visitations of this same
scourge.
It can readily be premised that Finland (“ the land of a thou¬
sand lakes”), whose surface area is subdivided by numerous
water courses, and which contains countless numbers of larger
and smaller inland lakes, would be well adapted for the develop¬
ment, or at least fully well qualified, for the reception of malarial
fever. Upon careful reflection, such would seem in reality the
case. The explanation of the so common appearance of this
fever in our country is assumingly sought for in the numerous
shallow-sea lagoons which permeate and deeply indent the
shores, in the many swampy meadows and loamy marshes
which intricately intersect the surface. As well, is it likewise
looked for in the more recently projected and effected drainage
of lakes ; and, too. in dry summers following the abundant pre¬
cipitations of a preceding year, occasioning a resultant con¬
dition of low tides in numerous large and small inland lakes;
while, in contrast, rainy summers and consequent high tides
here superinduce re-inundations of the marshy and shallow
shores, to the total extinction of intermittent fevers.
At what period malarial fever made its first advent into our
country is unknown, but the southern and southwestern (the
latter having been the first under cultivation) have for more
1879 1
Current Medical Literature.
461
than a century been known to have evinced themselves peri¬
odically the seat of intermittent fever. Yet we can trace its
course of extension step by step towards the interior, and as a
matter of interest we hud besides, during different epidemics,
that this fever steadily advanced to higher and again higher
northern regions. This method of fever progression was first
noticed during the last decade.
Experience has in our own country established the fact, that
when once malarial fever has here found foot-hold, it invariably
sojourns several successive years, after which it disappears
quite abruptly. Not seldom we here find isolated sporadic
cases of intermittent during a preceding year, as it were, in
advance, until usually winter begins, when it breaks out with
considerable violence, regardless of the mildness or severity of
the season. During the mouths of February and March, and
even at times as early as January, it attacks a multitude of
subjects simultaneously, acquiring its maximum keigkth dur¬
ing the succeeding months of April, May and June, to cease
with the true commencement of summer, when, as a rule, a
renewal takes place in autumn in the mouths of October and
November. In this manner the disease repeats itself in any
given locality within a period of time extending from two to
eight years, then leaving an interval, in the course of which
scarcely a case is seen.
The first intermittent fever epidemic of dimensions here,
known to us, prevailed during the years 1751 to 1758, was con¬
fined to the Aland Islands and the southwestern portion of the
country. This epidemic was made noteworthy by the remittent
type it assumed, and by the fact of it then being for the first
time described by - physicians (about which more will
be said anon). The subsequent epidemics prevailed during
the years from 1774 to 1777, 1812 to 1816, 1819 to 1821,
1826 to 1832, 1846 to 1843, and the last, 1852 to 1862.
Prior to these epidemics which prevailed in northern regions of
Finland, which have been six in one century, malarial epidemics
had already existed several years upon the European con¬
tinent. All of these enumerated above as having occurred
in Finland, were antedated by general epidemics of intermit¬
tent fever in Germany and to a partial extent in Swe¬
den during the years 1747 to 1748, 1770 to 1772, 1807
to 1812, 1824 to 1827, 1845 to 1848, and 1858. From
the nature of these data we are involuntarily fenced to
accept this evidence iu sustaining the conclusion that there
must exist some definite force of correlation which appar¬
ently controls this order of alternate rotatory or simultaneous¬
ness iu the different countries. We are thus able to recognize
the importance and v alue of the consideration of all circums¬
tances which bear influential relations, together with whatever
else of significance might present itself for accurate and
sedulous study ; possibly by such a method we might derive
Current Medical Literature.
[October
401'
more correct information concerning a knowledge of the laws
controlling epidemics in general. What is especially notable
of the malarial epidemics of Finland occurring during the last
century is, that they seemed altogether confined to the south¬
ern portion of this country and Aland Island. It has been pre¬
viously remarked that the first epidemic evinced no particular
tendency to follow a northward direction. It was only that
great and widespread epidemic which began in the year 1812,
after moderating its intensity during the year from 1817 to 1818,
and continued until 1821, is described as having appeared
about Wassa (lat. 08° 5(1), and Nyslott (lat. 02° 52'). Then
followed the next epidemic from 1826 to 1882, which again
showed no decided northward extension. It was still at that
time customary to send subjects of intermittent fever to the
interior for recovery and release from the fever. Toward the
close of 1840, we first learn to know the fever in the interior of
our country, for instance, about Tammerfors, Kangasala, Hol-
lola, Heinola, St. Michel and other localities.
When malarial fever reappeared in the year from 1847 to
1848, it prevailed not only along the waters of lakes Saima and
Ladoga, but urged its direction upward toward the church dis¬
tricts of Laukas and Sacryarwi (about lat. 62° 48'), and from
thence proceeded to the shores of the Gulf of Bothnia, while
up to that period the northeastern sections of Finland re¬
mained exempt.
It was not until the great and widespread epidemic of mala¬
rial fever of the years i852 to 1862 had appeared, that inter¬
mittent fever had first taken firm footholds in certain sections
of the country, where, hitherto, it had been hardly before
known or seen. As a result of this epidemic, the entire
south coast became affected ; from thence it extended to the
regions of the large inland lakes Paijane and Saima, again from
thence upward as high as Koupio (lat. 62° 54'), appearing be¬
sides over all the medical districts of the interior, assuming at
times, a degree of violence, that the stricken, in several locali¬
ties, have been estimated in numbers to have been fully one-
third of the entire population of these. While this epidemic,
during its first years, acquired extraordinary severity over the
entire southwestern and southern portions, with the same grade
of severity, it afterward extended its course to middle, interior
and northeast, touching then, though in a milder degree, like¬
wise, the shores of the Gulf of Bothuia, at length, reaching in
1861 Brahstad (lat. 64° 41'), then in 1862 it proceeded to
the eastward, and interiorly situated localities of Sotkamo and
Kajana (lat. 64° 12' ). These last named places are situated in
the highest known regions in Europe, wherein malarial fever
has never before appeared. Hence, the intermittent fever
zone extends higher north than has liigherto been accepted.
According to Hirsh, we find the statement that malarial fever
never reaches higher north than the 62° of latitude.
1879]
Current Medical Literature.
4G3
Withal, it remains remarkable, that the disease during these
epidemics, confined itself preferably to the southeastern sec¬
tions of the country, and that it was at all times less exten¬
sively manifest and widespread, and in general of much
milder behavior than in other sections, where it, at the same
time prevailed. Noth withstanding all these in points of clima¬
tological and geological conditions seemed in the aggregate
fully identical. The positive observation has here been made
that malarial fever has become far more general and wide¬
spread in the regions bordering the large inland lakes of Saiina
and Ladoga since the Werokosas, which form the chain of
water connection between these, have been dredged and drained.
It is, besides, even affirmed, that intermittent fever has, in
localities situated near the shores of the last named become
strictly endemic, as in Heinijoka, Jackimvaara and Mohla.
In like manner it also conducted itself in the immediate neigh¬
borhood of Hallola and Heinola, as also along the shores and
margins of Lake Paiane and its tributaries — not, however,
until these had been lowered by the dredging and drainage of
the cataract of Kalkis, which brought about augmentation of
exposed soil surface. Concerning other localities which under
ordinary circumstances seem to remain, several years after its
advent in 186 i, subject to intermittent fever, the church dis¬
tricts of Maxmo near Wasa, as well as the town called Brahstal,
may be mentioned.
These epidemics have each evinced entirely differential char¬
acteristics. It would seem during every epidemic, a temporary
cessation or a visible abatement must needs so modify the
fever, in order at a later period to acquire a greater degree of
violence, until such time when, as a rule, it vanishes abruptly.
The stage of incubation of intermittent fever seems capable of
long protraction. The established experience of old is here
still valid, that individuals who sojourn in intermittent fever
regions during fall are usually not subject to the attacks of
the disease until their return home in the following winter or
spring. The author was acquainted with the family of a physician,
the members of which who, after a stay of two spring seasons
on the south coast of the country, became victims of intermit¬
tent upon their return home to Tornea; and with two other
sporadic cases, these were indeed the only intermittent cases
which had there appeared during the last five years. Berg-
mann, in an interesting pamphlet, relates several interesting
examples of the stage of malarial incubation in Schweeden.
It may be said concerning the various types of intermittent
fever in our country, that the diurnal and ternary forms predomi¬
nate during winter and spring, whereas in the fall the fever begins
as a tertian or quartan, or sometimes beginning as a tertian,
merges latterly into quotidian, and even at times into tertian dup-
licata. During such summers as are characterized by excessive
heat, the elevation of temperature seems so influential in changing
6
464
Current Medical Literature.
[October
the intermittent form in a manner, that it becomes remittent.
This modification sets in, tor the most part, in the month of
August (now and then, also July), and continues until September
iias quite begun. This peculiarity is only observed during cer¬
tain years, and is in the main limited to southern and south¬
western portions of the country. Only exceptionally has this
form of the disorder manifested itself in the interior of Finland
beneath the 61st parallel of latitude. With the incoming of
lower temperature, this remittent form of malaria (which not
seldom attacks entire familes, and is known to us by the name
of August fever), changes into an intermittent of regular quo¬
tidian or tertain type. The mortality from intermittent and
remitteut fever in Finland is not extraordinarily great, but dis¬
eased conditions which follow these as sequl.e, in our coun¬
try so common ; are in reality those which are death producing
in a multitude of cases, and besides these are the causes which
stamp the healths of the more heavily scourged localities with
peculiar characteristics in common. Hence, following upon
intermittent fever we often here meet amemia, albuminous drop¬
sies, parenchymatous nephritis, and excessive enlargements of
the spleen. These consequent diseases as such do not, how¬
ever, appear incident to every epidemic, nor are their results
entirely general, nor the same in all localities of Finland. The
author maintains the opinion that the origin and cause of the
amyloid degeneration of the different organs found so com¬
monly in Finland at post mortem examinations, are to be
sought for in the influence of malarial poison upon the human
organism, and is attributable altogether to this. Also does he
deem the frequent presence of anaemia and chlorosis in certain
regions of Finland affecting an otherwise so robust and hardy
people ascribable to the lamentably injurious operations of the
intermittent fever poison.
The epidemic behavior of malarial fever, the theme of this
brief sketch, contains for the interest of sanitary relations of
our northern Fatherland data of great and important consid¬
eration.
CASES OF OVARIOTOMY.
Service of Dr. Nathan Bozeman.
Since May last, Dr. Bozeman has performed five ovarioto¬
mies, all resulting in recovery. In three of the cases both
ovaries were removed. Dr. B. attributes his success (100 per
cent, recoveries) to the following points : 1st. If the operation
can be safely delayed for a week or more, after coming under
treatment, lie prepares the patient by administering to her
tonics and food as much as she can bear. Iron he considers a
most valuable agent in the preparatory stage of the treatment.
2d. The antiseptic method (Lister’s) he invariably uses in this,
as in all major operations. He thinks his successes are greatly
Current Medical Literature.
465
1879 j
due to the means thus adopted of preventing peritonitis and
septicaemia. 3d. The treatment of the pedicle ; whether long
or short, he returns it into the peritoneal cavity. The doctor
transfixes and ties it, right and left, several times with wax,
carbolized, strong silk ligatures, and claims that there is no
necessity of using clamps or Kceberle’s serre-naeud. 4th. He
includes the peritoneum into his sutures when closing the
abdominal incision , which he never makes larger than is neces¬
sary in the median line. Carbolized silk sutures are also used
for closing the wound, as for tying the pedicle. Beef-tea, milk
and eggs constitute the food given as soon as the patient has
fully recovered from the anaesthetic (ether being used for the
purpose). If there is a tendency to vomiting, the food is admin¬
istered per rectum. Quinine and opium the doctor considers of
the highest importance in the after-treatment, given in full
doses, as being antiperiodic, and a preventive of peritonitis.
Should there be any undue elevation of temperature, not con¬
trolled by the medication enumerated, Kibbes’ cot comes into
requisition. The first incision he never makes larger than is
necessary for the introduction into the peritoneal cavity of his
abdominal spatula, as the doctor terms it (a flexible metallic
rod, 10 to 12 inches long, well rounded off, with a triangular-
shaped termination at either end, like Lott’s vaginal depressor),
about one inch long, also well rounded off. The size of the
tumor, its adhesions, if there be any, are thus explored with
the aid of this spatula. The incision is then enlarged to 4 — 6,
for the purpose of introducing the hand and separating the
adhesions, if their presence has been made out, in the mode
above described. The next step consists in tapping the cyst or
cysts with Spencer Wells’ trocar. In multilocular cysts he taps
one cyst after the other through the opening made in the first,
and so on, the patient being turned on her side. The cysts are
thus emptied to a size sufficient to pass his right hand through
the abdominal opening into the peritoneal cavity while draw¬
ing out the cyst or cysts with his left. The simultaneous use
of both hands Dr. B. considers of the most importance while
drawing out the cyst. The right hand introduced inside the
cavity completes the separation of adhesions that may have
remained after the use of his spatula, and also guards against
any undue stretching or possible rupture of the intestines, gall-
bladder, etc., with which there may be adhesions. The omission
of this precautionary measure doubtless had caused many fatal
results that may have terminated favorably had this precaution
been practised. 6 — 8 grs. of quinite sulphate and twenty-five
drops of liquor opii comp, administered per rectum, are the
doses of these remedies used from the first lor the purposes
mentioned. The use of hypodermic injections are being avoided
by I)r. B. After ovariotomy, he is of the opinion that on ac¬
count of the pain thereby produced, the patients abhor them,
and thus cause undue nervous excitement. Dr. Bozeman never
466 Current Medical Literature. [October
uses drainage tubes through Douglas’ cul-de-sac, but prefers to
draw off effusions by means of tubes introduced through the
abdominal opening, reaching down to Douglas’ cul-de-sac.
Dr. Bozeman performed his first case of ovariotomy in 1865,
also successfully, making in all six cases, wherein nine ovaries
were removed. The first operation he published September
1st, 1866, in the Medical Record , under the title, “ Remarks on
the History of Ovariotomy,” and the report of a case in which
the intra-peritoneal treatment of the pedicle with the silver
ligature was adopted with success. As stated above, Dr.
Bozeman now uses only waxed carbolized silk, both for tying
the pedicle and the abdominal wound. — The Medical Record —
The Obstetric Gazette.
AN ABSTRACT OF A PAPER ON THE EXTERNAL TREATMENT OF
SKIN DISEASES.
By John V. Shoemaker, A.M , M.D., of Philadelphia.
[Read before the Pennsylvania Medical Society. 1
After setting forth the object of the external treatment in
skin diseases, the speaker added that either a cure or a tempo¬
rary relief could be accomplished by either hygienic, medicinal
or mechanical remedies, or a proper combination of them. The
hygienic measures considered were the condition of the air, the
necessity of ablution and bathing, the suitable kind of cloth¬
ing, and the proper exercise and rest. These topics were dis¬
cus: ed at some length, and were followed by the means of
reaching disease by local medication. Under this class of
medicinal agents were included soaps, poultices, lotions, oint¬
ments, dusting powders, oils, caustics and the oleates. All
these medicinal agents were carefully considered in their turn,
and very many points as to their therapeutic application in
cutaneous diseases were derived from the observation and
experience of the lecturer. The oleates, preparations that were
recently introduced into practice, were said to possess in cer¬
tain diseases many advantages over ointments. In illustration
of this it was claimed that oleic acid possessed solvent powers
that were more active than most bases of ointments, and con¬
sequently, the chemical combination so formed would be more
potent when applied to the skin. Further, that the oleates
would not decompose like ointments, and wo aid on this account
be more effective, and not act as irritants to the skin. That the
oleates prepared either as a five or ten per cent, solutio . are
all, with the exception of the oleate of zinc, in the liquid state,,
and would, therefore, have a greater absorbent power. They-
would also penetrate deeper and more rapidly into the tissues
than ointments. And lastly, as they are of a liquid condition,
with one exception, they would be better suited for application
over the scalp, the beard, axillary and pubic regions* or any
Current Medical Literature .
467
1879]
hairy parts of the body, in preference to ointments, which fre¬
quently mat together the hairs.
The doctor, in concluding this valuable and practical sub¬
ject, adds : “ I have frequently had occasion to apply the
oleates as external remedies in the treatment of skin affections,
with the most happy results. 1 may first mention that the
oleate of atropia (one grain of the atropia to the ounce of
oleic acid) exerts a marked influence in arresting the abundant
secretion of seborrhcea, and in subduing high inflammatory
action in severe cases of erysipelas. Secondly, 1 have observed
that a 40 per cent, solution of the oleate of mercury, with the
addition of a small quantity of olive oil, and scented with some
essential oil, is an invaluable application for general thinning
and loss of hair. When brushed lightly over the scalp in the
above condition, it produces both a tonic and alterative effect
upon the part. I have also employed as an application, with
great success, a two-ounce solution of the oleate of mercury, of
10 per cent, strength, mixed with an equal quantity of olive
oil, in psoriasis and pityriasis, after all the scales and redness
have disappeared. The use of this preparation in these affec¬
tions protects and soothes the hypersemic skin, and prevents a
return of the diseased condition.
Mr. L. Wolf, pharmaceutist and chemist, of Philadelphia,
has lately made for me, after many tedious experiments, two
additional preparations of the oleates, namely, the oleate of
lead and the oleate of bismuth, and I believe I have been the
first to use these remedies as topical applications in cutaneous
affections. The former of these agents, the oleate of lead, is
manufactured by adding liquor potass® to a diluted prepara¬
tion of liquor plumbi subacetatis, and the precipitate collected
on a filter and dried. The dry oxide of lead should then be
dissolved in oleic acid, by means of the water bath. The
strength of the solution should be 5 per cent, of lead oxide to
the oleic acid, and as free as possible from steric and margaric
acids, in order to have it in the liquid form. Should either the
per cent, of lead be increased or the solution contaminated by
steric or margaric acid, the oleate will be semi-solid, and will
not have the same efficient action.
The oleate of lead, if prepared with care, in the manner I
have indicated, is an opaque, oily liquid. It is a mild astrin¬
gent, more readily absorbed than either Goulard’s cerate or
Hebra’s litharge ointment, while it possesses the advantage of
neither decomposing or turning rancid. I have obtained
remarkably good results from its use in eczema, in rosacea,
after depletion of the parts, in burns and in erythema. If
arrests morbid discharges, protects the surface, and by its
astringent and sedative action allays irritation.
The oleate of bismuth, an oily, brown liquid, the second one
of these new preparations of the oleates, is not so difficult to
manufacture as the last named, and I will, therefore, omit the
468 Current Medical Literature. [October
manner of making it. It, however, possesses valuable medi¬
cinal effect when applied in pustular eruptions, especially in
sycosis and hepatic affections. It is also a most useful remedy
in soothing and relieving cutaneous irritation when mixed
with an equal quantity of olive oil, and applied in acute specific
eruptions, especially in scarlet fever.
The paper also included under this head an account of the
oleates of iron and antimony, a full description of all the other
medicinal substances that were previously enumerated, and
finally, a concise and valuable allusion to friction, compression
and blood letting, the mechanical remedies for alleviating and
curing cutaneous affections. — Medical and Surgical Reporter ,
June 21st.
ERYSIPELAS CAUSED BY SEWER-GAS.
Years ago, the idea that facial erysipelas, or indeed that any
variety of this dire disease, could be originated by the entrance
of sewer-gas into houses, hospitals, or institutions, would have
been condemned as too absurd for credence. Bitter experience,
extending over a number of years, backed by the researches
of Mr. Pridgin Teale and others, has, however, finally settled
the question in dispute. There is now no more doubt that
erysipelas is originated by sewer-gas than that typhoid fever is
due more often than not to impure water. For instance, at the
Old Infirmary Lincoln, which was situated on a hill above
the city, erysipelas and sewer-gas were constantly present in
the wards. We remember seeing twelve or fifteen cases there
some twelve years ago. At that time the hospital drains com¬
municated with the town sewers ; and as neither were ventil¬
ated or disconnected, the hospital had the benefit of the full
pressure of the sewer-gas of Lincoln, because the hospital lavato¬
ries and closets occupied the highest points to which any of
the sewer connections extended. At Manchester, as we showed
some months ago, sewer-gas had demoralised the health of the
staff, and had so increased the amount of erysipelas and pyae¬
mia that the surgeons were afraid to perform even the smallest
operation. Recently the authorities of a large London hospi¬
tal proceeded to ventilate the whole of the drains and sewers in
connection with their institution. Up to the time these altera¬
tions were made, pyaemia and erysipelas had almost driven the
medical staff' to despair. When the whole of the ventilation
was completed, and so soon as the pressure was removed from
the traps of the closets and lavatories, no fresh cases were
found to occur. For months the hospital wards were free from
erysipelas and pyaemia. Suddenly there was a fresh outbreak
of these diseases, but it was noticed that the epidemic was con¬
fined to one of the surgical wards, built apart from the main
building on the pavilion plan, and having only one story.
Close investigation proved that the ventilation pipe in this
1879]
Current Medical Literature.
469
wing had been stopped up by a careless workman. When this
was remedied, all trace of the epidemic disappeared, and for
four years this hospital has been almost free from these dis¬
eases. Space will not allow us to quote further evidence on
this occasion, but any one who is interested in the subject will
obtain much useful information from Mr. T. P. Teale, of Leeds,
who has made this subject almost a special study. We have
been led to make the above remarks because, during the past
week, an investigation of great interest has been conducted by
the Somersetshire Coroner into the causes of a fatal outbreak
of erysipelas at the County Lunatic Asylum. It appears that
from December 1878, to May 1879, 23 cases of erysipelas oc¬
curred in the female infirmary ward, of which 2 were fatal. Bad
smells had been constantly present in this ward, and in other
parts of the building for many months past. Several of the
inmates had suffered from severe diarrhoea, of which one died ;
sore-throat, loss of appetite, headache, and nausea attacked
most of the patients. On the male side 9 cases of erysipelas
occurred, 2 of which were fatal. Here, then, we find 32 cases
of erysipelas occurring in a lunatic asylum in five months, of
which 4 proved fatal. When we remember the nausea, head¬
ache, sore-throat, and general malaise experienced by the other
inmates, coupled with the epidemic of diarrhoea and bad smells,
it is not difficult to divine that sewer-gas was almost every¬
where present throughout the institution. This was suspected
by the superintendent, Dr. Medlicott, and so with the aid of
the assistant medical officers, Messrs. J. F. Wood and T. S.
Sheldon, a searching investigation was made into the drainage
arrangements. It was then discovered that none of the soil-pipes
were ventilated ; most of them were of lead, and several were
rat-eaten and riddled with holes. On taking out the pan and
syphon of the infirmary closet a very bad smell was present,
which was touud to be caused by a hole in the soil-pipe, 3 by
1£ inches. This particular soil-pipe had a direct communica¬
tion with the main sewer. The main drain outside the infirmary
ward — where most of the erysipelas cases occurred — had been
choked more than once during the year, and on one occasion it
was blocked entirely to the extent of three or four yards. In
other parts of the building the fall was insufficient, and in con¬
sequence the main drain had been stopped several times.
In brief, almost every sanitary evil was found to be present
in this ill-fated institution ; fermenting sewage was a constant
factor, and sewer-gas, conveyed from the sewers to the wards
by the rat-eaten soil-pipes, had committed its fatal ravages
unchecked and unsuspected for at any rate months, and we
suspect even for years.
The moral is plain to read, but difficult to get people to realize.
Modern building, whether large or small, especially where
they are situated in or near towns, must pour their sewage into
the main sewers. As a consequence drain-pipes must, to a greater
470 Current Medical F/iterature. [October
or less extent, pass inside the houses, and so a risk of sewer-gas
is incurred. What is the remedy ? Simply to put an open
manhole, with pipe-drains passing through it between the sewer
and the house, to put a syphon with ventilator between the
manhole and the sewer, and in every case to carry the soil-pipe
above the top of the buildings, and to leave it perfectly open
at the top. In this way sewer-gas is effectually excluded
from houses, a constant draft of fresh air passes down the open
manhole, and through every inch of the household drains, and
defective traps and rat-eaten soil-pipes may practically be de¬
fied. Unless the connection with the sewer is cut outside an
inhabited building, and unless every inch of soil-pipe is thor¬
oughly ventilated in the simple way we have described, danger
of blood-poisoning exists. With these precautions, simple and
comparatively inexpensive as they are, even the oldest build¬
ings may be made not only sweet but perfectly healthy. — Sani¬
tary Record , June 6.
EPIDEMICS FROM A CHEMICAL STANDPOINT.*
By R. OGDEN DOREMUS, M.D., LL.D.,
Profossor of Chemistry and Toxicology in Bellevue Hospital Medical College ; Professor
of Chemistry and Physics in the College of the City of New York ;
Chemist of the Medico-Legal Society.
Dr. 0. R. Agnew, formerly attached to the New York Hos¬
pital, informs me that iu consequence of the reception of
patients suffering from “ship fever,” the north wing of the old
building near Duane street became so saturated with disease¬
breeding agents that it had to be abandoned. This was about
twenty -five years ago. The patients were removed from this
wing ; the windows were kept open for many weeks to accom¬
plish thorough ventilation ; the walls and ceilings of the wards
were scraped and whitewashed, but in vain ! Even the work¬
men engaged in this cleansing process were taken sick, and
one or more died.
So many hospitals, or parts of hospitals, iu Europe and in
this country have become magazines of disease, puerperal
fevers, pyaemia, etc., that many savaus urge that the buildings
shall be constructed of wood, and be burned up every second
or third year.
When Pandora, the all-gifted, opened the fabled box and
released its pernicious contents, which brought immeasurable
suffering upon mankind, “ the terrified female at length gained
sufficient presence of mind to close the lid ; and Hope there¬
upon was alone secured.”
Prometheus, who formed the first man out of claj~, kindled
his torch from the chariot of Phoebus, with whicli he blew eternal
From Bulletin of the Medico-Legal Society of New York, January, 1879.
1879]
Current Medical Literature.
471
flames into the breasts of his creatures. Notwithstanding the
ire of Jupiter, he ascended a second time and brought fire from
the sun.
The chemist was anciently designated the “philosopher by
fire.’’ Perhaps we are justified in saying that to him we should
look to antidote, at least, certain of the evils set free by her
whom Vulcan made, and intended to be the consort of the son
of Iapetus.
By the potency of modern science, Hope has been released
from Pandora’s box.
We propose to show that spirit can be set at war with spirit,
the combat resulting favorably to humanity.
There are no firmer believers in spirits than chemists ; for
they can make them of every hue of the rainbow, or colorless
and invisible, or even black ; of varying weights and odors ;
some grateful to our senses, others nauseating and disgusting ;
markedly differing in chemical qualifications — one the spirit of
life, the vital air; while a host “ whose name is legion” exist,
and can at will be produced, which are destructive to life.
With but few exceptions, all poisonous emanations from
humanity, in health or in disease, are compounds of the most
gaseous of all gases, hydrogen.
This lightest of all known elements, when just released from
combination with others, or in its “nascent” state, possesses
marvellous powers of affinity. Thus, one pound of hydrogen
can unite with sixteen pounds of sulphur, and can confer on
this solid body its own condition of gaseity. With carbon it
yields forms of illuminating gas ; with many metals, as iron,
zinc, arsenic, antimony, etc., it produces spirit-like bodies, some
of which are most poisonous. Such substances as pus, vaccine
virus, etc., are compounds of hydrogen; and future chemists
will doubtless discover that all disease-propagating gases or
germs consist in part of this particular ghost.
If, therefore, we can dehydrogenate them, or rob them of this
spirit, we cau destroy their power for evil.
To employ a political figure, chlorine gas is the great “ ring
breaker.” It seizes upon the chief of the ring, Hydrogen , im¬
prisons it, and breaks up the evil combination.
I have here a tall glass jar, the upper part of which contains
sulphuretted hydrogen gas, the lower part water. On bubbling
up through the water, this greenish-yellow gas, chlorine, as it
reaches the ill-odored gas above, instantly deprives it of its
hydrogen (forming with it hydrochloric acid) ; and you observe
the yellow deposit of sulphur on the water, and upon the sides
of the jar.
I now present a compound of carbon and hydrogen to this
chlorine — black carbon is at once deposited, the hydrogen, by
preference, combining with the chlorine.
Should I introduce the most poisonous form of arsenic, viz.,
arseniuretted hydrogen, to chlorine, the superior affinity of
7
Current Medical Literature.
472
[October
hydrogen for chlorine would be immediately pronounced ; the
hydrogen and chlorine would unite as before., and should there
be an excess of chlorine, a chloride of arsenic would be formed.
Should chlorine be exhibited to a mixture of sulphuretted
hydrogen and arseniuretted hydrogen gases, it would deprive
them both of their hydrogen ; the sulphur and the arsenic,
being in a “nascent” state, would unite, and form a sulphide
of arsenic, yellow orpiment.
If a glass rod be dipped in anhydrous hydrocyanic (prussic)
acid, which has been liquified by cold, on approaching the rod
with its adherent drop to a rabbit, the animal falls dead before
the poisonous liquid touches him— due to the inhalation of the
vaporous or gaseous acid. If chlorine be presented to this
most rapidly fatal of all the spirits, it instantly disarms it of
its virulence by robbing it of its hydrogen.
If equal volumes of hydrogen and chlorine be placed in a
glass flask in a dark room, on exposing them to the sunbeam
they combine with explosive violence.
Hence we feel warranted in the assertion that if chlorine gas
can be generated in great volume, and especially with the aid
of moisture, which facilitates its action, it can dehydrogenate
any of the virulent spirits which result from vegetable and
animal decomposition.
In 1841) 1 was consulted by one of our largest transatlantic
steamship companies as to the best method of disinfecting one
of the state-rooms, which had been occupied by a passenger in
whom small-pox developed a few days after leaving Liverpool.
The liberal generation of chlorine gas in said compartment
accomplished the desired result.
In the summer of 1805 1 had the pleasure of meeting on
Broadway Prof. Lewis A. Sayre, M.D., then Health Physician
to our city. He announced that the steamship Atalanta had
arrived at Quarantine from Liverpool with a large number of
steerage passengers ; that sixty of them had died of cholera !
He requested me to accompany him to the Mayor’s office to
discuss what should be done.
I expressed to Prof. Sayre and Mayor Gunther that chemical
agents, if liberally employed , could decompose and destroy all
these disease-spreading agents ; that ships could be disinfected
in twenty-tour or forty-eight hours better than by a detention
of forty days for ventilation ; that modern chemistry would
enable us to almost abolish quarantine by shortening the cus¬
tomary delay which its name involves.
Carte blanche was given by the Mayor.
Accompanied by my assistant, Dr. A. W. Wilkinson, a visit
was paid to Dr. Swinburne, then Health Officer at Quarantine,
who gave his cordial co-operation.
Among the most efficient agents with which wTe successfully
disinfected the ship referred to as freighted with disease, and
many other vesseis w hich subsequently arrived from dangerous
1879]
Current Medical Literature.
473
ports, was chlorine gas. Bolls of sheet lead were taken on
board the vessels, with hundreds of pounds of common salt and
peroxide of manganese; also carboys of sulphuric acid. The
lead was unrolled, turned up at the edges, so as to make recep¬
tacles eight or ten feet in length and four feet in breadth. Into
these troughs the salt and the manganese were mingled with
water, forming a black mud, and when all were ready to leave
the hold or part of the vessel where the troughs had been
placed, a carboy or more of sulphuric acid was poured into the
aforesaid mixture.
Huge volumes of chlorine were immediately given off; hun¬
dreds of pounds of this greenish-colored gas arose and diffused
in every direction. The hatches were “ battened down,” and
this potent element was left to accomplish our purpose, viz., to
dehydrogenate, and thus decompose, the death-breeding gases
and germs.
That this mode of treatment was eminently successful, was
demonstrated by the fact that not a single case of cholera
appeared in this city, or the cities connected Avitli this port, or
the section of our country to which the emigrants passed. So
complete was the disinfection that not only were the ships
purified, but also the articles of merchandise from infected
ports, as well as the baggage of cabin passengers and emi¬
grants. In previous years cholera was known to have been
developed in the interior of this State from boxes and trunks
containing household articles which had been brought from
parts of Europe where the disease existed.
Who can estimafe the loss of life and property had cholera
been introduced into New York, and thus probably have been
disseminated through the country '?
I am happy to learn that this process has been continued by
my quondam college-mate, Dr. S. Oakley Vanderpoel, the
present Health Officer at Quarantine, to whom our city and
the country is indebted for his faithful and efficient services.
Three years ago I was asked by the present Commissioners
of Charities and Correction to undertake the purification and
disinfection of the surgical wards of Bellevue Hospital. In
certain wards pyaemia had proved \Tery fatal. The heroic chlo¬
rine treatment (if I may use this expression) was adopted for
the wards, and ozone for the water closets.
Strips of paper were pasted over the crevices around the
windows and doors. Troughs of lead, as before described,
were brought into the ward ; a. sack of salt Avas emptied into
them, and about an equal weight of black oxide of manganese.
These Avere intimately mixed, by stirring them with water, by
means of wooden shovels. A carboy of sulphuric acid avus
emptied into pitchers, basins, and other vessels, and placed by
the sides of the troughs. The floors were then wetted with
water, and steam was alloAved to escape from the heaters until
the condensed moisture had dampeued the ceilings and was
trickling down the walls.
474
Curren t Medical Literature.
[October
Half a dozen assistants groped their way with me through
the mist to the sides of the most remote trough ; each of us
simultaneously poured out the contents of the vessels tilled
with sulphuric acid upon the salt and manganese, repeating
this operation at the second trough. We then hastily made
our exit, and nailed up the door, lest any one should accident¬
ally enter; for the amount of chlorine thus liberated would
have proved fatal to any one who might have ventured into its
presence.
The next day the windows were opened from the outside,
and after an hour or more of ventilation, we entered, and hav¬
ing first filled the earthen vessels with sulphuric acid, we
stirred up the mass resulting from the previous day’s reaction,
then added this second dose of acid, and again rapidly retreated
and secured the door.
In the first ward, where pyaemia had proved most fatal, the
contents of the troughs, chiefly sulphate of soda and sulphate
of manganese, were removed, and a second sack of salt, with
its equivalent of peroxide of manganese, were mixed in them
with water, and the full complement of sulphuric acid poured
into the mixture, after filling the compartment with steam as
before.
The walls and floors were then washed and scrubbed, alter a
third liberal treatment with chlorine was completed, twenty*
four hours having been allotted for each dose of chlorine to
fulfill its fell purpose, viz., to permeate the plaster walls, and
the very stones of the hospital in search of its prey, the foul,
death-dealing gases and germs that lurked in these hiding-
places defying all ordinary methods of removal.
After a day’s ventilation and drying, the disinfection was
considered complete. It was a pleasure to pass from the adjoin¬
ing wards into the purified one; the mawkish flavor, so common
to even ihe most cleanly hospitals, had entirely disappeared.
To test the efficiency of the chlorine gas, the cotton sheets
were left on some of the beds when the first charge was em¬
ployed. The next day these sheets were so tender that the
least touch sufficed to crumble them to pieces. The woolen
blankets were disinfected, but uninjured.
All the other surgical wards in the north wing of Bellevue
Hospital were treated twice with a most liberal charge of
chlorine. Estimating from the quantities of the chemicals em¬
ployed, between two and three tons of chlorine gas must have
been produced by the reaction !
The method described for generating chlorine is preferable
to the employment of hydrochloric (muriatic) acid and the bi-
noxide of manganese, because of the more copious yield of gas,
as may be shown by the following formulae:
2(80, HO) + Mn02 + Na Cl =
SO;)MnO + S03Na0 + 2(110) + 01.
Current Medical Literature.
475
187!) J
Here all the chlorine is liberated from the common salt
(chloride sodium), the sulphate of manganese and the sulphate
of soda remaining; whereas, by the use of hydrochloric acid,
only one-half of the chlorine is discharged as a gas : thus,
2(H Cl) + Mn02 = Mn Cl + 2 (HO) + Cl.
the other portion combining with the manganese to form the
chloride of this metal.
The first process generates beat by the action of the sul¬
phuric acid and the water. This facilitates the diffusion of
the heavy gas.
In consequence of the very pronounced odor of chlorine gas
many persons, including physicians, and even those who have
written on the subject of its applicability as a disinfectant, err
in regard to the quantity that should be relied on. One distin¬
guished physician narrated to me that he signally failed. He
placed some manganese in a saucer and poured hydrochloric
acid upon it ! Need we wonder at the result t
Ln a recent medical journal sent to me a description of modes
of disinfection is given ; under the head of chlorine the writer
says, “ Place four ounces of manganese on a plate and add
hydrochloric acid to it !”
There are incidental advantages in resorting to sheets of
lead as a suitable receptacle for the chemicals. Troughs of
any length can be easily and quickly made; and after the resi¬
dues of the reactions have been removed they can be rolled up
into a compact form. By unrolling them and turning up tlie
edges they can be used again, and as often as desired. The
sulphuric acid forms an insoluble sulphate of lead on the inner
surface, so that the metal is not perforated or destroyed.
The water-closets connected with the surgical wards of
Bellevue Hospital were deodorized and disinfected by sprink¬
ling in the urinals, for a number of consecutive nights a mix¬
ture of the manganate of soda and the sulphate of magnesia.
In contact with water these salts produce the permanganate
of soda, and at little cost. The reaction is thus expressed bj'
symbols :
3(Mn i)a NaO ) + 2(SO:, MgO)=
(Mn, Or NaO) + Mn(j, + 2(SO:! NaO) + 2(MgO).
Permanganate Soda + Bmox: Manganese -l- 2(Sulpliate Soda)
+2(Magnesia.)
In contact with the impurities of the urinals the perman¬
ganate ot soda decomposes, yielding a most active form of
oxygen, nascent oxygen, or ozone, which at once deodorizes
and disinfects.
This mixture has no unpleasant flavor such as characterizes
carbolic acid, cresylic acid, chloride of lime, hypochlorite of
soda (Labarraque’s solution), and many other disinfectants.
It may be constantly applied without annoying the patients of
Current Medical Literature.
47(J
[October
the sick room or hospital. It should be kept by the side of the
urinal, and the mixed powders should be thrown into the vase
or urinal each time it is used.
The liberal generation of chlorine gas has been repeated at
Bellevue every few months, and with the happiest results.
The most sanguine anticipations could not surpass the state¬
ment made by Dr. James R. Wood, the oldest surgeon of the
hospital, that “ since this thorough purification no case of
pyaemia has originated in the surgical wards!”
A few years ago the Commissioners of Charities and Correc¬
tion had under discussion the advisability of stripping the
walls of Bellevue end relining the edifice with wood and plas¬
ter. I doubt if even this expensive procedure would have
accomplished a much better result than was obtained by scrap¬
ing the walls of the old New York Hospital, for the very
stones were doubtless impregnated with poison.
If we ignore chemistry, the ancient Hebraic process is the
only efficient one — to “ break down the house, the stones of it,
and the timber thereof, and all the mortar of the house, and
carry them forth out of the city into an unclean place unless
we construct our hospitals of wood, and burn them as occasion
demands.
The latter method would effectually carry out the significa¬
tion of the word purify — the treatment by fire.
But in a large city we need hospitals distributed within its
precincts. The application of the torch might accomplish more
destruction than anticipated, unless hospitals were in the out¬
skirts of our cities. There are seventeen hospitals in different
parts of Paris.
To transport patients several miles diminishes their chances
of recovery, especially “ accident cases.”
The explosion of the Staten Island ferry-boat Westfield at
the South Ferry, shortly after the demolition of the old New
York Hospital, demonstrated the necessity of a commodious
hospital in the lower part of the city. Many of the scalded
and mutilated victims of this horrible accident had to be con¬
veyed a distance of three miles to Bellevue !
From 10. A. M., until 3 o’clock in the afternoon, the major
part of the active brains of New York is in the lower extremity
of our city. Accidents may occur to the rich man as well as to
his hired laborer. Some of our wealthiest men have died in
their down-town offices. Four years ago one of the mayors of
New York died in the City Hall. Medical men of distinction
were miles away. Had there been a hospital down town, phy¬
sicians of exper ience could have been commanded instantly.
Some may reply, We have provided a few beds in the lower
part of the city where the sick and injured may be temporarily
cared for. But those in attendance are mostly young men, and
although of undoubted ability, have not enjoyed the years of
practical knowledge which might be preferred.
1879]
Current Medical Literature.
477
If a large hospital was established, say on the Battery, the
most eminent surgeons and physicians of our city would be
competitors for the important positions, and thus at all times,
assuredly of the day, their services might be commanded. The
attention of our citizens, and of the Commissioners of Charities
and Corrections, should be called to consider the advisability
of some such provision.
One of the members of the Board of Trustees of the New
York Hospital, distinguished for his deep interest in caring for
the sick, and whose liberality has recently been expressed in
the erection of a surgical pavilion at Bellevue, favored me, at
my office, shortly after the completion of the elegant new hos¬
pital in Fifteenth street, between Fifth and Sixth Avenues.
The purpose of the visit was to solicit the details of the chem¬
ical treatment in the purification of Bellevue Hospital.
He stated that attacks had been made in the public journals
upon the folly and extravagance of the Board in constructing
the elaborate and expensive building, which at any time, and
even within a few months, might become in part impregnated
with disease, so as to be unfitted for the reception and treat¬
ment of patients ; and like the north wing of the old New vork
Hospital in Broadway (just above the City Hall Bark), would
have to be abandoned, and this in the face of the views of many
European and American physicians, that hospitals should be of
wood, and burned every second and third year.
We feel justified in claiming, as the result of personal expe¬
rience, that the ancient destructive methods may be abolished ;
that by resorting to the active and diffusive chemical agents,
in sufficient quantities , not only may clothing and goods be
thoroughly disinfected, but that ships, and even houses and
hospitals of solid masonry, may be speedily and completely
purified.
Chemistry, heroically employed, may save nations from the
miscalled “ visitations of Providence,” which are really resul¬
tants of improvidence, ignorance und neglect. Thousands of
lives may be spared $ innumerable sufferings avoided ; the re¬
tardation of commerce, by the forty days’ delay at our ports,
prevented, which involves millions of money ; our dwellings
and commodious hospitals kept in a fitting condition for those
enjoying the blessings of health or suffering from accident or
disease. — Sanitarian , July, 1879.
RECENT PROGRESS IN THE TREATMENT OF CHILDREN’S
DISEASES .
By O. H. Harden, M.D.
On the Use of Benzoate of Soda in Diphtheria. — Dr. Ludwig
Letzerieh.* The author’s studies of the above remedy in
Berliner klinische Wochenschrift, February 17, 1879.
478 Current Medical Literature. [October
diphtheria were instigated by the experiments carried out by
Graham in the laboratory of Professor Klebs, in Prague. The
cases subjected to treatment, in addition to numerous sporadic
ones, embraced twenty-seven, which came under his care dur¬
ing an epidemic of the disease in Berlin. Of these, three were
adults, and the remaining twenty-four children ; and eight
were severe cases, with extensive local affections and danger¬
ous general symptoms. None had been subjected to any other
treatment, whether local or internal. There was a fatal result
in only one case, a child, who had been much run down in
health before the attack, who was badly nourished, and who
had a disposition to trouble of the respiratory organs. Of the
eight severe cases three were boys and live girls, and their
ages were between five and eight and a half years. In all
these cases there were high fever, delirium, retention of urine
and of fteces, existing often befo.e the extensive local affection
had made its appearance. In the blood there were found
numerous bacteria and plasma corpuscles ( Plasmakugeln ), from
which, by cultivation in veal broth, very large colonies of
micrococci became developed.* This development, in the cham¬
bers for cultivating the micrococci ( Kulturlcanwiern ), at a
temperature of 86 degrees to 95 degrees Fahrenheit, was com¬
pleted in a few of the cases before the extensive exudations
upon the tonsils and pharynx had made their appear¬
ance — a proof that the general infection often takes place a
long time before the localization of the disease makes its
appearance. This is well illustrated in typhoid fever.
What is the action of benzoate upon soda in diphtheria1? It
has been shown, the author alleges, by the experiments of
Graham, that certain quantities of this remedy, when intro¬
duced into the system of an animal infected, will in a certain
time put a stop to the “ vegetation of the dephtheric poison,”
the amount necessary for this purpose being deter mined by the
weight of the body. In this manner, accordingly, the dose for
children and adults is regulated, and it is claimed by him that,
up to the present time, there is no other remedy that exercises
so rapid, continuous and therapeutic an effect upon the devel¬
opment and course of the diptheritic process as benzoate of
soda, llis formula for infants under one year old, is :
R. Sodae beuzoat. pur. - - 5.0 or Sodae beuzoat pur. - - 3i.
Aquae destillat., Aquae destillat.,
Aquae mouth, ppb. - - aa 40 0 Aquae meoth. ppt. — aa ?i.
Symp. cort. aurantii - 10. Syrnp. cort. aurantii -- 3ij. M.
S. One half tablespoonful every Lour.
The dose for children between one year and three years of
age is given as seven to eight grammes (two drachms) dis¬
solved in three and one half ounces of the vehicle, the whole
amount being given in the course of the day in half to one
*Vide Arehiv fiir experimentale Pathologie and Pharmakoiogie, von Klebs, Schmiede-
berg, and Naunyn, Band ix., Heft 3 und 4.
1879]
Current Medical Literature.
479
tablespoonful doses. For children between three and seven
years of age eight to ten grammes (two to two and one half
drachms) are given in the same way. Those over seven years
years old take ten to fifteen grammes (two and one half to four
drachms), and for adults the dose is fifteen to twenty-five
grammes (two and one half to six drachms) daily in four and
one half ounces of the vehicle.
An unpleasant after-effect of the medicine has never been
observed, not even in young infants.
The diphtheric membrane was treated with benzoate of soda
in powder, being sprinkled on or applied through a glass tube
or quill. There is n 3 slough formed, and thereby the danger
is averted of its acting as a firm covering under which an ener¬
getic development and growth of the organisms can take place.
The insufflation was made every three hours in severe cases ;
in the milder forms two or three times daily. With older chil¬
dren a simple solution of the salt (ten to two hundred) was
used as a gargle.
The author cites the following case as a typical illustration
of the way the medicine acts upon the general infection, the
effects being quite uniformly noticed after twenty-four to thirty -
six hours :
W. L., eight years old. Treatment began on June 19, 1878,
the second day of the disease :
June 19th,
evening,
106.3° Fahr.
pulse 136
“ 20th,
evening,
102.2° “
“ 124
“ 21st,
morning,
101.6° “
“ 114
U U
evening,
100-4° “
“ 112
“ 22d,
morning, .
99.5° “
“ 104
U < 6
evening,
98.6° “
“ 104
“ 23d,
normal,
normal.
In the above case the membrane on tonsils was very exten¬
sive, and was powdered. On the second day of the disease it
became circumscribed, thinner, and somewhat more transpa¬
rent, and on the 5th had nearly disappeared. The medicine
was continued a few days after this date, but at longer inter¬
vals, and the small exudation spots were powdered twice daily,
until the last remaining portion had completely disappeared
on the eighth day ot the disease.
The records of many other children, equally severely affected,
and of different ages, gave nearly the same results as the above,
and the effects of the medicine were always the same. The
author recommends this remedy highly in gastric and intestinal
catarrh, particularly of infants, and states that at times the
results are surprising in these latter cases. He recommends it
likewise in ( Mycotischen ) catarrh of the bladder, and firmly
believes in the statement of Klebs (to whom we are indebted
for the employment of benzoate of soda), that it is to be recom¬
mended in all diseases which originate by infection. — Boston
Medical and Surgical Journal.
8
480
Current Medical Literature.
[October
NEW REVELATIONS IN SANITARY SCIENCE.
It is highly gratifying to the philosophic mind to be relieved
from groundless fears ; and after the hullabaloo that has been
raised by heedless sanitarians about noxious effluvia, foul
drinking water, offensive sewer gas, and the exhalations of
decaying animal and vegetable matter, it would surely be a
relief to all to discover that this alarming talk has little found¬
ation in fact, and that we can sleep in a room impregnated
with the air from a sewer, and drink the fluid from that same
channel, without risk to our health. Here were certainly a
matter for congratulation.
Several recent writers strive to carry us to this conclusion.
From one of them we have already quoted in this journal —
Dr. George Hamilton, of this city. In the last volume of the
Transactions of the College of Physicians of Philadelphia, he
has a paper on the relation of sewer gas to typhoid fever, an
abstract of which we gave at the time it was read (see Reporter ,
vol. xl., page 384). He endeavors to disprove the assertion
that sewer gas is the most potent and common cause of typhoid
fever, in this or any city ; indeed, he considers any such view
“ utterly untenable,” “in direct antagonism with facts;” and,
in fact, argues that sewer gas has nothing to do with typhoid.
Nor is he willing to credit the opinion that the effluvia arising
from decaying vegetable matters is a source of the disease.
When it is considered that the typhoid condition is closely
akin to typhoid fever, that it often can hardly be distinguished
from it, and must have the same or a closely allied cause, the
exclusion of sewer gas and decaying organic matter from its
etiology assumes a wide and most important interest for the
surgeon as well as the physician.
Diphtheria and scarlet fever have been also attributed to
these same agencies ; but several writers have recently decried
this with great vehemence. They point to the intense severity
of these maladies in secluded farm houses, in well-drained
mountain hamlets, in windy and dry upland villages. It is
claimed that diphtheria is often more fatal in such localities
than in the most densely populated blocks of down town, New
York; hence, that this malignancy has nothing to do either
with foul air or impure gases.
Much stress has been laid on the importance of pure drinking
water, especially that it should be free from organic, particularly
decaying matter. But here comes Dr. Rudolf Emmerich, one
of those redoubtable Germans who are always found ready to
sacrifice themselves on the altar of science. He determined to
put the matter to the test, and as he was, like Ctesar, not
afraid to
“ Drink from the gilded pool
That beasts Avould cough at,”
he selected two of the dirtiest open ditches in Munich, and
made their undiluted contents his daily beverage, to the amount
1879]
Current Medical Literature.
481
of a quart or more. He first examined the water chemically
and microscopically. It was to the eye dirty, and to the nose
foul smelling, and that to such a degree that it was difficult at
first to avoid involuntary vomiting after taking it. It contained
fragments of garbage, dirty rags, hairs of men and beasts, par¬
ticles of feces, etc., as the trench was the general receptacle of
privies, dirt carts, dead cats, and the like.
For the first day or two after beginning the use of this water,
Dr. Emmerich suffered from headache, loss of appetite, catarrh
of the bowels, coated tongue, and other symptoms of a light
gastritis. In three days’ time all these symptoms disappeared,
and for a month, during which he continued to drink the water,
he was as well as ever. Next, he persuaded two couvalescents
in the hospital to try it. One had been suffering from consti¬
pation, headache, loss of appetite and muscular pains; after a
few days’ use of the ditch water, he decidedly improved. The
second had been long a victim to dilatation of the stomach and
dyspepsia. He was not the least injured by the free consump¬
tion of the putrid fluid. Finally, about a month after the
doctor had ceased his experiments, he happened to be attacked
with a sharp gastro enteritis. He rejoiced at such an oppor¬
tunity of testing his ditch water, and therefore, without using
any remedies, he began to drink it freely. In a few days he
was weil !
From these experiences (which will be found in the Wien-
Med. Blatter , No. (>, 1879) Dr. Emmerich concludes that u the
use of the most foul and putrid drinking water produces no
injurious result on the system in health ; and even existing
affections of the intestinal canal are not in the least aggravated
by it.”
What have the sanitarians to say to these facts and argu¬
ments ? Is our dread of uncleanliness, after all, a mere figment
of the imagination ? Shall we give up sewer traps, and close
drains, and water filters, as useless expenses ?
For ourselves, we confess we are far from satisfied that they
are needless ; and we still lean to the opinion that pure air
and water, a clean skin and a calm conscience, are all efficient
measures in preserving health and prolonging life. — Medical
and Surgical Reporter , September 0.
OBSERVATIONS ON THE DIGESTION OF MILK.
By E. F. Brush. M.D., Monnt Vernon, N. Y.
Mdk may be divided into two distinct varieties, according as
it is the product of cud-chewing or non-cud-chewing animals.
This is a distinction to which I think sufficient attention has
not been previously drawn. The former class — that of the
cud-chewers, to which of course the milk of the cow belongs —
contains a variety of caseine which coagulates into a hard mass
under the action of the digestive ferment, or during the lactic
482 Current Medical Literature. [October
ferment. This coagulation takes place in the natural process of
digestion with the calf.
During the summer I had a calf which l tied in a stable out
of reach of any food, and gave it nothing but fresh milk from
its mother ; half an hour after the ingesta of milk I always
found it chewing the cud. After diligent inquiry I have been
informed that the same takes place with the sheep and the goat,
the other domestic ruminant animals. We may from these
facts explain the difficulty experienced by the human stomach
in digesting the milk of ruminating animals.
The other variety of milk — that given by the non-cud-chew¬
ing animals, to which the human, equine and canine races be¬
long — does not, under the action of rennet or acids, coagulate
into the hard mass we find in the cow’s milk, but coagulates
into small granular or floeculent masses, easily diffusible.
This fact explains very simply the advantages of kumyss pre¬
pared from cow’s milk over the milk itself, in the artificial
feeding of chlidren. In kumyss the caseine is — if we may be
allowed so to express it — practically regurgitated and chewed ;
i. e., having been coagulated it is resubdivided, and incapable of
being coagulated under any acid or ferment.
There are other differences in the various kinds of milk
which tender modify the conditions under which it digests.
For example, it is a well authenticated fact that the amount of
caseine in milk is always in inverse proportion to the amount
of sugar contained in it ; the milk of* the cud-chewers contains
the smallest amount of sugar and the largest amount of case¬
ine, while the milk of the non-cud-chewers contains, on the con¬
trary, the largest amount of sugar and the smallest amount of
caseine. Even in the case of cow’s milk, in varying conditions
of the animal’s health, as the proportion of caseine diminishes,
that of sugar increases.
Another fact, too, deserves notice. The less sugar a given
variety of milk contains, the more rapidly does lactic fermen¬
tation take place and consequent putrefaction follow. Now, a
milk containing a large amount of sugar will set up alcoholic
fermentation under conditions the most favorable for lactic fer¬
mentation in a milk containing a small amount of sugar. The
bearing of this observation is that putrefaction follows lactic
fermentation, whereas alcoholic fermentation precludes to a
certain extent any form of putrefaetion.
Here we have another reason for the beneficial effect of
kumyss in the artificial feeding of children, for in kumyss the
sugar is all changed into alcohol and its associates. There is
no doubt at this time that alcohol, when properly presented, is
a liydro-carbonaceous food.
I will now relate in this conuectiou an experiment I performed
on myself, and which proved that the alcohol contained in
kumyss — say 3 per cent. — is all destroyed in the system.
I subsisted for a number of days on kumyss exclusively, tak-
1879]
Current Medical Literature.
483
ing eight bottles a day. During the time 1 was thus subsisting,
I saved all the urine, which I distilled and redistilled, and
tested for alcohol. But, although I used the best known and
most delicate tests, 1 failed to discover the slightest trace of
alcohol.
After this I took eight bottles of kumyss and distilled a few
ounces, and drank the distillate; in four hours I discovered
alcohol in the urine. This simple experiment shows, as we
have said, that alcohol as contained in kumyss is destroyed in
the system, but the same alcohol, when it has undergone the
process of distillation, is eliminated as alcohol.
In speaking of the difficulty presented in the digestion of
cow’s milk, I have mentioned kumyss as being the only perfect
substitute for milk, as it contains all that is valuable in milk
without the indigestible coagulum. 1 have under consideration
other means ot preparing cow’s milk to render it suitable for
children’s food, so that it may be prepared by those who live
in places where kumyss can not be procured, and 1 may here¬
after communicate to the profession the results of these inves¬
tigations and experiments. — A. Y. Medical Journal , Sept. ’79.
CHRONIC RHEUMATIC CARDITIS.
By N. S. Davis, M.D.
In purely chronic cases 1 have, for many years, used differ¬
ent preparations of the cimicituga, the phytolacca, and the
stramonium, either singly or combined in various proportions,
and with considerable benefit. Nearly two years since, my at¬
tention was called to the use of the senecio aureus as a remedy
of value in relieving chronic rheumatic irritation in any of the
fibrous structures of the body, and especially for removing
that state of morbid sensitiveness we call the rheumatic dia¬
thesis. I had under treatment at the time a delicate girl, nine
years of age, who had been attacked four years previously
with severe acute rheumatism, that involved in its progress
nearly all the articulations and the left side of the heart. After
a protracted period of suffering, she recovered, leaving a well
marked rough bellows murmur over the left cardiac region,
with the usual embarrassment on taking active exercise- She
had continued extremely sensitive to atmospheric changes, and
had renewed attacks of rheumatic fever, with swelling and
pain in some of the articulations, and increased cardiac distur¬
bance, two or three times a year, in spite of the most vigilant
precautions. She spent one of the winters in Florida, but had
a renewal of the rheumatism in a few weeks after her return.
It was at this time that a friend of the child’s father told him,
if he would get some senecio aureus root, put it into whisky,
and give the girl some three times a day, it would cure her.
The positive assurances of the friend evidently made an im¬
pression on the father’s mind, and induced him to call my at-
ij 84 Current Medical Literature. [October
tentioii to the matter. On referring- to such books as were at
hand, I found the article named in the list of secondary articles
of the Materia Medica, with no other account of its virtues
than the statement that it was reputed to possess moderate
diaphoretic and diuretic properties. Thinking that it would
do no harm to gratify the father’s desire to try the remedy,
and finding no preparation of it in the drug stores except a
small quantity of fluid extract, the little patient was put upon
the use of this, commencing with 0.3 C. O. three times a day.
Subsequently some tresh root was procured, and a perfectly
reliable fluid extract prepared for her use. This dose was
gradually increased to 0.0 C. C., and its use was continued
faithfully seven or eight months. No other remedies were
used, and no changes were made, either in hygienic manage¬
ment or residence ; but from the time she commenced to take
the remedy, until the present time — nearly two years — she
has not had the slightest return of rheumatic irritation, and
has slowly increased in flesh and strength, and is now able to
exercise quite freely with her playmates. There is still an
audible murmur over the left side of the heart, but much less
rough and harsh than two years ago. At no time during the
use of the remedy has there been observable any active dis¬
turbance of the functions of the system. From the first, her
appetite began to improve, and the functions of the skin, kid¬
neys and bowels have been performed with entire regularity.
Only once has there been need of medical interference, and
that only for two or three days, on account of slight sore
throat.
Of course the result in this case, standing alone, would
prove nothing. The use of the remedy and the subsequent
change in diathesis might be a mere coincidence. But during
the past year or eighteen months I have prescribed the remedy
in the form of fluid extract in a large number of cases, and
with sufficiently favorable results to justify you and the pro¬
fession generally, in making a thorough investigation concern¬
ing its value and remedial properties.
While on this subject, there is one important error concern¬
ing which I wish to caution you, and that is, the tendency,
when treating chronic diseases, and especially when endeavor¬
ing to correct morbid diathesis or constitutional conditions, to
change remedies too often. We are apt to forget that most of
these conditions are the result of slowly acting causes, and in¬
volve alterations in the adherent properties of the tissues that
can be changed back in the direction of health only by slow
and persistent influences, both of a hygienic and medicinal
character.
The senecio aureus is a plant that grows in sufficient quan¬
tities throughout the northern belt of the United States, and
is familiar to medical botanists. — Chicago Medical Journal and
Examiner , September, L879.
187!) j
Current Medical Literature.
485
BEEF AND ICE CREAM.
The following is an article of dietary importance. I believe
it originated with me. Lt is simple, novel and speaks for itself
so far as its efficaciousness is concerned. I combine ice cream
and beef so as to make a homogeneous mass. These are about
the properties : 120 grams cream, 30 grams sugar, 8 grams ext.
vanilla, 8 grams beef juice, (“ Johnston’s ” 1 have generally
used, but the juice squeezed from beef steak is just as good).
Any confectioner can make it extemporaneously (or within an
hour) or it can be made at home at short notice. It has done
me excellent service. — James I. Tucker, M.D. — Chicago Medical
Journal and Examiner , July, 1879.
CUPRUM AMMONIATUM IN NEURA.LGIA OF THE FIFTH.
( Bulletin de V Academie de Medicine.) (Seance of 1st April,
1879. By Dr. Fereol.) Dr. Fereol has obtained marked and
sometimes instantaneous relief from the exhibition of cuprum
ammoniatum, in obstinate cases of neuralgia of the fifth pair of
nerves. He does not claim to have found an infallible remedy,
but modestly asks for it a trial iu this troublesome affection.
In one or two cases the patients who were relieved had, pre¬
vious to its administration, been deprived of sleep for weeks.
The commencing dose should vary from gr. 0.10 to 0.15 a day,
gradually increased to gr. 0.30 or even 0.50, carefully watching
the susceptibility of each individual. It is best administered
in pills or capsules, and the daily amount above indicated
should be divided into eight or ten parts, to be taken at inter¬
vals, preferably with food. It is important to continue the
treatment for twelve or fifteen days after the cessation of pain.
— Chicago Medical Journal and Examiner, July, 1870.
VENTILATION OF HOSPITALS.
1 was recently called professionally to attend the veteran
ventilating engineer, Prof. J. Wilkinson, of Baltimore, Md.,
who has spent the past three years in the Northwest in supply¬
ing, for a variety of purposes, the system known as sub-earth
ventilation, which has ol late been introduced in Prussia and
other countries of Europe. The system has been in use in this
and adjoining Stales more than two years, and is said to have
proved par excellence. 1 have Irequently heard of the remark¬
able results attained by its use, but had not familiarized myself
with the detail of construction necessary, or the scientific prin¬
ciples involved in the system, until I formed the acquaintance
of Prof. W., the inventor of it.
It has been mainly used, hitherto, in structures for the manu¬
facture of dairy products, for which it has proved to be admi¬
rably adapted.
Confidently believing, as 1 do, that the system is superior
486 Current Medical Literature. [October
to any other for hospital buildings, I wish to present it to the
attention of the medical profession, for which I desire to avail
myself of the columns of the Record , believing that to be the
most useful and efficient medium of laying it before the largest
number of the most intelligent medical practitioners.
I will describe the appliances used, and the results attained,
which latter, I think it will be conceded, are just what consti¬
tute essential characteristics of all structures for human occu¬
pancy, and more especially of those that are to be the houses
of the sick and demented.
Buildings are supplied with air by means of a subterranean
air-duct placed in a stratum of earth in which the temperature
is uniform perpetually. Both entrances of the duct are open :
one to receive atmospheric air from the most salubrious point
available, through a well or shaft with the bottom of which the
duct connects; the other to discharge and distribute said air
to all the apartments to be tempered and ventilated.
The supply of air is regulated by adjustable valves, and any
required volume of it may be supplied to a building at the same
temperature as that of the earth in which the duct is placed.
This uniform temperature in the air supplied is unaffected by
the extremes of temperature in the external air, and is perpetu¬
ally about 50° F.
The walls of the duct being of a lower temperature than that
of the outer air in warm weather, when air is liable to contain
an excess of humidity, it is condensed on the walls, and is
absorbed by the clay bottom with which the ducts are con¬
structed, and the air is delivered to the building in an anhy-
drated condition.
In case it is desirable to retain any of the humidity with
which the air is charged, this is secured by the use of a plu¬
rality of ingress shafts properly distributed along the line of
the supply-duct, by the adjustment of valves in which air
properly tempered and with variable degrees of humidity may
be obtained. Additional devices for deodorizing and disinfect¬
ing to a still greater degree than that secured by the clay
surfaced bottom of tin* duct have recently been invented and
tested by Prof. W., and found to possess superlative potency,
and their hygienic value is believed to be so great that an
application for a patent for them will soon be made.
The walls of the duct being moistened by the condensation
of vapor on them, they effectually arrest all dust, pollen, and
motes floating in air, transmitted by the duct as it is now used.
The duct has invariably proved to possess the power of remov¬
ing ozone from the air.
Dairy scientists contend that ozone annually occasions a loss
to the dairymen of the United States and Canada of hundreds
of thousands of dollars. The effect of it on milk set for butter¬
making is, 1 am reliably informed, so disastrous that it has the
effect, every summer, and several times during the same season,
1879]
Current Medical Literature.
487
to reduce the amount of cream obtained from a given quantity
of milk from 35 to 00 per cent. I believe that a substance in
air, capable of precipitating acidification and the action of fer¬
ments to such a degree as does ozone, must materially augment
the insalubrity of said air, and that means for its removal from
air will add an invaluable factor in methods for securing the
greatest salubrity in the atmosphere of human habitations.
This system of ventilation is in use in central Mississippi,
and is said to be very satisfactory.
It has occurred to me that it might prove well adapted to
ventilating quarantine and yellow fever hospitals, for which T
hope it will be tested ere that unwelcome visitor again appears
in its favorite localities. C. M. Johnson, M.D.
— N. Y. Medical Record , May 10, ?79.
SUDDEN DEATHS IN DIPHTHERIA.
By A. W. Perrt, M.D.
One of the most terrible and uncertain features of diphtheria
especially, and to a less extent also of other cachectic diseases
of children, is the frequent occurrence of collapse and death
after the most serious symptoms have disappeared and the
patient has apparently entered into convalescence. It has been
discovered by MM. Mothien and Urbani, in 1874, that when
the blood contains 70 per cent, or upwards by volume of car¬
bonic acid it coagulates spontaneously in the blood vessels. The
normal volume percentage is from 20 to 30 per cent. This was
ascertained by an analysis of blood drawn from a man who
was affected with a spontaneous thrombus. In diphtheria a
high percentage of carbonic acid exists in the blood, and deter¬
mines the formation of blood clots in the heart, pulmonary
artery, or any of the systemic veins. The excess of carbonic
acid in the blood is due either to a deficient supply of oxygen
to the lungs by respiration, or to a want of power of the blood
corpuscles to fix oxygen, and this last is due to some obscure
defect of assimilation. In these patients, who appear to be
convalescing, we find no real appetite, although, if urged, they
will often eat a sufficient quantity of food. They slowly get
paler and more emaciated until a thrombus occurs, which gives
different symptoms, according to its location. M. Bouchut,
the eminent pediatricar of Paris, has formularized this as
follows :
u In all the cachexim and in chronic diseases, thromboses
may develop in any of the veins from the head to the feet, and
which produce a group of symptoms having a direct relation
with the function of the organ in which the thrombus is
situated.”
Sometimes, a week or more after the throat has cleaned off
in diphtheria and any breaches of tissue have cicatrized, a
slight excess in eating is followed by vomiting, purging, col-
9
488 Current Medical Literature. [October
lapse, and death in a few hours. These symptoms are due to
thromboses in the gastric, intestinal or cerebral veins, and have
no relation with the excess in eating, except coincidence.
Heart-clot is a more common cause of death, which has also
been attributed to the fatty degeneration of the heart which
occurs in diphtheria. In very young children, under three
years, the thrombus is more likely to occur in the sinuses of
the dura-mater, giving rise to edema of the pia-mater, convul¬
sions and coma. After a thrombus has occurred, the case is
about hopeless ; but much may be done to prevent their forma¬
tion by properly nourishing the patient. We should give those
remedies which directly assist in the digestion of the food, as
pepsin, lacto-peptin, muriatic acid, or, still better, where they
can be procured, foods already digested, viz., peptones, or
solutions of meat, and egg in artificial gastric juice, and extract
of malt. — San Francisco Western Lancet , July, 1879.
CASE OF EARLY WOMANHOOD.
Annie D., aged 4 years, was brought to me as an out-patient
at the Children’s Hospital here, by her mother, who stated
that, since the child was two weeks old, she had sutfered from
a discharge from the genitals, lasting from two to three days,
and returning as near as possible every mouth ; the character
of the discharge beiug, to use the the words of the mother,
u exactly the same as from herself, when she was unwell.” The
child was a fat plethoric little creature, with well developed
breasts, as large as are usually found in young women at the
age of 16 or 17, after menstration has become established ; at
times, according to the mother, they became quite hard and
prominent ; the nipples were dark, and rather large, over a
centimetre long, and standing prominently out in the centre of
dark areolae, two centimetres in diameter.
The external genital organs were well developed, the labia
minora being especially prominent. With the greatest ease, I
passed my index-finger two inches and a half up the vagina,
without causing the child the slightest pain. The cervix uteri
was large ; and indeed, the whole organ seemed fully as big as
the average virgin uterus at puberty. The front of the abdo¬
men and the back were covered with patches of ephelis. The
child was evidently rickety, genu valgum being marked.
The case seemed to me an interesting one, and worth record¬
ing ; for, excepting the absence of pubic hair, the child was a
perfect little woman. Strange enough, her precocity was con¬
fined alone in a sexual direction ; for whilst of her own accord
her mother had seen her frequently u offer her breast to the
baby,” yet mentally she did not exceed the capacity of her age.
The presence of the ephelis, or taches liepatiques , is undoubtedly
rare in infants ; and in this case, being most likely connected
with the advanced stage of sexual development of the child,
Current Medical Literature.
489
1879]
they enhance the interest of the case.— David Drummond,
Physician to the Children’s Hospital, and to the Infirmary,
Newcastle-on-Tyne. — British Medical * Journal , July, 1879.
INTRA UTERINE THERAPEUTICS.
Dr. Cnopf, of Nuremburg ( Memorahilien , part 5, 1879), has
lately tried the experiment of treating rachitis during intra¬
uterine life. The patient was a woman who had given birth to
several rickety children. Both parents were seemingly healthy,
but showed traces of rickets. Dr. Cnopf, treated the woman
with phosphates for several months previously to her delivery.
A very well formed healthy male child was born, which did not
present the slightest symptoms of rickets. — British Medical Jour¬
nal, , July 19.
THE BEDOUIN ARABS.
In Lady Anne Blount’s recent work on the Bedouin tribes of
the Euphrates, there are some notes as to the physical condi¬
tion of the Arabs that are medically interesting from more than
one point of view. It seems that, in spite of their absolute
temperance and constant open-air life, they decay prematurely.
Well made and handsome in youth, at 40 their beards are grey ;
at 50, they are old ; and the age of 00 is reached by few. From
childhood up, they are in hard training, eating but once a day,
and then sparingly $ and sleeping on the ground. This ensures
them high health and a full enjoyment of all their faculties, at
the time , but uses the body rapidly ; and a certain “ staleness ”
follows, which the Bedouins acknowledge by withdrawing early
from all unnecessary exertion. The reaction is quickly felt 5
men of forty complain of indigestion, rheaumatism, etc., and of
the first positive disease they die. In youth, ill health or defec¬
tive powers are unknown ; but a man who falls seriously ill
has as little chance of recovery, as the wild animal. Doctors
do not exist, nor is there any knowledge of herbs. The sick is
jobliged to move with the tribe. He is set on a camel, and clings
to it as best he can. In the tent, he lies surrounded by his
friends, who — very Job’s comforters — talk to him till he dies,
wounds too are often fatal, from want of knowledge or of qniet.
The Bedouins have no great appearance of muscular strength,
but they are singularly active and enduring. They are patient
and humane, and seldom allow their passions to "pass beyond
control ; one main reason being their sobriety. No drink stronger
than ulebben,” or sour milk, is known among them ; and they
look upon the use of all fermented liquors as disgraceful. Brutal
crimes have no place in the catalogue of Bedouin sins. The
ivomen are in person proportionately taller than the men ; the
alder of them often become fat and unwieldy ; the younger do
all the labor of the camp, fetching wood and water, setting and
removing tents, milking, and cooking. They live apart from
Current Medical Literature.
400
[October
the men, except their nearest relatives, but have plenty of
society amongst themselves. They seem to have good health
and good spirits ; but in mental qualities the women of the
desert are usually far below the men, their range of ideas being
extremely limited. — British Medical Journal, July 19.
REGENERATION OF THE EYE.
According to a French journal, some curious facts have come
to light about the regeneration of the eye during experiments
made by M. Philipeaux. He has aimed to ascertain whether,
on completely emptying the eyes of young rabbits and guinea-
pigs, the vitreous humor would be reorganized, and whether
even the crystalline lens would be reproduced. He has been
careful not to destroy the crystalline capsule, for experience
has shown that in order that an organ should be regenerated a
portion of it must be left in its place. A month alter the muti¬
lation was effected, the eyes which had been emptied were tilled
afresh, and the crystalline lens was restored. He operated on
twenty-four animals, and in each case the mutilated eye revived.
This would seem to show that the optic organ has the same
capabilities as the bones 5 the organic process repairs an in jury,
and reconstructs, more or less completely, that portion which
has been lost. — Boston Journal of Chemistry , July.
A NOVEL IDEA.
M. Monclar, a noted agriculturist in France, has suggested a
singular plan for varying the flavor of meat. He imagines that
by feeding cattle, sheep, pigs, and poultry in a particular way,
or rather by flavoring their food in various ways, their flesh
may be rendered much more agreeable to the palate than it
often is ; and there can be no doubt that he is substantially
right. Thus, for instance, one can assert, as the result of per¬
sonal experience, that poultry which have been fattened upon
food containing a slight admixture of chopped truffles are far-
better eating than those chickens which have been stuft'ed or
larded with truffles after they are killed. It is only natural
that such should be the case, for the flavor of the truffle that
is consumed by the chicken permeates the whole system, which
it cannot do when simply placed in the carcass. M. Monclar
instances cases in which hares killed in a wormwood field, larks
shot in a cabbage field, and eggs laid by hens which had eaten
diseased silkworms had such a nauseous taste that no one could
touch them; while, upon the other hand, some ducks and field¬
fares which had fed upon sprigs of juniper had a delicious
flavor. He has made several experiments— among others three
upon tame rabbits, which he fed with the waste of anise-seed,,
with barley and bran containing a slight flavoring of juniper,,
and with barley and bran containing a little essence of thyme.
1879]
Current Medical Literature.
491
In each case he found that the flesh of these animals was far
better eating than that of rabbits fattened in the ordinary way,
and yet that there was no trace of anise-seed or juniper in the
taste. His conclusion is that cattle, sheep, and pigs might be
fed in the same way, and that by varying the flavoring matter
beef, mutton, and pork might be made to have several different
tastes. — Boston Journal of Chemistry.
DRUG SMOKING.
Our readers are aware that medicated cigarettes, for use in
asthma, catarrh, and kindred diseases, have become popular of
late, and it is an interesting question whether this mode of
administering drugs has any special therapeutical value. I)r.
B. E. Thompson has been led to investigate the subject, and
gives the results of his experiments in a paper in the London
Practitioner. He says that the simplest and surest method of
combining medicinal agents so that the smoke may be inhaled
and brought into contact with the blood-vessels of the lungs is
by using paper soaked in a weak solution of nitre, dipped
afterwards into the tinctures or solutions of the drugs to be
administered, and rolled into cigarettes of uniform size. The
paper most suitable for the purpose was found to be Swedish
filtering paper, which burnt freely and gave out but little odor.
The scent of the smoke was, however, so disagreeable that it
was necessary to disguise it, and the following formula repre¬
sents the basis of each cigar : Swedish filtering paper, size 4 by
inches ; nitre, \ gr.; tinctua tabaci ( l in 8), 10 minims ; ol.
anisi, J minim. A solution of the drug to be experimented on
is then prepared, the paper floated on the solution, dried, and
cut to any required size. An eighth of a grain of opium produced
effects which were too intense, and 1-64 of a grain of extract of
opium was found to be sufficient for the initial dose. Cigarettes
with this amount of opium were smoked by four healthy men,
and in a few minutes a decided effect of dizziness was produced.
Not more than half the quantity of the drug can have been
retained in the lungs. Short accounts are given of nine cases
in which this preparation proved useful. In the first, eleven
hours’ sleep were obtained by smoking half a cigarette.
Dr. Thompson theu sums up his conclusions as to the admin¬
istration of opium in this manner:
The smoking of opium is especially adapted to cases of haras¬
sing cough ; the topical effect of the drug is immediately ob¬
tained without any part of the dose being wasted on other
tissues; moreover, this mode avoids those objectionable effects
which are a bar to the use of the drug when it has to be given
by the mouth into the stomach. Opium-smoking is peculiarly
useful in those cases of laryngeal ulceration in which all
attempts at deglutition are accompanied with extreme pain,
and the topical effect of the anodyne is chiefly sought. — Boston
Journal of Chemistry , July.
Current Medical Literature.
[October
492
THE DIPHTHERITIC POISON.
A singular instance of tbe vitality of the poison of diph¬
theria is reported in the Vratschebnijia Vedomosti. A gentle¬
man in the south of Russia had, four years ago, lost a boy
from diphtheria. A family vault having recently been con¬
structed, the coffin of the boy was transferred thither. Before
it was lowered down into the vault, the father wished to look
at the body, having entertained a suspicion that the child had
been buried alive. An opening was accordingly made in the
lid of the coffin, the whole family, including the five children,
looking on. The next day all the children were ill with diph¬
theria, and one of them has since died. — The Hospital Gazette.
SACCHARINE DIABETES.
The experiments of Dr. Fiirbinger, in Berlin, seem to show
that the two most active agents in reducing the excretion of
sugar in this disease are salicylate of soda and carbolic acid. —
Medical and Surgical Reporter , July 19, 1879.
TAE NECESSITY OF PROVIDING CHILDREN? WITH WATER TO
DRINK.
Dr. Murdoch, of Pittsburgh, has writtan a very sensible
health-paper on the Causes and Prevention of Cholera Infantum.
The majority of cases is to be traced to the food, and the num¬
ber is greatest among bottle-fed infants — on sour milk. This
cause is well known, of course, to physicians, but we doubt if
even the profession is at all times wholly alive to the sanitary
necessity of providing water for children to drink. Dr. Mur¬
doch says :
“ Another cause of the great mortality among children is the
neglect to provide them with cold water to drink. This, especi¬
ally during the hot weather of summer, is the source of more
deaths of young infants than all other causes combined. The ex¬
planation is simple. The little ones during the hot weather per¬
spire freely. This would not be the case were they entirely
naked, but, as is too often the case, they are kept sweltering
under clothing or blankets. The water which they lose by per¬
spiration causes them to be very thirsty ; they require water.
If no water is offered, they will drink freely of any fluid that is
offered to them. The fluid which is offered is usually milk,
often milk which lias become sour by the extreme heat. The
child is thirsty, but not hungry; but not getting the water,
which it does want, it drinks the milk, which it does not want.
The consequence is, the child’s stomach becomes overloaded
with food which it has not the power to digest. This food, in¬
stead of nourishing, is a source of irritation to the child’s stom¬
ach and bowels, and causes vomiting, purging, cholera infantum
and death.
1879]
Current Medical Literature.
493
u Children to whom no water is offered in hot weather are
like men cast away at sea with no fresh water to drink to cool
their parched tongues and quench their tormenting thirst.
These men will drink of the salt sea- water, and it is said that
they go mad with the distressing thirst which they have there¬
by increased. The salt water which these poor shipwrecked
men are tempted to drink is hardly more fatal to them than is
the sour milk which is often the only fluid offered to the thirsty
child.
“ Water is the sine qua non in the management of children
during the hot weather of summer. Even children at the
mother’s breast should often be offered water. But to chil¬
dren reared upon the bottle it is indispensable. It is their life.
It quenches thirst, supplies the place of water lost by perspira¬
tion, keeps up the perspiration which is necessary for main¬
taining the proper temperature of the body, and makes the little
one comparatively comfortable. It will do all this, and it will do
more ; for if the child’s thirst was always appeased, it would
refuse food when not hungry, and would never drink milk
when the milk was sour. The consequence would be that it
would only take milk when the milk was sweet, and in quan¬
tities which it, would be able to digest.” — Louisville Medical
News, July 19.
BROMINE IN LARYNGEAL CROUP.
Dr. W. Bedenbacher ( British Medical Journal , 1879, p. 234 ;
from Aerztliches Intelligenz-Blatt ), called to the case of two lit¬
tle girls, aged respectively 5 and 7, suffering with severe croup
of the larynx and air-tubes, ordered a tablespoonful of the fol¬
lowing mixture to be taken every hour :
If Decocti althese, f fiv ;
Potassi bromidi, 3i ;
Bromi, gr. ivss. ;
Syrupi simplicis, f?i.
On again visiting the patients, whom he did not expect to
find alive, he was most agreeably surprised. The difficult
breathing, dry hard cough, etc., had all disappeared $ the
breathing was free, and the cough loose ; several portions of
croupal membrane had been coughed up. Recovery followed,
without toxic symptoms. For children under one year, the
quantity of bromine in the mixture should be reduced to one
grain and a half, and for those from one to four years old, to
three grains. — Medical Times.
SURE NIPPLES.
It is observed that sore nipples are often due to the habit
which many young mothers have of applying mallow lotions
to them, which only renders the mucous membrane unnatur¬
ally tender. They also frequently induce sore nipples by the
494
Current Medical Literature.
[October
practice of applying the child to the breast every few minutes.
On the other hand, the same effect is produced by following
the advice of many nurses to defer commencing suckling to the
second or third day.
The breast has become hard and swollen, and the infant can¬
not draw milk by sucking. However, from whatever cause
sore nipples may arise, advise abstinence from employment of
any of the numerous remedies (especially those of a greasy
character) which are being constantly recommended as infalli¬
ble, and as constantly falling into disuse. Instead of these,
however deep and extended the chaps may be : Wash the nip¬
ple in pure water, and carefully dry it, and then powder it and
the sores with suberine, i. e., the impalpable powder of cork.
This, too, is much to be preferred in the hygiene of infancy to
the inert powder lycopodium, for it is cheaper and contains
some tannin. Over the suberine is to be placed a portion of
gold beater’s skin cut star fashion, in the centre of which some
apertures have been made by means of a very fine needle.
Whenever the infant is about to suckle, the suberine is to be
washed off, and the gold beater’s skin reapplied, by means of
which the child will suck without causing any pain. When it
has finished, the suberine and the gold beater’s skin are to be
replaced and so on every time. This simple treatment always
succeeds. — American Medical Bi- Weekly.
CARBOLIC ACID IN SHINGLES.
Dr. Lamberti reports, in the Revista Clinica di Bologna , a
case of herpes zoster, or “ shingles,” which he cured in a single
day by means of carbolic acid. He painted carefully the vesi¬
cles with the liquid acid, using a camel-hair brush, and then
covered the whole part with a thick layer of cotton wool. It
caused severe burning pain for two hours, after which ease was
obtained, and the patient, having received a dose of chloral
hydrate, fell asleep, and awoke the next day feeling quite well.
Nothing more was done, but the cotton wool was left on for
three days. On its removal then the vesicles were all dried
up, the crust adhering to the cotton-wool, and the spots that
remained were not in the least tender. A saline purgative and
a drink containing bicarbonate of soda were the only medicines
taken. No return has occurred after two years, and Dr. Lam¬
berti thinks this method of treatment may frequently prove of
great value. — Boston Journal of Chemistry.
DEODORIZED IODOFORM.
The very unpleasant pungent odor of iodoform can be com¬
pletely masked by oil of peppermint. For instance, iodoform
2.0, vaseline 30.0, rubbed up with six drops of oil of pepper¬
mint make an ointment with a pleasant aromatic scent. — Hos¬
pital Gazette.
1879]
Editorial.
495
j^DITOF\IAL.
FIGHTING YELLOW FEVER.
Autumn has returned, soon to bring the period of respite from
outbreaks of yellow fever. For after all the vigorous efforts
hitherto made to arrest the spread of this disease, the eagerness
with which we hail the approach of frost shows that our trust in
natural causes to effect this end is altogether better confirmed
than in human agencies. But a concession such as this need
not invalidate an affirmation that great good has followed efforts
to arrest the spread of yellow fever in 1879, nor even further,
that measures instituted to stamp out the disease after its ap¬
pearance, had been followed by successful results, however
brought about.
In proof of the first of these averments, we may cite our
readers to the great numbers of cases and outbreaks in differ¬
ent localities from which no spread has occured. The meas¬
ures practiced in all these instances have been isolation and
disinfection.
Unquestionably isolation is the most important of all meas¬
ures to prevent spread of yellow fever. The plain old farmer
who last year told the writer that he did not believe u yellow
fever could go anywhere unless you tote it,” expressed in coarse
but strong terms, his faith in an attribute which no one denies
that yellow fever posseses — that is — portability.
Disinfection must still be reckoned a means of stopping yel¬
low fever invasions lacking precise formulation. There is how¬
ever a very strong tendency among sanitarians to trust more
in detersive measures, and less to chemicals than formerly.
This we especially commend.
New Orleans has this year escaped an epidemic— in truth,
not over forty cases have occurred during the whole year In
the meantime the Citizens’ Auxiliary Sanitary Association and
the State Board of Health have worked with great energy and
success, to make the city as clean as possible. Yellow fever is
not a u dirt disease,” like cholera and typhus fever ; but no one
can affirm the character or amount of inliuence favorable to its
10
49(i Reviews and Booh Notices. [October
spread from tlie presence of filth. All admit that it has a
special cause. Most observers consider this cause a contagium
vivurn, and if so, some organic material must probably constitute
its pabulum, for even vegetable organisms require organized
substance as fertilizers if not actually for food. This pabu¬
lum may be often, or even generally, associated with filth.
But apart from any arguments of this kind, all old ob¬
servers of yellow fever have associated with its tendency to
infect localities and adhere to them with a fixed tenacity, some
quality which the contagium appears to possess, of planting
upon, or attaching itself to solid surfaces. Therefore scalding,
scrubbing, scouring, scraping and cleansing all surfaces in
proximity to yellow fever cases should be a rational aud valu.
able mode of disinfection. It must of course, be understood
that clothing, bedding and all textile fabrics be included in the
term surfaces.
To conclude, the work of the present year has much to
encourage us, aud our profession should feel hopeful that the
day is near at hand when we will be able to effectually banish
this great arch euemy to our public health, commerce and
prosperity.
Reviews and Book Notices.
Complimentary Dinner given to Professor IS. D. Gross, by Ids
; jljft Medical Friends, in Commemoration of his Fifty-first year in
the Profession , April 10, 1879. 8vo., pp. 42. Philadelphia :
Lindsay & Blakiston. 1879. [From Arrnand Hawkins,
196£ Canal street.]
This little volume gives a brief account of that interesting
occasion, together with the principle after-dinner speeches, let¬
ters from absent invited guests, list of subscribers to the enter¬
tainment, of the invited guests, both present and absent, etc.
The most appreciable feature of the book is the frontispiece,
a well-executed steel plate engraving ot Dr. Gross. The face
exhibits all the benevolence and more than the intelligence of
the professional philanthropist. The picture might properly
represent the Genius of Medicine, or benevolence and knowl¬
edge combined. S. S. II.
Reviews and Bool' Notices.
497
1879]
The Advantages and Accidents of Artificial Ancesthesia ; a
Manual of Anaesthetic Agents , and their Employment in the
Treatment of Diseases. By Laurence Turnbull, M.D., Ph.
G., Aural ’Surgeon to Jefferson Medical College Hospital,
etc. Second edition, revised and enlarged. With 27 illus¬
trations. 12mo., pp. 322. Philadelphia : Lindsay & Blak-
iston. 1879. [From Armand Hawkins, bookseller, 1964
Canal street.]
This edition contains as new matter, the results of some late
experiments with anaesthetics, particularly hydrobromic ether,
and the combinations of ether, alcohol and chloroform for the
purpose_of determining their proper proportions and advan¬
tages. A new table of deaths from chloroform is introduced,
running from 1869 to 1879, numbering 110 cases. It was
thought necessary to omit the bibliography and the historical
sketch of the discovery of anaesthesia from this edition, to
keep the book within limits of moderation.
In most other respects the original purpose of the work has
been adhered to, viz., to give a description of the most approved
agents used as anesthetics ; to state their composition, phys¬
ical aud'medical properties and chemical tests ; to describe the
best modes of administering them as well as the precautions to
bo observed and the proper methods of resuscitation, in case
of accidents ; to compare the various anaesthetics and inhalers
in use, from the experience of the author, his assistants and
his friends ; to show the relative safety and danger of various
agents.
Chloroform, of course, occupies a prominent part of the
author’s attention, and it is proper for our Southern readers,
with whom this agent is the favorite, to know that he regards
it as highly dangerous, and under most circumstances improper
for use. While admitting the force of testimony, that accidents
from the use of chloroform are relatively less frequent at the
South than at the North, he suggests — “There may be some¬
thing in the difference in the boiling point of chloroform in the
South, and in the fact of the air being more heating and stimu¬
lating.” It is to be hoped other readers may comprehend the
above reasoning better than we can claim to do.
The nitrite of amyl is recommended not only as an anaesthetic
by itself, particularly in angina pectoris, but as an adjunct to
498
Reviews and Book Notices.
[October
chloroform, in a small proportion, to counteract the depressing
influence of the latter. Ether may be used for the same pur¬
pose, either in a mixture, or as a substitute after insensibility
has been once produced. The mixture of chloroform and amyl
nitrite is named chloramyl, and consists of 10 drops of the latter
to one ounce of the former.
An instructive chapter is devoted to the legal responsibility
of physicians in the administration of anmstlietics, the medico¬
legal relations of anesthetics, and other kindred topics. As to
the practicability of the criminal administration of chloroform
to persons in natural sleep, about which the laity are so credu¬
lous and the profession so skeptical, he admits the possibility
in certain cases, in common with some other experts, particu¬
larly Prof. H C. Wood. A heavy sleeper aud an easy subject
for chloroform in the usual way might, we should suppose, be
thus exploited.
In choosing the proper anaesthetic, the author prefers, for
minor operations, where cost is not to be consulted and odor to
be avoided, the hydrobromic ether; for ordinary dental opera¬
tions, the nitrous oxyd gas, with reference to safety ; for grave
and protracted operations, pure ether.
Throughout the work the author quotes freely from the best
authorites, and it therefore reflects the opinions of a large
number of expert witnesses. In this course we feel bound to
commend his avoidance of dogmatism, and recognize the supe¬
rior claim of his work to the appreciation of candid readers.
On the whole, we regard this little volume as a useful contri¬
bution to medical literature, and one likely to prove a business
success. S. S. H.
The Heart and its Diseases, with their Treatment ; including the
Gouty Heart. By J. Milner Fothergill, M.D., Asst. Phys.
to West London Hosp., and to city of London Hospital for
Diseases of the Chest, etc. Second edition (entirely re¬
written) . with illustrations. 8vo., pp. 476. Philadelphia :
Lindsay & Blakiston. 1879. [Sold by Armand Hawkins,
1904 Canal street, New Orleans.]
The medical literature of this important organ has hitherto
not been a neglected field. Indeed it has been cultivaed by so
many industrious workers, that we might suppose there would
1879] Reviews and Book Novices. 499
be no place for a new author. Dr. Fothergill has demonstrated,
however, well founded claims to recognition by producing the
best work on the heart which has met our notice. A new and
prominent feature is the discussion at length of the relations
between structural lesions of the kidney and the heart, iu a
chapter entitled The G-outy Heart. Though the author’s opin¬
ions are not fully matured, he inclines to the belief that renal
decay precedes the cardiac changes and stand iu the place of
cause to the latter. Strong confirmatory evidence of this view
is adduced in the development of the correlated affections in
the second and third generations of families which have gained
and preserved wealth, with its accompaniments of luxury and
superabundant nutrition.
It is greatly to the credit of modern medicine and medical
men, that lesions of vital organs, such as the brain, the heart,
the lungs, the liver, the kidneys, have latterly been so accu¬
rately observed, both in the living and dead subject, that no
practitioner need be at a serious loss to diagnose the most com¬
mon of them. When, therefore, we observe burial certificates
bearing as death-causes vague and indefinite disorders of these
organs, among which “ Heart Disease ” is conspicuous by its
frequency, we are painfully struck by the conviction that
nothing out neglect of abundant opportunities can account for
such culpable ignorance. It is hoped that no reader of these lines
uses the term “heart disease” iu its naked simplicity, but
most would find this work instructive in its matter and agree¬
able in its style, for Dr. Fothergill, unlike many authors both
medical and non-medical, writes correct English.
The anatomy of the heart, both healthy and morbid, is illus¬
trated by suitable wood cuts and lithographs, and numerous
tracings of the sphygmograph exhibit its normal and disordered
action. S. S. H.
Physiology and Histology of the Cerebral Convolutions. Also
Poisons of the Intellect. By Ohas. Kicliet, A.M., M.D.,
Ph. D. Translated by Edward P. Fowler, M.I). 8vo., pp.
170. New York : Win. Wood & Oo. 1879.
The main portion of the volume is divided into two parts,
the first of which treats of the minute structure of the convo¬
lutions of the brain, and the second of their physiological prop-
500 Reviews and Book Notices. [October
erties and functions. Tlie first 46 pages, devoted to the anat¬
omy of the brain, both human and comparative, may be con¬
sidered precise and accurate ; but the secoud part is concerned
with investigations, largely experimental upon the lower ani¬
mals, in which conclusions are rather presumptive than demon¬
strable. For example, it is assumed that the faculty of speech
resides at the foot of the third left frontal convolution, though
it is admitted that aphasia may occur without lesion of this
particular convolution, and that the lesion may occur without
aphasia. Yet greater precision is claimed for such localization
of intellectual faculties than for any other.
Some attempts at further localization of mental faculties
have been made by different experimenters, with varying inex¬
actitude. Ferrier concludes that a relation has been established
between the gyrus augularis and vision ; between the first
temporal convolution and hearing ; between the gyrus hippo¬
campi and touch ; between the cornu ammonis and the senses
of smell and taste ; between the occipital lobes and hunger ;
between the region of the hippocampus and thirst together
with the sexual appetite; while Louget and Vulpian regard
the pons varolii as the seat of pain and the sensorium com¬
mune. This all is far short of the achievements claimed by
Gall and Spurzheiin and their sanguine followers in our own
day, yet physiologists are not ready to consider the question
settled, and the author claims for the more special intellectual
faculties only a definite relation to mass of the cerebrum and
complexity of the convolutions, a conclusion long ago reached
by comparative anatomists.
The volume closes with an essay on Poisons of the Intelli¬
gence, among which are included alcohol, chloroform, coffee,
hashish and opium. Their action on voluntary motion and
the functions of organic life are not considered, but their effects
upon the circulation and upon the functions of the cerebral
lobes are particularly delineated.
The book is illustrated by 23 wood-cuts, after drawings by
late investigators in this particular field, and by no means
remarkable as works of art. On the whole the work indicates
progress in this obscure branch of physiology, though it may
not always be iu the right direction ; but without deviation
there can be no advance in knowledge, and we should be
thankful for any attempt in a difficult field. S. S. H.
1879]
Boohs and Pamphlets Received.
501
Books and Pamphlets Received.
Lessons in Gynecology. By William Goodell, A.M., M.D.,
Physician in charge of the Preston Retreat ; Professor of Clini¬
cal Gynecology in the University of Pennsylvania; Fellow of
the American Gynecological Society ; Member of the Philo¬
sophical Society, etc., etc.
Twenty-first Annual Announcement of the Chicago Medical
College , Medical Department of the Northwestern University. /Ses¬
sion of 1879-80.
The Treatment of Epithelioma of the Cervix Uteri. By J.
Marion Sims, M.D., Founder of the Woman’s Hospital of the
State of New York, and formerly Surgeon to the same; Knight
of the Legion of Honor, etc., etc. Reprint from the American
Journal of Obstetrics and Diseases of Women and Children,
Vol. XII, No. iii, July, 1879.
Reports to the St. Louis Medical Society on Yellow Fever. By
W. Huston Ford, A.M., M.D., formerly Professor of Physiology
in the New Orleans School of Medicine, etc.; Member of the
St. Louis Medical Society, etc.
Transactions of the Medical and Chirurgical Faculty of the
State of Maryland — Eighty -first Annual Session , 1879.
Prospectus of the Loquet Leroy Day and Boarding School for
Young Ladies , New Orleans Female Collegiate Institute , 280 Camp
Street. Session 1879-80.
Nashville Medical College , now the Medical Department of the
University of Tennessee — 5th regular Announcement , Session of
1879-80.
Annual Announcement of the Louisville Medical College , Louis¬
ville i, Ky. — Session 1879-80.
Retroversion in relation to Lacerations of the Cervix Uteri , etc.
By Nathan Bozeman, M.D., New York. Reprint from Vol. Til,
Gynecological Transactions, 1879.
502
Meteorological and Mortality Tables. [October
Meteorological Summary — August, 1879. Station —
New Orleans.
Date.
! Daily Mean
j Barometer
a •
Ct <b
- t*
S 5
~ s
OH
Daily Mean
Humidity. |
Prevailing
Direction
of Wind.
Daily
Rain-fall.
1
General Items.
1
30.06
83.0
74.0
East.
.54
Highest Barometer, 30.135, on 2d.
2
30.11
82.5
77.7
East.
.05
Lowest Barometer, 29.586, on 2*2d.
3
30.08
84.0
74.3
South
.18
Monthly Range of Barometer, .549 in.
Highest Temperature, 89°.
4
30.04
84.0
70.7
West.
03
5
30.04
80.5
75.3
West.
1.48
Lowest Temperature, 69°.
Monthly Range of Temperature, 20°.
6
30.03
81 5
77.3
S. W.
.04
7
30.00
82.5
76.3
South
.36
Greatest Daily Range of Temperature,
8
30.01
81 .5
83.0
S. W.
.32
15° on 9th.
9
30.03
80.0
77 0
N. W.
1.11
Least Daily Range of Temp., 7° on 22d
10
30.04
79.7
63.7
North
00
Mean of Maximum Temperatures, 85°
11
30.06
77.7
63.0
N. E.
.02
Mean of Minimum Temperatures, 73.6°
12
30.04
78.2
70.7
North
.45
Mean Daily Range of Temp., 11.4°.
13
30.00
77.5
88.0
East.
2 52
Prevailing Direction of Wind, East.
14
29.91
79.7 78.0
N. W.
.06
Total Movement of Wind, 5,708 miles.
15
29.90
81.0 78.3
West.
.00
Highest Velocity of Wind and Direc-
16
29.90
80.0 66.0
N. W.
.00
tiou, 36 miles, East, on 22d.
17
29.91
79.5
56.3
North
.00
Number of Foggy Days, 0.
18
29 98
79.2
57.3
North
00
Number of Clear Days, 9.
19
30.02
79.2
51.7
North
.00
Number of Fair Days, 15.
20
29.98
81.5
63.3
East.
00
Number of Cloudy days on which no
21
29.88
81.2
74.7
East.
.37
Rain fell, 0.
22
29.64
80.5
83.7
East.
2.11
Number of Cloudy Days on which
23
29 66
82.7
76.0
South
.21
Rain fell, 7.
24
25
29.81
29.92
83.7
84.2
75.7
72.0
S. W.
West.
.00
COMPARATIVE
TEMPERATURE.
26
29.90
84.0
63.7
North
.00
1871 .
1876 . 82.2°
27
29.86
81.2
52.3
North
.00
1 1872 .
1877 . 83.1°
28
29-88
80.7
66.3
East.
.00
1873 . 81.2° 1
1878 . 83.5C
29
29.94
80.2
65.0
East.
00
1874 . 83.9° j
1879 . 81.0°
30
29.88
80.7
67.7
East.
.00
1875 . 79.3° |
1880 .
31
29.77
79.7
81.0
East.
.57
COMPARATIVE
PRECIPITATION.
Sums
Means
29.945
81.0
70.9
East.
10.44
1871 . inches.
1872 . “
1876.. 4.44 inches
1 1877 . 2.54 “
1873. ..8.30 “
1874.. . 4.82 “
1875.. . 8.61 “
i 1878.. 5.31 “
I 1879.. 10.44 “
| 1880 . “
Mortality in New Orleans from August 24, 1879, to
September 21, 1879, inclusive.
Week Ending.
Yellow
Fever.
Malarial
Fever.
Con sump
tion.
Small¬
pox.
Pneu¬
monia.
Total
Mortality.
August 31 .
3
10
17
o
6
81
September 7
4
7
17
0
2
96
September 14.
0
‘J
13
0
70
September 21 .
1
4
13
0
0
2
69
Total ....
8
23
60
0
12
316
NEW ORLEANS
Medical >nd Surgical Jodrnal
NOVEMBER, 1879.
PAGINAL pOJKJA
UNICATIONS,
Viiccination as a Protection Against Sin all -pox Before the
Tribunal of Common Sense.
By M. SCHUPPExlT, M.D.
In the New York Medical Record and republished in the
American Medical Bi- Weekly of June the 26th, I met with a
request of C. J. Fisher, M.D., of Boston, Mass., to discuss the
question : “Does Successful Vaccination prove that Small-pox
has not been recently experienced V’ I intended at that time
to assist the doctor with my experience and views (in regard to
the matter involved), but sickness and different other obsta¬
cles prevented me from giving a timely assistance, and thus
the matter rested, until of late, I again met in one of the
medical journals of Germany, with another and similar case in
which a colleague had become involved, and who was con¬
demned by the Criminal Court of his district to pay a heavy
penalty for having performed vaccination in an “ irregular and
lax manner.”
This reminded me of my former intention, if not obligation.
Still I do not intend to limit the present contribution by merely
referring to the question here involved, but to give it a
wider scope, and if I here for the first time report experiments
worthy of some consideration, which, though already made in
the year 1865, were never published before, I was wanting
504 Original Communications. [November
those inducements which have since presented themselves to
me. Not that I ever thought less of the results obtained by
the experiments referred to, but at the same time I thought
more of the opposition and the obstinate prejudice having
taken possession of the minds of so many otherwise clear¬
sighted and intelligent men in relation to vaccination as a pro¬
tection against small pox.
Being conscious of the utter inefficiency of vaccination as a
preventative against small pox, and aware of the manifold
mischief committed by it, yea, even the deaths it has caused,
I do not know but 1 was wrong in remaining silent. But now
my position has been strengthened by collected material, by
numerous evidences ot the evil, of the damages and injuries it
has caused, that I cannot keep that reserve any longer without
reproaching myself of becoming particeps criminis.
Before 1 enter the main subject of this contribution 1 will
state here in a brief manner, first, the case of Doctor Fisher.
The doctor was accused of having committed a great diagnos¬
tical error: A man suffering an attack of smallpox, had been
confined by the doctor (being quarantine officer), in order to
prevent a spread of the disease. From some cause or other,
this man considered himself wrongly deprived of his liberty,
and not believing, besides, that he had suffered small pox at
the time he was confined, hunted up some assistance to have
his opinion corroborated and in attempting this, fell into the
hands of the Philistines ; one of those fellows whom the doc¬
tor calls a “ Quack,” belonging to a class of leeches who are
ever ready to squeeze a dollar or two out of a fool, took the
matter in hand, and asserting boldly that the doctor had
wronged his client.
Fortunately for his purpose the u Quack ” met with a too
willing ear, and the fool submitted to a proposed vaccination
which it was promised would corroborate the statement made,
furnishing besides the unquestionable proof that he had not
suffered the small pox. As is often the case, the “ Quack”
had even more luck than he deserved, since he was spared to
invent auother lie, by the vaccination turning out successfully
which might as well have failed. The u Quack” had herewith
Schuppert — Vaccination — Small-pox.
505
1879]
made good his prediction ; and this made his cause bomb¬
proof. Unfortunately the doctor’s position became more
endangered, at least in the eyes of the ignorant public, by the
access of some of his u colleagues,” which he designated as
“ regulars,” and whom that man had won to strengthen his case.
The doctor should not have forgotten that in such a game
the number of u savants” count for a great deal ; besides there
was a member of the Medical Association of Boston in that
congregation who ought to be relegated cum infamia , to say the
least, if the Code of Ethics is to be sustained. In regard to
the vaccination result and the unanimity of the u regulars” in
their condemnation of the doctor we cannot wonder, if we take
into consideration how deeply that doctrine has gone into flesh
and blood to obstruct and bereave the judgment, and that it is
one of the cardinal points of the teachings of Jenner that vac¬
cine will destroy the power of conception of small pox virus.
Most assuredly the regulars” had sufficient reason to doubt
that a person having just suffered an attack of that disease
could not at that time (so shortly afterwards) present a condi¬
tion in which vaccination should have a successful issue. Too
indolent for searching the pages of history after failures of that
protective power, and too stupid to undertake some controlling
experiments themselves, and if it had been merely for their own
scientific advancement, they preferred ruminating what was
known to them as wholesome fodder. Men of that stamp remind
me of those natural philosophers who out of mere love of what
the Bible teaches, insist upon the offspring of the human races
from one pair, maintaining that our cousins — the American
redskins came from the Mongolians, because they had found
some slight resemblance in the formation of their respective
skulls, which is at present the hobby of the anthropologists.
It is useless to tell them that the Bible cannot be considered
scientific authority, or to prove to them the impossibility of the
change of races, and that the islands of the South Sea are in¬
habited by quite a different race, and that the Mongolians,
therefore, before they could have turned into redskins must first
have turned into Polynesians. It is of no use to try logic on
them. If they are forced to relinquish one point as inadmissible
500
Original Communications.
[November
up they come with another. In order to save their once as¬
serted Mongolian abstraction theory, they made use of the
terra firma, and tried again by the Tscliaktchen in the north
between Siberia and North America, but these people had do¬
mesticated animals, dogs, the reindeer, and they were cog¬
nizant of the use of milk ; all things the American Indians
were ignorant of at the time of the discovery of this continent.
Nothing was now left them but an immigration from the east¬
ern coast of Asia to the western coast of America. Yet they
attempted it, notwithstanding the existence of a still greater
impossibility since all such who would have dared it iu their
miserable small canoes would have died, long before they could
have reached their destination — the American shore. Besides
there is another hook in the many different languages. In¬
deed, but a fool could suppose that the Chinese or Japanese
would have exchanged their language for a hundred different
others. Exactly as we have proven here, it is with Jenuer’s
hare-brained theory of vaccination. After the “ infallible,”
absolute protection theory of a single vaccination had been
demolished ; after a readmission of the faculty of becoming
affected by s mall-pox at certain intervals had been demon¬
strated, revaccination was called into requisition, first, once
during a life time, then every 14 years, and from 14 the num¬
ber was reduced by and by to 5 and 3 years, till now, as in
Wiirtenberg, in Germany, the whole kingdom, kith and kin, is
revaccinated every second year, par ordre du mufti. If we
inquire after the result, singular as it may appear, yet it can¬
not be denied that, whilst the countries surrounding Wiirten-
berg are comparatively free from small-pox, there it never dies
out, but is flourishing in spite of vaccination. After revacci¬
nation had made in this, as well as in other countries, such
fiasco, and since the protection theory could not longer be
sustained, it was asserted that small-pox appeared, at least, iu
a more milder form, that a smaller number became affected,
and that the mortality also had evidently decreased. But
these subterfuges could not stand the test of truth. u The
great boon of the century,” cost its admirers a great deal of
anxiety in order to save it from impending destruction or
1879] Sciiuppert — Vaccination — Smallpox. 507
total annihilation. So they hit upon the ingenious idea to
explain its deficiencies by the deterioration of the vaccine in
the course of time, and in order to render it again effective, it
would be necessarry, they said, to go back to the original cow-
pox lymph and to humanize the latter. A happy idea, indeed,
for the moment, and it was taken hold of and proclaimed as
the new sheet anchor all over the civilized world.
Thus we had here in our midst, in one of the most frequented
streets — the Boulevard Canal — a stall, with cows kept in it,
and next to the office of the doctor. A great many people
went to see vaccination performed direct from the cow. The
spectacle lasted as long as it was new, but unfortunately, for the
doctor’s speculation it did not last long enough ; the nuisance
disappeared again soon after it had been established. What the
real cause of failure was, whether there were not quite enough
fools to make the thing pay, or if the stench drove out the
doctor, or because the new method was declared a dead failure
in Paris, France, before the end of the same year in which it
had been hailed as the New Messias, we are unable to say.
The latter explanation, in addition to the stench it had caused,
may be the more probable one.
It may not be improper to add some statements here which
I believe are not as generally known as they deserve. Of all
our domestic animals the sheep only is liable like man to suf¬
fer epidemic small- pox. The losses from the disease have been
estimated to be from 25 to 30 per cent, on the average.
In the lymph from the sheep called ovine , like in that of va¬
riola of man, microparasites have been found in the shape of
smallest spheroid corpuscles by Cohn, Haller, Keber, and
others. Though homologous diseases they stand in no direct
category to each other; never was small pox observed to en¬
gender the pox in sheep and vice versa.
But the lymph of variola inoculated on cows or cattle has the
same effect as from vaccine, and the lymph so obtained, a vari¬
ola-vaccine lymph, re-inoculated on man, produces like pure
vaccine, a local vaccine pustule without a general exanthema,
and is of course considered a safeguard, protecting man against
infection from small-pox.
508 Original Communications. [November
The opinion formerly adopted of the self development of ovine ,
counts at present hardly a single supporter. It is considered
a poison, sui generis , and is derived like small pox from subjects
infected with the same disease. The ovination or inoculation
of the lymph from the ovine, the pox of sheep, was formerly
much in vogue as a protection against the much feared pox
epidemics amongst sheep, but the losses experienced hereby
have caused an abandoning of this pernicious prophylaxis.
Amongst other animals, the pox of horses have only received a
certain consideration, because Jenner believed to find in them
the origin of cow-pox. But there is hardly a doubt that the
horse-pox is derived from men.
Equally so is the origin of the veritable cow-pox to be de¬
rived from the vaccine or variola of man. Though the poison
of variola is volatile and not like the poison of the vaccine of a
fixed nature, the small pox (variola humana veraj inoculated
in the cow produces nevertheless the true cow-pox, which re¬
vaccinated in man begets the common vaccine pustule (Gasser,
Sunderland, Thiele, Ceely, Badcock, Sentft, etc.).
The variola- vaccine thus engendered resembles the true cow-
pox or vaccine , it is said to be merely a little more intense.
The opinion that the cow-pox be derived from the variola or
vaccine of man is supported further by the following :
1. Cow-pox has been observed only on milk cows.
2. The pustules are seated exclusively on the udder of milk
cows.
3. The appearance of the pustules takes place foremost in
those months in which vaccination is mainly exercised.
4. The development of the pustules on the udder happens at
intervals and in batches.
5. The cow-pox appears most frequently where vaccination
has been made compulsory, or in small pox epidemics.
The conclusion hereby arrived at is, that the so-called original
cow-pox does not exist, but is always engendered from external
causes, commonly from the infected hands of persons who
had been milking.
What sense can there be, then, in the defense of vaccination,
to talk of a degenerated vaccine, or to insist upon a fresh col¬
lection of it directly from the cow ?
1879] Schuppert — Vaccination — Small-pox. 509
Are the disciples of vaccination, then, not forced to the con¬
clusion that such a cow-lymph has to be of less energy in
having previously gone through the system of the animal ?
Since variola lymph, if inoculated in the cow-udder, merely
engenders cow-pox, which has no more of the former character
of the variola, the conclusion will most certainly be justified
that the cow-pox lymph can have no superior qualities than
human vaccine. As protectives against the infection of small¬
pox, both are, as a matter of course, equally ineffective.
Bollinger, the author of an Essay on Vaccination, from whom
I have taken some of the foregoing statements, inquires: which
might have appeared first, the sheep-pox or the small pox ? I
believe this question may be answered with : Since sheep have
been created previous to man, sheep-pox ought to rank the
smallpox.
Bollinger also mentions injapa-uterine vaccination, whereby
the foetus was to be protected against small pox. He calls this
proposition absurd. I cannot see it in that light. There is
certainly no more absurdity in vaccinating the unborn, par
distance, than in the vaccination process after birth as prophy¬
lactic means against infection with small pox.
Besides, our author believes to have discovered a proof of
intra uterine small pox (variola sine exanthemata) of a foetus in
the case of a pregnant woman, 22 years of age, who, whilst suffer¬
ing from an attack of confluent small-pox, and being delivered
during the period of exsication of a child which, though it had
no signs or indication of having suffered small-pox in utero,
was still thus considered protected on account of vaccination,
three times performed on it, remaining without any reaction, and
though living in a room amongst other small-pox cases without
becoming infected.
If he admits this as a fact proving the theory, he has also to
admit the consequences. To what singular conclusions such
observations may lead we find, for instance, with Underhill,
who having vaccinated successfully a woman eight months
pregnant, remarks : “ Her child being four months of age, was
vaccinated but without reaction, therefore in vaccinating a
pregnant woman the foetus will become immune to vaccination.”
510 Original Communications. [November
The immunity in general against variola or vaccine is also here
explained by considering such persons to have suffered either
variola or vaccination during their fcetal or intra uterine life !
Can any mental condition but dementia beat that ?
Alike there is only one step from the Roman capitol to the
Tarpejian Rock, so is the serious often not far from the ridicu¬
lous. What would become of an administrative supervision
in case this intra uterine vaccination or even the theory of a
u Variola sine exanthemate” would be admitted ? Can a pupil
in future be refused admittance into a public school, because
that pupil does not present the cicatrices on the arm ! Can the
pupil still be tabooed if the certificate of the medical practi¬
tioner states: Vaccinated and re vaccinated during foetal life
per intra uterine operation ? Parents who are adverse to the
compulsory tomfoolery of vaccinating ordinances might profit
by this.
I will now produce from official sources and from dif¬
ferent documents, the proofs of the utter worthlessness
of revaccination, establishing sufficient evidence for the over¬
throw of all the assertions made at one or the other time in
defense of the following views :
That epidemics of small pox, after the institution of vacciua-
tion had become diminished in number, magnitude and sever¬
ity ; that the mortality from small pox had much decreased ;
that small-pox attacking a person once vacciuated would not
only change its severe character, but would protect the patient
against smallpox for a life time; that vaccinated persons
would not be attacked as easily as persons not vaccinated;
that small-pox epidemics could by vaccination be almost in¬
stantaneously arrested (as asserted by Sacco, Pessin and
Snow) ; that the security against infection of small pox in¬
creased with the number of vaccine pustules or marks, at
least for a number of years and that such marks ought to be
at least five in number ; and finally that a person having once
suffered small-po ■ could not he affected any more by vaccination.
I do not intend merely to disprove all and every assertion here
mentioned, but will give such undeniable and satisfactory
proofs, that in a person vaccination can be repeated almost
1879] Schuppert — Vaccination — Smallpox. 511
every three weeks, and thus ad infinitum with equal success if
only the proper vaccine has been used, no matter if the person
has had small pox or not ; that therefore, the method of
vaccination or revacciuation, be it with cow-pox lymph
or so-called humanized vaccine, if used as a protection against
small pox, is, to say the least, a blunder ; that finally this
method may under circumstances become dangerous if not an
irreparable injury, and that therefore under all circumstances
it ought to be relinquished “ poco di mattov as a great mental
delusion.
Notwithstanding the large area over which vaccination
had extended in a few decades ; that vaccination had become
popularized and even being made compulsory in Germany,
Sweden, Norway, Denmark, parts of England and of this coun¬
try, epidemics of small pox did not cease to exist.. Nearly all
over Europe epidemics were experienced quite as severe as in
times when vaccination was still unknown, yea, the epidemics
were even more severe in some of those jiarts than in regions
where vaccination was unknown and had never been exercised .
Though we do not know the contagion of small pox past
dispute, nor the reason why at times the disease may spread,
still full evidence has been procured that sm all-pox epidemics
depend upon eertain physical influences even if we have not suc¬
ceeded in defining them more precisely. Starting from this
incontroveritble truth, it must be obvious that vaccine or vac¬
cination can have no influence upon the appearance of small¬
pox. The fact that the proletarian classes present the majority
of cases of small pox, has been explained by the want of vaccin¬
ation. But if we grant that unvaccinated persons as a rule be¬
long to the pauper classes, we ought not to forget the impor¬
tant factor that these classes are besides characterized by a
want of that resisting physical power so necessary in the battle
for life, as a protection against disease in general, and most so
at a tender age ; we ought therefore not to be astonished at all
and at a loss to explain the greater mortality amongst the un
vaccinnated paupers.
In regard to the much talked of diminished number and se¬
curity of small pox after vaccination, I will give here a trust-
2
Original Communications.
512
[November
worthy and correct report from the St. Louis Hospital for
Small pox of the year 1870 (from November 1869, to May 1.S70) :
Admitted there were in toto 326 cases:
Vaccinated.
Not vaccinated.
Continent malignant cases.
. 9
u
it
17
Confluent .
<;
u
54
Distinct .
. 90
u
u
40
V arioloid .
. 55
u
u
6
209
117
What does this prove, but that with the exception of a few
more malignant cases among the non-vaccinated, which in
relation to the vaccinated were not more than 3 to 5 ; the un¬
vaccinated presented only a little over half the number of the
vaccinated inmates, and were even of a milder type, having of
varioloid only 6, while the vaccinated presented the high num¬
ber of 55 of such, which is the reverse of wliat has been as¬
serted in favor of vaccination. It is a result which cannot speak
more loudly in favor of non-vaccination.
In Sweden, with compulsory vaccination, we find officially that
in the year 1801 (prior to vaccination), 600 persons per million
died from small-pox. The mortality has since gradually increased
so, that in 1*74, the population being a little over 4,000,000,
4063 persons died from small pox, an increase of more than
400 per million inhabitants (Spinzig.)
According to other authorities, we find the calculation of
mortality extending over a greater number of years, does not
vary much when compared with the time prior to vaccination.
In Wurtenberg, the eldorado of vaccination, where it is said
that not 1 in 600 will escape revaccination, we find recorded
from 1854 to the year 1868, 12,901 cases of small pox, with 952
deaths, or a mortality of 7.3 per cent. If we compare this
number with that of the period prior to the introduction of
vaccination in Stnttgard, the capital of that kingdom, from
the year 1786 to 1796, we find nearly the same death rate,
1003 (being greater by 51). The celebrated Dr. Heim gives us
the number of cases of variola and varioloid after vaccination
1879 1 Schuppert — Vaccination — Small-pox. 513
in Wiirtenberg, from 1831 to the year 1836, of subjects rang¬
ing from 1 to 35 years of age, as follows :
Variola, 186 cases; varioloid, 869; total in 5 years: 1025.
And such is the result after every two years of re vaccination (!)
In the Royal Infirmary of Edinburg, during the epidemic of
small pox in 1863, we have the following :
Age. Cases.
From 10 to 15 ... . 34
“ 15 to 20. . . . 66
“ 20 to 25.... 106
Vaccinated.
Not vaccinated.
18
15
42
17
68
29
Etc., Etc.
At the General Hospital of Vienna, Austria, during the
epidemic of 1863, we have the following record of cases of
small pox admitted :
Age. Cases.
From 11 to 20 ... 2,634
“ 21 to 30 ...2,671
“ 31 to 40 ... . 406
Vaccinated.
2,228
2,329
354
Etc., Etc.
Not vaccinated.
406
304
52 (!)
Do we want better proofs, that vaccination, as a preventa¬
tive against small pox, is a lie ?
Though the mortality is not given here, will anyone surmise,
judging from the great decrease in the number of small-pox in
the unvaccinated, that the mortality is also in a minimum.
In Paris, France, where as we have seeu, the vaccine had
been taken directly from the heifer, after the old vaccine had
ceased to give the expected protection and was therefore con¬
sidered degenerated — what was the result l The number of
deaths exceeded twenty times that experienced in previous years
and the consequence was, that the heifer experiment was abol¬
ished in the same year it had been introduced with so much
enthusiasm the Frenchman is known for.
In London, England, since the enactment of the vaccination
laws, since vaccination has been provided for gratuitously and
made obligatory, wefiud iu the Register General’s reports the
annual average death rate diminished, but the calculation is
based only upon a comparison of 3 years previously to the
514
Original Communications.
[November
the compulsory ordinance, while of the latter period, where 13
years where counted, we find this quite different. In looking
somewhat closer into this disreputable cheat’s own reports, we
find the number of deaths after the compulsory ordinance far
in excess in comparison with an equal number of former years.
Such is falsifying history and deserves our utter contempt.
In this country there is hardly a city wherein vaccination
has not more strictly been observed than the city of the Quaker.
In Philadelphia, since 1860, almost every year about 9000 suc¬
cessful vaccinations were performed, with an average number
of deaths from small pox of 519 per annum.
During 1870 and 1871 re-vaccination was carried on by com¬
pulsion to an extent almost unparalleled. In 1870 over
30,000, and in the next over 18,000, persons were vaccinated, and
with the increase of vaccination it seems the number of deaths from
small pox did equally increase ; thus in 1870 there were 1879
deaths; in 1871 the mortality increased to 2585! These num¬
bers are given by the Board of Health, therefore reliable. If
we compare them with the 519, the average number of the non¬
vaccination period, we might, on being informed that the city
ordinance making vaccination obligatory be still in force, fall
into a state so vividly described by Virgil with “ obstupui
steteruntque comae , vox vancibus haesit.v
This report of the Board of Health is interesting still in an¬
other respect ; it says that “ most of the deaths came from
those wards of the city of overcrowded, badly ventilated hab¬
itations of the pauper classes, classes of people depraved mor¬
ally and physically,” and the number of deaths were 3 times
larger than of the better classes, notwithstanding the mncli
praised re- vaccinations ; corroborating therefore what I have
already mentioned above, that something else is icanting but vac¬
cination to resist the inroads of small-pox.
The same condition we find everywhere. Thus in London,
during the epidemic of 1871, the number of deaths from
small pox registered, amounted to 7876 (!) notwithstanding the
strict u compulsory vaccination ordinance.”
Thus has vaccination been accepted as the pathological sub¬
stitute for small pox, whilst both have nothing in common, are
1879 j SCHUPPERT — Vaccination — Small-pox. 51.5
separate and eutirely different diseases ; one being a local, the
other a constitutional affection, and one has as much influence
upon the other as the man in the moon has upon flow and tide
on our globe.
I now have still a small chapter for those dyspeptic croakers
who deny the fact that vaccination can be made effective and
will run its course whether small pox has preceded it or not ;
which chapter will probably interest Doctor Fisher more than
the balance of this paper. In the army of W iirtemburg out of
13,681 soldiers, we find the degree of success of vaccination iu
an official table as follows: In 7845 cases with normal cicatrices,
the result was perfect iu 31.04 per cent, modified in 28.05 per
cent., none in 40.92 per cent. Of 2025 cases vaccinated but
with no cicatrices from vaccination or small pox, perfect 33.73
per cent., modified 19.13 per cent, none 47.10 per cent.
Bearing marlcs of previous small pox there icere 200 cases, and
among these the result of re-vaccination was perfect in 31.95 per
cent., modified in 24.81 per cent., none in 43.23 per cent.
The number of cases of re- vaccination with previous small¬
pox resulted successfully, and was even larger than those with¬
out a success, or even of normal and defective cicatrices (!)
Here then we have on a large scale, the proof, that vaccination does
not interfere with small-pox, — what, moreover, could have been
expected a priori, since the two processes have nothing in com¬
mon. And yet vaccination and re-vaccination continue to be
compulsory in otherwise enlightened countries, and are defended
by men claiming superiority of judgment! Should we not
despair of human progress ! And with such facts before them
as the above, published in Simon’s reports, not one of our
scientific heroes thought it worth while to continue and extend
those experiments of re- vaccination, in order to find out if there
existed a limit or not. Of all the fallacies L undertook to over¬
throw, there remains but one : the influence of the number of
cicatrices. If this was really of any consideration, the report of
1836 on vaccination of the recruits of the Army of Wiirtem-
burg will decide it. Of cases with 2 cicatrices, the percentage
of success of a complete re- vaccination was 26.5 per cent.; with
3 cicatrices, 26.4 per cent.; with 4 cicatrices, 28.8 per cent.;
Original Oonunnnieatiom.
[November
r»i«
with 5 cicatrices, 27.7 per cent.; with 6 cicatrices, 26.9 per
cent.: in the modified it was nearly the same, or 61.4 per cent,
on a general average, while the failures amounted only to 38.6
per cent.; and of 3 persons with 7 cicatrices, although not very
distinct, there were no failures, but 66.6 percent, of a complete,
33.3 per cent, of a modified success (!)
The tables extant of Mason and Simon, by which they try to
prove that the fatality of small pox diminished with the num
ber of cicatrices, so that with 4 or more cicatrices the mortality
would be less than 4 per cent., do not deserve the least consid¬
eration ; they are nothing but a lot of illogical rubbish. Of
a similar character are the observations of Deutchbein and
Loettler, published in the Berlin Clin- Wochen-Schrift.
I will now present my own experiments, which I instituted
with a view of ascertaining the limits of re- vaccination, the
influence of the numbers of pustules, of cicatrices from vaccin¬
ation, and the substance of the relation between small pox and
vaccine. In January, 1865, occupying temporarily the ottice of
City Physician, and having in charge the Boys’ House of Re¬
fuge, 1 selected 30 healthy boys, between the age of 8 and 14,
to experiment on. The majority of them had never been vac¬
cinated ; at least no marks were recognized ; only 4 had dis¬
tinct cicatrices, 3 on each arm, and 4 had marks from small¬
pox ; there was also one of the boys who asserted that he had
had u the pox,” but no marks were visible. 1 had procured
some scabs from healthy children, not being able to obtain
fresh lymph. These were triturated with some glycerine in an
agate mortar, and made use of instead of the fresh lymph.
Every one of the boys received two incisions on each upper
arm, below the insertion of the deltoid muscle. In 7 of the
boys the vaccination was perfect. Amongst that number were
3 who presented the marks from small pox, from which they
had suffered one and two years previously. This number con¬
tained also the boy who pretended that he had suffered from
pox three years before, though no signs were visible. The
vaccination in all 7 boys was free from disturbance. Between
the 8th and 9th day 1 re- vaccinated the balance of the boys, to
the number of 23, taking the vaccine virus from such boys,
SCHUPPERT — \ ' accination — Small -par.
517
1879]
previously vaccinated, who presented the best filled vesicles.
Again in 9 of this number, vaccination had a proper effect.
Thus 14 remained, on whom the process had again to be tried,
as soon as fresh vaccine could be procured from those lastly
vaccinated. In 5 boys vaccination succeeded in the third
attempt, leaving 9 boys for another trial. Meanwhile the 7
boys in whom vaccination had been successful at the first trial,
after the scabs had fallen off, were re-vaccinated, and with per¬
fect success in all 7. Success in vaccination depends a great
deal on the place in the skin selected and the manner of incis¬
ing, or puncturing. If the lymphatics should be wanting, or
the incisions made too deep, so that they bleed, vaccination
may fail — be abortive. Of the 9 boys left from the third re-
vaccination, another effort sacceeded again in 3, so that 6 were
left who had resisted now 4 different vaccinations with different
vaccine matter. Meanwhile the second lot of boys had been
re- vaccinated, of which number 6 boys had presented themselves
again fit subjects for successful vaccination.
The 3 left here, came later again under the lancet, and after
two unsuccessful trials with one of them, were finally placed
on the list as perfectly revaccinated.
Of the (> boys who had so far resisted all attempts made, the
fifth trial took out 4 at once, and with as perfect a success
as could be desired, so that only two of the original 30
remained for further experimentation. During the interval I
had not only the third lot revaccinated successfully with one
exception, but the first lot of the original 7 already twice vac¬
cinated, had a third time been operated upon and with a fail¬
ure of only in one case, a boy, who, at that time suffered from
an attack of dysentery. This I found out but the next day
after the vaccination had been performed. He recovered,
though he did not come under the knife again. I might have
finally succeeded in vaccinating the last two boys, though they
had put at defiance so far five different vaccination trials, had
my official career as city physician not come to an abrupt end. I
was appointed to vaccinate the young ladies in the Upper District
High School. On my going there I met a boy of a friend of
mine, who had been previously vaccinated and suffered an
518 Original Communications. [November
erysipelas, which comprised nearly the whole extremity. I
took him with me and finding the young ladies all prepared
for the frivolous fray, presented the boy’s arm, when down
went the sleeves, and not one of the young ladies wanted to be
vaccinated any more. I complimented them for their good sense,
but that compliment cost me my position as city physician.
Some of them who since married arid are now mothers, will, I
hope, never forget that arm, and so at least my martyrdom
may have done some good.
Wlieu I had to discontinue my experiments, T had then in the
short time of not quite three months, vaccinnted 7 boys, three
times with perfect success, while 21 boys more were vaccinated
and once revaccinated with perfect success, and of 30 boys,
with the exception of two, all were vaccinated once, though
repeated trials and different, kinds of vaccine had been neces¬
sary to accomplish that object. The unavoidable conclusions
1 have arrived at are, that a successful vaccination is but the
result of local inflammation, caused by the introduction of
decayed animal matter into the skin, resp. the lymphatic ves¬
sels ; “ Ubi irritatio ibi affuxus that according to th<> na¬
ture of the vaccine and the singular disposition of the person
in the majority of instances a local, septical, small abscess is
caused, to be cast off again in time, without in the majority of
cases, leaving any bad traces behind ; and that vaccination
can be undertaken repeatedly and successfully at short inter¬
vals. with one or the other vaccine virus, no matter whether
the person has suffered previously from the infection of small¬
pox or not, with which latter process, being a septical poison-
oning of the blood, associated with a general disturbance of
the whole nervous system — marked by a high fever, pain in the
head and back, and an eruption of the skin extending over a
greater or lesser part of the whole body, but particularly over
those parts mostly exposed to light, as the face and hands — it
has nothing in common.
In those boys, well pitted from previous attacks of small¬
pox, revaccination met each time with perfect success ; this
experiment being repeated and following each other in quick
succession.
Schuppert — Vaccination — Small-pox.
519
1879J
Notwithstanding- the extensive, careful and minute examina-
inations of Keber, Coze and Felty, who have come to the con¬
clusion, that vaccine lymph and variola lymph do not differ
much from each other, we know from their distinct effects that
nothing is gained by these analyses. It is uot so rare that two
substances may resemble each other physically, yet differ
greatly in their effect, just as two bodies, apparently very dis¬
similar, may be of the same elementary constitution.
The destruction wrought by small-pox during the centuries
of our era is judged to amount to the enormous number of 45
millions of human beings.
When Jenner appeared with his inoculation proposition, this
came very opportune. Under the total helplessness of the times
against that scourge small pox it was so eagerly taken hold of,
that in scarcely two years it had almost gone the rounds of civ¬
ilized Europe, and it may be considered somewhat strange that
the favor with which it was received has nowhere been gener¬
ally withdrawn. If we inquire into the cause of this singular
spectacle : so general an acceptance of the propliylatic power
of vaccination ; the cause upon which that popular belief in its
virtue was and still is based, the universal practice rests, and
the conviction of its value is derived from ; if we cannot help
but acknowledge at the same time the facts that there is no
conviction, because a conviction implies a previous mental ex¬
ertion which we cannot expect from the mass of the people ;
we arrive at the conclusion, that we have to deal here with the
following factors : prejudice, custom, an inherited belief, alarm,
fear from an impending epidemic, “ the possibility it might do
good, because other people do it, the government orders it, con¬
sequently it must be wholesome ; besides, it can be had gra¬
tuitously.” Such and similar answers have to serve in explan¬
ation and take the place of reason and judgment. Let us look
now* at what is said of the opponents of that “ popular practice.”
“ The opposition is with them traditionally, an hereditary nega¬
tion, the animus oppouendi,” “such persons” a celebrated vac¬
cination author says “ think for themselves, but, nevertheless,
somehow or other the conclusion they arrive at is not the same
3
520 Original Communications. [November
as that of other people.” (!) He calls them “ eccentric,” and to
argue with them “ labor thrown away.” Another class of oppo¬
nents, he characterizes as “dishonest, suppressing some truths,
exaggerating and misstating others ; from them the cry of dan¬
ger proceeds”; another and more important class of objectors,
is composed of “ thinking men, but their reasoning is illogical,
having heard only one side of the question ; they are unaccus¬
tomed to value evidence : judge on insufficient grounds ; draw-
hig inferences from too limited data, otherwise they are honest.”
And we too are not forgotten as a professional class. “ Where to
plaee that fortunately small class of medical men who doubt, 5
he does not know, but he accuses them nevertheless of “ illog¬
ical reasoning.” It is a common trick of thieves, in trying to
escape, to raise the hue and cry of “stop thief!” “Illogical
reasoning?” It is at least reasoning; but where do we find
that amongst our men of faith ? With that nice anthology
with which our author has dignified our opposition we can be
satisfied. I, for my part, would not like to sit with him on the
same bench. The main author to whom I refer here is Ballard,
of England, who, in 1868, has written an essay on the subject
— a prize essay besides — which has been crowned, “ as the best
which has appeared in that line.” I may therefore be excused
in presenting to the reader a few more extracts from
that perspicuous, contemplative and philosophical author
of immaculate vaccine conception, who, penetrating with
a firm, resolute, infallible mind, the inexhaustible, inscru¬
table and mysterious depths of the vital power of the
human organism, concentrated in an epidermoidal cell,
and who in unfurling the banner of an inscrutable, myste¬
rious logic and veracity, maintains “ that mortality from small¬
pox has decreased through vaccination ; that small pox epi¬
demics have become comparatively of a mild character, and
that epidemics of small pox have even been arrested by vaccin¬
ation and re-vaccination, if rapidly undertaken.” It would be
impossible for the limited space of this article to scrutinize this
ill-fated prize essay more closely, and give it the attention
adequate to its deserts, but a few passages more quoted will
score sufficient to exult in, without exhausting the patience of
Schuppert — Vaccination — Small-pox.
521
1879]
the reader. u The areola around the vesicle, be it in small pox
or vaccinia, is ” — with our author — “ au incontestible proof of
a constitutional operation of the virus”]!) Is this not rather
an incontestible proof of ignorance of the most elementary
knowledge of pathological anatomy? He further explains:
u because if it was caused by the irritation or determination of
the blood it occasions, the introduction of other irritants into
the tissue of the skin would occasion a similar phenomenon.”
(He seems never to have observed a pustule produced by tartar
emetic, or even from an inoculation of syphilitic virus !) And
he is the more induced to see here the consanguinity of small¬
pox and vaccinia, because the areola besides commenced and
developed at precisely the same period iu both (!) ; and singular
to say, the effect of the mentioned substances (tartar emetic
and syphilitic virus) show the same interval also. Speaking
of the “ modus operandi ” of the virus, he unfortunately hits
upon a comparison with the yeast plant, which in its growth
and multiplication does away with the sugar in the infusion of
malt. Yet as we have seen that vaccination can be repeated
successfully ad infinitum , the comparison limps fearfully, and
more so in comparing it with small pox where, after the pro¬
cess is ended, it cannot be repeated. In his exertion to explain
the a modus operandi ” of small pox after inoculation, he finds
it singular that the virus first appears in selected spots, before
the general eruption breaks out, and is deferred until the 7th
to 8th day, to explain which, he suggests an analogy in natural
history of “ living particles of germinal matter, the eutozoa,
wherein comparative anatomy has shown from the ovum
set free, several stages of development before the complete
animal is developed, i. e., capable of reproduction of its
species ; that as long as the condition iu which the being Jives
remains unaltered, so long the stage of its development remains
in statu quo ; but when the conditions are changed, the stage
of development is advanced. Between the two stages, the
the ovum and complete animal, the forms of the intermediate
stages may be so unlike that nobody would recognize their
relationship.” I need hardly explain that our author here has
reference to the cyst worms, to animals and their complete
522
Original Communications.
[November
metamorphosis, the tape worm in man, or the fluke of inol-
luscas, the larvae of the dystonia in the liver of higher animals,
of the sheep or ox, for instance, u where it finds the last resting
place.” u So ” he holds, “ it may be with the inoculated small -
jiox virus, at the spot where the virus becomes arrested,
it attains its complete development, and there it generates until
all the transformed material in the blood has been removed or
is eliminated and the nervous phenomena which its presence
in the blood occasioned, cease and the fever subsides.” So our
contemplative author believes the inoculated virus of small -pox
operates locally and constitutionally (!) and may it “ find there
its last resting place,” till, to use his own words, u some sheep
or ox will swallow it ;” it may even for such animals be hard to
digest. The u vaccine virus” the speculative author thinks,
“ operates locally precisely in the same manner as the small pox
virus, and to a certain extent, constitutionally also.” With
regard to the so-called secondary eruptions, which have been
observed occasionally, it is doubtful if they have not been
eruptions caused by small -pox virus in the form of varicella,
which would be nothing extraordinary, since the two processes,
as I have shown, have nothing in common and may exist, yea,
have been observed to exist, together. He defines, besides
u vaccinia, a disease not natural to man, which did not thrive
in the soil of his body, that soil being foreign to it.” It seems our
author has to utter some nonsense wherever there is room for it.
The pabulum, he says, “ is the same as exists for small pox
virus, but the climate is unfavorable, it refuses to feed upon it
to the same extent. The virus does not thrive in the blood,
although it thrives at the place of puncture.” He thinks if
large quantities of vaccine were injected into the system, into
the blood-vessels, or lymphatics, then a secondary eruption
might follow, as in the horse, where the experiment was tried
with the horse-pox. Who will doubt that with such a horse
dose, an extended lymphaugietis with a vesicular eruption
might be produced ? “ The virus — according to our prized
author — will exhaust the system of the pabulum or material
for transformation, so that the subsequent introduction of a
second dose of virus produces and can produce no effect.”
1879] Schuppert — Vaccination — Small-pox. 523
I have shown by my experiments how much this assertion is
worth. His confusion in considering both processes alike, in¬
duces him to explain “ the system is no longer susceptible of
its influence; thus, in a patient who has undergone an at¬
tack of small pox, an attempt of inoculation of small-pox mat¬
ter is fruitless ; he is protected. If we produce in any person
the vaccine disease, he is protected against vaccine virus.
We inoculate small pox fruitlessly.” A wrong conception from
A to Z, repugnant to common sense, and in conflict with
reality. Protection against small pox is obtained by a conta¬
gion having affected a part of the blood which undergoes a
decomposition or alteration, and of which nothing remains to
sustain the process, consequently no reaction can follow a
renewed introduction of the contagion of the same virus ;
whilst in vaccinia a local, not a constitutional affection, the
process might repeatedly and successfully be tried as often as
the regressive, decayed animal matter, forming a septical, gan¬
grenous, small local abscess, is introduced on the locus minoris
resistentiae, where, according to the old maxim, Ubi irritatio
ibi affluxus, its presence will be established.
Vaccination, as a protective measure against small pox, has
forfeited its claim to the confidence of every clear-sighted man.
Whether it would be therefore in the general interest of man¬
kind to abandon its practice totally, altogether, cannot longer
be doubted. The protecting qualities of vaccine are based on
error, which under circumstances may become even fatal. That
syphilis has been transmitted in this manner, there are numer¬
ous historical proofs ; whether other diseases as tuberculosis,
scrophulosis, etc., have also been conveyed from one into an¬
other organism, is yet an open question. What shall we, after
after all this, say of a government which makes vaccination
still compulsory ? and is it not the worst kind of absurdity to
punish persons for performing vaccination u carelessly ” with a
fine of $120 or three months imprisonment, as in some parts of
Germany, whilst every person, parents, guardians, who do
not bring their children to the vaccinator, are fined
eight dollars and three days imprisonment? Such ridic¬
ulous, stupid, penal statutes are an outrage on com¬
mon sense, and most so in a country which boasts of
524
Original Communications.
[November
its civilization, and glories in the name of “the land
of the thinkers,” a land where hardly one in a hundred
escapes vaccination and re- vaccination and then has still to re¬
cord epidemics of small pox of a more or less violent character.*
The amount of money paid in England for re-vaccination is
said to amount to 1,500,000 dollars. When we consider the
number of people killed, or crippled for life, or made unhappy,
we are at a loss to express what we feel for governments like
those of England, Germany, Sweden, Norway, and Denmark,
where vaccination is still compulsory, when it rather should be
considered a criminal offense to practice it. May it never be
said of our great republic, at least of its general government,
that it has passed laws to make vaccination obligatory, though
I am sorry to say the attempt has been made in some State or
other. Witches are burned and drowned no more, the fagots,
“ faith’s solitary pyres” of the Inquisition, are nowhere to be
seen, how long will it be before the vaccination evil will be¬
come extinct and passed out of sight ? I believe it useless to
say one word more. Still it is distressing to find medical men
yet so ignorant of the history of a practice they so often come
in contact with, and it is even more deplorable to see them try¬
ing to make capital out of that ignorance.
I will close these pages with the hope that they may do
some good, and in taking leave of my medical brethren in Bos¬
ton, remind them of an epitaph proposed by a witty disciple of
the medical art, to Jeiiuer, the great apostle of vaccination :
“ Homo vanus et levis,
Cerebro vacuus et temerarius,
Monte etjudicio carens,
Scientiam profanisti,
Terrain perdidisti,
Populum occidi8ti.”
APPENDIX.
A LAWSUIT FOR CARELESS VACCINATION.
The Berlin Klin- Woschenschrift, Nro. 27, for this year, brings
the authentic report of a lawsuit against Dr. D., Sanitary Coun¬
cillor of Lyck, Prussia, for careless vaccination, in consequence
of which fifteen children are said to have died.
* The appendix will contain the case of the German physician I had reference to in
the beginning of this artiole.
1879] Schuppert — Vaccination — Small-pox. 525
The Attorney General on the side of the prosecution peti¬
tioned the Court for a judgment of 5000 marks (1250 dollars)
and 6 months imprisonment. The Court decided on a payment
of 1000 marks without a further corporeal penalty.
We will give here an extract of the case : Dr. D., a practic¬
ing physician of Lyck, and one of the signers of a petition to
the government for the repeal of compulsory vaccination, was
authorized by his superiors to perform general vaccination
in his district. After obtaining the vaccine from the govern¬
ment of Koenigsberg, he proceeded to vaccinate some children,
and having collected a sufficient quantity of lymph, began gen¬
eral vaccination in the village of Grabnits. He commenced
on the 19th of June last, to vaccinate 90 young children, and
60 elder ones, ready to go to school. At the same time cases
of scarlatina had appeared in the village.
A few days already after he had commenced to vaccinate,
there appeared amongst some of the youngest children an ery¬
sipelatous inflammation on the vaccinnated spots, the glands
in the armpits began to swell, ulceration, abscesses began to
form, associated with an eruption resembling measles or scar¬
latina over their bodies.
In all, 53 of these children took sick, of which 15 died during
a period of time from 6 to 8 weeks. A post-mortem had been
made on 5 of the children and two of them were pronounced
to have died from a resorption of pus ; in the 3 others scar¬
latina was assigned as the cause of death. These post-mortem
examinations had been made by an expert of the government.
Of the elder children not a single one had become sick.
Amongs the witnesses, a number of the mothers of the dead,
had testified that the vaccination incisions had bled a great
deal ; others stated that the doctor had taken vaccine from a
child with a scab on its forehead and an eruption on the skin,
and the vaccine taken from this child he had mixed with his
other : though on the day of inspection some of the children
had already presented ulcerations and eruptions, the doctor
nevertheless gave a certificate setting forth that the children
were “ properly vaccinated.”
The doctor himself stated, that he had made use of this same
526 Original Communications. (November
vaccine at a later date and liad never observed similar results.
A portion of the vaccine was sent to Berlin for examination
and there declared to be in a state of decomposition, containing
living organisms and therefore considered improper for use.
The Sanitary Physician declared that the death of two children
had been caused by using vaccine iu a state of decomposition,
which besides had been taken from a scrofulous child (!) where¬
by the extensive, large cuts had also to be taken into consider¬
ation. Dr. D. believed that bleeding in such cases was very
common and often unavoidable; he had never seen any harm
done by it. The doctor denied the decomposition of his lymph
at the time he had made use of it. A part of the sickness he
attributed rather to the customary action of the mothers to suck
out such wounds to prevent the action of the vaccine from
taking place, also wiping the vaccinated spots with their dirty
fingers. The dirt of the arms of those children, in one or the
other, might also have caused infection of the wounds ; besides,
he thought that the scarlet fever might be sufficient to have
caused the death of these children, without any blame resting
upon the physician.
He had a witness in the person of the school teacher, who
had accompanied him on these visits and who stated that
“ the doctor had always used a small brush, which he dipped
in the vessel containing the vaccine, to arm his lancet with.”
An expert of the Government, Dr. Pincus, “ Gelieimer Sani-
tats Rath” (“Secret Sanitary Counsellor”), gave it as his
opinion that much bleeding was against the rule and ought to
be reprobated as a technical incapacity, indicating too great a
haste in performing the operation. It besides caused unneces¬
sary pain to the children, and would often flood away the vac¬
cine.” (It would have been better for the doctor if the
vaccination had not had an effective result.) “Dr. Pincus
considered the taking of lymph from a scrofulous child
and mixing it with the balance of his other lymph imprudent
and unpardonable. He could not comprehend that the
doctor had not vaccinated from arm to arm, and not oftener
renewed his lymph, instead of taking the old one, which
certainly would in time decompose and putrefy from the
1879J Schuppert — Vaccination — Smallpox. 527
heat and exhalations of the localities ; though such a lymph
might retain some of its efficiency, still it might have caused
the erysipelatous inflammations and poisoning of the blood.
With regard to the death of these children he could not con¬
scientiously decide upon. Yet he thought that as the only
cause of the sickness and death could be considered the vaccin¬
ation with a lymph in the state of decomposition. The scarlet
fever as a cause of death he had to deny, since no bad influence
from it on vaccination had been observed in other localities
where that fever was prevalent; But in regard to the decom¬
posed lymph every objective proof was absent, since the doctor
had used the same lymph afterwards without it having pro¬
duced similar symptoms. The examination of the lymph m
Berlin, several weeks later, could not be considered as conclu¬
sive evidence, since decomposition might have taken place
during that space of time, etc.”
Another expert, Prof. Miiller, on the contrary, thinks
that the prevailing scarlet fever might have been an im¬
portant factor in causing this erysipelatous inflammations
and the death of these children. Just like in cholera epi¬
demics, where diarrhoea would frequently be observed, so
might even slight wounds of the skin produce such an ery¬
sipelatous inflammation.
Finally, it may be mentioned that for none of these children
who died was a physician employed, and the first, knowledge
that the Government received was through the report of the
Mayor of the village.
Nevertheless the Attorney General of the State charged the
accused with a gross and careless killing, respectively a serious
bodily lesion, and prayed for an imprisonment of the doctor
for six months and a penalty of 5000 marks. The court
of justice reduced the amount of fine to 1000 marks only, on
account of a careless performance of vaccination. Both par¬
ties have taken an appeal.
A further comment on this “cause celebre” is superfluous,
but the sooner such tyrannical laws of compulsory vaccination
are repealed the better will it be, and the more in accord with
the spirit of the enlightened 19th century.
4
528
Original Communication •&.
[November
A Case of Fibroid Polypus of the Uterus.
By THOS. J. ALLEN, M.D.. Shreveport, La.
On the loth of November, 1877, 1 was called to see Eliza M., a
mulatto, set. about 22 years, of healthy appearance, and rather
below medium stature. She was reared to do house work, and
possessed more than the ordinary amount of intelligence for
one of her race. From her I obtained the following history :
“ 1 began to menstruate about the age of fifteen, and was always
regular, but when near eighteen I became pregnant, and had
an abortion at about the fourth month. My health remained
good then for nearly three years. For the past year I have
suffered greatly when my menstrual period was coming on,
especially with headache. I am regular, but I think my courses
stay on me too long. T have always been of a very constipated
habit.” Upon examination by the biuanual method, the uterus
seemed about four times the size of a non-gravid one. As there
intervened but little adipose tissue, I was impressed with the
hard and unyielding feel conveyed to the touch, both vaginal
and rectal, much greater than usually obtains in ordinary hyper¬
trophy of this organ.
Upon the introduction of the speculum (Nott’s) into the
vagina, the os tinea* was found ulcerated, and the neck of the
uterus enlarged and indurated. 1 experienced some difficulty
in introducing the sound, and, as the uterus bled rather freely,
1 could not make a satisfactory exploration. With the hope of
obtaining a clearer insight into the cause of the enlargement, L
introduced a sponge-tent and let it remain twenty -four hours ;
upon its removal considerable haemorrhage ensued; the dilata¬
tion was unsatisfactory, and as the uterus had grown quite sen¬
sitive under the use of the tent, I did not think it prudent to
push the examination further. I cauterized the os and neck,
as far up as practicable, with nitrate of silver; applied the usual
pledget of cotton wool wetted in glycerine to the os, gave the
patient an opiate, and left her. On visiting her the following
day, I found considerable constitutional disturbance — high fever
and tenderness over the abdomen —the beginning of an attack
of metro peritonitis which followed. This I treated by rest,
Allen — Fibroid Polypus of the Uterus.
529
1879]
opiates, fomentations and mild purgation. The attack soon
yielded, but left the patient quite afraid of sponge-tents. She
was put upon the following 11 : Potass, iodide, grs. 5, liyd. bi-
chlor., grs. in half an ounce of syr. sarsap. co., three times
daily, and ordered to apply a blister over the womb when there
existed much tenderness.
I visited this case twice afterwards, and applied the argent
nit. at intervals of about a week, and ordered her to continue
the treatment for several months if it appeared to improve her.
She did so, and reported herself much improved. 1 was satis¬
fied there was considerable reduction in the size of the uterus,
or tumor if one existed at this time.
Her general health remained quite good until the summer
of 1878, when 1 was called to visit her and requested to
bring my uterine case as she feared a return of her old trouble.
On July 30th 1 called and learned that for several months she
had suffered greatly at each monthly period with headache and
pains in the abdomen. Her courses would last teu or twelve
days and then assume a muco purulent character. The bowels
had been most generally very constipated.
Upon examination 1 found a tumor occupying very nearly a
central position in the pelvis and extending considerably above
the symphisis; the right ovary was enlarged and quite tender.
This growth in the pelvis had been so gradual that she did not
remember when it began. She had lost considerably in tiesh
and had but little appetite. After a somewhat careful exami¬
nation, per vaginam et rectum , 1 was almost satisfied of the
existence of a tumor in the uterus and thought it most likely
a submucous or intra-mural fibroid ; it was quite hard, there
was but little intervening adipose tissue and 1 thought I de¬
tected a slight lobulated feeling to it. Upon introducing the
speculum there was sonsiderable muco-sanguinolent discharge,
the result of uterine catarrh, the os presented a very unhealthy
appearance and was covered with granular erosions aud was
much indurated ; a flexible bougie readily passed to the depth
of four inches, but Simpson’s sound had to be greatly curved to
be introduced.
530
Original Communications.
[November
The nature of her condition being made known to her, I had
little difficulty in obtaining her consent to use the tents, and
this visit l introduced a moderate size carbolized sponge tent,
but, remembering the trouble attendant upon a former occa¬
sion, I let it remain only eighteen hours; its removal was at¬
tended with some difficulty, so indurated were the os and neck
that the meshes of the sponge became imbedded in the tissues
and considerable haemorrhage followed its removal. When the
bleeding ceased 1 applied nitric acid, pure, to the diseased
parts and introduced the pledget of cotton wetted in glycerine.
No untoward symptoms followed the use of the tent except a
slight ovaritis of the right side, which was relieved by the ap¬
plication of a blister. I repeated the introduction of the tents
at varying intervals until six had been used, when their full
capacity had been reached, I could then both feel and see the
tumor. It was very hard to the touch and appeared quite vas.
cular. I could pass the finger around it, but such was its size
that I could not reach high enough to touch the pedicle, nor
could I, after the most patient use of the sound, determine the
size of its uterine attachment.
The weather being very warm, and the patient much exhausted
from confinement consequent upon the introduction of the tents
and the ovaritis, which invariably followed, I thought it pru¬
dent to desist from any further surgical interference. I put
. her upon ten grain doses of muriate of ammonia three times a
day, ordered the glycerine to be applied to the os tincae every
night, and a large quantity of warm water to be injected per
vaginam twice daily. Tnis treatment was to be kept up for
several months.
On the 6th of March last I called to see Eliza, and found her
laboring under severe uterine pains resembling those of labor.
She had just passed a catameuial period of about ten days in
duration. There was still present a muco-sanguinolent dis¬
charge from the uterine catarrh. The os uteri was dilated to
the size of a quarter dollar, and nature was endeavoring to
deliver the tumor. These symptoms continued for several
days, and her condition was rendered tolerable only when
under the influence of an opiate. Hitherto I had been alone
1879] Aljlen — Fibroid Polypus of the Uterus. 531
in my examinations, and had only employed a modification of
Nott’s speculum, devised by myself, aud wishing to advise with
some one as to the best method of opera ting, I took my friend,
Dr. K. A. Gray, to see the case with me, and we used Sim’s
speculum. The following plau of operating was agreed upon :
to forcibly dilate the os to its utmost extent, then to seize the
tumor with a strong vol sella forceps and forcibly to extrude it,
so that its attachment or pedicle might be readied and ligated.
In order to effect the dilatation, the patient was placed upon a
table in the dorsal position, the Xott’s speculum was inserted,
aud through this a long tri-valved rectal speculum for forcible
dilatation was introduced into the os, and it put upon the
stretch. This was done quite slowly, and did not require the
use of an anaesthetic. When we had consumed perhaps half an
hour testing the dilatability of the os, we found that, owing to
its previously diseased condition, one and a half inches was
the utmost limit it would bear without a rupture, while two
and a half inches was the supposed diameter of the tumor, and
its hardness precluded the idea of compressing it. Upon seiz¬
ing the tumor with the volsella, it gave the impression of a
short and very firm attachment to the fundus uteri. As stated
above, this examination was made without the use of an anes¬
thetic.
On April 2d, Drs. Ford, Gray and myself visited the case,
placed her upon a suitable table and administered chloroform.
After a careful examination, we resolved to try the removal of
the tumor with the ecraseur and wire. u After (I will here use
the expression of those who have tried it) great difficulty, we
succeeded in adjusting the wire around the pedicle aud began
the process of tightening, and were succeeding finely when the
wire gave way ; we mended it again and again with a like
result.”
Thinking a large catgut string might be stronger, but having
none at hand, we gave the patient a hypodermic injection of
morphine and left her.
On the following day we returned, placed the patient upon
the table and gave her chloroform, and proceeded to pass the
catgut ligature, but in this we signally failed, for as soon as it
532 Original Communications. [November
became moist, it seemed impossible to carry it to the fundus of
the uterus.
1 felt fully convinced that it would not do to longer delay the
removal of the tumor and resolved to try, if possible, to twist
it from its attachment. Having provided several pledgets of
cotton, wetted in equal parts of Monsel’s solution and water to
be used in case of hemorrhage, I seized the tumor with a
large sized volsella and endeavored to twist it. 1 thought 1
was succeeding well until I discovered a large piece of the
tumor removed ; there being but little hemorrhage, passing in
again the volsella until I grasped, perhaps, a third of the
tumor, I embedded them firmly, then with another volsella at
an opposite point, I firmly fixed these and began slowly, but
forcibly to twist the tumor upon its pedicle. Then to my
great gratification I felt it turn in the uterus and very soon
afterwards severed it from its attachment. There was no
hemorrhage, the application of the erasuer and wire the day
previous had doubtless prevented it. The removal of the
tumor was then effected by dividing it up in sections with a
strong pair of curvedscissors. When removed it weighed about
five ounces, was slightly lobulated, almost the shape of an orange
and had a very short pedicle of about an inch in diameter. I
present it to you to-night and regard it as a beautiful speci¬
men of a uterine fibroid polypus.
The treatment adopted was rest in bed, a light but generous
diet, turpentine stupes over the abdomen with linseed meal
poultices. The bowels being obstinately constipated at the
time, in consequence of the continued use of opiates for sev¬
eral days prior to the operation, castor oil was first used as a
cathartic in two drachm doses every three hours until the
desired effect was obtained. A slight ovaritis of the right
side, which yielded without any special treatment, was the
only untoward symptom following the operation. The uterus
was syringed out twice a day with one drachm of carbolic acid
to one pint of warm water. It has now been over two mouths
since the operation. The patient is up attending to her ordi¬
nary duties. She says that she has menstruated twice since,
the last time without any pain whatever.
1879] Shively — Foreign Body in the Windpipe.
533
Case of Foreign Body in the Windpipe.
By C. SHIVELY, M.D., Liberty Hill, La.
On the evening of Thursday, October 31st, 1878, I was called
to see Anna, daughter of W. T. B., aged 15 mouths. Ou
arriving 1 found the little patient laboring with considerable
difficulty of breathing, accompanied with paroxysms of cough
of a croupal sound. On inquiry the mother informed me that
her baby was choked with a grain of corn ; that some half hour
ago she was giving it some milk with a spoon, at the same time
it was playing with some shelled corn, and as she gave it a
spoonful of milk it got strangled, and she supposed it had got
a grain of corn down into the air passage. After examining its
throat as well as I could, and not finding or detecting anything,
1 gave it an emetic of ipecacuanha, which soon produced co¬
pious vomiting ; during the action ot the emetic she threw up
some fifteen or eighteen grains of corn, which gave no relief to
the dy spnce, but satisfied me to a certain extent that the for¬
eign body was a grain of corn in the windpipe. I visited the
child every few hours during the night and following day, and
after trying all the usual means at hand to assist the natural
efforts of the little patieut to expel the foreign substance with¬
out any avail, and seeing the child was gradually growing-
worse in consequence of the irritation and infiltration produced
by the presence of the foreign body in the air passage,
on Saturday morning I informed the parents that I could
suggest nothing towards the relief of their baby save an
operation, open the windpipe and through the artificial open¬
ing endeavor to extract the foreign substance. To this they
very readily consented, saying they were willing for anything
to be done to save their child. 1 consequently sent for Dr. K.
A. Crawford, who arrived iu a short while. After consulta¬
tion we concluded to operate as soon as possible, but after exam¬
ining our armamentarium in search of some little instruments
that we might need during or after the operotion, we found to
our great displeasure that we had none, such as canulars, little
curved forceps, or nothing of the kind for extracting foreign
bodies from the air passages in case we should have to search for
534 Original Communications. [November
it. Consequently we dispatched a messenger to Mt. Lebanon
in haste, to obtain some little instruments if possible, and con¬
cluded to defer the operation until 4 o’clock in the evening, un¬
less it should become necessary to operate sooner.
We watched the case closely, and about 3 o’clock in the after¬
noon we found the condition of the patient gradually growing
worse ; pulse 145 ; the breathing exceedingly laborious, appa¬
rently in consequence of a muco purulent infiltration in the tra¬
chea; the prolabia and fingers showed commencing cyanosis; in
fact, a glance at the little patient, even by no very experienced
eye, showed that death by suffocation was imminent — that a few
hours would likely put an end to the distressing scene without
some intervention of relief. We fully explained to the parents
the danger of death to the patient during the performance of
the operation, and the doubt as to ultimate recovery, even
should the ojreration terminate successfully. They readily con¬
sented and were anxious for the operation to he performed,
saying that it was very plain to their common sense that, as it
was, their little babe had but a short time to live, and that they
were were willing to risk anything whatever promising the
slightest hope ; that if it should die upon the table, it would
abridge its life but a short while, and its sufferings, to which
death would be preferable. 1 now placed the child upon the
table and chloroformed it, and with the assistance of Dr. E. A.
Crawford, I proceeded to perform the operation of tracheotomy.
Having the head held steady and inclined backward by an
assistant, I made an incision on the median line in the lower
part of the neck, about an inch or a little more in length, the
upper portion terminating a little above the cricoid cartilage.
After dividing the skin, fat, and fascia, the commissure of the
sterno hyoid muscles was exposed, which 1 carefully separated
with the handle of the knife. The tracheal rings being laid
bare, I detached the areolar investment with the handle and
point of the knife ; the haemorrhage was slight, some veins
being cut or ruptured, which were soon stopped with a pencil
of lunar caustic. I now opened the trachea, by introducing the
point of the knife in the lower part of the wound and cutting
upwards, the isthmus of the thyroid gland being kept out of
1879 1 Rohe — Recent Progress in Dermatology, 535
harm’s way. After completion of the opening through tin-*
windpipe, by the first expiration there was thrown out through
the wound a considerable quantity of muco-puruleut matter,
and the second expiration expelled the grain of corn. The child
now ceased to breathe, apparently from the exhaustion pro¬
duced by the effects of the operation and etherization. We
quickly opened the wound with some little hooks we prepared
for the purpose, and turning the child upon its side, respiration
was again established, and after the trachea became clear of
the infiltration breathing became easy, and after the patient
had somewhat returned to consciousness we removed the hooks
and let the wound close. Approximating the lips of the wound
with strips of adhesive plaster, and applying a weak solution
of carbolic acid two or three times a day, keeping the room it
occupied of an equitable temperature as near as possible, also
keeping its bowels well opened, constituted the principal after-
treatment. Notwithstanding some little trouble and difficulty
in keeping the lips of the wound together, the little patient
continued to improve, and is to-day, November 28th (twenty-
six days after the operation), perfectly sound and well. No
subsequent difficulty ensued; no sign whatever of paralysis
has shown itself, and its voice is as clear and good as before the
operation
Recent Progress in Dermatology.
By GEORGE H. ROHE, M.D., New Orleans.
I.— ACUTE EXFOLIATIVE DERMATITIS OF INFANTS.
[Prof. Von Ritter : Central Zeitung fuer Kinderheilluiude, October. 1878. Cesar
Boeck : Viertcljahresai hr. f. Dermatologic u. Svpli. t, 1878. Behrend: Ibid., 2 and 3,
1679.J
In most text-books ou skin diseases may be found an
account of a fatal affection which is described under the name
of “ Acute Pemphigus.” The affection attacks young children
only, runs a rapid course, and is in the majority of cases ter¬
minated by death. Prof. Hebra, of Vienna, and most derma¬
tologists of his school, emphatically deny the occurrence of
o
530 Original Communications. [November
pemphigus iu an acute or epidemic form. Supporting the
views of Hebra, Prof. Von Ritter in an elaborate article,
describes the affection as it occurred under his observation in
the Foundling Asylum of the city ot Prague, and gives it the
name at the head of this article.
The disease first appeared in the Prague Foundling Asylum,
in 1808, since which date it has been almost a constant, though
decidedly unwelcome guest iu that institution ; -97 children
were attacked iu the ten years; of these 150 recovered, 145
died, and the remaining two were still under treatment. Boys
are oftener attacked than girls. The children attacked were
nearly all between two and five weeks old. There is usually a
prodromal stage manifested by abnormal dryness of the integ¬
ument with desquamation of the epidermis, in the form of fine
branny scales. The skin of the lower part of the face, espe¬
cially about the angles of the mouth, becomes red and slightly
tumid. The margin of the redness, which rapidly spreads, is
indistinct, not being sharply defined against the healthy skin.
At the same time the skin at the angles of the mouth becomes
fissured and covered with scabs. The mucous membrane lining
the pharynx and buccal cavity is reddened and the palatal
arch is the seat of superficial erosions, covered by a grayish-
white exudation.
The appetite and digestion of the infant remain unimpaired,
and there is no increase of temperature. The redness and
thickening of the skin extends over the entire body. The face
becomes covered by yellowish translucent scabs upon a red¬
dened base, intersected in various directions by fissures. The
skin becomes wrinkled and the upper layer separates from the
cutis. The epidermis may be detached in large flakes, or is
cast off spontaneously. This process continuing until the en¬
tire surface is denuded of epidermis, presents an appearance
similar to that following an exte isive scalding. In favorable
cases the dark raw-flesh- • olor of the cutis soon gives way to a
lighter red, and in some cases the normal color of the skin is
restored in 24 to 30 hours. In unfavorable cases, on the other
hand, the color is a dirty brownish red, and the cutis becomes
dry and parchment-like. Iu those cases which terminate in
1879J Rohe — Recent Progress in Dermatology. 537
recovery, the normal condition is entirely re-established in a
week or ten days, the skin for a few days being covered by a
tine branny desquamation.
As sequelce of the disease, eczemas of considerable extent,
or pea sized and larger, superficial boils and abscesses,
sometimes in large numbers occur, and delay complete recov¬
ery. At other times extensive phlegmonous infiltrations occupy
considerable tracts of skin, and may result in grangrenous
destruction of tissue and death. In the latter conditions pneu¬
monia and colliquative diarrhoea not rarely precede the fatal
termination.
Relapses are infrequent. When they occur the disease is of
a milder type than originally.
Ritter considers the disease to be a manifestation of py®mic
infection, localized upon the external integument, and some¬
times extending to contiguous mucous surfaces, as the coujunc-
tiva, the mucous lining of the mouth, ete.
The diagnosis is easy, no other disease being liable to be
mistaken for it. In erysipelas, which sometimes affects infants
in a similar manner, there is always considerable elevation of
temperature; this symptom is absent in exfoliative dermatitis.
In pemphigus the bull® are surrounded by a reddish border,
separated from adjoining blebs by healthy integument. In
exfoliative dermatitis the redness and thickening are progres¬
sive and occupy finally the entire surface. The bull® of pem¬
phigus appear in successive crops, while relapses are rare in
exfoliative dermatitis.
The post-mortem appearances present nothing characteristic.
The etiology is unknown. The disease is not contagious. There
is no known means of prevention.
The treatment is purely symptomatic. Sufficient nourish¬
ment of the infant at the breast is of the first importance.
Pure air, the room not kept too warm. Locally, cool baths,
drying the skin with fine soft cloths and carefully avoiding
friction w ill meet the indications in most cases. Ragged and
loose patches of epidermis should be clipped off with the scis¬
sors, and all denuded and fissuied surfaces dusted with finely
538
Original Com municatiom.
[November
powdered calomel. The crusts which accumulate at the angles
of the mouth and render uursiug difficult and painful, are best
gotten rid of by soaking them with oil of sweet almonds and
carefully removing the loose ones by means of a dressing for¬
ceps. Baths of oak bark (80-100 grammes to one litre of water)
one-half of this decoction to be added to each bath, are some¬
times useful. In uncomplicated cases no internal medication
is necessary. All complications will of course receive appro¬
priate treatment.
Behrend gives brief notes of a circumscribed epidemic of the
same disease occurring in a country district in Prussia. He
criticizes the views of Yon Ritter, and groups the cases as
acute pemphigus. In view of the differences in the clinical
history of the two diseases, the name given to the affection by
Prof. Von Ritter and which heads this abstract, is believed to
be most appropriate, being in entire accordance with the en¬
deavors now being made, and nowhere with more energy than
in this country, to give to dermatology a sound and rational
pathological basis.
II.— TRICHORREXIS NODOSA.
[Schwimmer : Vierteljahresscbr, f. Dermatol, u. Syph. 4, 1878, Cheadle and Morris: Lan¬
cet, No.fi. 1879. Sherwell: Archives of Dermatology, July, 1879. Desenne: Bull. Gen. de
Therap. July 15, 1878.1
In 1855, the late Dr. Hermann Beigel, in a memoir read be¬
fore the Imperial Academy of Sciences of Vienna, described,
for the first time, a disease of the hair characterized by the
appearance of little fusiform swellings upon the hair-shaft.
The hair, at the points where these swellings appear, becomes
brittle and breaks easily, the broken ends having a brush-like
appearance. In most cases the hair of the beard only is af¬
fected. In 1872, Devergie and Billi described several cases of
the same disease, to which the former applied the name “ Tri-
coptilcse,” suggested by the eminent philologist Littre. The
name generally adopted by dermatologists at present is that
given to the affection by Kaposi, and which heads this para¬
graph.
The disease, according to Schwimmer, who appears to have
made a thorough investigation, consists in a disturbance of
1879]
Dell’ Orto — The Mature of Contagion.
539
nutrition of the hair, manifesting itself in constriction of the
bulbar portion, partial destruction of the medullary substance,
and the splitting up of the cortical layer into bristly fibres.
The disease is not parasitic. A number of cases have recently
been published in French and English journals under the de¬
signation : “ I'icdras, a new parasi ic disease of the hairy The
weight of the evidence is against its being parasitic.
No treatment hitherto used has been found uniformly suc¬
cessful. Repeated shaving gives the most promise of cure.
The Nature of Contagion.
( Read before the New Orleans Medical and Surgical Association, Sept. 20th, 187P.)
By JOHN DELL’ ORTO, M.D.
The subject that our confrere, Dr. Jamison, has clioseu for
his paper is one of the greatest importance — important to the
physician, the hygienist, and the philanthropist.
To know the nature of contagion means to know how to
attack and destroy the causes of the most terrible diseases that
afflict the human race. The field of discussion is vast, and I
must confess, too difficult for me. My ignorance in this matter
is so much greater thau my knowledge, that 1 should have pre¬
ferred to be here to-niglit as a listener than as a speaker. In
fact, if you ask me for a scientific definition of contagion, I
have to answer that I do not know. How, then, can I intelli¬
gently discuss a subject when the meaning of the word by
which it is expressed is so differently understood by phy¬
sicians? How can I profitably discuss the nature of diseases
and of poisons that are invisible, and which have hitherto
eluded all scientific investigations, and which can only be
detected by their effects on the human body ? Nevertheless,
I will say something, giving views drawn only from practical
facts and by way of induction.
I.
From the Latin tangere, to touch, I call such diseases conta¬
gious as may be transmitted from man to man, from certain
540
Original Communications.
[November
animals to man, and from a sick person to a healthy one com¬
ing in contact with him. This kind of disease comprises many
varieties, and as the nature of contagion in each is essentially
different, I divide them into two grand classes.
1st. Those that are infectious and create epidemics, such as
small pox, scarlet fever, milliary fever, and measles.
2d. Those that never become epidemic, such as syphilis, sca¬
bies, cow-pox, rabies, and malignant pustule.
Now, leaving aside this second class of diseases, and which
really have nothing to do with my subject, I will only speak
of the first class and especially of small pox.
The cause that originates these diseases is an unknown
morbific principle that has the property of reproducing itself
in the human system, as a seed does in the ground, poisons the
blood and communicates the disease to persons who have never
had it before, following a certain constant rule, almost as if it
was performing a physiological function. This communication
from man to man is made either by direct contact, infection or
inoculation from the blood or products of the same constitu¬
tional poison as, for instance, the pus from the small pox
pustule.
The emanations from the respiratory organs, and from the
cutaneous surface of the patients, contaminate the surrounding
air, which becomes impregnated with the poison, and an epi¬
demic follows.
The infection in these diseases always comes from the patients
themselves, and is independent of telluric or meteorological
circumstances. You take a case of small pox and bring it to
any place in the world, in any climate, at any season in the
year, where the inhabitants have never had the disease, or who
have not been vaccinated, and you will certainly cause an epi¬
demic; it does not matter whether the patient resides in the
most elegant and clean mansion of the rich, or in the most
humble and modest cottage of the poor.
The epidemic once established runs a more or less regular
course, as if it was dependent upon a peculiar law; it describes
its parabola and finally disappears. Where does the poison
go If After a lapse of time the disease re-appears. Where does
1S79| Dell,’ Out ) — The Nature of Contagion. 541
the poison (or gar: a if yon prefer the tin no) co ne from ? Hts
it been latent (or hi icrnating if you please) for years ? Is it a
de novo production ? We do not know. So it goes, gentlemen,
these germs are traveling away from the piercing eyes of the
microscopist and defying the most rigid laws of quarantine.
This is the history of every epidemic of these diseases. It is
very easy after the appearance of several cases in a community
to trace the course of the epidemic. But who can tell the ori¬
gin of the first case, the causa causarum ? Here is the problem.
Meantime in the actual state of our ignorance, some propliy-
latic measures must be taken in order to prevent these epi¬
demics, as far as human power combined with the interests of
commercial intercourse can do it. These means constitute what
we call a rational system of disinfection and quarantine. Hap¬
pily the coutagious diseases of which I am speaking are, with
the exception of small pox, not very severe in the majority of
cases. Under proper treatment, and taken in time, they are
easily curable and thus a light disinfection and quarantine may
be sufficient to keep them confined to limited places.
With regard to small pox, I would advocate the most rigid
quarantine, if we had not in our hands, in vaccination , its only
sure and certain preventive. The more I think of this matter,
gentlemen, the more respect and admiration I feel for that
great English philanthropist, Jenner, the discoverer of vaccin¬
ation, as one of the greatest benefactors to humanity, and I
consider as an enemy to our race the physician who is against
it. That there have been abuses, and that very serious mis¬
chiefs may have been the consequences of such abuses, I freely
admit, but this argument must not attack the system, which is
good. Let us fight the abuses ; let us impress upon the minds
of our legislators the necessity of passing laws of compulsory
vaccination -laws providing means for the propagation and
preservation of pure vaccine matter under the sole control of
responsible boards of health. There are dealers in vaccine vi¬
rus, as there are dealers in pork, in artificial milk, etc., on these
the government should keep a constant vigilant eye. This is a
question we would like to see resolved by the National Board
of Health. If we do not mind it may not be long before we
542 Original Communications. [November
are witnesses of the most fearful epidemics of small pox, tri¬
chinosis and cholera infantum. A great deal worse than yel¬
low fever.
II.
There are other diseases, the origin of which may be readily
traced to filthy conditions of certain localities and to putrid ex¬
halations caused by vegetable and animal matters in a state of
decomposition, or other bad sanitary circumstances. A person
living in such a locality may contract these diseases without
coming in contact with a sick person. We find, moreover, in
the fcecal evacuations of these patients certain poisonous prin¬
ciples that may communicate the disease to other persons. I
call these diseases infecto- contagious. Infectious on account
of the origin of the poison outside of the human body ; con¬
tagious by their secretions. These diseases are typhus fever,
typhoid fever, and cholera. I do not speak of the pest, because
I know nothing of it.
Thus epidemics of these diseases may occur both by con¬
tagion and infection, and may exist in every climate and in
every country ; on the top of the healthiest mountains in the
world, as well as on the plains of the tropics.
For their prophylaxis, we should rely more on good sauitary
laws and disinfection than on quarantine. Quarantine, more¬
over, should be more strict against cholera, because it seems
to be more contagious than typhoid fever. These suggestions
in regard to prophylaxis constitute what we call a rational
system of disinfection and quarantine.
III.
Again, we have a third kind of diseases, caused by miasmata
or effluvia from swamps, marshes, ponds, stagnant waters, irri¬
gated lands used for the cultivation of rice, etc., that contain
in their slimes the remains of animals and plants, that become
putrefied by the action of the sun a id of a high temperature.
I call these diseases infectious, because they are the result of
conditions exterior to man : the air is contaminated; the air is
bad; hence the name malaria. Here is the cause of the
disease ; here is the disease itself. A person must live there in
1879] Dell’ Orto — The Nature of Contagion. 543
order to contract the disease. A person sick with the same
cannot originate these miasmata or poisons, and for this reason
they are not contagious.
To this class of diseases belong intermittent or malarial fever
with its multiform and numberless varieties, and yellow fever.
Is the nature of the poison that causes malarial fevers iden¬
tical with that of yellow fever f
I believe not. Dr. T. Selsis, of Havana, whom I consider a
high authority in the matter, says that these fevers are two
distinct varieties of miasmatic poisoning.
The miasma, or paludisums of malarial fevers is more, it is
formed everywhere there are swamp lauds, or plains. The
number of swamp lands situated on the surface of our globe is
countless. In Asia, in Africa, in America, on the borders and
plains of the great rivers, in Europe, in England, in Hollaud,
in Sardinia, in the Eastern and Western Indies, etc., we find
many marshes, where, dur ing the summer season all types of
malarial fevers prevail ; milder in the cold and temperate cli¬
mates, more severe and pernicious in the warmer and tropical
latitudes.
The miasma of intermittent fevers remains limited to the
places, where it originates ; though it may be transportable, it
never goes to great distances ; it seems, that when the malaria
is brought in contact with a purer air, it loses its poisonous
principles; we never hear of imported epidemics of tertian
ague, pernicious fever, neuralgia, etc.
In the miasma that causes yellow fever, the localization is
still more limited to a few particular places than the other.
“ The work of decomposition,” says Dr. Selsis, (1) u of the vege-
u table and animal matter is more active, and requires the eom-
11 bi nation of a higher and constant temperature with certain
u unknown meteorological and electrical circumstances.”
Like the miasma of intermittent fever, the miasma of yellow
fever prevails more in the hottest days of the summer, than in
(1) Cronica Medico— Quirurgia of Havana — March, 1878.
6
544
Original Communications.
[November
winter. It is not contagious. I continue the quotation from
Dr. Selsis, “ but it may be transported to greater distances by
“ the atmosphere, containing the miasmata, capable of causing
“ symptoms of yellow fever in persons who breathe the infected
“ air, and a person sick with yellow fever cannot create these
“ miasmata around himself.”
From the West India Islands, the place, as they say of its
birth, this disease had been carried at different tunes into
other countries, and became epidemic. In the conclusions of
the Board of Experts, authorized by Congress, to investigate
the yellow fever epidemic of 1878, 1 read — Conclusion L8 : u In
“ some of the countries outside of the West Indies, which have
“ been visited by yellow fever, it seems to have established it-
“ self permanently, and to have become endemic, as for exam-
“ pie, in the Brazils.” These gentlemen have forgotten Vera
Cruz, and I will add New Orleans.
Whether yellow fever be indigenous or imported in the
United States, in order that it may become an epidemic, it is
necessary that the above named elements of infection be com¬
bined, almost as they are in the localities of its origin ; it can.
not be propagated by means of contagion. The facts that
we have observed last year, and those that we are observing
now of fugitives from infected places going to the cities of
Louisville, Cincinnati, St. Louis, Chicago, New York, etc., car¬
rying with them the morbific cause of the disease, dying of
the fever in hospitals, in hotels, in tenement houses, without
causing an epidemic, are splendid proofs in favor of this asser¬
tion.
Such also is the opinion of the physicians of Havana and
Yera Cruz. The populations living in the interior of the island
of Cuba and of the republic of Mexico, do not quarantine as
far as I know agaiust those ports ; they only have the good
sense not to go there during the unhealthy season. Yet epi¬
demics in the interior of those countries do not occur more fre¬
quently than here.
The assumption however by the gentlemen in favor of conta¬
gion is borne out by the following facts of some value, to which
I want to call your attention :
1879] Dell* Orto — The Nature of Contagion. 545
1st. Among the symptoms of yellow fever, there are two
pathognomonic of contagion, a sui generis smell and a peculiar
eruption.
A smell, a bad smell may be the cause of infection, more
than of contagion. A strong smell besides is observed in
many diseases that are not considered contagious, as for in¬
stance in the sweats of the patients of malarial fevers, in
dengue, etc.
We acknowledge the appearance in some cases of yellow
fever, especially in children, of a measles-looking-like exan-
tema, but it is not a constant symptom. Many text books do
not speak of it. Dr. Selsis never saw it in a long practice of
22 years. So far then we may consider this eruption mostly as
an accident proper to certain epidemics or localities, than as a
characteristic symptom.
2d. In Montevideo, during the epidemic of 1857(1> a young
and noble physician, Dr. Villardebo, an enthusiastic anti-con-
tagionist, drank the black vomit of one of his patients. A few
days afterwards he died with black vomit.
Here is, they say, the conclusive proof of contagion. Wait
a moment, gentlemen ; Dr. Chevria in Paris, and Fifth, I sup¬
pose in England, made the same experiment with negative
results.
What may be the reason of these different results ? The gen¬
tleman who died had been living for months in an infected
city in the full exercise of his profession, and it seems to me
that the cause of his disease ought to be attributed more to in¬
fection than contagion.
You know already, gentlemen, my opinion on the prophy¬
laxis for yellow fever. I still persist in the same. I said last
winter before this Association, that, rather than be every year
oppressed by the tyrannies of boards of health, some of whom
seem to make of the matter more a question of business, than
of principles, an absolute non-intercourse between the West
Indies and all the ports of the United States, would have been
<l)Dr. <T. A. Lede*m». Reviata. Medioo-Qnirnrgioa de Bueno* Ayree, Angnut, 1878.
54<> Original Communications. [November
preferable. Now, after the experiment of this year, I must say
that even such a measure would not save us againet the fool¬
ishness and nonsense of inland quarantines. This looks sad
and gloomy for the future of New Orleans and for our own
selves. If the hanging theory against sea-captains that has
been lately suggested by a medical member of our board of
health be adopted, what measures will they take against us —
physicians — who are continually in contact with so many foci
of infection ?
IV.
A few7 words on another kind of diseases, the nature of which
is x)er se neither contagious nor infectious, yet they become both
under peculiar circumstances — bronchitis, tonsillitis, dysentery,
cerebro spinal meningitis, erysipelas, gangrena, metro-perito¬
nitis. Nothing more common, more individual, more simple,
more non-contagious than these diseases. Let the atmosphere
be vitiated, and you will see the bronchitis become influenza,
grippe, whooping-cough (which are nothing but epidemic bron-
chitises) ; you will see the angina tonsillaris become pseudo¬
membranous croup (the contagious diphtheria). Let the air of
our hospitals be contaminated by unknown morbific principles,
and soon the slightest operations will be followed by contagious
erysipelas; the gangrena will become nosocomialis ; the metro¬
peritonitis, puerperal fever. How is that ? What has been the
cause ot such a change in the nature of these diseases — of such
a change in the medical constitution, in the clinical field of a
whole population ? We do not know anything. But wre feel,
that of all influences that we receive from the exterior world,
none must have more powerful action on our health than
the air.
Whatever the nature of diseases may be in their origin, it is
only as united to the atmosphere that we can conceive their
breaking into epidemics, and spreading from place to place;
and this propagation must be regulated by those laws which
govern the motions and direction of the winds, the moisture of
the air, and many meteorological and electrical phenomena that
we do not know.
1879]
Current Medical Literature .
547
It is in the study of these laws, we may finally discover the
true cause of disease and epidemics. To obtain such a result
it requires time and labor, it takes men of great learning in
microscopy, in chemistry, in pathological anatomy, in meteor¬
ology, in astronomy. Perhaps, the eminent scientists that the
government of the United States has sent to the Island of
Cuba, will soon be able to throw some light in the darkness by
which we are surrounded about the origin of yellow fever ! Let
us hope that their efforts will be succestful. Why should we
doubt. An accident, an apple fallen from a tree on the head
of a man of genius caused him to think, and the great law of
attraction, which rules the worlds, has been discovered. Per¬
haps, a modern Xewton is among the gentlemen.
In the interest of science, in the interest of humanity, let us
hope and wait.
EDICAL
ITERATURE.
THE PRESENT STATE OF THERAPEUTICS.
Au Address delivered at the opening of the fifty-sixth course of Lectures
in Jefferson Medical School.
By Roberts Bartholow, M.D., L.L.D.,
Professor of Materia Medica and General Therapeutics.
(Reported for the Medical Record.)
I heard, but a few years ago, a very able teacher, himself a
Professor of Practice, declare that if the four great chairs of
Anatomy, Surgery, Practice of Medicine, and Obstetrics were
well filled in a medical school, it was of little consequence who
occupied the others ; and as for Materia Medica and Therapeu¬
tics, any old woman could teach that His was the traditional
old woman who knew how to prepare catnip, tansy, and simi¬
lar teas, and on special occasions could administer castor oil —
an amount of therapeutical knowledge sufficient now for the
leaders of French medical practice, if we may credit some
recent reports from Paris.
Scientific physicians have usually held therapeutics in small
esteem, doubtless, because it had small deservings. In Bichats
time it was a feeling of contempt, which found expression in
his famous declaration : “ Materia Medica is a shapeless mass
of inexact ideas, of observations often puerile, of imaginary
548 Current Medical Literature. [November
remedies, strangely conceived and fantastically arranged.” No
one possessed of any knowledge of the subject, could now, on
examination of the therapeutics of that day, deuy the justice
of Bichat’s denunciation. It was an incongruous mixture of
empirical notions, based on the crude theories of various medi¬
cal philosophies — partly humoralist, partly solidist, partly of
the Italian contra-stimulant school. It embraced the mechani¬
cal and chemical theories of the great Boerhaave, the vitalistic
mysticism and the expectant practice of Stahl, and the solidist
theories of Hoffmann. The whole mass wTas hardly in advance
of that condition of therapeutics against which were levelled
the shafts of Montaigne, the jests of Moliere, and the morbid
fancies of Rousseau. In fact, it was not until the birth of
modern physiology that scientific therapeutics became possible,
and that epoch was at a period within the memory of men now
living. It may seem almost incredible, but it is true, that any
considerable body of scientific facts in therapeutics has been
the product of the last twenty years— for scientific therapeu¬
tics must always follow the course of discovery in physiology.
Even now, there must necessarily be two methods pursued in
advancing the knowledge of therapeutics : the empirical or
rational, and the physiological or scientific. The empirical
method is based on the principal, as ancient as our art, that a
remedy which has cured a case of disease must also cure analo¬
gous cases. The scientific method is the application of phys¬
iological research to ascertain the actions of medicines, and on
this sure basis is predicated the use of remedies in the treat¬
ment of disease.
The inherent difficulties of the subject, it must be admitted,
are in large part responsible for its tardy development. In
part its slow progress is due to an unreasoning conservatism,
which admits of but one road to the acquisition of truth.
Even now there are many so-called practical men who are dis¬
posed to sneer at physiological therapeutics, and to make
themselves unhappy over achievements which experience can
utilize, but has had no agency in accomplishing. They should
reconcile themselves to the inevitable by the philosophy of the
old Spanish proverb : Let the miracle he done, though Mahomet
do it. They should be satisfied with the progress of truth,
though they may not approve of the means by which that pro¬
gress has been achieved.
But the most vehement reactionists are yielding to the
force of therapeutical discovery accomplished by physiological
methods.
Thus, one of the most eminent therapeutical authorities of
our day has declared in a preface written so recently as Octo¬
ber, 1874: “In the first edition of this work the author con¬
tended against the mischievous error of seeking to deduce the
therpeutical uses of medicines from their physiological action.
Continued study, observation, and reflection have tended to
1879]
Current Medical Literature.
549
strengthen his convictions upon this subject, and to confirm
him in the faith that clinical experience is the only true and
safe test of the virtues of medicines.” The same author, in
another work on the same subject, after another five years of
study, observation and reflection, says, in a preface dated 1879 :
“ Whenever it seemed possible, an attempt to apply the results
of physiological experiment to therapeutical uses has been
marie; for although the two fields of inquiry may not be so
organically connected as to render the former a guide to the
latter, it is, nevertheless, true that a scientific explanation of
the curative powers of medicines must be sought in the results
of their experimental operation upon the animal functions.”
Xo revolution of opinion could be more complete; no renun¬
ciation of heresy more absolute. In 1874 empiricism is the true
guide, in 1879 physiological experiment. This, though some¬
what sudden, is significant of a change which is taking place
in the last strongholds of empiricism. Such a quotation must
satisfy the doubts of all — and they are legion— who respect
authority and are governed by its utterances.
I hope I shall not be misunderstood. Far be it from me to
abate one iota of the just fame of the author whose works I
have quoted, or to impute inconsistency in his opinions, or to
cast doubts on the accuracy of his judgments. 1 quote his
words to demonstrate the revolution which has taken place by
the application of the modern, scientific methods, with results
so convincing, that the deepest convictions from wide learning
and extended experince are made to yield. Honor and praise
rather to the honesty of him who can surrender his own cher¬
ished convictions rather than do violence to truth.
Kevolutions do not go backward, and they are apt to be
radical in medicine. Furthermore, it is surprising to what
extent fashion rules current medical opinion and modes of prac¬
tice Do the leaders in medical thought take a certain direction,
their followers pursue pell-mell. This is observable now in the
revolution which has taken place with respect to empiricism in
therapeutics, and in certain quarters there exists a disposition
to ignore all that has been accomplished by it, and to rely
exclusively on the physiological method. This extreme tend¬
ency ought to be resisted in so far as there is danger of putting
aside some of our most valuable acquisitions. Jr is far wiser
to possess us of every aid which either method can otter — to
accept the scientific facts which an exact physiological research
can contribute, and to retain and extend that knowledge, the
truth of which has been confirmed by the experience of genera¬
tions of accurate observers. In fact, when we come to investi¬
gate the subject, we find that the physiological method is not
free from sources of fallacy, from contradictory observations,
from conclusions that subsequent investigations show to be
erroneous. I freely admit that it is less hampered and over¬
grown by errors and contradictions than is the empirical
550 Current Medical Literature. [November
method, but there are uncertainties and confusion which ought,
if possible to be eliminated. The first step necessary is to have
a clear conception of the sources of error, and I lhink we may
spend a part of this hour very profitably in an attempt to
measure them. The important question is : What are the diffi¬
culties in the way of right conclusions respecting the actions
and uses of our remedies, especially their value in the treatment
of disease ?
We may certainly place foremost the imperfections of man —
the limitation of our faculties. Then comes the absence of the
necessary training, or its insufficiency, and the utter lack of
power of logical analysis in many of those who occupy the
position of authorities. The mental defects and raults of train¬
ing can never be overcome. “ In the conduct of life,” says Mr.
Mill, “ wrong inferences and incorrect interpretations of experi¬
ence, unless after much culture of the thinking faculty, are ab¬
solutely inevitable ; and with most people, after the highest
degree of culture they ever attain, such erroneous inferences cor¬
rect interpretations of experience.” Such being the case, it is
not surprising that in a matter so beset with fallacies as the
estimation of the curative power of a remedy, that there must
be few qualified by natural powers, and by training for the
task. The best equipped and most carefully trained intellect
may not possess the power of observation ; it may be unerring
in the conclusions formed from the facts submitted, but the
faculty of discernment, of seeing things as they exist may be
deficient or inaccurate. That which Mr. Hill calls “ mal obser¬
vation,” consists in “ something that is not simply unseen, but
seen wrong.” With the best intentions, the purest conscien¬
tiousness, men making observations — tiaiued observers — differ
surprisingly in their accounts of events occurring on a partic¬
ular occasion. A capital illustration of this fact has been
afforded by the discrepant accounts from the observers of the
corona ami solar protuberances Observed witli the same in¬
struments under the same conditions, the various operators
have differed widely, with the usual result of heated contro¬
versy. An ingenious theonzer has shown that the difference
lay in the eyes of the observers : some were astigmatic, myopic,
etc. As in Turner’s pictures, the artist’s oddities appeared
when he had lost somewhat his appreciation of the harmony of
colors. Not long since Klein saw, in investigating the changes
in typhoid, a minute organism which seemed to have an im¬
portant relation to the genesis of this disease, and there was
much enthusiasm expended over the discovery, but in a few
months a terrible iconoclast disposed of the discovery at one
blow, by showing that the supposed organism was nothing
more than a bit of albumen, altered by the reagents used in
making tfie preparation. Hew much easier to form accurate
conceptions, and give correct descriptions of things submitted
to the evidence of our senses, than the phenomena arising from
1879]
Current Medical Literature.
551
occult processes in the body. Unfortunately, many of those
occupying the position of authorities, always discern that which
their preconceived opi 1 1 ions led them to search for ; other observers
look at facts with vision tinted by what Mr. Spencer calls the
“professional bias;” in a variety of ways, the thing is not
simply unseen, but seen wrong. The salutary lesson which we
learn from this is: we cannot be sure that the things which we
suppose we see are actually before us, and the other and higher
lesson of patient waiting and study of our supposed facts, and
comparison of them with the facts of other observers.
If we observe correctly as to the range of utility of a medi¬
cine, we may fall into error in its use by ignorance of the nat¬
ural behavior of the disease in which it is exhibited. Before
any exact knowledge was possessed of the natural history of
diseases, it. was simply impossible to be accurate in respect to
the intlueuce of medicines over them. Before it was known
that a crisis occurs in pneumonia somewhere from the fifth to
the eleventh day, endless were the controversies as to the influ¬
ence of remedies in bringing this crisis about. How valueless
became all those discussions, carried on with such earnestness
and heat, when the natural history of pneumonia was made
out, and it was discovered that medicines had never produced
the crisis, which is an entirely natural process. Most important
additions have been made to the natural history of diseases
within a few years past, and we have now a sure point of depar¬
ture for the investigation of the future. I affirm this, notwith¬
standing the pessimistic declaration of Dr. Andrew Clark,
made before the medical section of the British Medical Associ¬
ation at their last meeting at Cork. He declares that “ of the
natural history of most chronic diseases — of their course from
first to last; of the modes in which the organism, uninfluenced
by drugs, and favored only by the conditions of health, deals
with these maladies in their origin, in tlieir modes of progres¬
sion, in their influence upon other parts, and in their issues
either in recovery or in death — we know almost nothing, and
certainly not enough for the commonest purposes of therapeutic
art.” The wholesale icouoclasm of this address is everywhere
remarkable, but in nothing has his zeal so outrun his discretion
as in these statements. 1 need mention but two classes of
chronic diseases to demonstrate the error of his statements —
the chrouic cardiac and renal affections — in regard to which we
know their course from first to last, and how the organism, un¬
influenced by drugs and favored only by the conditions of
health, deals with these maladies in their origin, in their modes
of progression, in their influence upon other parts, and in their
issue either in recovery or in death.
It may seem a comparatively easy task to determine how far
the mind influences the bodily functions in modifying the phe¬
nomena of disease, but it is extremely difficult to measure the
7
552
Current Medical Literature.
[November
operations of a force whose nature and source are unknown,
and whose powers are exercised capriciously, and without tbe
reign of law. A curious and most interesting book, compiled
by Dr. Take, has lately been published, in which are brought
together more thoroughly than ever before the facts scattered
through medical literature, illustrating the influence of mental
states on bodily functions. No one can peruse this book with¬
out being strongly impressed with the uncertainty which must
attend our estimate of the influence of remedies in all of those
conditions of disease over which a peculiar mental force may
exert a far greater curative power. Everybody has been more
or less familiar with the well-attested facts which have existed
on this point, but when they are brought together, ana¬
lyzed, and their lesson comprehended, we are simply amazed to
find that many morbid states, which medicines have failed even
to modify, are removed or cured by a force emanating from the
mind. If this mysterious force moves, how impossible to form
a correct judgment of the share which a medicine or a plan of
treatment had in the result.
When Sir Humphry Davy, then a young man unknown to
fame, was employed by Dr. Beddoes to make observations with
nitrous oxide, among the patients who presented themselves
for treatment was a paralytic. Before commencing the inhala¬
tion of the gas, Davy inserted a thermometer under the patient’s
tongue to ascertain the influence of the gas on the temperature
of the body. The patient was greatly impressed with the mys¬
terious little instrument, and declared, with much enthusiasm,
that he felt the influence pervading his entire frame, and was
already much relieved. Davy, observing the remarkable influ¬
ence of hope and expectancy, did nothing more than gravely
insert the thermometer day by day with surprising results, for
in a short time a complete cure was affected. If Davy had
administered the nitrous oxide, the case would have appeared
in medical annals as a cure of paralysis by the gas.
When a religcuse , in Cincinnati, with prayer and fasting, and
after a solemn service in which all of her sisterhood partici¬
pated, threw herself at the foot of the altar and would not rise
until healed — behold ! an ulcer of the leg. resisting all other
means of treatment — was cured by some drops of water coming
from the far-off, mysterious and sacred spring of Our Lady of
Lourdes. In the one case it was a mere impression on the mind
without the element of religious faith — a mere dependence on
the efficacy of dumb glass; in the other a profound religious
sentiment, than which nothing more powerful can sway the
human heart — and yet the result is the same.
When we come to analyze the examples of diseases cured
by powerful impressions, emotions, faith, hope, expectant at¬
tention — whatever the nature of the mysterious force — we find
that the cases can be referred to one of two classes : to func¬
tional morbid states of the nervous system, or to alterations of
Current Medical Literature.
553
1879]
structures — organic changes they are called —brought about
through the agency of the trophic nervous system. Everybody
is familiar with the plentiful examples of the first group, and
the second needs no explanation to Philadelphia physicians —
for in this city work has been done that has materially ad¬
vanced the knowledge of this subject. In these two large and
important groups of diseases, so much does the cure depend
on merely physical impressions, that it is difficult — often quite
impossible — to determine how far the mental state, how far
the remedies employed, contributed to the result. The practi-
titiouers of that medical jugglery who cures diseases by prayer
and the imposition of hands, or by the gifts of the natural
healer, understand full well the form of malady suitable for
their powers. There is now in the State of Massachusetts, a
preacher-doctor who cures by prayer and the imposition of
hands — the apostolic method — and therefore denies to his
grateful patients the privilege of recompensing him except by
voluntary gifts. The pecuniary outcome of his benevolence is
something remarkable, for he has now built up around him on
his domain of several hundred acres, a number of stately dwel¬
lings for the reception and care of the thousands going to him
from all parts of the United States. A patient of mine— a gen¬
uine Christian and a woman of the highest excellence, though
somewhat credulous and a little superstitious — having heard
of the wonderful cures wrought by this Massachusetts apostle,
resorted to him. I had from her own lips the story of her ex¬
perience. She told the great man that she was a firm believer
in the efficacy of prayer, having met with many examples, and
that she had come all the way from Ohio to be cured of an or¬
ganic affection of the heart. When the doctor- preacher heard
the nature of the malady he made a reply, in which, astonish¬
ing as it may seem, she saw no incongruity. He said : “ My
experience is, that the Lord rarely, if ever, interferes to cure
organic disease of the heart.” Nevertheless, he expressed a
willingness to try, as she had come so far, and, with hands on
hers, he did pray fervently, in which she joined as fervently,
for half an hour at a time on three days ; but my patient ex¬
perienced no relief, and came home the worse for the moral strug¬
gle which she had undergone. My client, as did all who came, it is
probable, left a considerable fee in the form of a gift, and was
not cured of her delusion, for she heard of numerous miracles
that had been wrought there, and she witnessed on all sides
the evidences of worldly prosperity; and she may have in¬
spected, for aught I know, the arsenal of crutches, canes, and
ear trumpets which these artists exhibit in proof and confirm¬
ation of their powers.
When anaesthesia by the inhalation of ether was demonstrat¬
ing in the Massachusetts General Hospital, Dr. Eliottson, of
London, was engaged in a far more wonderful work, teaching
the great lesson, that in a mesmeric sleep surgical operations
Current Medical Literature.
[November
554
can be performed without consciousness of pain. So zealously
and completely, although in the face of much obloquy, had
Eliottsou succeeded iu convincing sceptical and conservative
London of the genuineness of his work, that the discovery of
the production of anaesthesia by the inhalation of ether was
announced in the Medical Gazette under the heading, “ Animal
Magnetism Superseded.” Up to this time the capital opera¬
tions in surgery were almost daily performed in London whilst
the patients were unconscious iu the so-called mesmeric sleep.
Although Eliottsou misinterpreted the phenomena which he
observed, and became involved hopelessly in the absurdities
and mysticisms of Mesmer, he was nevertheless engaged in the
demonstration of important truths. If time would allow, I
might enter more fully into that remarkable state in which
there is a suspension of the methods of consciousness, and
show, indeed, that the recent observations of Ozermak and
others on animals, is an experimental induction of the same
state. It seems, indeed, that the condition of the brain in
which a peculiar curative influence is exerted over morbid pro¬
cesses, is the opposite of that state in which the activity of the
perceptive and volitional centres is in absolute suspension.
Closely allied to this subject are the remarkable phenomena
of JBurqism, or inethallotherapy, which at first excited the ridi¬
cule of the scientific, but which seem now likely to contribute
to our knowledge of this outlying department of mental and
nervous processes. The results obtained by Burq, and espe¬
cially by Charcot, are such as to merit the close attention of
therapeutical investigators, and must, if confirmed, enter into
the question of the curative power possessed by certain rem¬
edies.
We constantly hear physicians complaining that the pub¬
lished results of others, in respect to the utility of a particular
plan of treatment, cannot be realized in their own experiences ;
that, although Davy cured paralysis by the inhalation of
nitrous oxide, they cannot succeed, although they have care¬
fully observed all the conditions of the experiment. They
entirely overlook the fundamental fact that one physician sum¬
mons to his aid the mysterious mental force in hope, faith, ex¬
pectant attention ; and another represses it, not consciously to
himself, by a lack of personal enthusiasm, aud still more by a
lack of confidence in his own powers and in the power of his
remedies — fatal defects in the character of the physician which
will not escape the keen scrutiny of the anxious patient. 1
will not use the vulgar term “ personal magnetism,” for it has
no meaning, and the power is not a magnetic quality or power
— not a mysterious gift possessed by the chosen few. That
which inspires a supreme, unquestioning, all pervading belief
in the efficacy of the means proposed, is a reflex of the confi¬
dence of the physician — not a boastful, self-asserting egotism,
not the blind faith of ignorant credulity, but the well-founded
Current Medical Literature.
555
1870 J
convictions ot‘ the enlightened therapeutist, confident in his
resources from long experience of their capabilities. u The
Lord is on the side of the heaviest battalions,” was a favorite
sayiug of the great Napoleon. I hope I shall not be under¬
stood to speak in an irreverent spirit. My purpose is to illus¬
trate the lesson, that u God operates, not by partial, bat by
general laws that He gives us the faculties to acquire and to
apply knowledge in the treatment of disease ; that He does not
suspend the laws of nature for our benefit ; and that those
cures which seem miracles are entirely human and easily ex¬
plicable.
We derive from the whole subject the important lesson that
we have in a peculiar mental state or condition of the great
nerve-ceutres an extraordinary curative power in a large group
of diseases, and that in this fact lies one of the greatest sources
of fallacy in estimating the value of remedies. Furthermore,
it must be obvious that the physiological as well as the empir¬
ical method — that both methods are embarrassed by wrong in¬
ferences and incorrect interpretations of experience.
The progress of applied therapeutics is equally hindered by
the sources of error which I have pointed out. The end to
which all our studies are directed as practical physicians is the
application of remedial agents to the cure of diseases. An
unprejudiced thinker to whom the subject was mentioned
would assert with confidence that gentlemen engaged in a pur¬
suit requiring the use of certain agents to accomplish the
desired results, would be most solicitous to inform themselves
fully in respect to those agents. He would regard it as incred¬
ible that a considerable part of our profession are either indif¬
ferent or satisfied with vague notions, and that a still larger
part fall into routine methods with a few agents which have
to do duty for all possible conditions. This wide spread inap¬
preciation, indifference, or ignorance of the actions a id uses of
drugs is due partly to fashion, partly to the unpromising nature
of the subject. Within a few years past a therapeutical nihil¬
ism has been the position occupied by many of the most influ¬
ential leaders in modern medical thought. This movement is a
result, in part, of the overshadowing importance of physiolo¬
gical and pathological studies. The founding of great labora¬
tories and the brilliancy of discovery in these departments
have attracted universal attention to those studies which have
become the fashion. We see on every side the efforts put
forth to give this direction to medical study and teaching. The
desire of the time seems to be lo make students, histologists,
pathologists, microscopists, rather than sound practitioners,
full of the humble but necessary knowledge of the practical
departments of our art and science. I hold this to be a perver¬
sion of the duty of a medical school. Its first and highest
duty is to instruct students, not to pursue minute researches,
but to become thoroughly accomplished physicians and sur-
556 Current Medical Literature. [November
geons. No fact is more evident than that the highest order of
physicians and surgeons are not men remarkable for their
knowledge of microscopy, of experimental physiology, and the
other branches of theoretical medical science, and, conversely,
that the microscopists and pure physiologists are not remarka¬
ble as physicians, and, indeed, cannot be. The attempt to per¬
vert the proper purpose of medical schools, and to give a
merely science aspect to medical teaching is a fashion of the
time, which, if it gain more adherents, is likely to do serious
mischief to the cause of medical education. For young men,
allured to by thi glitter of scientific work, will neglect the im¬
portant and really more difficult attainments of true profess-
sional studies.
It is a mere pseudo-science which is misleading so many that
it has become commonplace to know something about drugs
and to prescribe them ; the new school of pathologists and
physiologists look upon the whole business of medicine giving
as unscientific, and therefore unworthy the attention of the
higher order of medical thinkers. It is a very fascinating doc¬
trine, that to be ignorant of drugs is to be regarded as superior
to the commonplace — as being in the higher walks of medical
life — and hence many make haste to adopt it, relying for the
hereafter on mint-water in the treatment of rheumatism, and
similar nihilistic absurdities. The great question of the time
is, does it pay ? Applying this utilitarian method to the sub¬
ject, T answer, it does not pay to be ignorant of therapeutics,
and l prove my position by some illustrative examples selected
from those recently deceased, so as not to be accused of mak¬
ing invidious comparison. The most successful physicians
Paris, Vienna, Berlin, London, Edinburgh have had for a gen¬
eration, were Trousseau, Oppolzer, Traube, Todd, Begbie — all
of whom were most careful students of therapeutics, have con¬
tributed to our knowledge of the subject, and were diligent
prescribers of remedies. These great men were not only suc¬
cessful teachers and clinicians, but had great local renown as
practitioners, and each had a large clientele. I beg you will
not, therefore, be misled by the depreciation of therapeutics by
presumed medical scientists, who are not sufficiently scientific
to feel their position assured, but must manifest their superi¬
ority by speaking contemptuously of the so-called practical
branches. Sum is sometimes taken for habeo , is an eccentric
rule of Latin grammar which is very applicable to the affairs of
modern life, and may have been and doubtless was, strongly
felt by the old Romans. To have is to be. Applying this rule
to the utilitarian side of the question, you may be well assured
that io have a competent knowledge of therapeutics is to be a
successful practitioner.
Many who have started out on a medical career with a com¬
petent knowledge of therapeutics have been disheartened by a
failure to obtain the expected results. Failures of this kind
Current Medical Literature.
557
1879]
arise from two causes : first, from an incorrect appreciation of
what nature and art respectively accomplish ; and second, from
an inability to make a correct therapeutical diagnosis. The
rage in our time is to make an accurate diagnosis of disease,
and it is an enthusiasm to be encouraged, but there ought to
be a corresponding desire to make an accurate therapeutical
diagnosis — that is, to ascertain the remedy adapted to the form
and character of the disease and the condition of the patient.
Into this problem many complex questions enter, and he only
can solve it correctly who has an intimate acquaintance with
the phenomena of disease, and with the whole range of rational
and scientific therapeutics.
What art, what nature can accomplish, is a wide subject
which I must merely mention. It is a singular fact that but
few young physicians, comparatively, recognize the limits of
remedial power. The result is that they may begin with a
blind, unquestioning faith, but they end with an unreasoning
scepticism.
Having now dwelt on the method and spirit in which thera¬
peutics should be studied, as much as my time will allow, I
must next say something of the manner in which it should be
taught.
Confronted at the outset of his career with the subjects of
materia medica, a student may well stand appalled. A subject
which embraces the mineralogy, the chemistry, the botany, the
pharmacology of several hundred articles belonging to the three
great kingdoms of nature, would seem to require the undivided
attention of a life given to the task. The student of medicine
canuot become sufficiently well informed in these sciences to
utilize them in the study of the materia medica, and at the same
time devote sufficient attention to his strictly medical studies.
The result is, he abandons an undertaking which seems to him
hopeless, cuts the subject of materia medica, and contents him¬
self with the fewest possible facts in therapeutics. He enters
into practice with crude notions, and is given to a boundless
credulity respecting the curative powers of drugs, or he culti¬
vates a sceptical dillettanteism, or becomes a sceptic, affecting
a patronizing forbearance for the weakness of those who have
faith in remedies. The condition to which practitioners are
now reduced in Paris is gravely stated in a letter which appears
in a recent issue of the Lancet — so gravely that it can hardly
be regarded as satirical : u No wonder therapeutic scepticism
is now the rule with prescribers. Thanks to the enterprise of
wholesale druggists, a host of elegant preparations are always
at hand, which relieve the scientific clinicien from the ridiculous
absurdity of writing a useless formula. Now that diseases are
allowed to run their normal course under the watchful eye of
the medical naturalist, the exhibition of an inert, but elegant
granule, must be considered a vast improvement upon the
active interference of oui- physicking forefathers.’'
Current Medical Literature.
558
[November
No wonder that, at a recent meeting- (last month) of the Paris
Academy of Medicine, there were loud demands for reform. No
wonder that Dr. Andrew Clark, in that recent iconoclastic
address from which I have just quoted, cries out that therapeu¬
tics, “ the highest department of our art, and one of its chief
ends, is in a backward and unsatisfactory condition.” He
attributes this unhappy state of things to several causes; but
the first is, that materia medica, not therapeutics, is taught in
the schools, and that there is “ no physician of experience and
authority who teaches the subject of therapeutics.”
Where must the reformation begin ? Obviously the reforma¬
tion is demanded in the direction which I have indicated, and
which Dr. Clark so vehemently emphasizes.
We must begin by stripping the materia medica of its use¬
less knowledge. We must relegate to the botanist, to the
chemist, to the pharmacist, the subject matters belonging to
them, and retain those things having connection with the
study and work of the physician. I can best illustrate this by
an example selected from the vegetable kingdom : let it be nux
vomica. We have first the names — botanical and chemical.
Then follows the source and botanical description, which is
Sanscrit to the average student, and knowledge without any
use to the practitioner as such. Next comes the pharmaceu¬
tical preparations, and a description of the mode of preparing
the tincture and extracts, and an elaborate account of the sep¬
aration of the alkaloids — a complexus of chemical and pharma¬
ceutical knowledge of great utility, indispensable, indeed to
the pharmaceutist, but useless to the physician, who is not en¬
gaged in the business of a manufacturing chemist, and who
cannot acquire this knowledge unless at the expense of his
proper professional education. The best students who make
the attempt to master the details of materia medica, acquire
but a vague notion of it, and drop the study as soon as possi¬
ble, except the few who expect to combine the business of
pharmacy with the practice of medicine — a union which al¬
ways results unhappily, and is not to be approved.
Dr. Clark complains in his energetic way that our works in
this department consist of materia medica teaching largely,
whereas they ought to be devoted to therapeutics only. This
is an extreme view to which 1 must decidedly express my dis¬
sent. There is certain knowledge of pharmacy and chemistry
which is necessary to accurate prescribing, and which must be
taught, if we would use our therapeutical knowledge intelli¬
gently. We must know the names of the drug, the forms and
preparation in which they are compounded, the active constitu¬
ents, the doses, the antidotes chemical and physiological, but
especially must we have full and accurate information in re¬
gard of the effects of the remedies and their uses in the treat¬
ment of diseases. All of this knowledge is immediately appli¬
cable to the requirements of the physician, and no part of it
Current Medical Literature.
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1879J
can be omitted without injury. I hold that the actions and
uses of remedies is the point on which the greatest stress
should be laid, and no information, empirical or physiological,
should be neglected. Let the student have the minutest in¬
formation from all possible sources of the physiological powers
and capabilities of a drug, its behavior as influenced by idio¬
syncrasy and dose, its applications in the treatment of disease,
the fallacies which affect a proper estimate of its powers, the
special conditions in which it is useful, why it should be pre¬
ferred to another remedy of the same class, and in fact any in¬
formation in regard to it which may facilitate the physician’s
use of his armamentarium. The artisan is taught the name of
the tool, the range of its uses, the mode of handling it under
special circumstances ; but he is not expected to acquire the
mineralogy of iron and the chemistry of steel — subjects con¬
cerned with its original construction.
The information which a teacher must convey to a class is
derived from two sources; from a study of the authorities who
have contributed to the subject ; from his personal experiences
and reflections. The literature from which he gleans is a wide
field and contains a multitude of workers, who differ in ca¬
pacity, in acquirements, in honesty. The instructor may pur¬
sue two methods in imparting his information : he may present
in order, chronologically or by subjects, a synopsis of the con¬
tribution of each individual worker ; he may subject the whole
to a careful analysis, weigh the merits and truthfulness of in¬
dividuals, and present the results in the plainest language.
The former plan confuses the student with a multitude of
names and opinions that vary and are often contradictory ; the
latter gives nim some salient points on which he may lay hold.
I maintain that the latter plan is the true one — that it is the duty
of the instructor to analyze the complexus of facts and opin¬
ions — to guide the intelligence of the student through a maze
to right conclusions. Those who wish to engage in investiga¬
tions on their account are either advanced students or gradu¬
ates, who possess the knowledge necessary to find their way
through the labyrinth.
I hold, further, that the instruction should be, as far as pos¬
sible, objective or demonstrative. The lecturer may content
himself with stating that drugs will produce certain results —
that stiychnia will cause tetanic spasms, and that conia will
paralyze — and he may illustrate the action of strychnia by an
exposition of some famous medico-legal case, as the poisoning
of Cook by Palmer, and the action of conia by recounting from
the Phaedro of Plato the death of Socrates; or he may at the
moment demonstrate the effects of the drug by an experiment
which makes the fact memorable in the student’s mental expe¬
riences. The chemist who merely tells his students that water
is composed of oxygen and hydrogen, and does not demon-
Current Medical Literature.
5(K)
[November
strate it by experiment, will hardly have done his duty. The
experiment vivifies the bald fact, and the impression is made
permanent. But how demonstrate your therapeutical facts?
This brings me face to face with the great vivisection question.
Though an advocate for rightly conducted vivisections, I pro¬
test against cruelty to animals, who are God’s creatures. I
protest against those barbaric sports in which more animals
suffer yearly — hunted to death — than have in all time been un¬
der the knife of the vivisector. More than all, I protest against
that inhumanity to man — the outcome of an unreflecting senti¬
mentality-- which prevents those scientific investigations hav¬
ing for their end incalculable benefits to man. Some of our
most important remedies and physiological knowledge of the
highest importance have been, and only could have been, ob¬
tained by experiments on animals. If animals are sacrificed
for the support of men’s bodies, why should they not contri¬
bute to the improvement of men’s minds ? Your sentimental
philosopher does not reflect on the humanity of the butcher,
except for the toughness of his matutinal steak. Not to oc¬
cupy further time with well-known arguments in favor of vivi¬
section, 1 hold that the actions of drugs should be illustrated
as far as practicable by experiments on animals, but the exper¬
iments must be decorous, not revolting, not cruel, and made
strictly to advance or impart knowledge for the benefit of our
fellow men. In these experiments animals have small occasion
to suffer, for the medicament or the anaesthetic so far obtund
the sensibilities of the centres of conscious impressions that
pain is not felt.
Why torture dumb brutes by experiments, which after all
cannot be utilized in the treatment of men’s diseases; for has
it not been shown that the actions on men and animals differ —
that rabbits eat belladonna with impunity, and pigeons cannot
be affected by opium l 1 might explain to you how idiosyn¬
crasies exist in men and animals alike, and are usually more
apparent than real ; but let me answer your objections by a
quotation from the most competent authority of modern times
— Claude Bernard, lie declares in that remarkable work —
“ Introduction to Experimental Medicine” (p. 218) — that “ex¬
periments on animals with deleterious and noxious substances
are very useful, and perfectly conclusive for the hygiene and
toxicology of man. The researches on medicaments or poi¬
sons are equally appliceble to man from the therapeutical
point of view, for the effects of these substances are the same
in animals as in man, except the difference in degree.” This
opinion, based on the largest experience, and after a career of
brilliant discovery, might be illustrated and enforced, if I had
the time, by the examples of benefits to the race obtained in
this way.
The crusade against vivisection in England, which has at¬
tained extraordinary volume and force within a few years past,
Current Medical Literature.
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1879J
is an outgrowtli of dog-worsliip, which has now become a form
of religion in the upper classes of society. With hair perfumed,
powdered, and curled, his canine worship sits at table with his
mistress, rides in the park in the afternoon, sleeps on downy
pillows at night; he has his maid to anticipate his wants, be¬
sides the undivided attention of his mistress, and when ill he
is waited upon by a celebrated physician. He makes no return
to society for the protection and benefits he receives; he pays
no taxes; he merely barks and growls in return for the love of
his mistress, and is altogether an ungrateful dog ; blithe has
driven physiological research out of England, and the gentle¬
men who were engaged in an important series of investigations
on the biliary secretion were compelled by him to go over to
France. An epidemic of hydrophobia and the loss of several
titled ladies will be necessary to prevent the apotheosis of the
dog, and to put vivisection in its proper position — for a cure for
hydrophobia can only be arrived at by experiments on this at
present distinguished member of society. — The Medical Record.
THE TREATMENT OF POST PARTUM HEMORRHAGE.
This brings me to the discussion of the agent to which I wish
to call the attention of the Fellows of this Society as the remedy
for post partum haemorrhage, occurring under the conditions I
have laid down, and in cases when the ordinary remedies of
friction, pressure, ergot, cold, etc., etc., have failed. This
remedy is common vinegar. I claim uo originality in suggest¬
ing it. I will merely state that I have used it, alone, as my
last resort, both in hospital and private practice, in many
(apparently desperate) cases of post partum hemorrhage, and
invariably with successful results. I have taught the use of
vinegar to my classes since 1854, and though 1 am in constant
receipt of reports of cases from my former pupils in which they
have relied on vinegar — often, in seemingly hopeless condi¬
tions — in all these years I have received the report of but one
case where the remedy failed to check the hemorrhage. In
this instance, my friend happened to have access to a galvanic
battery, and the electrical current at last proved the needed
stimulant to secure uterine contraction.
Vinegar I have found not only a certain remedy for post
partum hemorrhage, but a remedy as safe as it is certain to
cure. In the many very bad cases where I have used it the
hemorrhage was always arrested, and in but one instance did
the woman subsequently die, and in this case neither T nor the
immediate attendant (my friend Prof. John Neill) had any
reason to attribute the woman’s death (neither did we) to the
vinegar I had used to check a most appalling case of flooding.
In the many reports which I have received from my former
pupils on this subject, I have yet received none where any
unfortunate results have followed the application of vinegar.
562 Current Medical Literature. [November
Vinegar presents trie following advantages as an invaluable
remedy in the treatment of obstinate eases of post partum
hemorrhage, where the difficulty to be overeome is a want of
shrinkage in the uterine muscle. In the first place, it can
always be obtained — every household, even the humblest, hav¬
ing a vinegar cruet. In the second place, it can be applied
instantly, and without any apparatus. In the third place, it
always cures the hemorrhage, or rather, I should say, it has
never failed to do so in my practice. It is sufficiently irritat¬
ing to excite the most benumbed and sluggish uterus to con¬
tract, while, at the same time, it is not so irritating that its
subsequent effects are injurious. Fourthly, it is an admirable
antiseptic. Prof. Zweifel, of Erlangen, in his recent paper on
the prevention of puerperal fever, considers vinegar an excel¬
lent substitute for carbolic or salicylic acids. (l) Fifthly, it acts
on the lining membrane of the uterus, and on the gaping orifices
of the torn utero placental vessels as a valuable astringent.
Vinegar I suggest, then, to the Fellows of this Society, as a
most valuable remedy in post partum hemorrhage depending
on inertia, possessing the advantage of the solutions of the
persalts of iron, of the tincture of iodine, and, may I not add,
even also all the advantages of the actual cautery ; while its
use is attended by none of the difficulties, and followed by none
of the dangers that attach to these remedies.
I have just stated that vinegar may be applied instantly and
without apparatus — perhaps I should mention precisely my
method of using it. I pour a few tablespoonfuls into a vessel,
dip into it some clean rag or a clean pocket handkercliiei. I
then carry the saturated rag with my hand into the cavity of
the uterus and squeeze it ; the effect of the vinegar flowing
over the sides of the cavity of the uterus and through the
vagina is magical. The relaxed and flabby uterine muscle
instantly responds. The organ at once assumes, what J will
term, its gizzard -like feel, shrinking down upon and compress¬
ing the operating hand, and in the vast majority of cases all
hemorrhage ceases instantly ; should one application of vinegar
fail to secure sufficient contraction, the hand can be withdrawn,
and a second or even a third application can be made, until the
uterus shall contract sufficiently to stop the flow of blood.
Had I time, it would have been desirable to discuss this
interesting subject at greater length and more completely.
Thus it may be asked, suppose you should meet with a case of
hemorrhage where vinegar failed to excite sufficient uterine
irritation, and, consequently failed to arrest the flooding — what
should be done H My reply is, that, while such a case is sup -
posable, it is extremely improbable. I have never met with
one, and but one has been reported to me. My treatment,
however, in a case where vinegar failed, would be at once to
(1) Monthly A bstract of Medical Science, June, 1878.
1879]
Current Medical Literature.
563
resort to the application of the solution of the persalts of iron.
I should do so, too, with confidence that the remedy would stop
the hemorrhage, but, at the same time, 1 should consider my
patient placed in great additional danger by the use of my
cure, and I would employ it only on the ground that desperate
diseases justify the employment of heroic measures. If this
view be accepted, we are to consider the persalts of iron as the
last and extreme remedy to be resorted to in case of flooding;
never to be used save in those cases of uterine inertia where
the simpler and safer remedy of vinegar has failed ; and, inas¬
much as vinegar seldom or never fails to cure uterine inertia,
the persalts of iron are seldom or never to be employed in its
treatment. — [Dr. R. A. F. Penrose, Gynecological Transactions ,
Volume 3.
QUININE FOR HYPODERMIC USE.
The following is the preparation preferred in the Hamburg
General Hospital :
R. Quiniae rnuriatis.
20 parts
12 “
3 “
Acidi muriatici,
Urae,
The salt thus formed is soluble in equal parts of water, and
hence large doses can be given by the hypodermic syringe.
The quantity of this 50 per cent, solution injected varied
from a half to three syringefuls. The local irritation conse¬
quent on the injection was in most cases very slight, and at
most consisted in a circumscribed burning pain (which was soon
relieved by cold Goulard water), without redness or swelling.
Doses of a gram produced in men scarcely any subjective sen¬
sations, and the noises in the ear complained of by women and
children soon disappeared. The anti-febrile effects were evi¬
dent and certain, iutermittents disappearing after the second
or third injection. This form of administration seems especially
indicated (1) in those sensitive persons who have an invincible
objection to taking quinine by the mouth ; (2) when gastric af¬
fections coexist; (3) in children; and (4) in hospital and pau¬
per practice, as a much smaller quantity of quinine is required
than when it is administered internally. — Medical and Surgical
Reporter , September 20.
HOT APPLICATIONS TO THE HEAD IN UTERINE HAEMORRHAGES.
The anaemia of the brain is one of the most dangerous symp¬
toms in acute haemorrhage ; hence Schroeder recommends to
put the head of the patient low. Others recommend transfu¬
sion, some Esmarch’s apparatus on the extremeties (Moeller),
and nitrate of amyl has also been highly spoken of, in order to
force more blood in the anaemic brain.
564 Current Medical Literature. [November
Koehler used for the last seven years hot applications to the
head, in order to remove anaemia from the brain, especially as
the brain is considered the chief factor of life. At the same
time hot applications may be put over the cardiac region. As
sand is nearly always handy, he prefers hot sandbags. The
patient bears well sand of such high temperature that the hand
can hardly hold it. The sandbags are hardly applied when
consciousness returns, the pulse returns and becomes stronger,
the patient acknowledges to feel better, the dimness before the
eyes and the surging in the ears disappear, and as the heat in
the bag declines she requests another hot one. Even in most
desperate cases Dr. Koehler saved thus the life of his patient.
There is no time lost, inasmuch as any person can attend to it.
In acute anaemia, in consequence of epistaxis, the same treatment
succeeds. Let us discard the ancient horrible icebag in anaemia
from acute haemorrhages. The patient wants heat, it feels
agreeable to her, let us respond to this call of nature. — AUg.
Med. Cent. Zeitung , 2, 1879. —Maryland Medical Journal. — Nash¬
ville Journal of Medicine and Surgery, September, 1879.
THE POISON OF THE TOAD.
The common garden toad is well known to secrete an acrid
and irritating fluid in the large warts on its back; but that this
ever produces fatal results has not been believed. Neverthe¬
less, the London Medical Record reports the case of a child, of
six years old, following a large toad on a hot summer’s day,
throwing stones at it. Suddenly he felt that the animal had.
spurted some moisture into his eye. There then set in a slight
pain and spasmodic twitching of the slightly injected eye, and
two hours after coma, wavering sight, desire to bite, a dread of
food and drink, constipation, abundant urine, great agitation,
manifested themselves, followed on the sixth day by sickness,
apathy, and a kind of stupor, but with regular pulse. Some
days later, having become comparatively quiet, the boy left his
bed ; his eyes injected, the skin dry, the pulse free from fever.
He howled and behaved himself like a madman, sank into im¬
becility aud speechlessness from which condition he never
rallied. — Medical and Surgical Reporter , September 20.
CURARE IN HYDROPHOBIA.
Dr. Offenburg, of Munster, has lately treated with curare, a
woman who had been bitten by a mad dog. He did not confine
himself to the usual small doses, but injected about two deci¬
grams of curare under her skin in the course of five hours. The
patient was in a terrible state, and seemed on the point of being
suffocated when the injections were made. After the first in¬
jection the convulsion ceased suddenly. This was owing to the
power which curare has of paralyzing motion. After a short
Current Medical Literature.
565
1879]
pause, however, the convulsions began again, and sevaral ad¬
ditional injections had to be made. At last the effects of the
curare became so powerful that the patient was in danger of
dying of paralysis of the heart and the respiratory muscles, and
could only be saved by artificial respiration. She then fell in¬
to a state of exhaustion and weakness, from which she recov¬
ered alter a time, and became quite well. — Medical and Surgical
Reporter , September 20.
THE PRINCIPAL CONDITIONS FOR THE IMMEDIATE UNION OF
WOUNDS.
[From the Progress Medical.]
The powerful conditions which favor immediate union of the
soft tissues in wounds are :
1st. Exact apposition of similar part, which should be main¬
tained solidly in contact during the time requisite for union.
2d. Production of plastic lymph. 3d. Preservation from con¬
tact of air. 4th. Easy exit of the secretions. In this respect
M. Azam observes that if in the operation the elastic bandage
of Esmarch has been used, the quantity of blood which oozes
from the capillaries, after the ligature of the blood-vessels, is
such that he has given up this method of hemostasis. The
india rubber tube has still graver consequences if left on long.
He recently saw in the service of M. Broca a patient who had
the leg amputated below the knee for an injury near the ankle.
The elastic tube of Esmarch was applied to the lower part of
the thigh for two hours. An intractable capillary hemorrhage
followed ; then gangrene of the Haps, which necessitated ampu¬
tation above the knee. The hemorrhage returned, gangrene
also, and the patient died. 5th. Primitive union requires the
absence of foreign bodies from between the lips of the wound.
Catgut ligatures are a great improvement in this respect. 6th.
Protection of the wound against exterior influences, which is
accomplished by the dressing of A. Guerin. 7th. The proper
alimentation of patients. 8th. A good hygienic, both physical
and moral. A cetain number of the conditions necessary or
useful for primitive union are realized by the dressing of Lister
or of Alphonse Guerin; but the method of Bordeaux, which
partakes of both, is preferable.
It is applied as follows:
Perfect hemostasis is indispensable. The wound is then
cleaned, so as not to leave the least clot. Below or behind the
osseous section, if any, a large drainage tube is placed, which
iests at eacli end on the limb, and is firmly fixed in place by
collodion. The flaps are brought together in the most exact
manner possible by the twisted suture, placed deep. Then
superficial sutures should be put in, also twisted, with the same
care as in plastic operations on the face. This suture is then
covered with a layer of collodion, and only the two openings
506 Current Medical Literature. [November
remain through which the drainage tube passes. After wash¬
ing with carbolic acid solution, a mass of charpie is placed
around the drainage tubes, and the whole enveloped in cotton.
A resume of 262 operations with this mode of dressing shows
only 16 deaths; of the 262 operations 42 were amputations of
the thigh, amputations of the leg, and 111 were removals of
tumors. — Western Lancet , Sept., 1879.
THE STATUE OF DR. CRAWFORD VV. LONG— THE DISCOVERER OF
ANAESTHESIA.
We are happy to inform our readers that this statute will
form one of the National Gallery in Washington. It seems
that Congress has invited each State in the Union to forward
the statues of two of its benefactors, to be placed in the Art
Gallery at Washington. At the recent special session of the
Legislature of Georgia, James Oglethorpe — the founder of
Georgia — and Dr. Crawford W. Long — the discoverer of surgi¬
cal anaesthesia — were selected as the two most distinguished
of the sous of Georgia, whose statues should stand in the Capitol
at Washington. — Virginia Medical Monthly , Sept. 18, 1879.
A PHYSIOLOGICAL QUESTION.
William J. Scott, M.D., Cleveland, Ohio.
Seven years ago I had a patient, who, in a drunken row, re¬
ceived a severe cut in the right malar region by a glass thrown
by some one of the party. The wound was dressed by I)r.
Williams, who was then with me, and for four days the condi¬
tions seemed favorable. Then lie began to complain of stiff¬
ness of the jaws,, and the next day he had tetanus. Then I
supposed that he would have, in all probability, delirium tre¬
mens. Such symptoms were not manifested during the illness.
One night when 1 saw the man (who was colored), I remarked
to a friend of his, who was well soaked with whisky at the time,
that 1 feared that the former habits of the patient might affect
him badly now. He answered : “What do you fear ? Snakes ?
We neber get snakes.” That remark of a d* unken colored man
directed my attention to the subject. From that time to the
present I have not seen a case of delirium tremens among col¬
ored people. I have known frequently colored men and wo¬
men addicted to the same habits, which in other nationalities
lead to this condition. I have often met in the hospital, as
well as in private practice, mania a potu in persons who had
drank less than I believe some oi the other class who escaped
the disease. — Toledo Medical Journal.
[ We would be pleased to hear from some medical practi¬
tioners in the South on this subject. — Ed.]
1879]
Current Medical Literature.
567
THE OPERATION OF SPAYING FOR SOME OF THE DISORDERS OF
MEN TRUAL LIFE.
In a paper read before the Pennsylvania Medical Society, Dr.
Goo dell relates four cases in which lie has performed the oper¬
ation of spaying-. The first was for the (Hire of menstrual dis¬
turbances dependent upon a fibroid tumor. The patient was a
maiden lady, aged thirty-three, who had a subperitoneal fibroid
tumor, dipping down to the bottom of Douglas’s pouch, aud
reaching up to a point two finger-breadths above the umbilicus
aud to the left. The uterus was antefiexed, and the sound
gave a measurement of only three inches. Menstruation was
profuse, sometimes alarmingly so, lasting fully a week. She
was never wholly free from pain, but one week before each
period this pain began to increase, aud steadily grew worse
until it became unbearable, continuing without abatement
through the period. Thus three weeks out of every four were
virtually spent by her in bed. Treatment being unavailing,
extirpation of the uterus was contemplated, but the author
was led by the success of Dr. Tren holme’s case to try first the
effect of spaying. On October 4, 1877, both ovaries were
removed by vaginal section. The hemorrhage was very trifling;
no vessel needed tying, and not a suture was put into the vag¬
inal wound. The right o ary looked healthy, but the left con-
taiued a small cyst. From that day the patient lost all her
pains and aches, and they have never returned. The large
fibroid tumor also rapidly lessened in size, until, six months
later, it was no larger than a horse-chestnut.
In commencing on this case, the author refers to eleven
others, making twelve in all, in which spaying has been per¬
formed for fibroid tumors. Of these three proved fatal ; but,
in each, the ovaries were removed by the more hazardous
abdominal section. In one of Hegar’s cases a hemorrhage
occurred after five mouths, and the patient was afterwards lost
sight of. In the remaining eight, convalescence was uninter¬
rupted, the menopause was established, the tumor became
smaller, aud the women were virtually cured.
The second case was that of a young lady, aged twenty-seven,
who had great hemorrhage at her menstrual periods, and ex¬
quisite suffering, not only at these times, but a week before
and after. The uterus showed no lesion, and the pains radiated
from each ovarian region. The ovaries were removed by the
vagina. The pedicle was tied by silk, the others with gut;
this latter broke, and the pedicle was then crushed off with the
ecraseur. Her recovery was a slow one, being retarded by a
small pelvic abscess, which burst through the incision, and dis¬
charged the knot of the silk ligature. Menstruation did not
return, and her health became wonderfully better, so that she
deemed herself perfectly well.
The third case was that of a married lady, aged thirty-seven,
the mother of three children, the youngest ten years old. Her
9
Current Medical Literature.
568
[November
illness dated from the birth of this last child. Agonizing pel¬
vic pains at first entered in the monthly periods, then kept up
for some time afterwards, and finally never left her. She now
became bedridden, and an opium-eater. The uterus presented
no other lesion than a slight enlargement. The ovaries were
removed by vaginal incision on May 26, 1878. The hemor¬
rhage was freer than usual ; both ovaries seemed congested,
and one showed a beautiful corpus luteuin. Peritonitus set in
oft the second day, and, although it was limited to the pelvic
regions, she died on the fourth day.
In the fourth case the operation was performed on account
of insanity, the paroxysms of which appeared to be connected
with menstruation. The patient was a married lady, aged
thirty-eight, whose brain had given way from over-anxiety and
from over-nursing a sick child during the summer of 1875.
When seen by the author in 1878, she was subject to hallucina¬
tions, which came on several days before the appearances of
her menses, and led her to become so violent as to need locking
up. The attacks lasted during the continuance of the menses,
and for a week afterwards. Two distinguished alienists held
out hopes to her husband that with the change of life reason
would return. The author found a congested and hypertro¬
phied uterus, measuring 3.5 inches, and the left ovarian region
exquisitely tender ; the ovaries however, could not be outlined.
The ovaries were removed by vaginal incisions on November
13, 1878. The patient recovered without a single bad symp¬
tom, although she twice jumped out of bed within the first
week, and had to be forcibly put back, and held down. Men¬
struation did not return, but her mental condition has not im¬
proved. Notwithstanding this failure in the cure, the author is
intending to remove the ovaries from an epileptic young lady,
whose first fit began at her first menstruation, and whose pres¬
ent fits pivot around the monthly flux as a centre.
The chief point in which the author differs from several re¬
cent authorities is his strong preference for the performance of
tin- operation of spaying by vaginal, rather than by abdominal
section. This is based upon the ground of its greater safety,
eleven deaths having occurred in thirty-one cases of operations
by abdominal section, and only four deaths out of twenty oper¬
ations by vaginal section. In the vaginal operation he has not
yet tried the carbolic spray, but proposes to do so. Should it
be found impossible to remove the ovaries by the vaginal in¬
cision he considers that the abdomen can afterwards be opened
and the abandoned vaginal incision be utilized, if needful, as a
drainage opening.
In the vaginal operation, the author places the patient on
her back, not on her side, that air may be less likely to enter
the peritoneal cavity. A duckbill speculum is introduced, and
the perineum pulled downwards. The post-cervical mucous
membrane is next caught up by a uterine tenaculum, aud it
Current Medical Literature.
569
1879]
and the underlying- peritoneum are snipped open for about an
inch with a pair of scissors, of which he has found Kerchen-
meister’s to be the best. The index-finger of the left hand is
then passed in, the uterus pushed down from above by the
right hand, and each ovary brought down to the incision by the
finger hooked into the sling made by the oviduct. The ovary
is now seized by fenestrated forceps, and brought into the va¬
gina. The pedicle is transfixed by passing a needle, armed
with a double gut thread, between the ovarian ligament and
the oviduct, and each half securely tied. The ovary is then re¬
moved, the ligatures cut short, and the pedicles returned. In
three of the four cases the author closed the vaginal opening
with the suture, but, in the case with the incision left unclosed,
no protrusion of intestine took place.
From a collection of published cases of double ovariotomy
during menstrual lite, the author finds that out of 132 cases
there were fifteen in which regular monthly fluxes continued,
and nine in which such fluxes were either irregular or lessened
in amount. The cause of this unexpected continuance of the
menses, he attributes rather to the presence of a third or acces¬
sory ovary than to a portion of ovarium stroma having been
unwittingly left behind. Thus Beigel, in 350 autopsies, found
eight women with accessory ovaries. The author concludes by
expressing his belief that the operation of spaying, in carefully
selected cases, will prove the sole means for curing many men¬
tal and physical disorders of menstrual life, which have hitherto
baffled our science, and are a standing opprobrium to our pro¬
fession. — Boston Medical and Bury leal Journal, June 19, 1879.
Dr. Ta utter, of Buda-Pesth, relates a successful operation of
spaying in a case of congenital malformation. The patient was a
woman twenty-five years old, who had never menstruated. From
the age of fifteen, and more particularly from that of twenty,
menstrual moliminahad manifested themselves in the shape of
severe pain in the pelvis and back. These attacks gradually
increased, and at length became so s* vere that the patient re¬
mained in an unconscious state for hours together. Two years
beforeslie had married, and after the marriage, her atrophic
vagina had been made ac« essible by operation. After this .the
menstrual molimen only became all the stronger. Above the
blind extremity of the vagina could be felt a hard body, as large
as a nut (uterus). A band ran obliquely from this through the
pelvis, on the right and left of which could be felt movable
bodies, as large as nuts, and painful on pressure, which were
concluded to be ovaries.
The operation was performed by an abdominal incision to the
middle line. The ovaries were drawn into the wound, the ped¬
icles tied with silk in two halves, ai.d dropped. The convales¬
cence was almost free from any symptom of fever. At the date
of the report the period of menstruation had passed over three
times without any inconvenience.— Cenralblatt fur Qymkologie,
June 21, 1879. — Obstetrical Journal* August, 1879.
570
Editorial.
[November
THE ADVANTAGES OF ALCOHOLIC SURGICAL DRESSINGS.
In the Western Lancet , July, Dr. A. E. Regensberger brings
forward some evidence to show that alcoholic dressings are a
prophylactic against erysipelas, He adds:
Alcohol possesses three advantages over many other dress¬
ings, which may be briefly formulated. 1st, simplicity; 2d,
cleanliness ; 3d, absence of all odor. Unquestionably, some¬
thing that cannot be said of many of the complicated dressings
in use at the present day. To convince one’s self of the cor¬
rectness of the above assertion, having used or having seen it
properly employed for a short space of time, is all that is requi¬
site. In applying this dressing all that is necessary is some
alcohol and some charpie — no spray producers or other elabo¬
rate or costly paraphernalia. The piece of charpie is moistened
with alcohol, and the wound, after being otherwise properly
arranged on general surgical principles, is covered with it.
The dressing is changed two or three times in twenty-four
hours, care being taken to keep the charpie continually satu¬
rated with alcohol. In France a great many use tau de vie
camphree instead of alcohol alone. Whether the camphor adds
anything to the efficacy of the alcohol I am not prepared to
say, but l am rather inclined to think that it does not. Con¬
trary to what one might suppose, tiie pain occasioned by the
application of alcohol to a wound is not severe. The first two
or three applications cause a slight smarting sensation, after
which it is nil. Possessing all these advantages, and very few
drawbacks, we trust that this method may receive a trial by
the profession on this coast, and if it responds to the hopes
entertained of it, that it may be used universally. — Medical and
Surgical Reporter.
DITOE\IAL.
THE DOCTOR vs. THE APOTHECARY.
The mutual dependence of the physician and apothecary
is of such a nature that not only should their intercourse be
cordial, but respect shown each for the other. The legitimate
province of the former is to prescribe, the latter to see that
the prescription is properly dispensed, and physicians should
support those whose competency and honesty is assured.
A diploma from a recognized medical or pharmaceutical col¬
lege should be the guarantee of this competency, but long study
1879] Editorial. 571
and familiar acquaintance with the duties of the pharmacist
might stand in its stead. Should this requisite be required,
we feel assured that the number of stores would be limited,
and the physicians have less to complain of incompetency.
If there is a single matter in the province of physicians,
it is, that they have a right to have their prescriptions
filled by apothecaries of their own selection. Time and again
has the doctor failed to afford the relief expected, and often
this has been the result of base substitutes or improperly com¬
pounded prescriptions. Not long since we had occasion to pre¬
scribe some calcined magnesia for an infant, judge our horror
when we found that the sulphate of magnesia had been substi¬
tuted. Example after example can be cited to at once estab¬
lish the fact that there should be a demand for educated phar¬
macists.
It is time that the physicians of New Orleans were taking
action to protect themselves from the impositions of druggists
and apothecaries. The knights of the mortar and pestle, in¬
stead of attending to their legitimate duties, compounding
the prescriptions of physicians and in good faith repeating
these only when especially ordered, derive quite a revenue
from the sale of repetitions ; thus injustice is done the doctors,
and the way is paved for weak-minded men and women to be¬
come the victims of opium, chloral or alcoholic drunkenness.
Is it dealing fair with the physician for the druggist to fill
on demand an old prescription ordered for some particular case,
but now lauded around and handed about by neighbors who
administer the remedy in cases of sickness when the diagnosis
is the result of no greater skill than that possessed by an old
woman ?
There is still another matter connected with this subject that
demands careful consideration ; we allude to the habit that wre
fear is universally common with apothecaries, and it is their
habit of “ counter prescribing.” We speak knowingly when
we say that there is a growth of this habit. Druggists pre¬
scribe daily for men, women and children whose faces they
have never seen, and whose diseases are represented to be colic,
costiveness, or fits, by that inevitable old woman in every
neighborhood. The harm done by this complacency on the
572 Editorial. [November
part of druggists toward their neighbors is not to be estimated,
as the facts are concealed from the physician or only accident¬
ally exposed. This act on their part is only to be compared
with the illegitimate sale of poisons, and both should be dis¬
countenanced by law and the medical profession.
To remedy the evils set forth, the druggists must come to the
rescue. Let them form an association, admitting none others
than those holding diplomas or strong evidence of their pro¬
ficiency, appoint a committee to confer with the local medical
societies, adopt rules that will thoroughly establish their status,
and we will guarantee the hearty co-operation of the medical
profession. Let it be known that extortion, counter prescrib.
ing, and repetition of prescriptions, unless expressly ordered,
shall be discontinued, and we feel certain that their position
will be appreciated and sustained by the profession.
HYPODERMIC INJECTION OF MORPHIA.
Dr. H. Kane, No. 3(50 Bleeker street, New York city, is
engaged collecting statistics in regard to the hypodermic injec¬
tion of morphia, and wishes the experience of the profession
throughout the country.
All communications strictly confidential unless permission is
given by the writer to use his name.
The medical profession in New Orleans can undoubtedly add
much valuable information on this subject and we hope they
will respond fully to the inquiries made. He asks the follow¬
ing questions :
1st. What is your usual dose ?
2d. Do you use it alone or with atropine !
3rd. What is the largest amount you have ever adminis¬
tered ?
4th. Have you had inflammation or abscess at the point of
puncture ?
5th. Have you had any deaths or accidents caused by this
instrument ?
6th. Do you know of any cases of opium habit thus con¬
tracted ?
When there has been an autopsy, (5) please state the fact
and results.
1879]
Reviews and Book Notices.
573
Reviews and Book Notices.
Materia Medica and Therapeutics ; Vegetable Kingdom. 'By
Charles D. F. Phillips, M.D., F. R. C. S. E., Lecturer
on Materia Medica, Westminster Hospital, London.
Edited and adapted to the United States Pharmacopoeia.
By Henry G. Piifard, A.M., M.D., Professor of Derma¬
tology, University of the City of New York, etc. New
York: William Wood & Co. New Orleans: Arinand
Hawkins, 19G| Canal street.
Another volume of u Woods’ Library of Standard Medical
Authors,” adds to the success of the enterprise, a work of un¬
questionable merit. The arrangement of the drugs is accord¬
ing to botanical characteristics, and each is presented under
the following heads : Active ingredients, physiological action,
therapeutic action, illustrated by the effect in special diseases,
and preparation and dose. A few unimportant articles of the
materia medica are omitted by the editor and a number of iu-
diginous and some of foreign origin are introduced.
We are informed that a second volume of this work, devoted
to inorganic materia medica, is nearly ready for the press.
A Clinical Treatise on the Diseases of the Nervous System. By
M. Rosenthal, Professor of Diseases of the Nervous Sys¬
tem at Vienna. With a preface by Professor Charcot.
Translated from the authors, revised and enlarged edition
by L. Putzel, M.D., Physician to the Class for Nervous
Diseases, Bellevue Hospital, Out-Door Department, etc.
New York : William Wood & Co. New Orleans : Arinand
Hawkins, 19G£ Canal street.
The two volumes from the great German neuralogist will
undoubtedly increase the popularity of “ Woods’ Standard
Medical Authors.” Professor Rosenthal has for years been a
recognized authority among the German medical faculty, and
his reception by the American medical profession will be
cordial.
The work is systematic, and great care and thoroughness is
exhibited in the diagnosis, prognosis and treatment of nervous
diseases. Hydro-therapy and electricity receive especial prom¬
inence, and the former is taught with a degree of precision
that will render this, almost unknown to us, system of practi¬
cal avail.
574 Reviews and Booh Notices. [November
DeBow1 s Revieiv. New Series. Volume 1, No. 1. October, 1879.
This monthly publication was established in 181G and for
many years was conducted by its founder, whose name it bears.
Devoted to the agricultural, commercial and industrial
resources and progress of the country, particularly of the
South, it achieved great success under the management of
Mr. DeBow, being particularly valuable in the matter of
agricultural and commercial statistics, in which its editor was
most pains-taking and judicious. Like most publications in
the South, the Review shared the general ruin, attendant on
the late war, and a subsequent attempt to re-establish it under
the management of its founder, Mr. DeBow, proved ineffectual,
owing to the continued depression of the material interests of
New Orleans and the Southwest.
The present is, however, a more favorable occasion, since
there is evidence of a new era of prosperity ahead. At the
same time the experience of Judge Burwell, acquired by many
years of service in the commercial department of our daily
journals, and that of the publisher, Mr. L. Graham, well
known as the publisher of this journal , and a veteran in the
typographical art, afford assurance that the management and
execution of the Revieiv will be ably performed.
The table of contents of this number includes the following
subjects of carefully prepared articles : The Isthmus Canal ;
America Reacts on Europe ; The Social Standard of the South ;
On to Sonora; The Western Iron Trade; Auxiliary' Quaran¬
tine; Modern Egypt; together with editorial resumes , commer¬
cial, agricultural and financial.
We regard this publication as one deserving the encourage¬
ment and support of all who are interested in the prosperity of
our country, particularly of the Great Valley, and if the intro¬
ductory number of the new series be duly appreciated by the
public, its success will rival that of bygone years. S. S. H.
Analysis of the Urine , with Special Reference to the Diseases of
the Geni to- Urinary Organs. By K. B. Hoffman, Professor
in Univ. Gratz, and R. CJltzmann, Docent in Univ. Vienna.
Translated by T. Barton Bruns, A.M., M.D., Resident
Physician Md. Univ. Hosp., and H. Holbrook Curtis, Ph.B.
8vo., pp. 2G9. New York : D. Appleton & Co. 1879.
This work, of course, was not intended as a complete trea-
18791
Reviews and Book Novices.
575
tise on diseases of the kidney, but merely as a guide to diag¬
nosis and prognosis. The first of the eight chapters into which
it is divided treats of the Histology of the Urinary Organs ;
the second of the Excretion of Urine ; the third of the Urine,
as regards (A) its General Description, (B) its Physical Charac¬
teristics, (0) its Chemical Composition, (D) the Sediment, fol¬
lowed by a recapitulation on the analysis of urinary concre¬
tions ; the fourth chapter describes the reagents and apparatus
proper for approximate determination of urinary constituents ;
the fifth exhibits a quantitive determination of a few of the
constituents of the urine; the sixth gives a key to the approx¬
imative analysis of the urine ; the seventh treats of general
diagnosis; and the last of special diagnosis of diseases of the
urinary apparatus.
An examination of the book satisfies us that it has been
carefully prepared and can be relied on for correctness. The
new chemical notation is used, and also the metrical system of
weights and measures. As an appendix to the text eight col¬
ored plates illustrate the solid constituents of the urine.
On the whole we regard the book as well adapted to its pur¬
pose and a decided convenience to the practitioner who aims at
something beyond guess-work in diagnosis and prognosis of
urinary disorders. S. S. H.
The Grounds of a Romwopalffs Faith : Three Lectures delivered
at the request of the Matriculates of the Department of Medi¬
cine and Surgery f Old School) of the University of Michigan.
By Samuel A. Jones, M.D., Prof. Mat. Med., Thera, and
Experimental Pathogenesy in the Homoeopathic Med. Col.,
Uuiv. Mich., etc. 12ino., pp. 92. Boericke & Tafel, N. Y.
and Phila. 1880.
The Lectures are upon the following subjects :
I. The law of Similars. Its claim to be a Science in that it
enables Prevision.
II. The Single Remedy a Necessity of Science.
III. The Minimum Dose an Inevitable Sequence.
The above title is eminently appropriate, inasmuch as homoe¬
opathy is based wholly on faith, and is in reality a religion
rather than a science. The prevision claimed as one of its
achievements is another word for prophecy, which is par excel¬
lence a sacred gift, not claimed by any scientist. The distiuc-
10
57 b Reviews a/nd Book Notices. [November
tive attribute of the homoeopath is declared to be “ Not the law
of cure, uot the infinitesimal dose, not the Halmemanniau hy¬
pothesis of Chronic Diseases; none of these, but simply this —
his fixed faith in the efficiency of drugs.” Another evidence of
the religious character of homoeopathy is the reverence felt for
the author of the system by his followers, amounting to a belief
in his infallibility and perfection quite akin to the homage paid
to Moses, Mohammed and Joseph Smith. The great lights in
medicine are more or less honored in their day ; but their au_
thority can not stay the o..ward march of science, and they are
left as monuments of the past.
This is a land and an age of religious toleration, and no one
should forbid the name of Hahnemann to be glorified, or scoff
at the faith of his followers in the mysterious potency of the
thirtieth dilution of gun-flint or common salt. To many minds
such faith is not only a comfort, but a necessity. Distrustful
of their own knowledge and understanding, they seek refuge in
the mysterious and incomprehensible, rather than trust science
in its acknowledged imperfections. Yet, with all its absurdities,
homoeopathy is not the worst form of idolatry. True, lives are
sacrificed in its blind following ; but the fittest survive in this
mode of selection, and the race becomes improved, as it cer¬
tainly must by the ravages of small pox and other diseases
made avoidable by enlightenment and prudence.
In the second lecture the single remedy is set up as the per¬
fection of therapeutics, while noting the gradual progress from
polypharmacy to simplicity in the history of medicine. One
point, however, needs explanation for our unregenerate compre¬
hension, and that is the invariable resort to alternate doses from
two different remedies. Perhaps this is another mystery of the
system, incomprehensible and therefore sacred ; perhaps it was
suggested by antiphonal modes of worship, as practised in
other religious rites.
The last lecture traces a gradual diminution in dosage among
medical men, but fails in establishing a connection with the
infinitesimals of homoeopaths. The potency developed by pro¬
gressive dilution is probably one of the most sacred mysteries
of the w hole system, and undoubtedly the most awful in sub¬
limity. Being incompatible with the established and under-
Reviews and Book Notices.
577
1879]
stood properties of matter, this astonishing capacity of multi¬
plying force by divisiou of substance becomes a veritable
miracle, and ranks with the doctrine of transubstantiation.
The grammar and rhetoric of Dr. Jones are unimpeachable ;
the mechanical work of the little volume is excellent. In flexible
binding, with Faith as its title-word, and its three chapters
joined in one volume, it is peculiarly adapted for a manual to
aid in propagating the gospel of Hahnemann. S. S. H.
American Health Primers. The Summer and its Diseases. By
James Wilson, M.D. Philadelphia : Lindsay & Blakiston.
New Orleans : Armand Hawkins, Medical Bookseller, 196£
Canal street. 12mo., pp. 100.
This valuable little work tells in an admirable manner of the
cause, prevention and treatment of summer diseases. The
subjects taken up are: the Summer, Sunstroke, Summer Diar.
rhcea, Cholera Infantum, Summer and Autumnal Fevers, Sum¬
mer Colds and Hay Asthma, and the Skin in Summer and its
Diseases.
The wholesome advice contained within its pages should be
known to every family, and we trust the little book will be
appreciated.
Real-Encyclopddie der gesammten Heilkunde. Medicinisch-chirur-
gisches Hxndworterbuch fur praktische Aerzte. Editor: Dr.
Albert Eulenburg, Professor at the University of Greifs-
wald. Publishers: Messrs. Urban & Schwarzenberg,
Vienna.
From Messrs. Urban & Schwarzenberg, in Vienna, we have
received the first number of “ Real-Encyclopaedia of the entire
Medic. d Science, a Medical and Surgical Dictionary for Medical
Practitioners.”
Besides a catalogue of the articles to appear under the head¬
ing A, it contains a list of the coadjutors, numbering ninety,
belonging mostly to academical institutions of Germany and
Austria, and possessing already wide spread reputation through
former original productions. It contains, furthermore, an in¬
troduction by the editor, Prof. Eulenburg, in Greifswald, stat¬
ing the object and design of the whole undertaking, and finally
the text of the articles reaching from u Aachen” to u Accom¬
modation” in alphabetical order.
578
Books and Pamphlets Received. [November
In the iutroductiou, the editor gives a historical synopsis of
the undertakings of a similar character in the beginning of this
century, and mentions the causes which, at that time, made their
appearance desirable, and which at present are still more pre¬
dominant. There is no doubt that the work, of which we now
have the beginning before us, fills up an important gap in medi¬
cal literature, and rentiers it possible for the general prac¬
titioner to keep pace with the progress of his science without
having to gather the information he may desire from many
different books ; it presents the theories of modern science in
a condensed form, and un trammeled by party opinions. The
French literature possesses two modern works of a similar kind
and tendency (Jaccoud, Deckambre), enjoying great popularity
in France, having, through numerous articles of a monographic
character, considerable scientific importance. The editor thinks
that he may claim the same for this new German Encyclopaedia;
not only the names of his coadjutors and his own reputation,
but especially the contents of the articles published in this
number we have before us, warrants that he is not deceived by
illusions in this respect.
The first number of the work (it covers 80 pages, and is
furnished with numerous illustrations) contains, besides other
articles, elaborate ones about Aachen (Lersch), Abdominal-
typhus (Zuelzer), Abfuhrmittel (L. Lewin), Abortus (gynae¬
cological, Klein wach ter, and medico-forensic, Hofrnan), Ab¬
scess (Lamlois), as well as the beginning of the article “Ac¬
commodation ” (Schmidt — Bimpler). We shall look for the
continuance of this work with great interest. The first volume
will be published during the present year, and the whole work
is expected to be completed in course of 3-4 years.
Books and Pamphlets Received.
Laceration of the Cervix Uteri. By A. Beeves Jackson, A.M.,
M.D., Formerly Surgeonin-Chief of the Woman’s Hospital of
the State of Illinois, etc., etc. Beprint ftom the Chicago Med¬
ical and Surgical Journal and Examiner for August, 1879.
579
1879] Books and Pamphlets Received.
Eyesight and How to Care for It. (American Health Primers.)
By George C. Harlan, M.D., Surgeon to the Will’s Eye Hospi¬
tal, etc.
Student's Pocket Medical Lexicon. By Elias Lougley, Phila¬
delphia, Pa.
Reference and Dose Book. By C. Henry Leonard, M,A., M.D.
Sexual Neuroses. By J. T. Kent, A.M., M.D.
Annual Catalogue of the Sayre Female Institute , Lexington , Ky.
25th Session , 1878-9.
Report of the Special Committee on Medical Education , before
the Illinois State Medical Society. Twenty-ninth Anniversary.
Presidential Address before the American Medical Association
at its Thirtieth Annual Session held at Atlanta , Ga., May 6, 1879.
Physiological Antagonism the Therapeutic Laic of Cure. By
Electus B. Ward, M.D., Assistant to the Chair of Practice of
Medicine in the Long Island College Hospital, Brooklyn, K. Y.
Buildings for Insane Criminals. By Walter Channing, M.D.,
Boston, Mass. A paper read at the Conference of Charities in
Chicago, June 11, 1879.
Sanitary Problems of Chicago , Past and Present. By J. H.
Rauche, M.D., Chicago.
Proceedings of Alumni Association of Rush Medical College ,
Chicago , 1879.
On the Connection of the Hepatic Functions with Uterine
Hypercemias , Fluxions , Congestions , and lnfammaiionn , with Ap¬
pendix. By L. F. Warner, M.D., Boston, Mass., Vice-President
of the Gynaecological Society of Boston and Physician to St.
Elizabeth’s Hospital for Women, etc., etc. Reprint from the
Transactions of the American Medical Association, 1878.
Franco- American Commerce. Statements and Arguments in
Behalf of American Industries against the Proposed Franco- Amer¬
ican Commercial Treaty.
College of Physicians and Surgeons , New York Medical Depart¬
ment of Columbia College , Seventy-second Annual Catalogue , Ses¬
sion of 1879-80.
North Carolina Board of Health — Method for performing Post-
Mortem Examinations.
580
Books and Pamphlets Received. [November
Statement of the Board of Health o) Galveston of the Reasons
for the Establishment , of Quarantine against New Orleans , on
July 21, 1879.
Reflex Cerebral Hypercemia. By C. H. Hughes, M.D., St.
Louis, Mo. Reprint from the St. Louis Medical and Surgical
Journal , June, 1879.
History of the Discovery of Anaesthesia. By J. Marion Sims,
M.D., M.A., L.L.D., New York, author of “ Silver Sutures in
Surgery,” etc. etc., Member of the Historical Society of the
City of New York. Honorary Fellow of the Royal Academy
of Medicine of Brussels, etc., etc., etc. Reprint from Virginia
Medical Monthly, May, 1879. >
The Student’s Guide to the Diseases of Women. By Alfred
Lewis Galabin, M.A., M.D., F.R.G.P., Assistant Obstetric
Physician and Joint Lecturer on Obstetric Medicine to Guy’s
Hospital, etc., etc.
Emotional Prodigality. By C. Fayette Taylor. M.D. Read
before the New York Odontological Society, March 18, 1879.
Reprint from the u Dental Cosmos,” July, 1879.
On the Priority of the Discovery and Use of Intentional
Anaesthesia. By J. M. Taylor, M.D., of Corinth, Miss. Reprint
from the twelfth volume of the Transactions of the Mississippi
State Medical Society, 1879.
Observations on the Mechanical Treatment of Disease of the Hip-
Joint. By Charles Fayette Taylor, M.D. Reprint from the
Boston Medical and Surgical Journal, March 6, 1879.
Vegetarianism , the Radical Cure for Intemperance. By Har¬
riet P. Fowler.
On Ghlor-Stannic Acid. By J. W. Mallett, F.R.S. Reprint
from the Journal of the Chemical Society, August, 1879.
Annual Announcement Savannah Medical College , Session
of 1879-80.
The Thermantidote. An instrument for preventing the evil
effects of heat from Poquelin’s Thermo-Cautery when operating in
deep cavities. By H. C. P. Wilson, M.D., Baltimore, Md. Sur¬
geon in charge of the Women’s Department of the Union
1879]
Books and Pamphlets Received.
581
Protestant Infirmary, etc., etc. Reprint from Transactions of
the Medical and Chirurgical Faculty of Maryland.
Remarks on Ovariotomy with Relation of Cases and peculiari¬
ties in Treatment. By Nathan Bozeman, M.D., New York, Sur¬
geon to the Women’s Hospital of the State of New York, etc.
Reprint from the Medical Record, July and August, 1879.
The Use and Abuse of the Obstetrical Forceps. By Thomas
Kennard, M.D. Read before the St. Louis Medical Society.
Reprinted from the St. Louis Medical and Surgical Journal ,
July, 1879.
A New Operation for Entropion and Trichiasis. By F. 0.
Holz, M.D., Ophthalmic Surgeon to Illinois Charitable Eye and
Ear Infirmary, and to the Alexian Brothers’ Hospital, Chicago.
Published in the Archives of Ophthalmology , Vol. viii, No. 2.
The Yellow Fever Germ on Coast and Inland. A discussion of
ship and railroad quarantine before the Medical Association of
Georgia, Rome, April 18, 1879. By Henry Fraser Campbell,
M.D., Augusta, Ga. Reprint from Transactions.
Notes of Hospital and Private Practice. By Henry Gib¬
bons, Sr., M.D.
A few well-established Facts in connection with Squint. By
Julian J. Chisolm, M.D., Professor of Eye and Ear Surgery in
the University of Maryland; Surgeon-in-charge of Baltimore
Eye and Ear Institute, etc., etc. Reprint from Transactions of
Medical and Chirurgical Faculty of Maryland.
A Reply to Dr. John Van Bibber on the Future Influence of the
John Hopkins Hospital on the Medical Profession of Baltimore.
By John S. Lynch, M.D., Professor of Principles and Practice
of Medicine in the College of Physicians and Surgeons, etc.,
etc. Reprint from Southern Clinic.
Microscopical Studies on Abscess of the Liver. By J. C. Davis,
M.D., Denver, Colorado. Reprint from Archives of Medicine ,
August, 1879.
Dermatitis Venenata , or Rhus Toxicodendron and its Action.
By Roswell Park, A.M., M.D., Assistant to Chair of Anatomy,
Chicago Medical College; Surgeon to South Side Dispen¬
sary, etc.
582
Meteorological and Mortality Tables. [November
Meteorological Summary— September, 1879.
Station— New Orleans.
Date.
! Daily Mean
j Barometer
Daily M< an
Temp’ture.
Daily Mean
Humidity.
Prevailing
Direction
of Wind.
Daily
Rain-fall.
General Items.
1
29 48
79.2
79.3
S. E.
.34
Highest Barometer, 30.183, on 27th.
2
29.81
80 2
70 3
West.
....
Lowest Barometer, 29.361, on 1st.
3
29.97
80.7
68.3
West.
.00
Monthly Range of Barometer, .822 in.
4
30.01
82.0
62.3
East.
.00
Highest Temperature, 90° on 9th.
5
30.08
80.0
67.0
N. E.
.00
Lowest Temperature, 65° ou 15th.
6
30.06
80.7
62.7
East.
.00
Monthly Range of Temperature, 25°.
7
30.05
83 2
75.3
S. E.
....
Greatest Daily Range of Temperature.
8
30.05
83.2
66.7
West.
17° on 15th and 18 h.
9
30.06
84.0
71.3
East.
00
Least Daily Range of Temp., 5° ou 1st.
10
30. 1 1
78.7
76.3
N. e.
.09
Mean of Maximum Temperatures, 83.3°
11
30.13
79.5
76.7
East.
.06
Mean of Minimum Temperatures, 71.0°
12
30.05
79.0
79.3
East.
.77
Mean Daily Range of Temp., 12.3°.
13
30.02
73.5
82.7
North
.19
Prevailing Direction of Wind, East.
14
30.04
76.0
59 7
North
.00
Total Movement of Wind, 6,021 miles.
15
30.04
76.0
55.7
N. E.
.00
Highest Velocity of Wind and Direc-
16
30.05
77 5
59.3
N W.
.00
tion, 40 miles, Southeast, on 1st.
17
30.07
77.7
60.7
East.
.00
Number of Foggy Days, 0.
18
30.02
80.0
59.3
East.
.00
Number of Clear Days, 14.
19
29.96
79.5
65.7
East.
.00
Number of Fair Days, 7.
20
29 93
80.0
66.0
N. E.
....
Number of Cloudy days on which no
21
29.92
78.0
70 0
North
.00
Rain fell. 2.
22
29.98
74.2
72.3
N* E.
....
Number of Cloudy Days on which
23
30.06
75.0
87.3
East.
25
Rain fell, 12.
24
30 12
77.2
86.3
East.
.48
25
30.11
78.5
78.0
North
.00
COMPARATIVE
TEMPERATURE.
26
30.13
77.2
630
East.
.00
1871 . |
1876 . 79.1°
27
30.14
75.5
66 3
East.
.00
1872 . ,
1877 . 78.4°
28
30.10
75.7
73.3
East.
.00
1873 . 78.8° |
1878 . 78.7C
29
30.07
76.5
70 7
East.
.00
1874 . 78.9° |
1879 . 78.5°
30
30.11
76.0
86.3
East.
.97
1875 . 76.6° |
1880 .
COMPARATIVE
PRECIPITATION.
Sums
1871 . inches.
1876.. 0.26 inches
Meaus
30.025 78.5
70.6
East.
3.15
1872 . “
1877 .13.21
1873... 3.19 “
1878.. 2.64 “
1874... 4.21 “
1 1879.. 3.15 “
1875... 7.89 “
| 1880 . “
Mortality in New Orleans from September 21, 1879, to
October 19, 1879, inclusive.
Week Ending.
Yellow
Fever.
Malarial
Fever.
Consump
tion.
Small¬
pox.
Pneu¬
monia.
Total
Mortality.
September 28.
2
6
9
0
0
86
October 5.
0
6
13
0
6
85
October 12.
0
7
21
0
3
87
October 19.
1
7
22
0
0
1
88
Total.. . .
3
26
65
0
10
346
NEW ORLEANS
Medical >nd Sue[gic>l Journal
DECEMBER, 1879.
PAGINAL poyViyVIUNICATIONS
Acute Rheumatic Arthritis.
The word rheumatism has of late years been subjected to
severe criticisms by cotemporary authorities, both in our coun¬
try and in Europe.
This name being regarded, especially in Germany, as a mis¬
nomer, particularly by such authorities as Senator, Heule and
Hueter, and have in consequence adopted the adjective rheu¬
matic, and have applied it to each and every part effected,
thinking it to be more appropriate to the progress of morbid
anatomy and of etiology, and keeping within the limits of our
present knowledge, and that rheumatism, whilst not aspiring
to anything beyond a merely symptomatic conception of the
majority of diseases, includes diseases radically heterogeneous.
These authorities argue that in discarding the name and
group rheumatism, and adopting the epithet rheumatic, they
simply obey the usual custom in pathological nomenclature, in
distinguishing those diseases whose morbid anatomy has been
thoroughly investigated (the articular class), arthritis, artho-
meningitis, or poly arthritis, according to the parts chiefly or
exclusively involved; while the muscular affection, about
whose anatomy less is known, broadly as myopathies ; or since
pain is the leading feature in most of them as myalgias, both the
articular and the muscular class of these affections being
termed rheumatic, in order to distinguish them from symptoms
584 Original Communications. [December
and structural alterations of a similar kind arising from other
causes.
Acute rheumatic arthritis is a peculiar specific kind of in¬
flammation and exudation into the joints, and has at first the
characteristic development and appear, mec of all inflamma¬
tion, that is, swelling, heat, pain and redness. It is
essentially a febrile constitutional disease, often ushered
in by one or more chills. It is often due to a sud¬
den suppression of some of the important functions of
the economy — mostly those of the surface of the
body. It is often one of the most potent causes of organic
diseases of the heart. Though a very common disease, and
but rarely fatal, is always liable to cause permanent deformity,
and is often followed by serious destructive oomplicatious.
Cold, dampness, poor food, and improper clothing, are impor¬
tant causal factors. It is thought to be a blood poison, due to
presence of acids, probably lactic acid in the blood. The prin¬
cipal tissues of the body affected are, the white tissues, such as
sheaths of muscles, capsular ligaments, periosteum, and sero¬
fibrous tissues of the heart.
It is advanced by Professor Stille, that it is not, in the
proper sense of the term, a true inflammation, and he basis
his view on the fact, that though in all instances accompanied
by fever, there is but slight, if any tendency to suppuration,
and that he has never met with such a result, and that rheu¬
matic arthritis seldom leaves behind it the results of inflam¬
mation in the joints themselves, however severe has been the
attack. When lesions have been found after death, and such
cases are of exceeding rarity, they have undoubtedly been the
result of an arthritis due to other causes, such as pyaemia, and
that by a pyaemia he means a general blood-poison, accom-
panied4by a tendency t > suppuration all over the joints as well
as elsewhere.
Before proceeding further, it might prove of interest to
record the progress of the study of this disease. Even in the
fourth century we find that Hypocrates was familiar with a form
of arthritis, attended with fever, during which now one, now
another joint became painful, occurring by preference in the
1879] ( Wiendahl — Acute Rheumatic Arthritis. 585
young, and seldom proving fatal. Sydenham drew a line of
distinction between gout and rheumatism, calling the former
podagra. Cullen first drew attention to the inflammatory char¬
acter of the joint affection, and separated it not only from
gout, but also from chronic rheumatic arthritis, and from rheu¬
matic affections of the muscles. Even in the present century
Chomel, Pidoux and Alexander grouped the two affections
as divers manifestations of one and the same humoral vice —
a rheumatic or gouty dyserasia. It is only of late years
that this view has been altogether abandoned.
To Wells is attributed the first demonstration of the special
frequency of cardiac mischief in the forms of pericarditis, en¬
docarditis and myocarditis occurring from rheumatism, aud des¬
ignating them as rheumatism of the heart. Chomel, Andral
and Bouillaud more particularly drew general attention to the
cardiac complications of accute rheumatism.
Hervey, the Chegoin, in 1845, called special attention to the
occurence of severe cerebral symptoms in certain unfavorable
cases of this disease.
A rapid rise of temperature has, within a decade of years,
been observed to precede the fatal issue in acute rheum-arthri¬
tis — or the so-called metastatic rheumatism. Finally, Griesiu-
ger was the first to notice the relation of certain forms of insan¬
ity to a previous attack of rheumatic-polyarthritis. He believed
them to be especially connected with the rheumatic process.
ETIOLOGY AND PATHOGENY.
Climate and season favor the development of rheumatic
fever According to Hirsh it is preeminently a disease of tem¬
perate latitudes. It is rarely met in the polar regions. In tem¬
perate latitudes, especially in Northern and Central Europe, the
distribution is highly irregular. In many parts, such as in
Cornwall, Guernsey, and the Isle of Wight, in the Belgian Can¬
ton of Beauraiug in Jekateriuoslaw, the disease appears to be
unknown or excessively rare. In temperate climates the maxi¬
mum prevalence is from October to May, while there is a falling
off during the summer months. Athmospherical influences
have at times, produced epidemics of rheumatism, Lange,
Pringle, Lancisi, Stoll, Merteus and Stoerek.
580 Original Communications. [December
Lebert says that the year 1857, at Zurich, was noted for the
prevalence of the disease.
The special predisposing causes of rheum-arthritis, are occu.
pation and mode of life, and exposure to extreme changes of
temperature, and insufficient protection during active bodily
exertion, and also the habitation of damp houses ; but this
seems less prone to cause the acute, than the chronic form of
articular inflammations and myopathies. Age is an important
factor; youth and manhood are especially liable; the favorite
period being between purberty and the age of thirty ; from 30
to 50 years coming next in order. After 50, first attacks are
extremely rare ; subsequent ones are less uncommon. Children
are seldom affected before the fourth year, becoming more com¬
mon after the fifth year, obviously, on acconnt of the develop¬
ment of muscular activity, when out door pursuits and school
going furnish more opportunities of exposure.” (Stille.)
The instances of the record of children prior to the age of 4,
or at the breast, are so rare as to lead to the inference that they
are due to errors of diagnosis. Beyond CO years, it is reported
to be impossible to find a record of a first attack. Sex does not
seem to predispose, excepting where the calling exposes the one
or the other to injurious influences. A first attack predisposes
to others, and this is increased by subsequent ones. Intervals
between successive illnesses becoming progressively nearer,
while the subsequent ones become more lasting, and the local
disturbances becoming of a more severe nature, ultimately
lapse into a chronic state. Intervals of three to five years
usually, sometimes even ten years, intervene between second
attacks. Comparatively, but few persons have more than one
or two attacks. The disease occurring in early life is prone to
be complicated with cardiac mischief, to which the patient soon
suecumbs.
Certain diseases predispose to the affection, especially scarlet
fever, typhoid, dysentery, and the puerperal state. In scarlet
fever the period of desquamation is the period of danger, while
in dysentery and typhoid only after recovery and during con¬
valescence. Among the existing or accidental causes of the
disease, chilling of the surface takes a prominent place, especi-
1879J Wiendahl — Acute Rheumatic Arthritis 587
ally sudden cooling of the body when heated by exertion and
exhausted and perspiring. Opportunities of catching cold are
more abundant during the frequent and sudden changes of
temperature, particularly in the spring aud in autumn, attribut¬
able to their cold and dampness. Many cases occur in which
neither a chill nor any exciting cause can be discovered. Senator
mentions that he met with some in which the disease followed
closely upon severe emotional disturbances, fright, for instance,
the patients having been overheated at the moment, but denying
having been exposed to any source of cold. He instances a case
due to fright, from an outbreak of tire whilst dancing in a ball
room. Cold is thought to produce it by carrying away caloric,
while dampness not only deprives the body of caloric and of
electricity, but also exerts a depressing influence upon all the
functions of life. Not only do the cold and dampness carry
these vital stimulants, but they prevent exhalation, and so
cause the retention of eifete material within the body. (Stills.)
The joints, according to Hr. Stille, suffer more than other
parts of the body from the influence of cold and dampness, or
affect them sooner because they are not protected by muscles
aud fat, aud have less blood and therefore less heat in them ;
and again, cold is prone to produce temporary suspension of
habitual discharges, menses, the flow of milk and the secretion
of pus. Whatever produces a suspension of discharges, may
of course bring on rheum-arthritis, but cold and dampness,
when they check such discharges, always produce such.
ACUTE RHEUMATIC ARTHRITIS A BLOOD POISON.
Not attempting to enumerate the many and various theories
which are advanced to explain the real and direct cause of the
disease, there is one of quite recent date which is preeminent
among all the rest, as clearing of very many dark points, and
is, that the phenomena of acute rheumatic arthritis are all
caused by the accumulation and retention of lactic acid and of
other acid products in the blood. Through the beneficial
effects and the marked reduction in the quantity of sugar in
the urine of the diabetic by the administration of lactic acid,
Dr. Foster, of England, during the treatment of a diabetic
patient, perceived that at each three distinct administrations
588 Original Communications. [December
of lactic acid during the same attack of diabetes, he produced
each time a well marked attack of acute rheumatic arthritis —
this patient never haviug had a previous attack of rheumatic
arthritis. Each time the drug was suspended, the rheumatic
phenomenon disappeared without any other treatment. Whether,
says Dr. Stille, the remarkable and consistent effects of lactic
acid in the case of Dr. Foster’s show any real and palpable con¬
nection between the assumed cause of the disease and its real
cause, whatever that may be, I do not know; but of one thing
I can be absolutely certain, and that is, that the lactic acid in
this case at least, if not in ordinary cases of acute rheumatic
arthritis, directly produced the actual symptoms peculiar to
acute rheumatic arthritis.
The acidity of the blood in this disease has been conclusively
proven to be greater than in any other affection, while the salu¬
tary and immediate effect of the administration of alkalies in
its treatment gives additionally strong support to the idea that
all the trouble is caused by the over abundance of some acid in
the circulation, whether that acid be lactic acid or not. That
acute rlieum-arthritis is due to blood poisoning there is no
doubt. Rheumatism, says again Dr. Stille, means a defluxion
of some humor upon the joints. This old definition is confirmed
by the most recent researches. It is a general systemic disease
which assumes a local form.
PATHOLOGY.
The inception of acute rheum-arthritis is manifested by the
violence or mildness of the attack ; in the one ushered in with
severe shivering, high temperature, and great pain in the joint
or joints affected; in the other with scarce an initial chill, with
a corresponding amount of local manifestation. The elevation
of temperature is usually moderate, seldom exceeding 102° and
104° F. The skin is not very hot to the touch, and is usually
bedewed with perspiration, which has a sour odor. The urine
is scanty, concentrated and of high specific gravity, is strongly
acid, and deposits brick -red urates, and free uric acid crystals
and urates of soda. Tongue moist and coated with a whitish
fur; bowels usually confined ; joints, one or more are simulta¬
neously or successively affected. The inflammation has a great
1879] Wiendahl — Acute Rheumatic Arthritis. 589
tendency to leave its seat and migrate to another joint, or to
all the other joints at once, or to one of the internal organs.
Here, again, Dr. Stille says, lies auother proof that we have no
local disease to deal with. The severity of the attack depends
often in the number of joints implicated, and by many it is
thought that heart complications are due to a multiplicity of
joints atfected, or at least to .several or more joints. The dis¬
ease is usually bilateral. The inflammation may return anew
to the same joint or joints of origin. Affected joints are swol¬
len, red. hot, and painful to the touch. The pain may amount
to only a simple feeling of tension, or it may be lancinating, or
throbbing, or boring, and often of an intolerable degree. The
disease may affect also the fibrous tissues of the hands, instep,
nucha and back, the sclerotic coat of the eye, and Dr. Thomas
Buckler, of Baltimore, says, the joints of the ossicles of the ear.
The intensity of the fever is proportionate to the number of
joints affected and intensity of local sysmptoms. The fever often
shows notable remissions, with a corresponding diminution in
the arthritic symptoms. Exacerbations frequently occur about
evening ; sleep is interrupted by the severity of local symptoms.
The decubitus is painful, motionless — a breath of air, a touch
of the coverings produces the most violent exacerbation of
pain.
The mind is generally unclouded, except in rare exceptions,
or unless there is cerebral complication. The disease is self-
liinited, and may go on for weeks or even months — generally
from six to eight weeks. It may be much prolonged by com¬
plications. It becomes chronic in a small minority of cases.
Sub-acute rheumatic arthritis is distinguished by the mild¬
ness of all corresponding symptoms and disturbances. Death
is often due to a sudden, rapid rise of temperature. A notable
hyperpyrexia distinguishes some cases, the thermometer show¬
ing a rise from 107 to 112°. The disease may pr ove fatal under
these circumstances, without any grave local complication,
death being attributable to the high temperature. These
cases are characterized as malignant. Delirium, convulsions
and coma are sometimes associated with the high temperature.
Convalescence from a severe attack is generally very slow.
590 Original Communications. [December
MORBID ANATOMY.
Acute poly-arthritis, per . se, being rarely fatal — opportunities
of studying structural alterations do not often occur. Even
the special changes found are so trifling as to have added little
knowledge concerning the essential nature of the disease, and
in such instances have only confirmed the observations during
life ; acute inflammatory process are often very indistinct after
death. The amount of effusion after death, does not corres¬
pond always to the amount recognized during lile. The pres¬
ence of fluid differs from ordinary synorria by its greater fluid¬
ity. True, pus is exceptionally found in rheum-arthritis. In
former times when vivisection was employed, the blood drawn
was found to be very florid in appearance, and threw up upon
allowing to stand, a thick huffy coat. In some cases the pro¬
portion of the fibrin in the blood, was found to have risen from
two and a half parts in one thousand (parts of blood) to five
and even eight parts in the same amount. This great excess
of fibrin in the blood is a very interesting pathological fact.
In no other disease is the fibriu so greatly in excess — according
to Dr. Stille there is but one plausible explanation of this
phenomenon. That it may be due to an arrested development
of the white corpuscles whose destruction would render intel¬
ligible the extreme pallor and debility of patients suffering
from this disease ; it being at present a seemingly well estab¬
lished fact that the red corpuscles are formed directly from the
white (corpuscles). The loss of strength is due to the enor¬
mous waste of tissue brought about by the excessive discharge
of solids in the urine.
Becquerel and llodier found the serum to contain less than
its due proportion of solids. The blood is usually firmly coag¬
ulated after death ; it is dark and fluid only in such cases as
prove rapidly fatal with a sudden rise of temperature. The
abnormal development of lactic acid according to Todd, Fuller,
Bouchardat and alias, iu the blood during life, has often been
assumed but never proved to occur.
Complications, especially with the thoracic viscera are usual.
In cases which run their course with a high temperature and
severe cerebral symptoms, parenchymatous degeneration of
1879] Wiendahl — Acute Rheumatic Arthritis. 591
particular organs, or swollen condition of tlie liepatliic cells
and renal epitlielia, are said to have been found, the brain it¬
self being free from morbid change, or else, markedly con¬
gested with minute extravasation of variable amount of
oedema in the pia mater and arachnoid. (Senator.)
There is frequently some 'kind of eruptions' accompanying
attacks of rheum-arthritis. Sudamina are very common. Ery¬
thema, both simple and nodose, occasionally appear and also
at times urticaria.
Small quantities of albumen may be found during one or
more days, without the presence of any other signs of renal
mischief. The phenomenon is propably due to an increase in
the intensity of the pyrexia.
NERVOUS SYSTEM.
Most cases of rheum-arthritis are in general free from cere¬
bral symptoms — in certain unfavorable cases, however, the
nervous centres may be variously involved. Such as acute
cerebral or spinal meningitis, mental alienation or severe brain
symptoms without any more demonstrable lesions of the
structure than are met in enteric and other infective maladies.
Drunkards ohbroken down constitutions are most liable to
severe cerebral disturbances and in these, the disease though
not at first of a very severeTtype ; soon assumes an irregular
march, marked by early delirium, the temperature undergoes
a great and sudden rise ; the skin becomes hot, the abundant
sweating often subsides, the pulse becomes hurried and com¬
pressible, the sensorium much oppressed, the face cyanotic and
pale and after an interval of a few hours or a few days ends in
death. With regard to this abrupt rise of temperature, Sen¬
ator ventures the following : That it may be that the pyrogenic
and phlogogenetic matters which are undoubtedly present in the
blood undergo a great and sudden increase, and paralyze the
heart regulating centres, or stimulate centres presiding over
heat production ; or we may suppose that the primary effect of
those substances is to paralyze or at any rate to weaken the
heart contractions and thereby to reduce the arnonut of heat
given off.
2
592 Original Communication*. [ December
FEBRILE PHENOMENA.
The fever is proportionate to the number of joints interested
and to the intensity of the inflammation and runs no typical
course. Initial signs occur barely in half of the entire num¬
ber and is not usually severe, generally speaking several slight
fits of shivering take place, and are followed by a sense of
warmth on the first day. In all, except the mildest eases, the
temperature ruus up to 102° F., or a little higher. Evening
exacerbations occurring on subsequent days may bring it to
104°. In its further progress the temperature obeys no defi¬
nite rule. Periods of remission or even complete intermission
lasting for twelve or even twenty -four hours are very common,
and they are always followed by moderate febrile reaction and
an exacerbation of the disorder, a rapid subsidence is rare, the
fall being gradual, extending over several days. A rise of
temperature is the first symptom recognized in the onset of
complications. A correspondence between the temperature and
the pulse rate is not always maintained. A quickening of the
pulse occurring without the rise of temperature is often due to
the severity of the pain and the consequent mental excitement.
In severe cerebral symptoms the temperature reaches the
highest limits, except in sunstroke (I believe) ever noticed in
the human subject, some reaching as high as 111 and 112° F.
before death.
COMPLICATIONS.
Fewer diseases present such a great variety of complications
as poly arthritis. They occur in both the mild and severe form,
though, perhaps, more often in the latter. They may take
place at an early stage or at the height of the disease ; per¬
haps less often when declining. They are sometimes found
setting in simultaneously with the joint affection, or even pro¬
ceeding the latter by a short interval, so as to make it doubtful
which of the two is the primary disease. The most frequent
of the complications are pericarditis and endocarditis ; of the
two, endocarditis occurs the most frequently, but pericarditis
is attended with far greater danger to life. Rheum-arthritis
seems to be associated with a tendency to disease, especially
to inflammation of internal organs. Recovery from pericarditis
1879] Wiendahl — Acute Rheumatic Arthritis. 593
may be expected in the majority of cases. Endocarditis offers
no immediate danger, but is of great importance as being often
the starting point of slowly progressing changes which result
in serious lesions, after the lapse of many years. Generally
pericarditis accompanies endocarditis. This coni] dication
occurs shortly in severe forms of acute rheum-arthritis, though
it may happen in cases of the sub-acute form. These heart
complications are much more common in the young than in
older patients ; nay it may be laid down as a law, that the
younger the patient the greater the risk of his heart becoming
affected. The risk is greater before puberty. It is generally
accepted that the heart is implicated in fully one-third of all
cases occurring during this period. This danger continues
great until about the twenty-fifth year of life — after that
period endocardial complications are the exception — save when
organic mischief has left a predisposition to renewed inflam¬
matory changes.
Inorganic or functional m urmurs, very common in polyarthritis
are a fertile source of error, and the semblauce of cardiac in¬
flammation is further increased by pain in the pectoral and in¬
tercostal muscles, or in the diaphraghm with the feeling of oppres¬
sion, the dyspnoea, and the acceleration of the pulse, with which
they are associated. Pleurisy and pneumonia occur often
also, in rheumatic arthritis. Bilateral pleurisy has been often
observed.
Inflammation of various mucous surfaces is not unusual,
specially bronchitis, also pharingitis and cystitis. Among cere¬
bral complications, meningitis and spinal meningitis occasion¬
ally occur. Insanity of a true type not abscribed to the
rapid rise of the temperature, but promoted by the pain and
want of sleep, pointed out by Tuengel, and exhibiting every
variety of excitement and depression from well marked mania
to melancholia. Sometimes of short duration, at others pro¬
tracted into the period of convalescence, persisting after com¬
plete recovery and constituting the protracted form of rheu¬
matic brain disease. It may also determine an outbreak of
delirium tremeus in drunkards. When endocarditis exists,
symptoms of cerebral disturbance may be caused by embolism
of the arteries of the brain.
594 Original Communication x. {December
DIAGNOSIS. /
Rheumatic polyarthritis, though offering no difficulty of
diagnosis by its characteristic symptoms of joint affection and
fever, may yet be easily overlooked by not carefully
differentiating certain symptoms which are associated in
other diseases with inflammations and neuralgic pains
in the joints. Foremost among these is pyaemia. Where such
doubts exist, we should look for some local suppuration ante¬
cedent in point of time to the articular malady. In default of
this sign, the rigors and the temperature variations, the occur¬
rence of metastatic deposits in other organs, especially in the
lungs, the profound constitutional disturbance, the disorders
of the sensorium, the icterus — all of them phenomena which
scarcely ever occur in rheum-arthritis. Many diseases of a
pyajinic nature, certain varieties of puerperal fever, for instance,
in which the characteristic febrile symptoms and the phe¬
nomena localized in the generative organs are not well marked,
may puzzle a good deal at first, but are usually set at rest by a
future course of development. What is true of pyaemia is also
of glanders. But the patient’s history, employment, the pres¬
ence of abscesses in the muscles, pustules and ulcers on the
skin and the nasal mucous membrane — finally the onset of
delirium and utter break-up of the system, must assist as dis¬
tinguishing marks. Gout is not easily mistaken for the dis¬
ease, on account of the advent during the night, and after pro¬
longed gastric disturbances, and further, that it manifests itself
in the beginning in a single joint, and that a toe-joint. Again,
the advanced time of life of the first attack, contrary to rheum-
arthritis.
Traumatic arthritis is very unlikely by its association to
injury ; scrofulous arthritis by its chronic course, its tendency
to pus formation, and other signs of scrofula.
The articular or hysteric neufoses described by Brodie, Stro-
meyer, and especially by Esmarch, are absolutely apy retie, but
may nevertheless suggest the possibility of mild poly-arthritis.
Absence of fever and any palpable alteration in the painful
joint, its limited character, its freedom of pain during sleep,
when any position may be imposed to the affect-eel limb, t-lie
1879] Wiendahl — Acute Rheumatic Arthritis. 595
constitution, and above all the mental state of the patient,
who is usually of the female sex, and finally the prolonged
duration of the symptoms. From certain pains in the ansemic,
in the subjects of scurvy, puerpura luemorrhagica and haemo¬
philia are often purely neuralgic, unattended by any change or
swelling of the joints, and never pass into the graver forms,
nor followed by complications and by sweating, which is so
constant a feature in rheum-arthritis.
In infancy, various forms of multiple inflammation about the
joiuts are met with which may simulate the disease, such as
acute rickets, syphilitic ostreochondritis, and separation of
epiphysis, due to many other causes. The early period of life
in which they occur is sufficient to distinguish them.
ISSUES AND SEQUELAE. PROGNOSIS.
Death is usually rare, being due more to complications or
unfavorable conditions of patients than to joint affection, even
when this is severe. In most of the fatal cases death is usually
due to sudden rise of temperature, and in persons of intem¬
perate habits. In a small proportion of cases, death is due to
complications during the poly arthritis, and most frequently by
peri- or endocarditis, more rarely by meningitis.
The ultimate issue in non-fatal cases depends on the presence
and nature of complications. The prognosis is favorable in the
very mildest, which have followed a sub-febrile temperature.
As long as there is fever the prognosis must be left doubtful,
excepting after the third week, w hen complications rarely arise.
Youth being most prone to heart complications, the chances of
complete recovery are less promising in these than in adults,
owing to the risk of permanent disease in that organ.
Chorea is a frequent accompaniment of mitral valve affec¬
tion. At 25 years the disease usually terminates in complete
recovery, with the exception of a remaining tendency to renewed
attacks at variable intervals of time. Permanent alterations
in one or more joints are left, only in a relatively small number
of cases who have undergone a very intense or protracted
attack ; that is, chronic inflammatory conditions liable to ex¬
acerbation from trivial causes — thickening, ankilosis, and even
ulcerations. Such consequences are more common after re-
596 Original Communication 8. [December
peated attacks, and especially after the sub-acute forms of
rheum-arthritis, or such as drag on for a length of time.
Mental disease, in the form of melancholia, is more common
as a sequelae in adults than in children. Orchitis is mentioned
by Duffy as a sequelae of the disease in Malta, and that it
usually ends favorably.
The prognosis is upon the whole a favorable one.
TREATMENT.
The disease tends to recovery after a self-limited duration,
varying from a week to two months. The treatment of acute
rheumatic arthritis, apart from complications, nearly always
gets well, and may be abandoned to palliatives and nature, and
to rest and good nursing. But it would hardly be expected
that we should refrain from treatment in the face of the mani¬
fold disturbances and dangerous complications prone to or
urgently calling for interference. Lebert, from experience, was
impressed with the belief that it is more protracted and at¬
tended with graver complications, when left to itself than when
subjected to treatment.
Bleeding, refrigerent salines, mercurial and antimonial prep¬
arations belong to the past ; the medication having varied with
the present theories concerning its pathology. No medicine or
medication can, or has ever stopped an attack of the disease.
To arrest or abridge the duration of the attack and to prevent
the cardiac complications are the important objects of medica¬
tion. Lemon juice originally recommended by Dalrymple and
Owen Rees, of London, and methodically tried by Lebert, was
administered in the beginning, with 4 ounces per day ; increas¬
ing the daily allowance by one ounce each day, during the first
few days until 6 ounces had been reached. This being given a
tablespoonful every two hours in half a glass of sugared water
was found to mitigate the fever and shorten its average du¬
ration, but did not lessen the complications. It does good in
mild cases but cannot be relied upon in severe attacks.
For the past twenty years the alkaline treatment has been
used in this country and England upon theoritical grounds, in
order to antagonize the abnormal production of acid supposed
to go on during rheum-arthritis. If promptly and efficiently
1879] Wlendahl — Acute Rheumatic Arthritis. 597
employed, it shortens the duration and very considerably lessens
the liability to pericarditis and endocarditis. To be effective the
alkaline remedy should be given in full doses, at short intervals,
until alkalinity of the urine is produced. On the subsidence of
the active symptoms, two grains of quinine may be added with
advantage to each dose. The alkaline must be gradually dis¬
continued, but thequinia continued.
One or two drachms of the bi-carbonate of soda or potassa,
repeated every four hours, will render the urine alkaline in from
twelve to twenty-four hours. These doses are generally well
tolerated by the stomach, if given during efferversceuce, with
citric acid or lemon juice. After alkalinity of the urine is pro.
duced, the doses may be much diminished, but they should be
sufficient to keep the urine alkaline. The good results of the
alkaline treatment are not obtained unless it be pursued in this
efficient way. Small or moderate doses are of no use. The
prevention of heart complications no doubt depends on the
arrest of the disease by medication which shortens the attack.
(Prof. A Flint.)
Senator says that since alkalies must be given in large doses,
we should choose sodic salts in preference to the corresponding
potassium or ammonium compounds.
The former base is, in itself, indifferent ; and the latter may
do harm to the heart and nerve centres.
In giving the bi-carbonate of soda we may induce purgation
or diarrhoea, but this, if necessary, may be controlled by lessen¬
ing the dose, and may be always prevented by adding a few
drops of laudanum to it. The remedial effect might be attained
more speedily by employing Gerrhardt’s inhalations of carbo¬
nate of soda, which has been employed with excellent effect in
recent endocarditis.
In connection with alkalies, might be mentioned blisters,
which are advocated by Legroux, Dechilly, and above all, by
Davies, and which have the power of shortening the course of
rheumatic-arthriis, by eliminating the materies morbi, and alter¬
ing the condition of the blood from acid to alkaline. To produce
this effect they must be applied over all the affected joints.
598 Original Comm unications. [December
Experience, if not science, lias decided conclusively in their
favor. (Stille.)
Salicin has been recommended by Dr. Maclagan in 1870. Given
in doses from fifteen to thirty grains, repeated every two or
three hours, it sometimes proves an abortive remedy, and in the
majority of cases, in twenty -four or forty -eight hours, the gen¬
eral symptoms are notably diminished if not arrested. After
cessation of pain and fever it should be continued in small doses
for a week. A renewal of the symptoms should be met by full
doses of the same remedy.
Salicylic acid or the salicilate of soda have proved as success¬
ful as the salicin. They are more apt to cause gastric disturb¬
ance, and to occasion considerable diaphoresis. Professor Stille
and others, however, accuse it of producing disorders and even
grave accidents, in almost all the functions of the economy and
in some cases producing ringing in the ears, or deafness, or a
rapid pulse, or an excessively high temperature, panting res¬
piration, albuminuria, delirium and imminent collapse, and that
in one published case this anti pyretic did not lower, but on the
contrary, seemed acutually to raise the temperature so high,
that immediately after death it stood at 111° F. However true
the above, yet it does not entirely comport with my experience
in more than twenty-five cases. “ It may be given in simple
doses, repeated every two, three or four hours, according to the
intensity of the disease and local symptoms, and should be con¬
tinued until arrest or notable improvement has taken place.
(Prof. Flint.)
Quinia in full doses is a useful remedy in this disease.
Opiates are invaluable as palliatives— try methylamine or its
isomer ; propylamine has also its advocates. Recently, Coze,
of Strasburg, and especially Dujardin Beaumetz, have found it,
after extensive series of observations, as capable of quickly
controlling the pain and fever, and subsequently removing the
articular swelling also, and found the secretion of urea lessened
during its administration.
Colchicum, whilst being laid aside by some, is regarded by
others as the specific and infallible anti-rheumatic, and even
employ it as means of determining whether a particular disease
1879] Wiendahl, — Acute Rheumatic Arthritis. 599
be rheumatic or not. It is not decided whether it be curative
in purgative doses, or whether its irritant effects on the bowels
should not be avoided either in acute or chronic cases.
Colchicine. Skoda holds the highest opinion of its beneficial
influence upon the inflammatory changes in the joiuts. He pre¬
scribes one grain of colchicine in from two to three drachms of
water, with a few drops of rectified spirits to assist in dissolv¬
ing it, giving five drops of this solution once to twice or three
times a day, until (usually in two or three days) active purging
sets in and the pains abate.
Local measures of treatment are indicated to relieve pain and
tenderness referred to the affected joints ; alkaline lotions with
laudanum, the chloroform liniment, or lead and opium wash,
and the tincture of aconite — each affords more or less relief.
It is usual to surround the joints with cotton batting, to
protect them from friction of the bed clothes and jarring
movements. Extension of the limbs by pulleys and weights
relieve by separating the articular surfaces. Rendering the
limbs immovable by splints or by bandages and plaster of Paris,
may sometimes be resorted to. German writers, Stromeyer,
Esmarch, Senator, recommend cold applications by means of
wet compresses, and even of ice. With the ideas of Metas¬
tasis, says Prof. Flint, which formerly pervaded pathology,
refrigerant applications would have been deemed hazardous,
but experience shows that no harm follows this method of
palliation. The wet pack applied to the affected joints may be
tried as a means of relieving pain, a hypodermic injection with
a filled Pravas syringe, of one per cent, watery solution, are at
once safe and convenient. Senator says that he was struck
with the rapid way in which it relieved pain ; the limb
should be well covered, afterwards. A temperature of 105°
and over, calls for an antipyretic treatment. If not diminished
by salicins and salicylic acid, quinia should be given and the
» temperature reduced by cold sponging or the wet sheet, the
latter measure repeated as often as the temperature rises.
When in connection with liyperexia, the symptoms referable
to the circulation denote asthenia or collapse, alcoholic stimu¬
lants should be given freely. (Flint.)
3
600 Original Communications. [December
The sweating may be controlled by small doses of atropine,
from one sixtieth to one thirtieth of a grain. (Stilh*.)
During the febrile stage of acute rheum-arthritis, the diet
should consist mainly of farinaceous and mucilaginous prepara¬
tions, with lemonade and carbonic acid water as a drink.
Otherwise, the diet should consist of beef tea, or broth with
bread and milk, and no solid food should be allowed.
J. H. Wien dahl.
History of the Yellow Fever Epidemic of 1878 in Canton,
Mississippi.
By A. T. SEMMES, M.D.
On the railroad, two hundred miles north of New Orleans, is
situated the busy little town of Canton, counting with its
suburbs about thirty-five hundred inhabitants.
Situated about two hundred and fifty feet above the sea level,
and built upon a fiat table land ridge between the Pearl and
Big Black rivers, in central Mississippi, it suffers every summer
and autumn with the various malarial diseases of the Missis¬
sippi Valley.
On the south and west, distant from the centre of the town
about one mile and a half, a muddy bayou struggles sluggishly
through its many windings, overflowing extensively with every
heavy rain fall, and drying up in stagnant pools during the
summer drought.
Through the bottom portion of the town a smaller ravine
runs, spreading out over its flat vale with each heavy shower,
and, upon receding, leaving many small lagoons to slowly
evaporate by the summer heat.
Only once before, in the year eighteen hundred and fifty-
five, was Canton affected with an epidemic of yellow fever,
though several times in the interval persons sick with the fever
have come from infected places, and died here without spread¬
ing the disease.
1879] Semmes — Yellow Fever Epidemic. 601
As early as June of eighteen hundred and seventy-eight, the
unusual heat had begun to produce, much sooner than com¬
mon, serious spells of remittent fever, and as the month of J uly
came, filling each successive day with a heavier roll call for aid,
the physicians in the surrounding country, suspicions of yellow
fever, began to excite the fears of all who had any recollection
of 1855.
Noticing closely day by day, the features of our bilious fever
patients, showing a constantly increasing shading off into
many symptoms of yellow fever cases ; I expressed my hon¬
est belief that, without some marked improvement in our
climatic conditions, we would certainly drift into a visitation of
the dreaded scourge. Still, as many others besides myself
were fully satisfied of the perfect insufficiency of such quaran¬
tines as we could enforce, no measures for quarantining were
started till the 1st or second of August, when already the
deadly enemy was among us.
On the 20th of July I attended a young man, who had no
communication with any person or goods of any sort by which
he could be infected; still his case had every feature and
symptom of the cases of yellow fever which I had nursed in
the epidemics of 1853 in Louisiana and in 1855 in this place.
With regard to this case, though I feel satisfied myself of its
real character, I wish to state that he left Canton on the 20th
of August and remained in the country eight days. In the
first week of November, he returned to Canton, to a house in
which there had been thirteen severe cases of fever, and there
aided for fourteen days in nursing two of the severest cases of
the whole epidemic. At the end of the fourteen days he was
attacked with the fever, being quite sick for three days, but
not nearly as sick or weakened as in his original attack.
1 mention these facts so minutely for the reason that many
will contend that his having the fever in November, proves
that he did not have it in July. I have known some such
second attacks, and so do all writers mention similar cases.
In the last week of July, a telegraph operator, who had but
recently left New Orleans, had the fever in a private residence
in the extreme northwest portion of the town, infecting no
602 Original Communications. [December
one, as at least seven or eight weeks elapsed before the dis¬
ease reached that part of city. On the 2d of August, a rail¬
road engineer, who occasionally passed an hour or two in the
office of the above mentioned operator, had the fever in a rail¬
road boarding house ; but no infection seemed to affect anyone
else among the boarders, as it was at least six weeks or more
before the disease reached this locality.
On the 1st or 2d of August there came to Canton, from New
Orleans, a school teacher with the yellow fever on him, and
was nursed by a family next neighbors to the above mentioned
engineer, but none of the family were infected.
On the 1st and 2d of August, a family reached Canton from
New Orleans, being received into the house of quite a large
family. In a few days the children of the New Orleans family
were slightly sick and excited the suspicions of one of our
physicians, who visited them. In the next few days, following
four more of this combined New Orleans and Canton family
were very slightly sick, but were treated without a physician,
by the host, with calomel and quinine, and were up and attend¬
ing to their duties in thirty six to forty hours. The other four
or five members of the family were not sick at all.
On the 8th of August (in the yard of what is known, in the
Canton History of the Epidemic of 1878, as the Henry House),
an old negro woman was taken very ill with what afterwards
proved to be of the same nature as all of the succeeding malig¬
nant fever cases of this portion of the town.
This Henry House is on the same street with the residence of
the above mentioned combined New Orleans and Canton family,
with a space of about two hundred feet between them.
The old negress had not been out of her own premises, nor
held any communication with the neighbors.
On the 10th or 11th August, a little white child in this Henry
House was taken violently ill, and in one or two days her father,
Dr. McKiu, was prostrated, then in rapid succession one after
another of this Henry House family sickened, with the excep¬
tion of two white members who went through the entire epi¬
demic without being infected.
In the rear of this Henry House had been festering, all the
Semites — Yellow Fever Epidemic.
r,03
1879]
summer, a very filthy lagoon, filling the neighborhood every
evening with a horrid stench. Also under this house was an
old disused cellar filled with stagnant water. From* about the
14th or 15th August, all the families of this portion of Canton
to the windward of this lagoon were, in quick succession, stricken
down with the yellow plague, while all the families in the oppo¬
site direction from this pool were more slowly and much more
mildly taken.
1 have been thus explicit in stating facts and points in re¬
gard to the Henry House, as some physicians, who are certain¬
ly as competent as myself to judge, but who were neither here
during the epidemic, and who were not here after its subsidence,
long enough to work out all facts and previous cases, have posi
t.ively decided that our epidemic of 1878 was due entirely to the
importation from New Orleans of the fever, by the New Orleans
family whom I have mentioned above, as refugees,, in the resi¬
dence adjoining this Henrv’House.
In opposition to this opinion, I shall now return to the first
week of August. On the 2d of August and the 4th and 5th, up
to the 7th of August, I treated a family in a part of the town,
remote from this Henry House, one after the other of its mem¬
bers becoming very sick with what I regarded ,at first as very
refractory malarial fever, till the fourth case (a young man,
Worlmer) gave me satisfactory evidences of yellow fever. After
his case the remaining members of the family, in the course of
twelve or fourteen days, though they had removed from the
town, had yellow fever mildly.
Unaided by any microscopic observations of the blood or se¬
cretions of my patients, and over- worked both day and night to
such an extent as to prevent me making regular periodic notes
upon the pulse and temperature, I hesitate somewhat to give a
positive diagnosis of a good many cases which could not be
traced to an imported origin. However, in truth I shall state
that if hundreds of other cases were yellow fever, as so pro¬
nounced by experts, then these cases of mine were yellow fever
of local origin, or else all the past history of yellow fever is
rendered more than doubtful.
If nothing short of inspection, by post mortem examination
594 Original Communications. [December
and demonstration with the microscope, afford the only infallible
means of diagnosiug pernicious malarial fever from yellow fever,
then the overtasked practitioner of medicine, in a sweeping, de¬
vouring plague, as we had here in 1878, is not competent to
decide disputed points of the nature and features of yellow
fever, which for fifty years have puzzled the minds of hundreds
of able and experienced experimentists. Guided by the teach¬
ings of a Stone, a Dowler, a Cartwright and a score of New Or-
eans ablest physicians I had for twenty -five years, considered
yellow fever as needing no importation to give it a starting
point.
Neither could I believe, from my teaching and my experience
in 1853 and 1855, that contagiousness was one of its properties.
The facts that have presented themselves to me in the epi¬
demic of 1878 at Canton, as well as some cases I have treated
here during other years (notably 1871) forces me to express my
opinion of yellow fever being indigenous to all the lower Missis¬
sippi Yalley when we have the climatic conditions of 1878.
With regard to contagion, our epidemic of 1878 has com¬
pletely confounded my former opinion.
The disease was unmistakably contagious here, and from
the accounts I have read of other afflicted places, contagion
seemed one of the most promineut features. In fact so plainly
shown in many instances was this sure and rapid communica¬
tion of the disease by any one from the infected town visiting,
even for a few hours, a family in the country, that we must ad¬
mit either the theory of contagion, or that many isolated farm
houses throughout the State were infected without direct im¬
portation.
In 1855 this contagious feature was certainly disproved by
scores of sick cases being removed from the town out to crowded
residences in the country, and there dying with black vomit,
without a single instance of communicating the disease. One
other marked difference in the epidemic of 1878 from that of
1855, was the apparent malarial type of the fever last year which
was not known in that of 1855. 1 am aware that some able ob¬
servers deny the possibility of the coalescing of yellow fever
with malarial fever, but until future development of post mor-
1879] Semmes — Yellow Fever Epidemic. 605
tem examinations and microscopic ivestigatiou prove the opin¬
ion totally untenable I shall be compelled to adhere to the idea
that the pernicious malarial fever or haemorrhagic malarial
fever, and haematuric fever, are really and truly an indigenous
form or type of yellow fever.
One fact I can certainly state with regard to our Canton epi¬
demic of 1878, namely : that the free use of calomel, podophyllin
and quinine, in almost every single case which came under
my notice, produced a decided amelioration in eighteen hours
of all the symptoms ; with an undoubted remission in more
than a majority ot those cases even that proved themselves to
be of the yellow fever nature by the albuminous urine, by dis¬
tinct black vomit and by the odor andjaundiced color.
Also must I state that the above treatment gave to the physi¬
cians, w ho adopted it, the satisfaction of footing up an honor¬
able and laudable balance sheet of cases and deaths ; while
those who did not use this medication were very unsuccessful
in the management of the disease.
This brings me to the point of prophylactics upon which I
can say very little as the idea of w arding off an attack by
previous medication, wras generally discountenanced.
Two individuals under my constant notice labored day and
night in the most infected houses, and over the beds of the
worst cases for six or seven weeks before taking the fever, and
even then very mildly. These two persons used daily eighteen
or twenty grains of quinine.
Neither age nor sex, in white or black, seemed to make a
different degree of susceptibility to the disease, but those of any
age or color w ho had been subjects of remittent fever were more
quickly infected, though not more violently affected than others
in good health.
The occupation of the person, as far as my limited observa¬
tions went, made no difference in liability to take the fever,
nor did the condition of life as regards poverty or affluence.
A sudden fall in the thermometer about the fifteenth day of
September made a considerable increase in numbers of new
cases and number of deaths.
Taking a radius of one mile to cover the area of the entire
606
Original Co m m unications.
[December
town of Canton with its suburbs, we include a population, be¬
fore the epidemic, of about thirty-live hundred. About twelve
hundred of these remained during the prevalence of the fever ;
giving a total of yellow fever cases of nine hundred and fifty,
and of deaths from yellow fever of one hundred and fifty.
The epidemic visited every portion of the above area, dimin¬
ishing gradually in violence, and giving us only five or six
cases during the week, between the 7th and 15th of November,
after which time there was only one case, of a refugee, who,
in six or seven days after returning to Canton, took the fever
on the 6th day of December.
Up to August 1st, when already the disease was in our
midst, no sanitary measures of any sort were adopted, looking
towards prevention ; but a good deal of street work (such as
trenching along the sidewalks, cutting down weeds, etc.), had
been going on for several weeks, notwithstanding protests had
been made against it.
After August 1st, a very free use of crude carbolic acid and
of lime was had recourse to as disinfectants, both having been
sprinkled over the public streets and private yards, and liber¬
ally used in most of the houses.
Their use did not seem to place the least check upon the pro¬
gress of the fever, but I am not aware of any injury it caused
the sick.
Report of the Committee
APPOINTED BY THE NEW ORLEANS MEDICAL AND SURGICAL ASSO¬
CIATION, OCT. 25th, 1879, ON THE FOLLOWING SUBJECTS, SUB¬
MITTED BY THE EXECUTIVE COMMITTEE OF THE AMERICAN
PUBLIC HEALTH ASSOCIATION, TO BE READ AND DISCUSSED
AT THEIR MEETING AT NASHVILLE, TENN., NOV. 18th, 1879.
Propositions.
1. How ty) deal with a city in the yellow-fever zone in order
to prevent the appearance of a first case.
2. How to prevent the importation of a first case.
2879] Report of Committee — Public Health Association. 607
3. How to deal with a first case and early cases generally
when, in spite of precautions under first and second headings,
it has made its appearance.
4. The duty of local boards of health, or other health authori¬
ties, to report such cases promptly, even though there may be
some doubt as to the diagnosis. Whether the knowledge that
such reports would be faithfully made would not have a tend¬
ency to allay apprehensions and give confidence to other com¬
munities while warning them of the importance of making
preparations for contingencies.
5. Under what circumstances may it become necessary or
expedient to remove the unacclimated portion of the population
from an infected place? How may this be effected for the
poorer classes of the population, and how should the people
thus removed be cared for and supported ?
6. Measures for isolating a dangerously infected place.
7. Organizations for the relief and treatment of the sick in
an infected city.
8. Measures for preventing the spread of the disease from an
infected place by railroads, including the management of trans¬
fer stations.
9. Inspection of steamboats at an infected place and at inter¬
mediate stations between the port of departure and their final
destination. Should stations of observation be established by
the National Board of Health ? If so, what should be their
relations to the health authorities of the States within whose
territorial limits they may be established.
10. Results of the co-operation and aid given by the National
Board of Health to State and municipal boards under the pro¬
visions of the act approved June 2, 1879. What suggestions
may be made to render this system more efficient ?
1. How to deal with a city in the yellow-fever zone in order
to prevent the appearance of a first case.
Answer. — Put such city in the best possible hygienic con¬
ditions.
a. — Drainage. Proper elevation and grading of the surface
of the soil. All surface- gutters to be provided with sides and
bottoms of masonry or chemically prepared wood, to facilitate
flushing. All yards to be graded so as to drain into the gut¬
ters. All streets to be properly graded and paved. Banquettes
carefully constructed. All privy vaults, where existing, should
be required to be so remodelled as to avoid all possibility ol
siepage. lu the construction of neic privies , every care should
be taken to remedy the detects of the present system.
4
608 Original Communications. [December
b. We would suggest, as applicable to most houses already
built, such practical alterations as would improve their general
sanitary condition ; i. e., elevation of the lots upon which they
stand to avoid all stagnant water, and such alterations as are
deemed necessary to improve their ventilation.
In building new houses , there should be an ordinance enacted
and rigidly enforced by the proper authorities, requiring a
specific elevation of the whole lot to be built upon, above the
level of the street — such ordinance to be complied with before
the foundations are allowed to be commenced.
We would suggest thirty inches as the minimum elevation for
the floor above the surface of the lot.
No tenement houses to be allowed, as in our opinion they are
always calculated to favor accumulations of filth, and thereby
the production of disease.
Sufficient light and proper ventilation are essentials to health,
also an abundant supply of pure water-.
Where cisterns are used, the greatest care in their construc¬
tion and management is necessary.
All accumulations of garbage or tilth to be specially pre¬
vented.
Extensive excavations or disturbances of soil to be forbidden
from May to November.
The thorough police of the city by trustworthy and compe¬
tent sanitary inspectors.
2. How to prevent the importation of a first ease.
Answer. — By a rational quarantine under the direction and
management of physicians of undoubted capacity and recog¬
nized integrity.
Require all vessels, at all seasons of the year, to be subjected
to careful inspection by the quarantine physician and to be sub¬
jected to such detention as he may deem necessary for efficient
cleansing or disinfection. Establish a quarantine hospital for
the treatment, of infectious or contagious diseases arriving at
quarantine — and we would advise that suitable facilities be
provided for the unloading of cargoes and their proper disin¬
fection when judged necessary.
1879] Report oj Committee — Public Health Association. H09
3. How to deal with a first case and early cases generally
when, in spite of precautions under first and second headings,
it has made its appearance.
Answer. — Every means should he adopted to insure the
earliest information to the health authorities regarding such
case or cases.
Isolate, as far as practicable, the locality where such cases
have occurred, and delegate to the proper authorities sufficient
power for a thorough and repeated disinfection of such local¬
ity. All clothing and bedding of patients should be thor¬
oughly disinfected by heat, or destroyed. In case of death,
immediate private burial to be insisted upon.
4. The duty of local boards of health, or other health author¬
ities to report such cases promptly, even though there may be
some doubt as to the diagnosis. Whether the knowledge that
such reports would be faithfully made, would not have the
tendency to allay apprehensions and give confidence to other
communities, while warning them of the importance of making
preparations for contingencies.
Answer. — All suspicious cases should be at once reported to
the proper health authorities, whose duty it should be to investi¬
gate such cases and report them without delay to all other in¬
terested communities. We believe this to be the only course
to pursue to gain confidence and allay useless apprehension.
5. Under what circumstances may it become necessary or ex¬
pedient to remove the unacclimated portion of the population,
from an infected place ? How may this be effected by the
poorer classes of the population, and how should the people
thus removed be cared for and supported ?
Answer. — We do not believe that yellow fever is contagious,
communicated from body to body — but that the cause, what¬
ever it may be, spreads through the atmosphere, and that a
certain amount of the poison in this medium is necessary for
its manifestation. That its spread is not by diffusion, other¬
wise it would grow less and less in intensity ; but, that it is
capable of multiplying in some way, as yet unknown to us,
thereby increasing the intensity of its infection. That this
010 Original Communications. [December
atmospheric infection-tendency while greatly due to, is not
wholly dependent upon heat and moisture, but that the pres¬
ence of decomposing organic material and the gases arising
therefrom enter largely as a factor, if not in its production, at
least in its spread; and that cleardiness of person and sur¬
roundings will go far towards preventing its spread, if not
securing its entire eradication.
The removal of the unacclimated from the place of infection
is a measure of wisdom, and would save many lives. The
presence of the disease and its disposition to spread, as man¬
ifested in the successive attacks of several members of the
same household or adjoining households, should be the signal
for a general removal of the unacclimated ; for the rapidity of
its spread, is evidence of its intensity.
The details of measures for the removal of the poor will be
suggested and controlled by the circumstances of location and
surroundings. The governments, national, State, or municipal,
or all three, aided by private contributions, should furnish
means for their care.
6. Measures for isolating a dangerously infected place.
Answer. — When the disease has progressed to such an extent
as to render a place dangerously infected , within the meaning
of the term as employed by the National Board of Health, we
would recommend the removal of all persons liable to infection
and regulate intercourse so as by all possible means to prevent
the ingress of unacclimated persons.
7. Organizations for the relief and treatment of the sick in
an infected city.
Answer. — Each infected district should have its own hospital
centrally located, of sufficient capacity to meet all wants, and
presided over by a staff of medical men of standing and repu¬
tation in their profession and community. Each hospital
should have its ambulances easy and comfortable, and every
patient dependent on charity for its support and medical treat¬
ment, if discovered within the first twelve hours after the inva¬
sion, should be removed to said district hospital. The hospital
staff should have entire control of the district, and such
patients as have been sick for twelve or more hours should be
1879] Report of Committee — Public Health Association. 611
treated at their place of residence by this staff, and their neces¬
sities should be relieved from the hospital upon the order of the
attending physician.
8. Measures for preventing the spread of the disease
from an infected place by railroads, including the management
of transfer stations.
Answer. — We recommend the adoption of such measures by
the National Board of Health as shall secure, during the preva¬
lence of an epidemic, the abolition on railroad cars of all up¬
holstered articles of furniture, rugs, carpets and such other
material uot washable, as well as all other material capable of
conveying infection, and the substitution therefor of mattresses,
chairs, seats, etc., made of wire, cane, wood or other open
material. That the cars, especially sleeping cars if used, be
open to free ventilation, as there can be no better purifier than
the current of air which passes through cars when in rapid
motion. Also, that all articles of bedding be thoroughly
washed in boiling water after leaving point of departure.
Transfer stations should be under the supervision of compe¬
tent medical officers, subject to the rules and regulations
of the National Board of Health.
9. Inspection of steamboats at an infected place and
at intermediate stations between their port of departure and
their final destination. Should stations of observation be estab¬
lished by the National Board of Health 1 If so, what should
be their relations to the health authorities of the States within
whose territorial limits they may be established ?
Answer. — As relates to inspection of steamboats, we recom¬
mend the same regulations in regard to furniture as already men¬
tioned for railroad cars, and the faithful execution of the follow¬
ing rules as already adopted by the National Board, and put
into use last summer at New Orleans, to- wit :
“ Any decayed wood in the deck or floors should be looked
for and required to be replaced by sound wood forthwith, or be
left without covering of any kind and be required to be satur¬
ated daily with a boiling hot solution of copperas — one quart of
copperas to the pailful of boiling water. All kitchen, pantry
612 Original Communications. [December
or other decks or floors subject to frequent wettings and damp¬
ness, should receive a last washing daily from hot copperas
water. All storerooms or closets should be looked into and
the stowing away of damp or soiled clothing therein prohibited.
Water closets and urinals should be scrupulously clean and
odorless.
“ The hold and keelson of all steamboats and other vessels
should be examined with special care, and whenever any bilge
water or offensive odor is present, cleansing should be required
by pouring in and pumping out water, by use of the syphon
pipes for carrying steam at as high a heat as possible, under
the dunnage, and by the use of copperas until all foul odor is
removed. Merely damp holds and keelsons should be sprinkled
with copperas to prevent mustiness.”
Stations of observation should be established by the Na¬
tional Board of Health, at certain intervals along routes to be
provided for by the regulation of the Board, and should be
provided with ample and comfortable accommodations for tak¬
ing care of such sick as it may be deemed necessary to remove
from cars or steamboats. Said statious should be governed by
the rules and regulations of the National Board of Health.
In connection with the management of railroads, we would
call attention to the fact that a convention of railroad mana¬
gers has been called to meet at Nashville, Tenn., on November
19th. We heartily endorse this movement and are convinced
that it will be productive of much good.
u The object of this meeting,” to quote from their circular,
u is to secure uniform rules and regulations that will give the
greatest protection by affording reliable means to arrest the
spread of infectious or contagious diseases, while at the same
time providing for the movements of freights and passengers
with the least inconvenience compatible with safety to the
public health.”
10. Result of the co-operation and aid given by the National
Board of Health to State and municipal boards under the pro¬
visions of the Act approved June 2, 1879. What suggestions
may be made to render this system more efficient ?
1879] Report of Committee — Public Health Association. 613
Answer. — In the consideration of this subject, your com¬
mittee do not esteem it incumbent upon it to speak for distant
communities, and therefore will restrict its observations to the
State of Louisiana and mainly to the city of New Orleans.
The subject is naturally divisible into two sections, and the
results of the co-operation and aid furnished by the National
Board of Health will first receive attention.
Its co-operation has been carried out chiefly through its
medical inspectors and sanitary officers. In localities where
yellow fever has been an unfamiliar visitor, they have aided in
distinguishing real from supposed cases, have greatly con¬
tributed by their advice to prevent panic, and in case
of actual presence of the disease, have directed suita¬
ble means for its repression. Having been selected with
reference to their fitness tor the service these officers
have also acted as inspectors on railroad trains and
steamboats, and have superintended the movement of mer¬
chandise, and of travellers and their baggage, and there is
reason to hope that the failure of yellow fever to spread from
New Orleans and Memphis in 1879 may be due to their well
directed efforts. This view is fortified by the fact of its some¬
what extended spread from the Morgan city focus, where the
above system of co-operation was long delayed by the late dis¬
covery of the outbreak. It may safely be affirmed, that Missis¬
sippi city is the only place which has received yellow fever
infection from New Orleans in 1879, and in this locality the
rules of the National Board of Health were not enforced, owing
to the doubts in the first cases.
Another important result, which is perhaps attributable to
the co-operation of the National Board of Health, lias been the
establishment of confidence among threatened communities in
the measures adopted for their protection by that Board, and
by State and local Boards of Health, the general compliance
with the rules of the National Board of Health by local health
authorities, and the moderation of inland qurrantine restric¬
tions to such an extent that its inconveniences have not amounted
to serious hardships, such as occurred last year. Besides this,
the thorough system of inspection and disinfection of vessels
614 Original Communications. [December
by the National Board of Health, meeting as it did the hearty
approval of those interested in steamboats and shipping inter¬
ests, materially assisted commerce by sooner opening ports
closed against us. Another result has been the continuance of
the work inaugurated by the Marine Hospital Service, of gath¬
ering and disseminating intelligence of the appearance and
progress of infectious diseases, in addition to which circulars
have been issued, giving instructions in detail for perform¬
ing works of a sanitary character, and forms for carrying
out the inspection of persons, merchandise, and their car¬
riers on routes of travel. There can be no doubt that
the bulletin and circulars issued by the National Board of
Health have greatly contributed to a general awakening to
the importance of the subject of public hygiene, and that
trustworthy intelligence has tended to remove apprehension,
and obviate interruption of intercourse. It is desirable that
the Board should largely extend its system of health reports
from foreign ports, so that our maritime quarantine restric¬
tions may hereafter be removed or relaxed against localities of
whose health we are still mainly in ignorance. The pecuniary
aid from the National Board to State and Municipal Boards
ha« ten employed in works of local sanitation where means
were wanting to the local authorities, and this has amounted in
New Orleans to a little more than $3,800, and elsewhere in
Louisiana to about $2,000 more. It would be difficult to esti¬
mate the immediate results of this sanitary work, for the effect
of disinfecting agents upon the progress of yellow fever is still
an open question. The work of cleansing however, has had a
good moral effect both by inspiring confidence and by the force
of a good example. With reference to the second head
of the subject, your committee find so good ground for
satisfaction in the working of the National Board of Health —
in other words, they find its success so much greater than they
had reason to hope, that they would not undertake to suggest
any changes of magnitude in its functions or powers. It was
supposed by many that the usefulness of the National Board
of Health would be proportional to its powers, but the result
seems not to have justified that opinion. The character and
1879J Holt — Yellow Fever in New Orleans during 1879. 615
reputation of the men selected for this responsible position,
together with the acknowledged wisdom of the plans and regu¬
lations framed by them, speedily won the public confidence,
especially iu the regions visited by the epidemic of 1878. Their
regulations have been generally adopted throughout the States
east of Texas, and the moral influence of the National Board,
there is good reason to believe, has beeu more effectual than
any authority which could have beeu conferred by the Federal
government. Having confidence that the Board will hereafter
rectify whatever defects of administration the operations of the
first year have brought to their attention, we deem it unneces¬
sary to make any specific suggestions.
Respectfully submitted,
D. C. Holliday, M.D.
J. P. Davidson, M.D.
S. S. Herrick, M.D.
Wm. P. Brewer, M.D.
L. F. Salomon, M.D.
Representing New Orleans Medical and Surgical Association.
Yellow Fever in New Orleans During the Year 1879.
By JOSEPH HOLT, M.D., New Orleans, La., November 22, 1879.
[Concluded from September Number. J
Mr. President and Gentlemen of the New Orleans Medical and
Surgical Association :
At a meeting held August 2d, of the current year, I presented
to you a paper entitled “The Chain of Circumstances Con¬
nected with the Appearance of Yellow Fever in New Orleans
during the year 1879.”
This was done with the special object of putting on record
at the earliest possible moment, every fact and detail connected
with the first cases, suspicious or assured. For it is undoubt¬
edly a fact that neglect in regard to the proper recording at
the moment of occurrence of these first cases, has given rise
to the discrepancies of opinion, to the fruitless arguments and
5
616 Original Communications . [December
fierce contentions which have singularly characterized the in¬
vestigation of the origin of yellow fever, as to whether indi¬
genous or imported, and as to the probable causes of its
appearance.
Weeks and sometimes months elapse between the time of
the occurrence of these cases and the first effort iu the taking
of evidence.
It is safe to declare that no physician can accurately remem¬
ber at the end of a season, particularly of an epidemic, those
tacts appertaining to each case, which are absolutely essential
in a scientific recording of the outbreak of yellow fever ; and
yet this is by far the most important information connected
with an investigation of the disease.
When men draw upon their memories for their statement of
facts, such evidence ceases to be of the slightest value in
science.
There could hardly be instanced a more forcible illustration
of the truth of this assertion than that afforded in the memor¬
able labors of the Congressional Yellow Fever Investigating
Committee, visiting this city last winter.
Haviug presented to you a detailed account of eighteen
cases associated with the inception of yellow fever, by request,
I will now complete the record of all the cases which have
appeared in this city during the year 1879.
It will be remembered that of the eighteen, the first seven
occurred in the family of Mr. Stout, No. 184 Third street, be¬
tween Constance and Magazine streets, Fourth Municipal Dis¬
trict, and of these cases, one was taken ill June 16th.
The eighth was the case of their servant, Louisa Creel, who
having nursed the sick in this family, was herself seized on the
day of her arrival at her mother’s house, near Mississippi City,
and died on the fourth day of her illness, July 10th.
Cases 9, 10, 11, 12 and 13 followed in quick succession — all in
the Creel family. Case 14 was that of the boy Heyward, a near
neighbor of the Creels. The few remaining cases occurred in
this city in the immediate neighborhood of the Stout family,
and were clearly recognized as yellow fever and were so record¬
ed as cases 2, 3, 5 and 6, in the office of the Board of Health.
1879J Holt — Yellow Fever in New Orleans during 1879. 6L7
Case 1, as recorded by the Board, was that of Jacob Iken,
coxswain of the steamship Baltimore, aged 29 years, native of
Hanover ; was taken ill March 26, during the evening.
The steamship Baltimore arrived at Quarantine Station, Mis¬
sissippi River, on the 25th day of March, from Rio de Janeiro.
The quarantine physician caused the port holes to be opened
and the steamer to be disinfected and fumigated. The steamer
remained at the quarantine station until the morning of the
27th, when she left the station for New Orleans.
On the evening of the 26th, after returning, the patient was
seized with a chill, severe back and head ache, but got up on
the morning of the 27th and attempted to work. He was com¬
pelled to retire at 9 A. jVJ.
The steamer arrived at the head of Gaiennie street where she
was laid to wharf on the afternoon of March 27th. The patient
was taken to the Touro Infirmary at 4, P. M., when he was at¬
tended by Dr. F. Loeber. Recovered.
Case 4, Louis Aufret, age 5 years, white, native of France,
residence 105 Bourbon street, second district : was brought ill
from Morgan City, where he fell sick July 25th. He was at¬
tended by Dr. E. Murphy; case clearly marked as one of yellow
fever. Died August 1st.
Case 7, Frank Ticknor, age 22 years, native of New Orleans,
white, residence 470 Poydras street, rear of the first district ;
was taken ill July 25th, about 9 P. M., with chill, intense head¬
ache and pain in all his limbs. He was attended by Dr. J. D.
Hunter, and was seen by Drs. Bemiss and Joseph Holt.
The case was one of peculiar severity and protracted. Ex¬
cepting black vomit he presented every symptom peculiar to
the severest case of yellow fever. Recovered.
It is interesting to state that not only was he a native, but
had been repeatedly exposed to epidemics of yellow fever with¬
out being affected.
According to his own statement he drove his float along
Magazine street about the time of the occurrence of the recog¬
nized case, and some two weeks before his own illness The
probabilities seem to be that his was an independent and origi¬
nal case of the disease.
618 Original Communications. [December
Case 8, M. Mahoney, age 9 years, white, native of New Or¬
leans, residence 590 Annunciation street, in the vicinity of the
Stout cases ; was taken ill July 29th and attended by Dr. R. J.
Mainegra. Recovered.
Case 9, Mrs. J. R. Howell, age 35 years, white, native of
Massachusetts, residence No. 119 Washington street, in the in¬
fected locality $ attended by Dr. C. B. White. Taken ill July
30th. Recovered.
Case 10, Charles Howell, age 4 years, native of New Or¬
leans, son of case 9 ; was taken ill July 30th, Dr. White attend¬
ing. Recovered. He and his mother absent from the city in
1878.
Case 11, Rufus Hireman, age 27 years, white, native of Ohio,
residence 233 Dumaine street, second district ; has spent 4 years
in this city but absent during the year of 1878. Was taken ill
August 12th, attended by Dr. C. B. White. Recovered.
Case 12, Marie Dupuy, age 14 months, white, native of New
Orleans, residence No. 477 Constance street — infected centre
fourth district ; was taken ill August 16th, Dr. R. A. Bayley
attending. Died August 21st, having had black vomit and
convulsions.
Case 13, Mrs. Anna M. Hood, the wife of General Hood, age
42 years, native of New Orleans, residence 220 Third street,
about two squares from the family of Mrs. Stout ; was taken ill
August 22d, attended by Drs. Bickham and Logan. Died
August 24th.
Case 14, Keefe, age 7 years, white, native of New Orleans,
residence 602 Fulton street, infected locality ; was taken ill
August 24th, Dr. R. A. Bayley attending. Recovered.
Case 15, Ida Rodjiskey, age 18 years, white, native of New
Orleans, residence 207 Third street, infected centre, Dr. Joseph
Schmittle attending 5 was taken ill August 25th. Recovered.
Case 16, Lydia Hood, daughter of General Hood, age 10
years, native of New Orleans, but heretofore absent with her
parents during the summer ; residence same as case 13, Drs.
S. M. Bemiss and J. P. Davidson attending ; was taken ill
August 26th. Died August 30th.
1879] Holt — Yellow Fever in New Orleans during 1879. 619
Case 17, General J. B. Hood, age 48 years, native of Vir¬
ginia, residence same as case 13 ; was taken sick August 27th,
Drs. S. M. Beiniss and J. P. Davidson attending. Died August
30th.
Case 18, George T. Cotton, age 4 years, white, native of New
Orleans, residence 38 Fourth street, infected centre; was taken
ill August 27th, Dr. R. J. Mainegra attending. Died Septem¬
ber 1st.
Case 19, Alice Williamson, age 5 years, nativity not stated,
white, residence No. 78 Washington street, infected district ;
was taken ill August 28th, Dr. R. J. Mainegra attending. Died
August 31st.
Case 20, Ethel Hood, daughter of General Hood, age 9
years, native of New Orleans, but away during the summer,
residence same as case 13 ; was taken ill August 29th, Drs. S.
M. Beiniss and J. P. Davidson attending. Recovered.
It is important to state that during the illness of General
Hood, his wife and two children, it was discovered upon a
careful investigation made by his physicians and Dr. Wm. G.
Austin, of the Board ot' Health, the mansion, although appar¬
ently complete and elegant in all of its appointments, was really
in an unsanitary condition of the worst character, due to the
existence of a closed and unventilated privy vault in the base¬
ment, under that part of the house occupied by the sick. There
was also another vault under the same general roof, in a partic¬
ularly foul condition.
Case 21, Fred Weicks, age 34 years, white, native of New
Orleans, residence 891 Tchoupitoulas street, mauy squares re¬
moved from the infected locality ; was taken ill August 29th,
Dr. Mainegra attending. Recovered.
Case 22, Harry Shelton, aged 6 years, white, native of New
Orleans, residence 746 Magazine street, infected centre ; taken
ill August 30th, Dr. Mainegra attending. Recovered.
Case 23, Eloise G. Walker, age 24 years, white, native of
Mississippi, 12 years in New Orleans, residence 750 Magazine
street, infected centre; taken ill September 1st, Dr. S. S. Wood
attending. Recovered.
620
Original Communioations.
[December
Case 24, Thomas Witter, age 10 years, white, native of New
Orleans, residence 177 Laurel street, infected centre ; taken ill
August 26th, Dr. J. P. Lehde attending. Recovered.
Case 25, J. C. Matthews, age 45 years, nativity unknown,
residence 192 Laurel street, near case 24 ; taken ill September
2d, Dr. R. A. Bay ley attending. Died September 7 th.
Case 26, Henry Waag, age 26 years, white, native of France,
residence 100 Bourbon street, nearly opposite case 4; was taken
ill September 3d. Died at the Charity Hospital September
6th ; he came to New Orleans, from Houston, Texas, three
months before his illness , was taken sick on the morning of
Wednesday, September 3d, and removed to the hospital the fol¬
lowing day.
Case 27, Louis Goldsmith, age 20 years, white, native of
Germany ; he arrived ■ eighteen months ago from Europe,
resided in Point Coupee parish of this State, one year, and in
Morgan City during the past six months. He came to New
Orleans from the latter place on the evening of September
11th. Was taken ill the following evening, and was admitted
on the 13th, at 3 P. M., into the Touro Infirmary, Dr. F.
Loeber, attending. Recovered. His case was one of peculiar
severity.
Case 28, George Smith, age 6 years, white, native of New
Orleans, residence Pacific Avenue, Fifth District ; was taken
ill September 13th, Dr. W. H. Riley, attending. Recovered. Next
door, same tenement house, a man from Morgan City, died a short
time before, from so-called haemorrhagic malarial fever, hav¬
ing thrown up blood before death.
Case 29, Mrs. Walker, age 38 years, nativity unknown,
white, residence Bartholomew street, Fifth District, arrived
from Morgan City on the evening of September 10th. Was
taken ill September 13th, Dr. W. H. Riley, attending. Died
September 17tli.
Case 30, Mrs. Ann Sorkhahn, age 31 years, native of Ger¬
many ; was residing as a servant in the family of Mr. George
Auer, the brewer, No. 540 Tchoupitoulas street, between Mar¬
ket and St. James, First District. She Ml sick September
1879] Holt — Yellow Fever in New Orleans during 1879. 621
15th, and went immediately to the house of a relative, No.
1172 Magazine street, attended by Dr. S. Chandler. Died,
having ejected black vomit September 21st.
Some light has been shed concerning the origin of this case
and of case 36, which occurred subsequently on the adjoining
rear premises, by the discovery that an unacclimated girl, Miss
Mary Goodrich, aged 18 years, living in the same house as
case 36, was seized late in the evening of September 8th, with
fever, accompanied by intense pains in the limbs, back and
head. She was confined to her bed ten days, and treated by
her mother, who managed her case after the simple method of
hot mustard foot baths, castor oil and rigid dieting.
According to the testimony of herself and mother, this young
lady had not been off the premises for many weeks prior to
her attack.
Case 31, Mary Croker, adult, age unknown, white, residence
187 Delord street, came from Morgan City on Wednesday,
September 17th. Was taken ill September 20th, Dr. Thomas
Layton, attending. Recovered.
Case 32, Miss Paulina Menge, age 15 years, white, nativity
not stated, residence 300 Jackson street. Had never had yellow
fever. Generally absent from New Orleans during the sum¬
mer. Was taken ill September 22d, Dr. C. J. Bickham, attend¬
ing. Died September 25th.
Case 33, Mrs. Muse, age about 30 years, white, nativity not
stated, residence No. 163 Third street, between Constance and
Laurel streets, infected centre. W as taken ill October 3d, Dr.
C. J. Bickham, attending. Recovered.
Case 34, Lizzie Mazzoletti, age 6 years, native of New
Orleans, white, residence corner of Franklin and St. Andrew
streets ; was taken ill October 13th, Drs. Folwell and Watkins
attending. Died October 18th.
Case 35, Capt. J. H. Menge, age 40 years, white, native of
Mississippi, residence same as case 32 ; was taken ill October
15th, Dr. C. J. Bickham, attending. Recovered.
Case 36, Mrs. Marie Murray, age 35 years, native of France,
Original Communications.
[Decemtjer
622
residence 16 Market street, near New Levee; was taken ill
October 16th, Dr. A. Petit, attending. Died October 20th.
This patient lived on same square as case 30. Had lived in
New Orleans five years. Said to have had yellow fever in
1878. On investigation, Dr. Ryan, who attended her, declares
that he did not consider her case as really one of yellow fever.
Case 37, Rev. George Ernest Friedrichs, age 27 years, white,
native of New York, residence No. 447 £ Chippewa street
infected locality; was taken ill October 17th, Dr. Joseph
Schmittle attending. Died October 23d. He had been in
New Orleans six months.
Case 38, George Stumpf, age 19 years, white, native of
Louisiana, residence Zempel street, Carrollton ; was taken ill
October 19th, Dr. Thomas Campbell attending. Died October
26th.
Case 39, John Cotton Haber, age 14 months, white, native
of New Orleans, residence 573 Dryades street near Philip street ;
was taken ill October 20th, Dr. C. H. Tebault attending. Died
October 23d.
Case 40, Caliate Yiller6, age 21 years, white, native of
Louisiana, residence 94 Polymnia street, First District; was
taken ill October 20th, Dr. C. H. Tebault attending. Recovered.
Case 41, Charles Dogherty, age 5 years, white, native of
Washington, D. C., residence 725 Dauphine street, Third Dis¬
trict ; was taken ill October 21st, Dr. C. H. Tebault attending.
Recovered. Family removed from 390 Magazine street one
week before the boy sickened. Had lived in New Orleans
nearly five years.
This completes the record of cases as accounted for in the
office of the Board of Health, and, no doubt, comprises all
that have occurred.
The physicians of this city hare been singularly mindful of
their duty to the public, and have uniformly reported promptly
their cases, suspicious or assured.
The analysis of this record may be rendered in the following
summary :
1879] Holt — Yellow Fever in New Orleans during 1879.
Total number of cases, diagnosis ( wv t ui )
ern<! . | nL ( «
Male, 22. ♦ . .
Female, 19. J *
Total deaths . { Female, 10 J 19
Cases of children ten years of age i Male, 11. )
and under . ) Female, 6. ) 1
Deaths of children ten years of age ( Male, 4. i ^
and under . ) Female, 4. 1
Cases of persons over ten years of i Male, 12. \ 9d
age . \ Female, 12. j ^
Deaths of persons over ten years of i Male, 5. i . .
age . ( Female, 6. 1 1
Natives of New Orleans . 19. 1
Natives of State at large . 2. > 41
Persons from abroad . 20. )
623
ORIGIN OF THE DISEASE.
The infected locality comprised an area of forty-five squares,
bounded by First and Seventh, Tchoupitoulas and Chestnut
(not including six squares of the south-west corner of this
area), Fourth Municipal District.
The disease made its appearance about the centre of this
area, showing itself unmistakably first in the case of Louisa
Creel, who had been nursing the sick in the Stout family, and
who sickened the same day of her leaving them. Her case
gave rise to the series of cases near Mississippi City, as men¬
tioned. The first recognized cases in this city, occurred in the
immediate vicinity of the Stout family. Within the infected
area there were twenty-four cases.
There is not the slightest evidence upon which could be
founded a suspicion that the infection was brought into this
area by importation of any kind; but on the contrary, the
whole weight of testimony is in favor of the opinion that it
was engendered spontaneously from local causes.
To say that it was the offspring of germs surviving from the
epidemic of last year is mere quibbling, a figment of the imagi¬
nation. It is a safe assumption, inasmuch as no one can
demonstrate the contrary, any more than can one exhibit a germ.
6
*>24 Original Communications. [December
Tt is pertinent, however, to ask where the germs came from
which gave rise to the considerable epidemic of yellow fever
which prevailed over the same area during the autumn of 1876 ?
Theie had been no case in that locality for three or four years
previous, and yet it appeared then among the children just as
it has done this season, without importation.
Outside the infected area seventeen cases occurred, one im¬
ported by ship, and four from Morgan City, an infected place.
There is no authenticated instance of the disease having been
communicated to any one by an imported case.
Besides the spontaneous occurrence of the infection in the
area mentioned, it appeared in five separate and distinct parts
of the city, widely remote from each other, as in cases 7, 470
Poydras street, in the rear of the First District; 30, 540
Tch ou pi toulas street; 36, on same square, front of First Dis¬
trict ; 34, corner Franklin and St. Andrew streets, rear of Fourth
District ; 40, 94 Polymnia street, First District ; 41, 725 Dau-
phine street, Third District.
The evidence in each of these cases justifies the belief that
they were each original manifestations of the disease.
It may reasonably be asked : if the infection without impor¬
tation can manifest itself at one point or in one locality ; why
not in five or any number of places ?
Experience, however, has taught that our great epidemics
have invaded the city from one or two areas of original infec¬
tion, and have not sprung into existence from a multitude of
primal foci.
According to our experience, the meteorological conditions
were not suitable to the appearance aud spread of yellow fever.
The spring and summer were unusually cool. There was at no
time a protracted spell of weather uncomfortably warm, but
during each of the summer months there occurred many days
of unseasonably low temperature. And fiually. there never has
been in the history of New Orleans such an awakening of the
whole people to a sense of their danger and to an appreciation
of the vital issues at stake, as was shown during the entire
spring, summer and autumn, in the energetic and persevering
effort to clean this city.
1879 J Holt — Yellow Fever in New Orleans during 1879. 625
Not only those having public charge of health affairs, but
the citizens in their homes displayed a most commendable zeal
in their determination to effect domestic sanitation, and in their
compliance with orders from the health officers.
The city authorities, the State Board of Health assisted by
the National Board, and the Auxiliary Sanitary Association,
concentrated their utmost efforts in the sanitation of the in¬
fected area, and indeed, accomplished the actual and complete
cleansing of this part of the city.
The pestilence subsided coincideutly with the thorough
cleaning of this locality, but to what extent was it simply
coincident or directly consequent, we are forbidden by the
requirements of scientific enquiry to declare.
Of three things we are certainly assured : we know that per¬
fect sanitation is the one great experiment yet to be tried in
the solution of the yellow fever problem ; that the disease has
ceased to occur epidemically in certain cities, heretofore
scourged, coincideutly with an improved municipal sani¬
tation, and, finally, that every city, town, or ship, in
which the disease breaks out and spreads, is a city,
town, or ship, in a foul and most unsanitary condition. And
moreover, with all deference and becoming modesty, we chal¬
lenge any man to cite, with corroborative evidence, oue single
instance to the contrary : that is, of yellow fever occurring
de novo , and spreading in a community where there did not
exist bad hygienic conditions due to the massing of human
excrement and other filth in close proximity to habitations.
Their streets and premises or decks might look severely clean,
but to the scrutinizing eye of a sanitarian, the place would be
seen disgustingly filthy.
If ever we discover the talisman, whose charm shall save us
from yellow fever, we will also discover upon it a few cabal¬
istic characters, the spring of its magical potency. These, w hen
arranged, will spell one word, “Cleanliness.”
626
Original Communications.
[December
Recent Progress in Dermatology.
By GEORGE H. ROHE, M. D., New Orleans.
DERMATOLOGY IN AMERICA.
At the recent meeting of the American Dermatological Asso¬
ciation, the president, Dr. Duhring, in his annual address, gave
an interesting account of the rise and progress of dermatology
in this country. The first work published in America on a der¬
matological subject was “ A Brief Guide in the Smallpox and
Measles,” by Thomas Thatcher, 1677. This was probably the
first medical work that appeared in this country. The first
course of lectures on skin diseases was gi ven by the late Dr. EL
D. Bulkley, at the Broome Street (N. Y.) Infirmary for diseases
of the skin. Dr. J. 0. White, of Boston, delivered the first
course of lectures on dermatology in Harvard University. Pro¬
fessorships of dermatology (didactic or clinical) now exist in the
medical schools of most of the large cities of the United States,
and are generally filled by competent men. In some instances,
however, the occupants of these chairs leave much to be de¬
sired in the way of special qualification.
In 1870 Dr. M. H. Henry, of Hew York, began the publication
of the American Journal of Syphilography aud Dermatology,”
which died, for lack of support, in 1874, with the close of the
fifth volume. The publication of this journal exerted no little
influence on the progress of this special study and with its es¬
tablishment dates a new era in the study of dermatology. The
Vienna school, represented in this country by White, Duhring,
Wigglesworth, Bulkley aud a number of others, began to exer¬
cise a healthy influence, and has at present almost succeeded
in sweeping out of view the antiquated pathology and absurd
etiological notions of the older English and French schools.
The suspension of the American Journal of Syphilography
and Dermatology was speedily followed by the publication of
the Archives of Dermatology, under the editorship of Dr. L. D.
Bulkley. This valuable journal still appears regularly and gives
promise of a long and prosperous existence. In its pages have
appeared some of the most interesting clinical, as well as ex¬
ceedingly valuable scientific papers upon the subjects within
1879] Rohe — Recent Progress in Dermatology. 627
the limits of this specialty. It is now the only journal of its
class published in the English language.
In 1876, Dr. Duhring, above alluded to, began publishing an
atlas of skin diseases, consisting of cases painted from life and
reproduced by chromo-lithography, each case being accompanied
by about two quarto pages of descriptive letter -press, contain¬
ing a brief but comprehensive clinical history of the case il¬
lustrated. The sixth part of this atlas has been recently issued.
The work is universally acknowledged to have no equal except
the magnificent plates of Hebra, published in Vienna. In 1877,
Dr. Duhring published “ A Practical Treatise on the Diseases
of the Skin,” which is unquestionably the best English work
on the subject of which it treats. Dr. H. G. Piffard, of New
York, also published an elementary work on Dermatology in
1876. During the present year Dr. George Henry Fox has
commenced to issue a series of photographic illustrations of skin
diseases, which exhibits the various affections with marvelous
fidelity to the originals. This record is an evidence of the
earnestness and activity of American Dermatologists.
In 1869, was organized the New Yrork Dermatological Society,
and, in the Centennial year, the American Dermatological
Association was formed at Philadelphia.
At the three annual meetings of this Association, a large
number of interesting clinical papers were read, but it is
desired here to call especial attention to the valuable scientific
work performed by various members of the association. At the
meeting in 1878, Dr. I. E. Atkinson of Baltimore, read a very
elaborate paper on “ the botanical relations of the trichophyton
tonsurans” (the fungus found in ringworm). The paper was
illustrated by drawings of microscopic preparations, showing
the fungus in various stages of its growth and development.
The conclusions to be drawn from Dr. Atkinson’s researches
point to the very close relationship of the various so-called
species of fungi, as claimed by Hallier, and more recently by
Grawitz, of Berlin. Inasmuch, however, as clinical facts seem
to justify different conclusions from those pointed out by Dr.
Atkinson’s careful researches, it will be well to await the
results of further experiments. At the last meeting of the
628 Original Communications. [December
Association, Dr. 0. Heitzmann, of New York, gave an account
of the results of his “ microscopic studies on inflammation of
the skin.” The first part of the paper might just as well have
been omitted, as it was merely an abstract of the historical
summary of the doctrines of inflammation contained in Strieker’s
Lectures on General Pathology, with which most of the
members of the Association might have been supposed to be
familiar. The original part of Dr. Heitzman’s paper however,
was of great value, and the conclusions arrived at, so important
as to justify their insertion here.
1. In epithelium the first step of the inflammatory process
consists in an increase of the living matter, both in the proto¬
plasmic bodies and between them; the former produces the
coarse granulation of the epithelia, the latter the thickening
of the so-called ‘ thorns ’ in the cement-substance. Any parti¬
cle of living matter, both in the epithelia and between them,
through continuous growth, may lead to a new formation of
epithelial elements, with the termination in hyperplasia of
epithelium (psoriasis, squamous eczema, horny formations, etc.).
2. In connective tissue the first manifestation of the inflam¬
matory process is the dissolution of the basis substance and
reappearance of the protoplasmic condition. By this process
and the new formation of medullary elements, which may
start from any particle of living matter, the inflammatory in¬
filtration is established. The sum total of the inflammatory
elements, which remain united with one another by means *>f
delicate off shoots, represent an embryonal or medullary
tissue. If the new formation of medullary elements be scanty,
the resolution is accomplished by reformation of basis-sub¬
stance (erythema, erysipelas, etc.). If, on the contrary, the
production of medullary elements be profuse, a new formation
of connective tissue will result, hyperplasia (scleroderma,
elephantiasis).
3. The plastic (formative) inflammation may be accompanied
by the accumulation of a larger amount of a serous or albu¬
minous exudation in the epithelial layer (miliaria, sudamina,
herpes), or in the connective tissue of the derma (urticaria).
In both cases complete resolution will ensue.
Current Medical Literature.
629
1879]
4. Suppuration in the epithelial layer of the rete nmcosuin is
produced by an accumulation of an albuminous or fibrinous
exudation, by which a number of epithelia are destroyed, and
by new formation of blood corpuscles from the living matter
of the epithelial elements themselves. Epithelial suppuration
heals without the formation of a cicatrice (eczema madidans
and pustulosum, impetigo, pemphigus, variola).
5. Suppuration of the connective tissue of the derma results
from the breaking apart of the newly-formed medullary
elements, which, being suspended in an albuminous or fibrinous
exudation, now' represent pus-corpuscles. Pus is a product of
the inflamed connective tissue itself, and always a result ot
destruction of this tissue. Suppuration of the derma invaria¬
bly heals by cicatrization (abscess, furuncle, acne, ecthyma,
variola).
F
URRENT
EDICAL
ITERATURE.
Translations From French Journals.
By J. H. Wiendahl, N. O., La.
ERYSIPELAS OF THE FACE, COMPLICATED WITH ENDO-PERICAR-
DITIS.
Reported by l)r. NaS8R, Chef de Clinique, Hospital St. Andre de Bordeaux.
Gazette dee Hospitaux, Sept. 6th, 1879.
It has long been known, that inflammation of tissues of the
heart, may occur during an attack of erysipelas. When ancient
authors met with inflammations of the mouth, pharynx, the
bronchi® or the serous tissues of the heart accompanying an
erysipelas, they looked upon these manifestations as a true in¬
ternal erysipelas. Of late years Professor Jacond has particu¬
larly insisted upon the frequency of these cardiac complications
during the evolution of an erysipelas ; and he strenuously en¬
deavors to establish a relation between these analogous compli¬
cations, with those which arise during scarlatina and variola,
in order to connect erysipelas with these eruptive fevers ; and
with some show of plausibility to establish a similarity of dis¬
ease. He has shown that endocarditis, pericarditis and myo¬
carditis are met with in the same order of frequency, and he in-
630 Current Medical Literature. [December
gists upon the necessity of making daily examinations of the
heart in attacks of erysipelas.
These ideas were confirmed by a certain number of published
observations made by M. Sevestre in 1874.
These diseases are of two kinds ; those interesting the myo-
cardia, are more or less similar to those which are met with in
fevers of a severe type, and in cases where the temperature
attains a high degree. The others attack principally the serous
tissues of the heart, such as the endocardium and pericardium.
We will re produce in point a case observed in the clinic of
Professor Picot.
Faucis L., aged 29 years ; entered the hospital May 16th, 1879 ;
of robust habit; passably fat ; had measles at 10 ; variola at 20 ;
syphilis at 24, for which he was treated during fourteen months ;
two years ago was attacked with bronchitis, which lasted two
mouths.
He presents to-day an erysipelas of the face, which embraces
the whole of that portion of the face constituting the nose and
cheeks. It began three days ago by the nose ; he does not re¬
member of having recently had any lesions whatever about the
face, and attributes the disease to insolation.
The glands of the neck are somewhat tumefied, particularly
those of the left side.
Attention is drawn to the heart by a marked expansion over
that region. The apex beat is in the fifth intercostal space,
about a centimetre anteriority of the nipple; at auscultation,
heart sounds, are very distaut, but not abnormal in sound ; ex¬
cepting at the base of the orgau a kind of indistinct friction
sound. Pulse irregular and intermittent ; temperature 39.4°
Prescription. — A blister over the precordial region, and a
potion of 75 centigrammes of a digitalis infusion.
May 17th. — Morning, pulse 96 ; temperature 39.4° ; sounds of
heart are clearer than on the preceding day, but a bruit de
souffle at the apex. Prescription — continue the infusion of
digitalis, with the addition of 5 grammes of the extract of cin¬
chona.
Evening. — Pulse, small, irregular, intermittent, 104 per min¬
ute; temperature 39.2°; erysipelas progresses, occupies the
whole of the face and forehead, and invades upon the scalp, and
extends to the ears aud to the superior part of the neck.
18th. — Morning, temperature 39.2° ; pulse better, fuller with¬
out intermission and irregularities ; 92 pulsations. Auscultation
reveals the same signs as before; mitral souffle and friction
sound on a limit with the base of the heart persisting.
Evening. — Temperature reaches its maximum; pulse still at
92.
19th. — Morning, we have a brisk deffervescence of the disease ;
temperature falls from 39.5° to 38°, pulse is very slow aud ir¬
regular ^ tongue good, medication is stopped.
Evenmg. — Temperature declines to 37°; erysipelas not
1879] Current Medical Literature. *531
having progressed above mentioned limits, begins to fade.
Auscultation, we find a double impulse of second heart-sound
at the apex.
20th. — Is improving ; temperature decreases continuously, and
falls below the normal, 36,5° ; the face desquamates ; bruit de
souffle at the apex. Ordered wine of bark.
21st. — Temperature still declines, 36.2° ; bruit tie souffle per¬
sists ; paint the precordia with iodine, and sufficient alimenta¬
tion.
22d. — Temperature remains below normal ; the patient expe¬
riences no pain, but complains of weakness. Potion of Todd.
23d. — Pulse 44 ; temperature 36.1° ; same state, same medi¬
cation. This state persists ; the strength returns slowly. On
the following days no heart blowing is found.
28th. — Convalesence is still very alow ; pulse 48, intermittent ;
these intermittences seem to return at regular intervals, two
pulsations, then an absence, and so on. Prescribed 4 pills of 5
centigrammes of caffein.
30th.— Under this treatment the iutermittence has disap¬
peared ; pulse still small but regular ; no souffle with first, sound
at apex, but still is a little prolonged. It seems without doubt
that in this observation, we have had an affection implicating
the serous tissues of the heart. The arching of the precordia
and the distant sounds observed at the onset, were due to a peri¬
carditis which yielded rapidly to the influence of revulsives, and
to the evolution of the primative disease. Moreover, the bruit
de souffle observed at various times, at the apex of the heart,
and with the first sound and which modified itself gradually, to
completely disappear, was due to an inflmmation of the eudocar
dium at the level of the mitral valve.
NOTE OF A REMARKABLE CASE OF SCROFULA AND CONSECU¬
TIVE TUBERCULOUS.
Dr. Jules Kkynard, Gazette flea Hospitaux. May,
In the beginning of October, 1873, I was called to see a child
of six years, which the mother said was affected with tabes
mesenterica, and for which it was under treatment for a year.
This child, quite emaciated, had upon its neck several
characteristic cicatrix, and still two suppurative ganglions.
The abdomen was enormous, and had increased much since
two months. It had at the time fever each night ; there was
absence of appetite and extreme weakness ; there was an
evident ascites ; but there existed besides, and as first cause*
a simple engorgement or a tuberculous degeneration of the
meseuteric glands. It was difficult to determine, though the
last hypothesis seemed probable. At all events, there was
pressing need to relieve the abdomen by drawing oft’ the water.
The operation was done by means of the aspirator, and I
drew off about 1500 grammes.
7
fi 32 Current Medical Literature. [December
We had next to seek to improve its general condition, and
to act with energy against the diathesis. But this child had
already taken cod liver oil in large doses, iodide of potash,
and posphate of lime in powder. It had taken baths of
sulphur, paintings of iodine, without having produced the
slightest benefit; its parents had but little faith in these
means, and I was obliged to seek a new treatment, with the
doubt of having my prescriptions well followed. I then thought
of the solution of the ehlorhydro phosphate de chaux, (of lime),
a preparation which was beginning to be in vogue, and 1
ordered a table-spoonful at each meal, without any other
adjuvant save a strict hygiene.
I must admit, to my great astonishment, the condition of
this little patient improved in a very rapid and truly wonderful
manner, so much so, that after six months, without any other
means, the child looked invigorated and strong, having a
normal abdomen, no suppurating glands, in a word, perfectly
cured.
For three years I had no report of the child, when in 1877,
it was brought to me in almost as great a cachectic condition as
at my first visit ; but this time it was the lungs that were
affected.
For several months already the child coughed without its
parents paying attention to it, but it is only its decline,
weakness and extreme emaciation which alarmed them.
There was manifest crepitations at the apex of the right
lung, and cavernous respiration at the left — with this, some
expectoration, but a febrile state each night. I began anew
with only the chlorhydro-x>bosphate of lime ; 1 ordered besides
the best of regimen, out door exercise or promenade, sunlight,
and a few months afterward, with the exception of the
physical signs which still persisted, but to a less degree, he
had again made such progress that one could scarce from his
improvement believe that he was the broken down and
emaciated child which had been seen only a few months
previous.
Since I have not lost sight of him, T hav e again at 4 or 5 inter¬
vals, prescribed the above solution of lime, and he has preserved
since as satisfactory a condition as possible. This winter, es¬
pecially, though we experienced great atmospherical variations
and a very unfavorable humidity, I did not observe a symptom
which could have awakened the least fear. The physical signs
have kept apace with his general improved condition, and it is
with difficulty that we can detect a weakness of the vesicular
murmur. This observation appears to me to be interesting on
account of its series of tuberculous manifestations and the
rapidity with which it was arrested and improved by this one
medicine to the exclusion of all others.
I have already published a few notes upon this subject in this
journal, but I have never observed as pure and as conclusive
1879]
Current Medical Literature.
C*33
a case. I do not pretend to conclude that other medications are
null or of little value. Phthisis is not one we all know. But
there is a fact which overides all, especially at its onset ; it is the
general breaking down of the economy ; at tirst it is the effect of
the disease and later it favors its development. It is against
this peculiar state or condition that the chlorhydro-phosphate
of lime has such marvelous action.
Better than all others, in fact, this mediciue awakens and
stimulates the long lost appetite. It facilitates digestion and
assimilation, it acts besides directly upon the general and it
may be the local condition.
But with this potent fact, there are diverse symptoms which
require a special treatment. It is thus that in most cases that
wood creosote is needed to moderate expectoration and seems
to have a kind of topical action. The sulphate of atropia will
equally produce good results against nocturnal sweating. In
certain cases we should have recourse to arsenic, etc., etc.
Even cod oil which is used so often without discretion and is
such a common placed remedy, may be very useful if given at
intervals only, even if given alternately with the solution of
the chlorhy (Bo-phosphate of lime, or simultaneously, which
would render its digestion easier.
Nothing should be neglected ; but even if prevailing symp¬
toms demand a different medication, the chlorhydro-phosphate
of lime can be given in all cases of phthisis. This is what is
demonstrated among many other observations, and the one
which I here relate, since with it no other medication was
employed.
DOES SYPHILIS CONSTITUTE AN ABSOLUTE OBSTACLE TO
MARRIAGE?
By Dr. M. Fourhikk, Gazette des Hospitaux.
It is often remarked, that we should not marry, when we
have had syphilis, this, Dr. Fournier considers an exaggerated
expression of faith and sentiment, but says, we should first
get cured, then marry.
That it is an insurmountable obstacle, and an absolute inter¬
diction to marriage, he says : each day’s observation shows in¬
contestable examples, and that we daily meet with men whom
we have treated for syphilis, and who have married, and have
absolutely not transmitted the disease to their wives, and have
had children as hale and hearty as could be desired. The
proofs to this truth abounds in the recollection of all practi¬
tioners. As for myself, he continues, I have fifty-one complete
records. These fifty-one syphilitic husbands have had ninety-
two children. I remember particularly one of these lias four
and the other five children ; physician of their families and
under daily surveillance, I have never observed the slightest
trace of syphilis, either in their wives nor in their children.
634
Onrrent Medical Literature.
[December
He concludes, yes, a hundred times, yes, one can marry after
having had syphilis. But one should marry only under certain
conditions, which it is necessary to determine.
The danger that one incurs by marrying without having the
affection cured, is dangerous both as a father and husband.
He is dangerous as a husband by the lesions to which he
exposes his wife, and in two ways :
1st. By simple, common and vulgar contagion by which he
may transmit syphilitic lesions in the thousand intimate rela
tions of conjugal life.
To cite an example, a young gentleman who had married
contrary to my advice, having syphilitic sores at the mouth,
which were taken for ulcerations, due to the abuse of cigar¬
ettes ; three months after his marriage, his wife had an indu¬
rated chancre of the lip, due to a syphilis which was not yet
cured ; examples of the kind are frequent in the newly mar¬
ried ; is easily understood, first on account of the extreme con¬
tagiosity of secondary accidents, and again on account of the
very multiple relations and the familiarities of domestic life,
lr would indeed be a rare exception to see a young wife live
beyond a few months with a sypliilised husband without con¬
tracting the disease — as remarked by a wit, syphilis is divided
between man and wife as the daily bread.
2d. By placental contagion or by contagion, a young girl
espousing a man with a syphilis in its vigor, you are after a few
months summoned to her for various forms of accidents of the
skin of a sypliilictic nature, such as mucous patches at the
mouth, adenopathies and alopecia, etc., etc. If you enquire
into the origin of the accidents, you find no trace of initial
chancre, nor bubo, the faithful companion of chancre ; you
find but secondary manifestations, without any traco of primi¬
tive signs; on the other hand, if examining the husband aside,
and interrogating him whether he has observed some slight
erosions, he protests energetically, and affirms that he has
nothing of the kind, aud that he has taken special care to
examine himself after each congress, etc.
With truth indeed the wife may be sypliilised by the mere
contact of this exteriorly healthy man : this fact, apparently
paradoxal, has been too frequently met with to be able to
entertain a doubt ; it produces itself with a significative
insistence, and it commands in reality. This mysterious con¬
tagion is explained by the fact that the woman is. pregnant —
always in these cases, you will find that the woman has been
either pregnant or aborted some few days before, and, in fact,
the mother has taken the syphilis of its child, and not from
her husband. The contagion was produced by a placentary
exchange : this is to-day an absolutely authentic fact.
In resume, a spliilitic husband can become a source of danger
to his wife : firstly , directly by the transmission of syphilitic
accidents ; secondly , indirectly by his fecundating power, in pro-
1879] Current Medical Literature. 635
creating a syphilitic child which communicates syphilis to its
mother.
B. A man carrying a non-extinguished syphilis is dangerous
as a father to his children. Until of late the heredity of syphi¬
lis was considered as fatal, but the question has changed ; not¬
ably in Germany, an effort has been made to arrest this paternal
heredity. The syphilis of the father, for some authors, is rarely
hereditary j for others, it is never. It has been written that
the paternal influence at this aspect is null, and that the off¬
spring of a syphilitic man is healthy.
This doctrine is tainted with great errors and exaggerations,
that it imports, even in a social view, that we should combat
with energy. 1 maintain, as a constant fact, that a syphilitic
father is a source of mischief to liis offspring. But I admit
that a syphilitic heredity coming alone from the father, the
mother remaining free, is much less rigorous than has been
upheld. The father being syphilitic, the mother healthy, the
child has all chances, when born, not to be syphilitic.
This concession made to the partisans of the doctrine which
1 oppose, 1 proclaim the results of observation, and I maintain
that it is not true that the paternal influence is never repro¬
duced upon his offspring. If the paternal heredity occurs sel¬
dom and rarely, it happens at times. The father a syphilitic,
the mother being healthy, have produced syphilitic children.
Rieord, Trousseau, Diday, Liegois, etc., etc., all have published
reports of such occurrences. This is, however, but a small item
of the question. It becomes more grave by the following con¬
siderations : The death of the foetus in utero is a very common
occurrence in the oases in question. The child of a syphilitic
father dies in the womb of its mother, and is expulsed by an
abortion or by a premature labor.
A young wife, becoming pregnant, aborts once, twice, three
times, successively, without our becoming able to discover
absolutely any other cause than the syphilis of the father, and
what is still more convincing is the means of proof ; the father
being treated, each successive pregnancies attain their end,
and the children are born living and in good health. 1
have observ ed these facts a great number of times. Another
example among many others : I one day met one of my school¬
mates whom I had not seen in many years ; he relates his life
and misfortunes; his wife, though well constituted and very
robust, has had four successive abortions. I recollected that
he had formerly had an attack of syphilis, which had been
made light of and left untreated. I advised him to undergo a
serious course of medication. This advice was followed, and
fifteen months later I had the pleasure of hearing that he was
the happy father of a healthy born child. Two subsequent
pregnancies were followed by alike happy results, his oldest
child being ten years to-day, aud very robust and healthy.
In resume, each time that we meet with a series of successive
636 Current Medical Literature. [December
abortions, happening in a well formed and healthy woman, we
should often remember that they are attributed to no other
cause than to the syphilis of the father, which kills the chil¬
dren in utero.
Another capital point is, that a syphilitic is a source of dan
ger to his children in quality of spouse to their mother. He
can, in fact, transmit the disease to his wife, and from them,
both parents being syphilitic, what will be the lot of the chil¬
dren f For a child born of a syphilitic father and mother there
are but three aliernatives : firstly, either it will die before birth,
and assuredly it is what would be the best for it ; secondly, or
it will be born at term, but bearing the taint of syphilis ;
thirdly, or it will survive with a compromised health, and
exposed to all the alternatives of disease.
a. For the first case, death in utero, the experience is known.
A thousand facts testify to this truth. All other observations
concur in a manner to appear to having been stereotyped on
the same type. This baneful influence shows itself even upon
ulterior pregnancies ; we meet with a series of 4, 6, 7, all ter¬
minating in the same manner. 1 saw at Lourcine a woman
who married at 19, a vigorous and superb woman, who had
three happy deliveries. Her husband, in an extra conjugal
adventure, caught syphilis and communicated it to his wife,
who became pregnant and aborted at the 5th month ; a second
pregnancy terminated by the premature birth of a dead child;
a 3d, 4th and 5tli with the same fatal results ; a 6th by an
abortion at the 3d month ; a 7th by a miscarriage at six weeks.
This fact is extremely convincing ; seven abortions succeeding
to three healthy deliveries, and occurring after the transmission
of syphilis.
b — The syphilitic born and living child is exposed to all the
consequences of infantile syphilis ; by means of all care and
devotion we scarce save a few victims, but the greater majority
of children die. It may be possible that the child escapes
death and syphilis, but the hereditary influence will present
itself in another form : by the native debility which charac¬
terizes the most of the children, puny, oldish, wrinkled and so
poorly constituted; nothing attests syphilis, but they are so
weekly that they cannot live, and shortly succumb, flickering
out without disease, without apparent cause, even at the au¬
topsy, or they are subject to certain morbid predispositions :
1st. They are often born, or become hydrocephalic; 2d. They
are frequently predisposed to nervous troubles, to epilepsy of
childhood, later to convulsions; often to simple convulsions.
Finally, they have a manifest tendency to lymphatism, and offer
a feeble vital resistance to scrofula. I do not mean that scrofula
is for that a metamorphosis of syphilis, as has been wrongly
pretended. It is a morbid entity which has its character as
well as syphilis, but it is incontestable that syphilis constitutes
a predisposition to scrofula, in so far as the debilitating,
1879]
Current Medical Literature .
637
asthenic diseases impoverishes the organism in the same man¬
ner as the physiological misery of confined air and over-crowd¬
ing, etc., etc.
c — A man marrying with a non -extinguished syphilis is a
source of danger to himself, on account of the personal dangers
to w hich he is exposed. He is exposed to a series of acci¬
dents, infinitely serious and even mortal. What, save some
fewr exceptions, these accidents come only at a distant period,
iu a tertiary state, contracted usually in youth and early man¬
hood, syphilis becomes only at a mature time of life, when he
has become the father of a family. What a sad situation,
medically speaking, is that of a man who has all the chances
of being exposed to the assaults of a syphilitic diathesis. He
is sick for the future ; he is injured physically, indebted to
syphilis ; sooner or later he will have to acquit himself. Is it
honest, is it moral that this man should think of marrying and
becoming a father ? This is assuredly immoral and inadmis¬
sible.
After having exposed how a syphilitic man is dangerous in
marriage, we will pass now from the theory to practice and
endeavor to establish at what conditions one having had
syphilis should be to be pronounced admissible to marriage.
The solution of this question is assuredly very perplexing ;
it brings us upon a field yet unexplored, when we have not the
experience of our predecessors to guide us on, at least of those
whom a true and just respect have pronounced the masters of
art. There is no programme traced in advance; it is after
what I have read and observed that I will detail to you the
couditions to wrhich, in my opinion, we should advise one in
that category to marry.
This man must fill five indispensable conditions:
1st. Absence of actual manifestations. This is a consider¬
ation absolutely elementary for all ; the mere presence of the
slightest accident should be a cause of not marrying ; it would
be a startling testimony of his disease, and the subsequent
dangers to which his wife and children would be subjected.
This as a cause of exclusion of marriage is evidently too formal
not to seem superfluous to insist further. Yet, we should not
be misled, for many another instance of this incredible au¬
dacity has been observed ; 1 have myself met more than twelve
examples of men affected with actual symptoms of syphilis on
their marriage day, such as psoriasis palmaris, affections of the
scalp, of the mouth, mucous patches, syphilitic sarcocele, and
even indurated chancre. What can be their motives ? It may
be either ignorance or interest.
2d. Advanced age of the disease. We may formulate this
axiom: The more recent the syphilis of the husband, the
more numerous and grave are the dangers which hea*carries
into the married state ; and reciprocally, the more old the
syphilis, the more favorable are the chances for him. It. is, in
638 Current Medical Literature. [December
fact, the recent syphilis which is liable to greater contagion ; it
is in the fifth, sixth and tenth months that the manifestations
of syphilis are more disseminated, the more dangerous aud
predisposed to returns. Nothing is more apt to recur again or
repeat itself than mucous patches ; in smokers the erosions of
the mouth are reproduced as often as ten to twenty times in a
short time. The recent accidents of syphilis are formidable,
inasmuch that they have a predilection for the mouth aud
genital organs, two localities essentially dangerous relatively
to the contagion in marriage.
It is in the secondary period also that the phenomena are
mild and insignificant in appearance; they are the more dan¬
gerous, precisely on account of their apparent mildness, for we
know that they are then eminently contagious.
On the contrary, at a more advanced or older period, those
dangers no longer exist, or are more restricted, for opposite
reasonings; the manifestations of tertiary syphilis are in fact
more discreet, consists of deeper lesions, wide and important,
of which we are not unacquainted with the danger.
The danger of heredity is not less than that of the con¬
tagion to the wife; the distant period of the disease would
still be a favorable oondition to avoid this danger. A woman
has first one or two miscarriages ; then, by the influence of
times, a premature labor, then she gives birth at term, but of
a still-born child or to one predisposed to soon die; finally she
brings forth a living child. Time theu improves the paternal
influence.
The conclusion is then that an old syphilis is an essential
condition to bring into wedlock ; a syphilitic has no right theu
to aspire to marriage only if a certain period of time elapsed
since his syphilitic inoculation. But what is this period of time ?
This is a delicate point ; to give an arithmetical measure is a
serious difficulty. On the one side, the age of the syphilis is
not the only thing to be considered ; but to formulate a precise
period, I do not believe that a syphilitic should think of marry¬
ing before a minimum of from three to four years of time, has
elapsed, and a greater time would be best. The longer he
will put it off, the more the chances will be in his favor. Within
this period, observations show but few catastrophies ; beyond,
the accidents are attenuated to a considerable extent.
3d. A certain period of immunity should elapse since the last
manifestation. The patient should have remained completely
exempt from all specific manifestations during a certain time —
is a security which seems necessary under various considera¬
tions. This time having elapsed, enables one to judge of the
degree of abatement of the diathesis ; it is an evidence of the
actual non-activity of that diathesis, of which it announces the
wearing off and consequently the decrease of the dangers of
contagion and heredity.
4th. Non-threatening character of the syphilitic diathesis.
Current Medical Literature.
639
1879}
Assuredly there exists cases of syphilis of a light and grave
form. The former terminates with a small number of super- -
ficial accidents, while the grave form, even when treated, pro-,
duces serious lesions. The quality of the syphilis is then not
without serious importance. If the type be light, with mild
and superficial lesions, if it speedily yielded to treatment, we -
have excellent givings for the client. All this total of benignity
tranquilizes the physician, renders him more tolerant, and
favorably predisposes his verdict. But inversely, if he has to
deal with a bad syphilis, the conditions change. We will cite,
a few principal types of this kind. , . .
a. Bad syphilis are those which are remarkable for the inces- / ,
sant reproduction of the same accidents, especially at the mouth , •
and at the penis, even when they are quite superficial. Thus I ,
saw a young man who had nothing but a roseola, palmar pspri- a
asis and lingual syphilides, which were frequently reproduced,
in spite of an energetic treatment carried to 15 and 20 .centi¬
grammes of the proto-oxide. The affection renewed itself until
this day. After each treatment the ulceration disappeared,
and renewed itself later, is cured by the treatment, and so on.
What would have happened had I permitted marriage after a
first cure ! The question is answered; he has a mistress* and
he has communicated the disease. ;
b. Are bad syphilis those which are of a grave character at
diverse titles, by the intensity, by the multiplicity, and by the
nature of the accidents ; those which soon assume the tertiary
form, become visceral and remain refractory to all treatment.
c. Those which invade an important organ essential to life,
such as the brain. Cerebral syphilis is particularly dangerous
on account of the organ affected and the reproductions to which
it exposes, for they are almost always constant. Thus, a young
man who had, in 1868, accidents for which he was imperfectly
treated, married in 1875, in spite of my counsel, and was taken
with cerebral symptoms, haemiplegia, amnesia, hebetude. He
was cured of his haemiplegia, but he remained in a state border¬
ing upon dementia. Another one perceives that whilst hunting
he cannot carry lifs gun with the left arm; he is taken in the
following year in the movements of the tongue, speaks confus¬
edly, stutters ; treated and cured. He marries, contrary to my
advice ; ten days afterwards be is taken with grave cerebral
symptoms, followed by hmmiplegia and amnesia, and six
months later he is taken with dementia.
5. Specific treatment sufficiently prolonged, is, parexcellence,.:
the capital condition. It is this treatment which lessens- and
conjures the dangers of syphilis, and which constitutes the best
safeguard at first against the personal risks to which the
patient is exposed.
We can in fact affirm to-day that a syphilis energetically
treated at its onset and during a certain length of time, has no
tertiary period, whilst a n on-treated syphilis or unsufficiently
8
640 Current Medical Literature. [December
so, runs to this tertiary period, save in rare and inexplicable ex¬
ceptions.
It is yet the treatment which diminishes and suppresses the
causes of the contagion ; it is still it, which diminishes and sup¬
presses the chances of heridity. What relates to the father, a
wife undergoes a series of abortions which have no other cause
than the syphilis of the father, let this one be treated and the
pregnancies terminate favorably. Likewise for the mother ; she
receives a syphilis from her first husband and becomes a widow ;
she marries again to a healthy man of which she conceives
children, which are syphilitic ; she is treated and gives birth to
healthy children. Finally it operates the same for the com¬
bined influence of father and mother ; syphilitic couples have
syphilitic children. They are treated and produce children ex¬
empt from syphilis. There is none; a new and extraordinary
fact has been observed. It has proven sufficient, for a child to
be healthy, that its syphilitic parents be under the provisory
mercurial treatment. A syphilitic woman has seven pregnan¬
cies, followed by seven children, which all die ; she is treated,
has an eighth pregnancy which terminates by the birth of a
healthy child, the same for a ninth ; for a tenth she is not treated,
she has a syphilitic child which dies at the sixth mouth ; she is
newly treated and an eleventh birth is produced by a healthy
child.
In resume, all these considerations prove the corrective influ¬
ence w hich is exercised by the syphilitic treatment. The capi¬
tal condition for a syphilitic man who marries, is that he should
be sufficiently treated, that he should be subjected to a long
treatment, regulated and methodized. Combined with time, the
specific treatment, by successive medications co-ordinated during
several years, is the best security to hope for a cure, and conse¬
quently to authorize marriage. Time on one part, treatment on
the other, these are the two major conditions which one should
furnish who wishes to enter into wedlock.
1 do not wish to terminate without a passing remark with re¬
gard to sulphurous waters, which are commonly considered by
the common class as possessing the propriety of bring out the
traces of a latent diathesis, “ of bringing out syphilis.” Each
year a great number of syphilitics religiously go to the springs
to undergo the 21 days traditional cure, in the hope, u if there
remains anything in their blood,” that the sulphurous waters
will bring it out ; if nothing comes out, they consider themselves
cured and in a fit condition to marry.
This revealing action of the sulphurous waters is far from
being real. These waters are no doubt useful to the syphilitic
upon other reasons and especially as tonic and as adjuvants to
the mercurial treatment; but they are not by any means a
discharging reactif of syphilis as an acid acting upon a salt ;
this is absolutely false.
The truth is that, without doubt, in reason of the stimula-
American Public Health Association.
641
1879]
tiou of which I speak, we often perceive that the ferrruginous
waters produce eruptions upon syphilitic subjects ; the syphil-
ictic exanthemata are common with these patients ; but, many
and many times the treatment in these stations does not pro¬
duce any eruptions whatever in the patients who have remained
syphilitic ; one, two, five, even six seasons have not produced
any revealing effect. We should then abandon the legend of
the revealing action of sulphurous waters ; let us take ad¬
vantage of their action, if there be auy ; this is better than
nothing; but, for once that they will make the diagnostic,
twenty times they will fail ; let us not abuse this absolutely
false criterion.
Conclusion— To all who have not filled the five indis¬
pensable conditions which we have formulated, we should
refuse marriage.
We will declare admissible to wedlock whoever shall present
these all united. J. H. W.
Seventh Annual Meeting of the American Public Health
Association.
The American Public Health Asssociation met in the hall of
the House of Representatives, Nashville, Tenn., on Tuesday,
November 18th, at 12 M„ President J. L. Cabel in the chair,
and about two hundred members present.
After some preliminary business, and the reading of several
invitations to the Association to visit places of interest, Col.
Geo. E. Waring, of Newport, Rhode Island, read the following
paper :
THE DRAINAGE AND SEWERAGE OF CITIES.
The President has asked me to prepare a paper concerning
the most perfect methods of city sewerage, one which may
serve as a standard of comparison in considering the character
of existing work. It would savor of presumption to describe
or to prescribe methods radically different and better than
those now in use. It is impossible to foretell the improvements
which are to grow out of the present rapidly increasing interest
among intelligent and ingenious men in all that relates to sani¬
tary practice. If I were to attempt now to set forth the details
of a perfect system of sewerage, I fear that my recommenda-
642 Seventh Annual Meeting of the [December
tions, like Dr. Richardson’s Hygeia, would surpass what prac¬
tical men and investors of capital would accept.
The most that it is prudent to do is to consider the question
in its purely sanitary bearings, and to indicate in what way
the best requirements of public health may be met, in the light
of our present knowledge.
So far as we can judge of the future from the indications of
the present, it would seem that in one respect we are to wit¬
ness a very marked change in the practice of sanitary engineer¬
ing. There is much reason for believing that there will be a
distinct separation between the application of sewerage to the
removal of domestic and manufacturing wastes and soil water,
and the construction of conduits for the protection of public
and private property against the action of storm water. This
latter, like the construction of roadways and bridges, will be
treated as a purely civil engineering question, having, at best,
only an indirect sanitary relation. The interests of public
health, so far as sewerage is concerned, will, in my opinion, be
best served by a close adherence to the collection and removal
of foul waters, and to their proper final disposal.
This suggestion is not new. The discussion between the ad¬
vocates of the combined and the separate systems of sewerage,
especially in England, has long been active. The issue between
them seemed doubtful until the matter of agriculture or chem¬
ical purification of the effluent became prominent.
The arguments in favor of the exclusion of storm water from
the sewer proper, seem to me so conclusive, that I no longer
hesitate to accept such separation as essential to the best sani¬
tary sewerage. . - ■ "
Sewers large enough to remove storm water, according to the
usual formulas, are open to several serious objections.
The question of cost is so often the controlling question, even
in improvements of the most vital importance, that the expense
entailed by the construction of storm-water sewers constitutes
an insuperable obstacle in the case of many a small towu where
sewers are most necessary. Even in the larger cities, the ex¬
penditure in this direction might sometimes, if not always, be
economized for the benefit of other necessary work.
The larger the sewer the more difficult becomes the matter of
ventilation. -
Cases are extremely rare where sewers of the storm-water
size are not, at least during the dry and hot season, sewers of
deposit, to such an extent as to have their air made most foul
by the decomposition of their sediment.
Where the question of final disposal has become important,
the admixture of storm-water with the sewerage leads to the
constant embarrassment of the system, whether the process be
chemical or agriculture. ,
There seems to be no controlling reason why storm-water
should be admitted to the sewers at all for very long reaches
1879J American Public Health Association. 643
of the street ; and not seldom, throughout the whole of the
smaller towns, the whole rain fall may be discharged over the
surface without causing inconvenience.
Until about 1854 the cities of Albany and Troy, both large
towns, and both having very steep grades, terminating on level
ground, had no storm-water sewers. The inconvenience caused
during heavy storms was inconsiderable, and there was practi¬
cally no material injury to public or private property. I am
informed by the engineer of both cities that neither inconven¬
ience from the overflowing of the streets nor injury from wash
constituted an essential argument in favor of sewerage. The
sewers were built to the storm-water rise only in conformity
with the general custom.
The carrying of surface water to a depth of 10 or 15 feet be¬
low the surface seems to be at least unnecessary. Street wash
can be safely admitted to sewers only after passing through
settling basins, which are sure to accumulate an offensive and
dangerous amount of decomposing filth.
I believe that one of the most important improvements that
we are destined to see is the removal of storm water, as far as
possible, by surface gutters — carrying away the greater accu¬
mulations through very shallow conduits, largely, perhaps,
through covered gutters, easily accessible for cleaning and
flushing. . .
This part of the engineering problem being satisfactorily pro¬
vided for, the sanitary drainage of a town — the removal of the
wastes of its population — becomes a simple problem. It im¬
plies, however, one condition, which, although almost unknown
in America, has been shown by foreign practice to be an at¬
tainable one — that is, it requires that the streets be kept clean
by some other means than occasional drenching by storms.
There is no more inefficient, costly and dangerous scavenger
than the rain which falls upon the surface of our roadways and
washes their horse-droppings into the catch-basins at the street
corners!
In my judgment a perfect system of sanitary sewerage, for a
small town or a large one, would be somewhat like the follow¬
ing :
No sewer should be used of a smaller diameter than six inches,
because (a) it will not be safe to adopt a smaller size than 4-inch
for house drains, and the sewer must be large enough surely to
remove whatever may be delivered by these; (b) because a
smaller pipe than 6-inch would be less readily ventilated than
is desirable ; (c) and because it is not necessary to adopt a
smaller radius than three inches to secure a cleansing of the
channel by reasonably copious flushing.
No sewer should be more than six inches in diameter until it
and its branches shall have accumulated a sufficient flow at the
hour of greatest use to fill this size half full, because the use of
a larger size would be wasteful, and because, when a sufficient
644
Seventh Annual Meeting of the [December
ventilating capacity is secured, as it is in the use of a six-inch
pipe, the ventilation becomes less complete as the size increases,
leaving a larger volume of contained air to be moved by the
friction of the current or by extraneous influences, or to be acted
upon by changes of temperature and of volume of flow within
the sewer.
The size should be increased gradually and only so rapidly as
is made necessary by the filling of the sewer half full at the
hour of greatest flow.
Every point of the sewer should, by the use of gaskets or
otherwise, be protected against the least intrusion of cement,
which, in spite of the greatest care, creates a roughness which
is liable to accumulate obstructions.
The upper end of each branch sewer should be provided with
a Field’s flush tank of sufficient capacity to secure the thorough
daily cleaning of so much of the conduit as from its limited flow
is liable to deposit solid matter by the way.
There should be sufficient manholes, covered by open grating,
to admit air for ventilation. If the directins already given are
adhered to, manholes will not be necessary for cleansing. The
use of the flush tank will be a safeguard agaiust deposit. With
the system of ventilation about to be described, it will suffice to
place manholes at intervals of not less than 1000 feet.
For the complete ventilation of the sewers it should be made
compulsory for every householder to make his connection with¬
out a trap, and to coutinue his soil pipe to a point above the
roof of his house. That is, every house connection should fur¬
nish an uninterrupted ventilating channel, four inches in diam¬
eter, throughout its entire length. This is directly the reverse
of the system of connection that should be adopted in the case
of storm-water and street wash sewers. These are foul, and the
volume of their contained air is too great to be thoroughly ven¬
tilated by such appliances. Their atmosphere contains too much
of the impure gases to make it prudent to discharge it through
house drains and soil pipes. With the system of small pipes
now described, the flushing would be so constant and so com¬
plete, and the amount of ventilation furnished, as compared
with the volume of air to be charged, would be so great that
what is popularly known as sewer gas would never exist in any
part of the public drains. Even the gases produced in the traps
and pipes of the house itself would be amply rectified, diluted
and removed by the constant movement of air through the
latter.
All house connections with the sewers should be through in-v
lets pointing in the direction of the flow, and these inlets should
be funnel shaped so that their flow may be delivered at the bot¬
tom of the sewer, and so that they may withdraw the air from
its crown ; that is, the vertical diameter of the inlet at its poiut
of junction should be the same as the diameter of the sewer.
1879] American Public Health Association. 645
All changes of direction should be on gradual curves, and, as
a matter of course, the fall from the head of each branch to the
outlet should be continuous. Changes of grade within this
limit, if considerable, should always be gradual.
So far as circumstances will allow, the drains should be
brought together, and they should finally discharge through
one or two main outlets.
The outlet, if water-locked, should have ample means for the
admission of fresh air. If open, its mouth should be protected
against the direct action of the wind.
It will be seen that the system of sewerage here described is
radically different from the usual practice. I believe that it is,
in all essential particulars, much better adapted to the plan of
sanitary drainage. It is cleaner, much more completely venti¬
lated, and is exactly adapted to the work to be performed. It
obviates the filthy accumulation of street manure in catch basins
and sewers, and it discharges all that is delivered to it at the
point of ultimate outlet outside the town before decomposition
can even begin. If the discharge is of domestic sewage oidy,
its solid matter will be consumed by fishes if it is delivered into
a water-course, and its dissolved material will be taken up by
aquatic vegetation.
The limited quantity and the uniform volume of the sewage,
together with the absence of dilution by rain-fall, will make its
disposal by agricultural or chemical processes easy and reli¬
able.
The cost of construction, as compared with that of the most
restricted storm-water sewers, will be so small as to bring the
improvement within the reach of the smallest communities.
In other words, while the system is, in my judgment, the best
for large cities, it is the only one that can be afforded in the
case of small towns.
Circumstances are occasionally such, as in St. Louis, as to
require extensive engineering works for the removal of storm¬
water through very deep channels. Ordinarily, as I have
before said, the removal of storm- water is a very simple matter,
if we will accept the fact that it is best removed, so far as pos¬
sible, by surface gutters, or, in certain cases, by special con¬
duits placed near the surface.
It is often necessary, in addition to the removal of house waste,
to provide for the drainage of the subsoil. This should not be
effected by open joints in the sewers, because the same opening
that admits soil water may, in dry seasons, and in porous soils,
permit the escape of sewerage matters into the ground, which
is always objectionable. Soil water drains may be laid in the
same trench with the sewers, but preferably on a shelf at a
higher level, and they should always deliver into the upper
part of the sewer or into a man-hole at a point above the flow
line of the sewerage.
646' Seventh Annual Meeting of the | December
There is one point connected with the drainage of towns
which is'iiot sufficiently appreciated, especially in this country,
that is, that it is easy and cheap to secure a deep outlet in low¬
land and to deliver sewerage at a considerable elevation for
agricultural treatment by artificial pumping.
The average cost of pumping for water- works is about 9 cents
per foot of elevation for each million gallons raised.
On this basis the cost of raising the sewage of a town of
10,000 inhabitants, supposing every three persons of the popu¬
lation to contribute 100 gallons perjday to the flow, would be
about 3 cents per day for each foot of elevation.
Even Supposing that 20 inches or about one-half of the annual
rain fall finds its way into the subsoil, the cost of lifting this
10 feet to a surface outlet would, on the same basis, cost only
about $160 per annum for each one hundred acres of the town
area.
Both of these estimates are practically somewhat too low,
because a small amount of water cannot be lifted relatively so
cheaply as a large amount. I give these figures only to show
that, with a community of any considerable size, it is really a
matter Of minor consequence whether the natural outfall is
high or low.
The experience of Holland, in the practice of drainage, indi¬
cates a complete relief for the natural disadvantages even of
the city of New Orleans, of which the cost would be quite insig¬
nificant as compared with its benefits.
Many of our riparian towns, dependent upon high lying water
as the outlet for their drainage, or, like Chicago and Milwaukee,
delivering their foul drainage into streams whose contamina¬
tion means the contamination of the town itself, may find their
only practical relief by means of au artificial outlet. The city
of Boston is now establishing a conspicuous example of the
application of mechanical power to deep drainage and distant
removal, even applying this costly means for the discharge of
the rain fall of an enormous area.
Aside from its benefit in securing deep drainage, discharge
by pumping makes us quite independent of natural topography
in adopting means for agricultural disposal. Pumping, and the
separate removal of foul waters, puts it in our power, under
all circumstances, to adopt this means for purifying our out¬
flow. Along our gieatest rivers, from a sanitary standpoint,
the disposal question counts for nothing. The Mississippi river
will annihilate the sewage of St. Louis to whatever size she
may grow ; but there is au enormous proportion of our towns
which must, for purely sanitary reasons, adopt some other
means of outlet than delivery into rivers and harbors.
1 There is an agricultural consideration, and an important oue,
which looks to the utilization of all our sewage, but in the
present condition of our agriculture this must remain a second¬
ary argument. Wherever we resort to irrigation as a means of
1879J American Public Health Association. 647
purification, the manural value of the sewage will serve to
lessen the cost of our work. Probably it will nowhere repay
the whole cost.
The methods of irrigation disposal are various and all are
not equally well adapted to all conditions. The outflow of a
large town can be purified satisfactorily, either by simple irri¬
gation over large areas or by intermittent downward filtration
over much smaller areas of land properly graded and deeply
underdrained. Under this system the discharge is intermittent;,
and during the intervals the soil filter is purified by atmos¬
pheric action.
The outflow of smaller towns, of public institutions and of
suburbs and country houses, may be much the most satisfac¬
torily treated by the absorption-drain or sub-surface irrigation
system, working in conjunction with Fields’ flush tank. By
this system a small area of land, naturally or artificially well
drained, is underlaid at a depth of ten inches from the surface,
by a series of open-jointed, agricultural drain tiles. At each
discharge of the flush tank, the accumulated sewage is sent
rapidly into the tiles, whence it escapes through the open joints
into the soil. During the interval between the discharges the
water, purified by filtration, settles away to the subsoil, and
fresh air enters to supplement, by oxidation, the purifying
action of the roots of the grass or other crop growing on the
land.
This latter system has now been so thoroughly tested under
various conditions as to climate and quality of soil as to have
proved itself of almost universal applicability. It has the very
great advantage that, as the sewage never appears at the sur¬
face of the ground, it may be carried on in immediate prox¬
imity to the dwelling. It would be equally effective, under
proper arrangement, in dealing with the sewage of cities ; but
for such use it would be much more costly than would the
removal of the sewage to a distant field, where surface irriga¬
tion would be unobjectionable.
I trust that, as I am neither a Southerner nor a physician, I
may be excused for attaching more importance than many of
you probably do to the proper drainage and cleansing of a city,
and to the proper disposal of its outflow, than to any system
of quarantine. My knowledge of the history of the yellow
fever epidemics iu this valley is infinitely less than yours; but
I feel warranted, and I take my warrant from the history of the
plagues which devasted the filthy mediteval cities of Europe,
and from my own knowledge of the want of cleanliness and
want of drainage in the city of Memphis, in venturing the
suggestion that even that fever-smitten town may be made an
impossible field for the invasion of yellow fever in an epidemic
form. While yellow fever is for the moment uppermost in all
our minds, and while its sudden and more fatal outbreak strike
9 '
648
Seventh Annual Meeting of the [December
the public imagination with peculiar force, we should, as sani¬
tarians, never lose sight of the fact that it is one of our minor
diseases ; that, indeed, along the banks of the Mississippi river
far greater mortality and infinitely greater disability results
from the constant operation of diseases which should come
equally within our purview, and which are equally preventable
by measures of sanitary improvement.
NIGHT SESSION.
The attendance was unusually large, many ladies being
present.
Addresses of welcome were delivered by his Excellency Gov.
A. S. Marks, Dr. E. M. Wight, President of the Tennessee
State Medical Society, and His Honor, Thomas Kercheval,
Mayor of Nashville.
The President, Dr. J. S. Cabell, delivered his Annual Address
which was an elaborate and exhaustive treatise upon the or¬
ganization and work of the National Board of Health.
SECOND DAY— WEDNESDAY, NOV. 19.
The Association met at 10 A. M. In the absence of Elliot
C. Clark, C. E., of Boston, Dr. Chas. F. Folsom, of Boston, read
that gentleman’s paper upon “ The City Scaveugering of Bos¬
ton,” in which the removal of garbages, ashes, etc., was fully
described.
Bev. Hugh Miller Thompson, of New Orleans, read an ex¬
haustive paper on the “ Disposal of the Garbage at New Or¬
leans,” in which he described the present method as contrasted
with that in vogue before the epidemic of 1878.
A lengthy paper on “ Municipal Sanitation,” by Dr. E. J.
Janeway, was read.
AFTERNOON SESSION.
Dr. A. L. Gihon read an interesting and ably prepared paper
on “The Protection of the Innocent and Helpless Members
of the Community from Venereal Diseases and their Con¬
sequences.”
On the conclusion of the paper a motion was made and unani¬
mously carried that the president appoint a committee of five
who should consider the suggestions, or substance of the ad¬
dress, and report at the next meeting resolutions looking to
1879J American Public Health Association. 649
the establishment of a plan for protection from veueral diseases,
and Dr. Gihon be made chairman of the committee.
EVENING SESSION.
A paper by Dr. Alfred E. Woodhull, U. S. Army, was read,
entitled “ May Not Yellow Fever Originate in the United
States F the paper being an u Etiological Study of the Epidemic
in Savannah in 1876.”
Dr. Woodhull claimed that the epidemic of 1876 did unques*
tionably originate in Savannah, aud adduced argument to sup¬
port his theory.
THIRD DAY— MORNING SESSION.
The meeting was called to order at 9:30 A. M. ; election of
officers being in order, the following were elected :
Dr. J. S. Billings — President,
Dr. Sami. Ohoppin — First Vice-President,
Dr. R. 0. Kedsil — Second Vice-President,
Dr. J. B. Lindsley — Treasurer.
New Orleans was selected as the place of meeting of the next
Annual Session.
The President appointed as a committee, upon the suggestions
embodied in Dr. Gihon’s paper, the following gentlemen : Dr.
A. L. Gihon, W. E. Griffith, J. M. Keller, Sternberg and Bail-
hache.
Dr. W. H. Brewer, of New Haven, Conn., read a paper on
the u Interesting phenomena Developed by the Prolonged Im¬
mersion in Water of the different Woods.”
Dr. J. D. Plunkett, of Nashville, Tenn., read a paper on
u Cotton as a Fomite,” in which he said that “ the recognition
of cotton as one of the class of extra-hazardous fomites, and its
capacity to transmit or communicate yellow fever or other in¬
fectious diseases, has up to this time scarcely been questioned.
In 1859, a select committee of the Chamber of Commerce of
New York, reporting upon quarantine laws, were so impressed
with the dangers attaching to cotton that they singled it out
especially, and formulated a distinct interrogatory regarding
it. A diversity of opinions were given, all, however, leading
to the assumption that cotton was particularly dangerous. I,
650
Seventh Annual Meeting of the [December
myself, however, having exhausted all sources of information
at my command bearing upon this subject, the following
strange and remarkable fact is elicited, that not a single case
of yellow fever is recorded as having originated from contact
with cotton carried from an infected place. Whether this
negative testimony be due to omission, or establishes a scien¬
tific truth, is a matter to be corroborated or disproved by
further experience and more careful and extended obser¬
vation.”
Dr. G. B. Thornton, President of the .Memphis Board of
Health, then read a paper, giving the history of the epidemic
of yellow fever of 1879. Not being satisfied as to whether the
epidemic was imported, or of local origin, being unable to
satisfy himself whence it could have been imported, he rather
advocates its local origin.
NIGHT SESSION.
Dr. H. F. Campbell, of Augusta, Ga , read a paper on u The
Yellow Fever Quarantine of the Future,” of which the follow¬
ing is a synopsis :
What shall be our quarantine ? The present quarantine sys¬
tem is impracticable ; too cruel for humanity to tolerate. It
stupefies the honest convictions of a majority of the profession.
Yellow fever is not contagious ; i. e., not communicable from
individual to individual ; and though the theory of personal
contagions is not generally believed in by the profession, yet
the same old laws remain on the statute books.
A quarantine of vessels, and also of railroad trains, should
be strictly enforced during the prevalence of yellow fever.
Never let a single car, that is freighted from or takes passen¬
gers in an infected port, come to a healthy town. Let them be
met at least twenty miles from the city by fresh cars, both for
the passengers and the freight. Keep out all baggage, trunks,
and clothing, but let the individual come in, even if the Jever is
on him. Do not say to the refugee, fleeing from the dread pes¬
tilence, Go back, with your wife and children, to the infected
region, and breathe again the foul air laden with the seeds of
death. Let the individual be thoroughly disinfected ; change
his clothing at quarantine ground ; even wash his head with
carbolic acid, if thought necessary, but let him find refuge in a
place of safety. The germs in the body of the man himself are
incapable of propagation.
The yellow fever subject is laboring under the dire effects of
a poison, but centuries of experience have demonstrated that
1879] American Public Health Association. 651
he can no more communicate his disease by emanations from
his own body or secretions, than can the subject poisoned with
strychnine communicate his frightful tetanus to his friend or
his nurse ; as the strychnine itself is required to produce an¬
other case, so in yellow fever, a fresh supply of atmospheric
disease germs is required to produce the phenomena.
Dr. Campbell said that though at first he disliked the idea of
a national or “ central ” quarantine, yet in the present state of
things it seemed to be imperatively demanded. Some of the
State Legislatures are controlled by men who actually snarl at
the idea of appropriating a mere pittance to the work of sanita¬
tion. They refuse to give over $1500 to meet the expenses of
the board and to publish its reports, though they are at the
same time lamenting the national quarantine and decrying it
as a political measure. This alone would make it necessary
that Congress should take charge of the matter.
The earliest epidemics of yellow fever occurred at the North¬
ern ports, New York, Philadelphia, Boston, etc.; afterward in
Savannah, Charleston, etc., and again, after railroad communi¬
cation became general, in interior towns. At present the fever
does not ravage the Northern cities, though it continues its
deadly work in those of the South, Why ? Because at the
South there has not been the knowledge and foresight to keep
it out by appropriate legislation and the enforcement of a
proper quarantine.
In reference to the preservation of the disease germs in
closed rooms, etc., Ur. C. gave it as his belief that such germs
do “lie over,” but do not retain all of their potency. Yellow
fever is an exotic. It finds a soil here where it can produce a
fine crop. But the germs then “ go to seed,” and if not killed
by intense cold, but preserved in closed rooms, closets,
trunks, etc., may again give rise to a second, but milder, epi¬
demic. In the third year the seed run out ; they are virtually
killed, having neither potency to again produce disease, nor
any reproduction power.
FOURTH DAY— MORNING SESSION.
Dr. R. G. Jennings, of Little Rock, Ark., read a paper on
“Quarantine and its results in the State of Arkansas in 1879.”
Dr. D. C. Holliday read the report of the Committee of the
New Orleans Medical and Surgical Association, answering in
regular order the ten propositions as propounded in the circular
of the American Public Health Association. Said report is
published in full elsewhere in the Journal.
After the reading of the above report, Dr. Sternberg, U. S.
army, offered a resolution to the following effect : “ That the
report as read be adopted as the unanimous expression of the
C52
Seventh Annual Meeting of the [December
opinion of this Association, and as such be commuuicated to
the National Board of Health.” Said resolution being in¬
formal, inasmuch as according to rule it had not been pre¬
sented through the advisory committee, was not voted upon,
but the final resolution^ coming from said committee and
adopted by a unanimous vote really embodied all the im¬
portant suggestions of the above report, couched in many
instances in almost the identical language.
Col. John F. Cameron, of Memphis, read a paper on “ Camps
and Depopulation at Memphis in the Epidemics of 1878 and
1879.”
Dr. Clias. F. Folsom said he had been directed by the Advi¬
sory Committee to offer the following resolutions, which were
unanimously adopted:
Whereas, the National Board of Health has, in accordance
with the law which created it, requested the advice of the
American Public Health Association regarding the form of a
permanent national health organization of the United States,
including its relations to quarantine, both maritime and inland,
and,
Whereas, the opinions of the Advisory Council of the Asso¬
ciation, upon the subject of health legislation, collected and
presented to this body through Dr. J. M. Toner, Chairman of
the Council, have been duly considered ; therefore,
Resolved, that, in the opinion of the American Public Health
Association, the present National Board of Health has been of
such vast service to the country that it is not expedient to make
any essential change in its organization, and that auy minor
improvement in details should be left to the Board itself.
2. That the investigations which have been commenced by
the Board are approved and should be continued, and that simi¬
lar investigations should be undertaken by it into the consider¬
ation and prevention of other diseases as well as yellow fever.
3. That Congress should appropriate sufficient funds to en¬
able the Board to employ the best talent and apparatus in such
scientific and practical inquiries.
4. That the operation of the existing quarantine law, and of
the rules and regulations prepared by the National Board of
Health on that subject, have accomplished great good, and that
no change in the law should be made without the most careful
and serious consideration.
5. That in the opinion of the Association, the national quar¬
antine should be under the direction of the National Board of
Health and of an executive committee, to be selected by that
body.
1879] American Public Health Association. 653
6. That this Association has no suggestions to make with
reference to any amendments to existing legislation in regard to
quarantine, preferring that they should come from the National
Board of Health, as the most competent body to advise what¬
ever may be best.
7. That it is expedient for the National Board of Health to
call an international congress for the discussion of the very im¬
portant subjects of international sanitary quarantine, etc.
8. That is the duty of the General Government to build, equip
and conduct, at the mouth of the Mississippi river, a quarantine
station at such a place as may be designated by the National
Board of Health.
9. That the Secretary of this Association be instructed to
forward to the National Board of Health a certified copy of
these resolutions, together with the reports and documents of
the Advisory Council, and that the executive committee be in¬
structed to such action, during the next session of Congress, as
may seem best suited to promote legislation in accordance with
these resolutions.
Dr. Folsom also read the following resolutions, but said that,
as the points contained in them were included in those of the
Advisory Committee, they were not recommeded for adoption :
By Judge J. W. Clapp, of Memphis : Whereas, the appear¬
ance of yellow fever as an epidemic in Memphis, Tenn., during
the last two summers has created an apprehension that the ill-
fated city may continue to be visited by this scourge, the effects
of which extend far beyond the infected locality and assume
national importance, not ouly as regards the public health and
safety, but as effecting our inter state commercial relations ;
therefore,
Resolved , that this Association recognizes the fact that the
sweeping epidemics which have occurred in Memphis during
the past two summers have been of such a character that they
are no longer local in their bearings, but national; therefore, it is
respectfully urged upon Congress the early consideration of
measures looking to the prevention of similar epidemics at that
point.
By Dr. Gibbs, U. S. Navy : Be it resolved by the American
Public Health Association, that it shall be the duty of the
National Board of Health to designate, for the information of
the President of the United States, such foreign ports as shall,
by said Board, be deemed infected, in the sense that all vessels,
arriving from the same into the seaports of the United States,
shall be subject to quarantine laws. The previous sanitary his¬
tory of said foreign ports, based upon consular and other infor¬
mation, shall be considered by the National Board of Health in
designating such infected ports or localities.
Be it further resolved , that it shall be the duty of the Presi¬
dent of the United States, upon being so advised by the National
Board of Health, to cause a general proclamation to issue in
654
Seventh Annual Meeting of the [December
which a list of such ports and localities shall be declared infec¬
ted in their commercial relations with the seaports of the United
States for a period of six months, viz : from the first day of May
until the first day of November.
THE ADVISORY COMMITTEE.
The President announced the appointment of the following
Advisory Committee :
Alabama — R. D. Webb.
California — Dr. Henry Gibbons.
Florida — Hon. S. C. Cobb, Pensacola.
Georgia — Dr. H. F. Campbell.
Illinois — Dr. J. H. Rauch.
Indiana — Dr. J. F. Hibberd.
Mississippi — Dr. Wirt Johnston.
Louisiana — Dr. D. C. Holliday.
Maryland — Dr. James A. Stewart.
Massachusetts — Dr. Azel Ames.
Pennsylvania — Dr. Henry Hartshorne.
Ohio — Dr. T. C. Minor.
Missouri — Dr. Homan, of St. Louis.
Rhode Island — Dr. E. M. Snow.
Tennessee— Judge J. W. Clapp.
Virginia — Dr. L. S. Joynes.
Michigan — Dr. H. B. Baker.
West Virginia— Dr. James E. Reeves.
District of Columbia— Dr. Toner.
New York — Dr. Elisha Harris.
North Carolina — Dr, J. F. Wood.
South Carolina — Dr. C. W. Chamberlain.
New Hampshire — Dr. L. F. Conn.
Vermont — Dr. H. I). Holtar,
Texas — Dr. Rutherford.
Wisconsin — Dr. E. L. Griffin.
Minnesota — Dr. C. N. Hewitt.
New Jersey — Hon. L. Lilly.
Arkansas — Dr. A. L. Breysacker.
Kentucky — Dr. Pinckney Thompson.
Delaware — Dr. Bush.
United States Army — Dr. McParlee.
United States Navy — Dr. B. F. Gibbs.
National Board — Dr. Stephen Smith.
Commissioner of Education— Gen. Eaton.
Dr. S. S. Herrick gave a statement of the cases of fever
which occurred in New Orleans in the sammer of 1879. The
cases were only 4L in all, to which number should probably be
added seven cases which occurred earlier, beginning June 16,
American Public Health Association.
655
1879J
and between that time and July 3, so mild in type as not to be
recognized as yellow fever until they were found to be con¬
nected with cases occurring later.
AFTERNOON SESSION.
The time was taken up in discussions upon yellow fever and
quarantine.
NIGHT SESSION.
During the discussion of the papers read at the morning
session. Dr. Choppin introduced the following resolution :
Resolved, That a committee on quarantine be appointed by
the American Public Health Association, whose duty it shall
be to formulate a system of quarantine with such rigor and
precision as to prevent the importation of the specific cause of
yellow fever.
Dr. Ohoppin said that by a non -intercourse quarantine, he
meant the detention of vessels at quarantine station, disinfec¬
tion, separation of the sick from the well. The value of com¬
merce with the ports from which fever was imported was much
less than supposed — probably $500,000 to New Orleans — yet
the loss by the results of the importation of two cases in 1878
were not less than $12,000,000, and for the country over $175,-
000,000. There was great hope for utterly stamping out the
disease in Memphis and New Orleans by rigid quarantine and
the prevention of any further introduction of the poison.
Dr. J. P. Dake, of Nashville, opposed the resolution, because
the National Board of Health had this question under consid¬
eration, and the resolution was unnecessary.
Dr. Elliott, of Savannah, declared himself to be an advo¬
cate of a strict quarantine, but was not in favor of stopping
commercial intercourse with the West Indies for six months in
the year. He believed such a course to be unnecessary. Will
it not answer every purpose to stop the ship at quarantine,
discharge the cargo, and thoroughly disinfect the vessel itself?
Let this method have a fair trial before proceeding to declare
non-intercourse. If the plan is thought to be unsafe, the vessel
might be unloaded at quarantine, discharging cargo into
lighters, then loaded in the same manner and sent away with¬
out coming up to the city at all. At least let this plan be
thoroughly tried before proceeding to such extreme measures
as interrupting commerce and declaring absolute non inter¬
course during the six months of the year when fevers prevail.
Dr. Lloyd Howard thought there ought to be a difference
between quarantine rules for different ports. He did not be¬
lieve in an absolute non-intercourse quarantine.
Dr. Choppin advocated the resolution as necessary.
The reading of the resolution was called for.
10
656 Seventh Annual Meeting. [December
Dr. A. N. Bell, of New York, opposed the resolution because
shutting off ships would perpetuate disease, as the ships would
still retain the infection for years, unless cleansed. We should
not be afraid to take hold of the ships and cause the infection
to disappear.
Dr. S. C. Cobb, of Pennsylvania, endorsed Dr. Bell’s views.
Dr. C. F. Folsom, of Massachusetts, called for the question,
and the resolution was rejected.
The following resolutions were adopted :
Resolved, That the replies to schedules under circular 2, of the
National Board of Health, be referred to that Board.
Resolved , That this Association, in adopting the recommenda¬
tion of the President, that the clerical and traveling expenses
of the Secretary, necessary to the performance of his duties as
Secretary, be paid by the Association, recommend also that he
be paid the sum of $100 for the past year’s services.
Dr. Early’s resolutions, presented at the afternoon session,
were tabled, in accordance with the recommendation of the
Executive Committee, as were also resolutions by Dr. T. M.
Stevens, of Indianapolis, favoring the establishment in each
State of hospitals for the treatment of contagious and infectious
diseases.
The following were also tabled, in accordance with a similar
recommendation :
By Hon. E. A. James, of Chattanooga:
Resolved , That it is the opinion of this Association that yel¬
low fever can originate in the United States.
By Dr. A. N. Bell, of New York :
Resolved , As the sense of the A. P. H. Association, we hail
with eminent satisfaction the determination of the people of
Memphis to institute forthwith such means of practical sanitation
as may be deemed to be essential for the redemption of that city
from yellow fever ; and that we will, individually and collec¬
tively, exert ourselves in the promotion of the work.
Votes of thanks were then passed to the institutions of learn¬
ing and others from whom invitations had been received.
To the Local Committee and the citizens of Nashville for
their cordial hospitality and attention to the wants of the
members, which has done so much to make this a harmonious
and en toy able meeting.
To Dr. J. Berrien Lindsley, Secretary of the Local Com¬
mittee, whose laborious services and tireless energy has effected
the most successful meeting in the annals of this Association ;
and to his assistant, Judge Pitkin C. Wright, for his courtesy
and attention.
Dr. A. L. Gribon offered the following resolution, which was
adopted by a rising vote with hearty applause:
Resolved , that the American Public Health Association, re-
Editorial.
657
1879J
cognizing the ability and dignity with which its retiring Presi¬
dent, Prof. Jas. L. Cabell, of the University of Virginia, has
performed the onerous duties of his office, gratefully tender him
its thanks for the invaluable service he has rendered it, and the
great cause in which it is enlisted, and assures him that he
carries with him the respect and affectionate regard of everyone
of its individual members.
Dr. Hewitt, of Minnesota, offered the following resolution,
which was adopted :
Resolved, that the thanks of the Association be presented to
Dr. H. B. Baker, the retiring Treasurer, and that the Secretary
be instructed to communicate to him the genuine condolence in
his recent bereavement.
President Cabell said that he did not think the preservation
of good order was at all due to him, but to the uniform good
conduct of the members. He thanked them kindly, and then
declared the Association adjourned. L. F. S.
NEW ORLEANS IN 1879.
The summer of 1879 will long be remembered in New Orleans
as one of unparalleled healthfulness, and the weeping Jere¬
miahs of the country now find that they have been mistaken
in asserting that to be unhealthy is the normal condition of
this city.
The death rate for several consecutive weeks was remark¬
ably low, and on one occasion the total deaths for a week
amounted to but 68. This low rate of mortality was attained
but once before in eleven years.
The summer months have been remarkably pleasant and in
delightful contrast with some of the health resorts to which
the residents of this city flocked. The mean temperature has
been comparatively low during the months of June, July,
August and September, being respectively 88, 87, 81, 78°.
Nights rendered oppressive by heat were rare. Reference to
the records kept by the United States Signal Service proves
that the velocity of the wind was greater than for the corres¬
ponding months of the preceding year. These favorable con-
658 Editorial. [December
ditions of our climate seem to us to play an important part
in accounting for the healthfulness of our city.
Another factor tending to increase the healthy condition of
the city has been the wide-spread and earnest endeavors of the
Board of Health, the New Orleans Auxiliary Sanitary Asso¬
ciation, timely assistance from the National Board of Health,
and notable efforts on the part of citizens generally to keep
the city as clean as possible. The old plan of dumping gar¬
bage from the streets and gutters into vacant squares in the
rear of the city has been abandoned, and a system of removal
of this foul and offensive matter into barges and deposited into
the Mississippi river below the city inaugurated. The streets
and gutters have as far as practicable been flushed with river
water, and thorough and repeated cleansing of yards, drains
and privy vaults has been insisted on.
The question for solution is the cause of this comparative
immunity from disease, and we are forced to the conclusion
that the combination of factors referred to above must have
contributed largely to the general health. Recognizing the
necessity of a rational quarantine; insisting as strongly as
we can that infectious and contagious diseases shall not be
brought to the city we must pass in review several facts
in regard to the small outbreak of yellow fever which occurred,
and ask whether quarantine and consequent non-introduction
of the fever prevented the appearance of the disease. Yellow
fever was repeatedly brought to the city; once from Rio
Janeiro, and several times from Morgan City. These cases
were never perfectly isolated, and, whether they recovered or
died, not a single case has been traced to them. Other cases
appeared in New Orleans, and one portion of the city was
declared infected ; here case after case developed, but nothing
of an epidemic tendency prevailed. To solve its appearance in
-■
the Fourth District, the most importunate introductionist failed
to discover that it had been imported, and physicians favoring
the theory of spontaneous development, or in favor of the hiber¬
nating characteristic of the germs, found a vast field for specu¬
lation.
The readers of the Journal have been favored with an
.
1879 J Reviews and Book Notices. 659
analysis of the cases of yellow fever occurring during the year,
by that untiring and pains-taking sanitarian, Dr. Joseph Holt,
and the concluding remarks of his article not only will bear
repetition, but should be carefully weighed :
“ Of three things we are certainly assured ; we know that
perfect sanitation is the one great experiment yet to be tried
in the solution of the yellow fever problem ; that the disease
has ceased to occur epidemically in certain cities, heretofore
scourged, coincidently with an improved municipal sanitation,
and, finally, that every city, town, or ship, in which the disease
breaks out and spreads, is a city, town, or ship, in a foul and
most unsanitary condition. And moreover, with all deference
and becoming modesty, we challenge any man to cite, with cor¬
roborative evidence, one single instance to the contrary : that
is, of yellow fever occurring de novo , and spreading in a com¬
munity where there did not exist bad hygienic conditions due
to the massing of human excrement and other filth in close
proximity to habitations.
“ Their streets and premises or decks might look severely
clean, but to the scrutinizing eye of a sanitarian, the place
would be seen disgustingly filthy.
“If ever we discover the talisman whose charm shall save
us from yellow fever, we will also discover upon it a few caba¬
listic characters, the spring of its magical potency. These,
when arranged, will spell one word, ‘ Cleanliness.’ ”
Reviews and Book Notices.
Clinical Medicine. — A Systematic Treatise on the Diagnosis and
Treatment of Diseases. Designed for the use of Students and
Practitioners of Medicine. By Austin Flint, M. D., Profes¬
sor of the Principles and Practice of Medicine and of Clini¬
cal Medicine in the Bellevue Hospital, Medical College, Etc.
Philadelphia. Henry C. Lea; New Orleans, Armand Haw¬
kins, Medical Book Store, 196£ Canal street. 8vo., pp. 795.
Price $4 50.
The fact that another work from the pen of this eminent
clinical teacher is announced is a guarantee of cordial reception
by the profession.
The work before us is a wonder of condensation, but the
author has sacrificed thoroughness to brevity. A short terse
060 Reviews and Booh Notices. [December
sentence, expressing to the writer’s mind what would require a
page to render plain to the student, requires too much study,
and, unless this work is read in connection with more thorough¬
ly pathological treatises, it will scarcely be appreciated.
The introductory chapter is well calculated to furnish the
student with full information as to the methods of examining
patieuts and recording cases, and the value of such preliminary
teaching cannot be too highly estimated.
But to our minds the most valuable portion of the work is
contained in the preliminary observations connected with the
study of diseases corresponding with the different physiological
systems. The value of each symptom is carefully analysed.
That portion of the work referring to the treatment of dis¬
eases is, as will be expected, essentially modern and complete,
though given too much after the style of aphorisms.
The index is elaborate, and the volume is published in good
style.
Reports to the St. Louis Medical Society on Yellow Fever ; consist¬
ing of the Report of the Committee appointed to Inquire into
the Relations of the Epidemic of 1878 to the City of St. Louis ,
and a Report on the Meteorological Conditions and Etiology
of Yellow Fever , and of certain other diseases associated with
a high temperature , and on the Treatment of Yellow Fever.
By W. Hutson Ford, A.M., M.D., formerly Professor of
Physiology, New Orleans School of Medicine, etc. 8vo.,
pp. 327. St. Louis : Geo. O. Rumbold & Co., 1879.
The first of these reports was prepared by a committee con¬
sisting of Drs. W. Hutson Ford, Walter Wyman, and F. J.
Lutz. The points which they took under consideration were as
follows :
I. Cases of yellow fever developed in St. Louis in persons
coming to this city from Southern cities, where the disease was
prevailing,.
II. Cases of yellow fever treated at the Quarantine Hospital.
III. Cases of yellow fever arisiug in St. Louis, its suburbs,
at Quarantine, and on board the Quarantine transport steamer,
Edwardsville, by contagion from cases developed in persons
from points at the South, where yellow fever was epidemic.
IY. Cases either of yellow fever, or closely simulating that
disease, arisiug in St. Louis and its suburbs without known
contact with other cases, or where no such contact existed.
Reviews and Booh Notices.
661
1879]
Y. Classification and summary of all cases of yellow fever
occurring in St. Louis and its vicinity in 1878.
Tlie following are the conclusions arrived at by the com¬
mittee, respecting yellow fever in general and the diseases as
affected by the local conditions of St. Louis.
1st. Yellow fever may be acquired in St. Louis, by contact
with persons sick with that disease, and with the apparel of
persons who have been in contact with the sick ; by entrance
into the holds or apartments of steamers, or by communication
with their cargoes.
2d. Yellow fever, or at least an equally fatal disease in no
way distinguishable from yellow fever, and like it, contagious,
(Miss Enwright from the person of her mother,) may be gen¬
erated in loco by bad sanitary conditions in this city and its
suburbs.
3d. The population of St. Louis does not acquire the capacity
of receiving yellow fever, until late in the season, viz., the end
of September and month of October, in the great majority
of cases.
4th. Individuals weakened by disease, and especially the
subjects of malarial fever, evince the greatest readiness to
acquire yellow fever by contagion.
5th. A sort of hybrid fever, characterized by intense and
often repeated rigors, analogous to break-bone fever (Dengue),
may be acquired in St. Louis by contact with places or things
which have been in relation with persons sick of yellow fever.
6th. For the prevention of yellow fever in St. Louis, the most
rigid quarantine possible should be established, with reference
to cities in which yellow fever may appear, to be maintained
until the month of November, or a permanent decline of the
weekly mean temperature to 40°.
7th. Subjects of yellow fever at quarantine, should be segre¬
gated there, and served by a special corps of attendants, who
should not come in contact with any other patients.
8th. No disturbance of the soil, or rectification of drainage,
should ever be practiced in the presence of yellow fever.
9th. The subjects of yellow fever should, if practicable, be
promptly removed from the city and taken to quarantine.
10th. All sanitary measures i elating to the abatement of
nuisances capable of causing disease, should be instituted and
completed before the month of July.
11th. The cardinal property of yellow fever, so far as St.
Louis is capable of being invaded by the disease, which has
now been unfortunately proved, though on a very limited scale,
is its indisputable contagiousness; but inasmuch as an accept¬
ance of this contagion implies a certain receptivity previously
wrought by meteorological influences in conjunction with the
effluvia of putrefaction, still greater attention than ever should
662
Reviews and Book Notices.
[December
be paid to matters of drainage and general sanitation. Such
action will constitute a safeguard to the public health, we are
assured, more reliable than even a rigid quarantine, while in
numberless other ways, it will conduce to the welfare of our
city. All of which is respectfully submitted.
As regards the above propositions, we would remark upon
the second, that the description of the cases of Mrs. Enwright
and her daughter is not conclusive to our mind that they died
of yellow fever; besides, the daughter died forty days after the
mother in a house a square and a half distant. The third find¬
ing is based on observation of a single year, and is not worth
mentioning as a scientific conclusion.
As to the fifth conclusion, it is to be regretted that the com¬
mittee fail of elucidating the peculiarities of the people or of
the climate of St. Louis, which could account for so remarkable
a hybrid production. All the conclusions, particularly those
just referred to, and the 11th, afford a striking example of
drawing dogmatic inferences from slender data, inasmuch as
the total number of cases of yellow fever at St. Louis in 1878
was 151, and confirm an observation of the late Warren Stone
— that doctors who have gone through a single epidemic think
they know all about yellow fever, but lose their conceit, the
more they see of the disease.
The second part of the volume is contributed solely by Dr.
Ford, of which 130 pages are devoted to the etiology of the dis¬
ease. The following quotation affords a fair illustration of his
views, which, however, lack the merit of originality :
Yellow fever is caused in the first instance, whenever it
appears, by the emanations from putrefying animal matters,
more especially the urine and faeces of man and animals, and
is propagated by its own materies contagiosa.
* The cities of warm regions near the sea level are especially
liable to yellow fever, nnd as they are in continual communica¬
tion with each other by land or water, all such cities must be
regarded as a single compound centre of civilization, with
necessary relations to each other, and constant transference of
inhabitants.
*******
Nevertheless the fundamental origin of yellow fever, in the
submission of the human body at abnormally high and long
Why, then, has yellow fever never appeared on the shores of the Indian ocean ?
Reviews and Boole Notices.
G63
1879J
continued degrees of lieat and atmospheric humidity, to the
influences of the effluvia of putrefaction, is to be uncondition¬
ally accepted, and no paradox whatever is implied in the
assertion that a given case or outbreak may have been due,
either to sceptic effluvia, or to the materies contagiosa.
It has never been asserted by the advocates of the above
notions that tropical America, particularly along its Atlantic
and Gulf coasts, possesses any monopoly of the special insani¬
tary conditions named ; nor has it been explained by these
philosophers why yellow fever never appears along the eastern
shores of Africa, the southern and eastern shores of Asia, nor
the islands of the Indian and Pacific oceans.
The book closes with about 40 pages devoted to the Theory
and Practice of the Administration of Veratrnm Viride in Yel¬
low Fever. The result of the use of this remedy he declares to
be “A reduction of the mortality to one-third, or even less
than this, of what is usual in other modes of practice.” The
volume closes with these words: “In my opinion, the intelli¬
gent employment of veratrum viiide is the only method of
medication which in appropriate cases is entitled to rank as
the rational treatment of fever.” The reader is requested to
make his own comments. S. S. IT.
Student’s Pocket Medical Lexicon ; (jiving the correct pronuncia¬
tion end definition of all words and terms in general use in
medicine and the collateral sciences , the pronunciation being
plainly represented in the American phonetic alphabet. With
an appendix , containing a list <>J poisons and their antidotes ,
abbreviations used in prescriptions , and a metric scale of
doses. By Elias Longley, author of a “Pronouncing Vo¬
cabulary of Geographical and Personal Names,” etc.
18mo., pj». 303. Philadelphia: Lindsay & Blakiston, 1879.
[From Arm and Hawkins, 196£ Canal street.]
The peculiarity of this lexicon is the phonetic alphabet,
which is used to represent the pronunciation of all words but
those of which there can be no doubt. Twenty new cliarac
ters are used, while c, q and x are omitted from this alphabet,
as being redundant, and thus the forty-three elementary
sounds of our language are represented, each by its own char¬
acter. The system is easily mastered by a little study, and is
then more convenient than any other. There can be no doubt
10*
664 Reviews and Book Notices. [December
that the general use of this alphabet, the additional letters of
which bear a close resemblance to our Roman clia acters of
kindred significance, would greatly facilitate children in learn¬
ing to read and spell our difficult language, and would at the
same time contribute much to rendering its orthography and
pronunciation fixed and uniform. The principal disadvantage
would be a partial concealment of the derivation of words, by
deviation from their original orthography, but this would be
of no consequence to those ignorant of the original languages,
while those familiar with them would easily overcome such
difficulties.
Words derived from the Greek and Latin are pronounced
according to the general rules of the English language, in
preference to the Continental style, following the custom which
prevails at Oxford and Harvard.
The definitions are necessarily extremely concise, and no
attempt is made to show the derivation of words.
Some important words are omitted : for instance Hyper¬
trophy and Phthisis ; a few are pronounced not in accordance
with the best authorities. But these imperfections do not
destroy the general usefulness of the work and can easily be
corrected in another edition.
On the whole we regard the little volume as highly conve¬
nient and meritorious. S. S. H.
Winter and its Dangers. By Hamilton Osgood, M. D., of edito
rial staff of the Boston Medical and Surgical Journal. 16
mo., pp. 160. Philadelphia: Lindsay & Blakiston. 1S71).
(Sold byArmand Hawkins, 1961 Canal street, New Orleans.)
This is No. VI, of the series of American Health Primers,
edited by W. W. Keen, M. D., intended for general readers and
sold at 50 cents a volume. The ten chapters at e devoted to the
following subjects :
I, General Considerations ; II, Dangers Arising from Errors
in Dress; III, Carelessness and Ignorance in Bathing; IV, In¬
attention to Pulmonary Food fin other words to ventilation];
V, Danger from Overheated Air ; VI, Indifference to Sunshine;
VH, Sedentary Life and Neglect of Exercise; VIII, The
1879] Reviews and Book Notices. 005
Dangers of School-life in Winter ; IX, Winter Amusements;
X, Closing Observations.
The book is full of judicious observations and advice, written
in plain language, free of technicalities. Though its warnings
are more suited to cold climates than to our own, with its short
and mild winter, much of its instruction is Applicable to South¬
ern readers. It ought to be in every liousohold. S. S. H.
Atlas of Skin Diseases. By Louis A. Dull ring, M.D., Professo
of Skin Diseases in University of Pennsylvania ; Physician
to the Dispensary for Skin Diseases, Philadelphia ; Derma¬
tologist to the Philadelphia Hospital, etc. Parts III and
IY. 4to. Philadelphia: J. B. Lippincott & Co.
We have received parts 3 and 4 of the above work, which
certainly to our thinking contain the most magnificent colored
illustrations ever published in this country. Part 3 contains
plates of squamous eczema, erythematous and papula pustular
syphiloderm, and purpura. The illustrations are drawn from
life, and colored by the celebrated artist, Hermann Faber, and
chromo-lithographed by Moras, of Philadelphia. Part 4 con¬
tains illustrations of vitiligo, alopecia areata, favus and eczema
rubrum. A concise history of the case, giving the symptoms,
diagnosis, prognosis, and results of treatment, accompanies
each portrait. The work is to be completed in 8-10 parts, at
$2 50 per part.
For some reason parts 1 and 2 have not yet been received
by us.
First Step in Chemical Principles. An Introduction to Modern
Chemistry , Intended Especially for Beginners. By Henry
Leffraann, M.D., Lecturer on Toxicology, Summer School,
Jefferson Medical College, etc. 10mo., pp. 52. Philadel¬
phia : Edward Stern & Co., 1879.
This little volume contains the substance of the author’s
*-
lectures delivered for several years past to the quiz-classes at
Jefferson Medical College. Medical students generally have
more difficulty with chemistry than with any other branch
taught by lectures, owing to tlicir previous ignorance of the
principles of the science. A careful study of this volume pre¬
vious to the lecture course would mainly supply the defect,
and such we conceive to be its proper use. S. S. H.
COG Meteorological and Mortality Tables. [December
Meteorological Summary — October, 1871).
Station— New Orleans.
5 j-
o> o
c z &
e .
c >.
.5 .2 ~
r-Z
Date.
i?§
'S ° K-
? 0. ?
>
General Items.
« 5S
aa
an
C3 £
Pi — <
£5 o
«
1
30.13
79.2 83.3
East.
.00
Highest Barometer, 30.343, on 24th.
2
30.11
79. 5
81.7
East.
.02
Lowest Baromete
29.732, on 16th.
3
30.09
80.0 73.7
East.
.00
Monthly Range of Barometer, 0.611 in.
4
30.02
80.5
09.0
East.
.00
Highest Temperature, 86° on 2d.
5
29.91
78.0 75.7
N. E.
.13
Lowest Temperature, 50° on 25th.
Monthly Range of Temperature, 36°.
o
29 81
74.7 78.0
North.
.05
7
29.94
76.2 85.0
N W.
.05
Greatest Daily Range of Temperature,
8
30 05
78.0 80.7
East.
.11
10° on 29tli and 30 h.
9
30.08
79.2 81.7
East.
00
Least Daily Range of Temp. ,7° on 26th
10
30.07
79.2 70.3
East.
.00
Mean of Maximum Temperatures, 77.6°
11
30.01
79.0 73.3
N. E.
02
Mean of Minimum Temperatures, 05.4°
Mean Daily Range of Temp., 12.2°.
12
30.04
79.0 75.0
N. E.
.00
13
30.05
77.2 75.0
N. E.
.00
Prevailing Direction of Wind, North.
14
30.00
77.2 72.7
N. E.
.00
Total Movement of Wind, 0,762 miles.
15
29.85
74.2 83.0
N. E.
.17
Highest Velocity of Wind and Direc-
16
29.82
70 7
77.7
N. W.
.01
tion, 29 miles, East, oi»20th.
17
30.01
77.5
00.3
North
.01
Number of Foggy Days, 0.
18
30.08
71.0
51.3
North
.00
Number of Clear Days, 9.
19
30.07
07.7
48.7
North
.00
Number of Fair Days, 10
Number of Cloudy days on which no
20
30.01
C5.0
75.0
Nor th
.00
21
30.00
70.2
83.0
N ortli
.00
Rain fell, 6.
22
30.00
71.5
81.0
N. E.
.00
Number of Cloudy Days on which
23
30.22
70.2
64.0
North
00
Raiu fell, 11.
24
30 31
35.3
Nor tli
.00
25
30.29
01.0
63 7
East.
.00
COMPARATIVE
TEMPERATURE.
2()
30.20
00.0
77.0
.25
1871 .
1876 . 67.0°
2/
30.11
02 0
o7.0
Nort li
.54
1872 . .
1877 . 70.2°
28
30.07
05.0
02 0
N. W.
.00
1873 . 08.2°
1878 . 70. 6C
29
30.02
00.5
53.7
N. W.
.00
1874 . 70.4°
1879 . 72.1°
30
30.07
07.7
70.0
South
.00
1875 . 673.°
1880 .
31
30.22
64.5
70.0
N. W.
....
COMPARATIVE
PRECIPITATION.
Sums
Means
187 1 . inches.
1 1876.. 0.24 inches
30.059 72.4
72.1
North
1.36
1872 . “
1873... 1.89 “
1 1877 . 9.15 “
j 1878.. 5.07 “
1874 _ “
| 1879.. 1.36 “
1875.. 2 09 “
| 1880 . “
Mortality in New Orleans from October lOtli, 1879, to
November 23d, 1879, inclusive.
Week Ending.
Yellow
Fever.
Malarial
Fever.
Consump¬
tion.
Small¬
pox.
Pneu¬
monia.
Total
Mortality.
October 26
3
6
10
0
1
96
November 2
0
0
21
0
4
113
November 9.
0
8
15
0
5
113
November 10
0
7
14
0
11
111
November 23
0
3
14
0
4
89
Total .. . .
3
30
80
0
25
522
NEW ORLEANS
Medical jind Surgical Journal
JANUARY, 1880.
Pr1
IGINAL J^OjVyVlUNICATIONS.
Prevention of Disease— Prophylaxis in Person.
By JOHN B. ELLIOTT, M.D.,
Professor Materia Medica and Therapeutic* and Clinical Medicine, Medical Department,
University of Louisiana.
k
To touch upon this subject at the present time needs no
apology. The question of our ability to prevent epidemic dis¬
ease has grown to be in the last two years one of national im¬
portance, and has become a matter of vital interest to the great
commercial centres of the Mississippi valley and the Atlantic
coast. When we realize that during the past summer at least
one-third of the commonwealths of the Union were more or less
apprehensive of an epidemic invasion of yellow fever, and that,
thereby, their commercial highways were obstructed and their
populations held ready for flight, we may form some feeble
estimate of the terrible cost of such apprehensions, and by it
may measure with approximate accuracy the responsibility that
rests upou the shoulders of the medical profession touching the
prevention of disease. The appointment of State boards of
health tells that the people demand some help at the hands of
the profession, while the higher creation by Congress of a
National Board of Health, with powers so broad as to cause
alarm through its invasion of political precedent, gives evidence
that the representatives of the people feel and sympathize with
the demand, » /.
668 Original Communications. [January
On the other hand, the work that has been done during the
past year by the various uiedieal bodies shows that the respon¬
sibility has been fully realized by them, and teaches that where
means and power are given to the guardians of health they will
be used With honest intent and good results.
To discuss wliat has been done is not, however, the purpose
of this paper. The question that presses now is, what may we
do for the future ? The general methods in vogue for the pre¬
vention of epidemic disease are the offspring of common sense
rather than of professional knowledge, and it would seem that
the public have a right to expect more than this at our hands.
More than this every conscientious worker in medicine must
hope to bestow, or else must lose that iaitli in the future pro¬
gress of his science which will sap the foundations of his energy
and arrest endeavor.
To sum up briefly the available methods of prevention, we
may class them as follows :
\ External f Quarantine-
Prophylaxis ) ( Prophylaxis in Place.
( Internal { Prophylaxis in Person.
Upon the first the medical profession is at variance : it has
at times signally succeeded; at others it has signally
failed. The laity, according to their relation to the
centre of infection, are divided. The populace of au
infected district are apt to think that the quarantine which
closes their channels of commerce is a useless imposition, while
those communities in commercial neighborhood with the dis¬
eased centre regard quarantine as the only hope left them for
escape. Granting, however, the theoretical efficacy of quaran¬
tine, disease will at times penetrate its lines, and the commu¬
nity so reached becomes its prey with no other means of pro¬
tection than local sanitary measures, or prophylaxis in place.
As this measure is most often resorted to after disease has
made its appearance— is used to arrest rather than to prevent —
its utility is in great measure lost. As a matter of fact, how¬
ever, the two methods mentioned are civil rather than medical
methods. Common sense dictates them, and the civil arm is
quite competent to inaugurate and perfect them. The ouly
1380J t^LLiOTT— Prevention of Disease.
purely medical method is prophylaxis in person* or the use of
agents that will destroy the poison of the disease in the blood
before the poison destroys the person. Patients attacked by
disease are sick long before they take to bed or see a physician*
and the period preceding the technical sickness has long been
recognized as the period of “ incubation So clearly is it
accepted as a fact that disease poisons enter the system and
then require time for the accomplishment of their effects, that
most diseases have their definite periods of incubation assigned
them, and all quarantine laws tacitly express this conviction
by prescribing a time of probation for persons from infected
districts. To combat and destroy disease in the person during
this preliminary stage, or rather, to prevent the formation of
this stage, is a problem left for the medical profession, aud
offers the only true medical method of preventing disease^
Setting aside, at present, the nature of disease poisons, a
perfect prophylatic against a given disease, is an agent that is
harmless to the individual taking it, while destructive of the
poison in the blood.
No argument is necessary to prove that certain chemical
compounds are believed to be destructive to the poisons of
epidemic diseases. The annual use of this class of compounds
has enlarged to such an extent as to have generated a new
branch of commerce. Vast amounts of money are annually
expended in attempts to destroy the disease poisons in the
streets of our cities, and the public mind has become so familiar
with the fact of disinfection, as to regard its omission as a
civic delinquency. The general recognition, therefore, both by
the professional mind and by the mind of the laity, of true
material poisons, as the causes of epidemic disease — which
poisons can be met and destroyed externally to the body —
leaves no ground for argument against attempts to meet and
destroy those same poisons after they have entered into the
body of the individual. Furthermore, it is but rational to
conclude that it is a much more hopeful task to prevent the
breaking down of a system by killing a poison before its work
is accomplished, than to remedy at last the physiological damage
which is manifested in the complete collapse of the incipient
670 Original Communications. [January
chill and the subsequent reaction of the febrile state. Too
often the period for medical aid has passed before the physician
is sent for, and the blame of the fatal issue has to be borne by
the practitioner who has no room for his skill. In such an
issue the blame does not belong to the individual practitioner
so much as it does to the profession at large, who have failed
so far to furnish sufficient methods of prophylaxis in person.
To this branch of medical inquiry the present paper is a
contribution, the following experiments and results bfing
offered with the hope that they may stimulate research and
lead to some results in this direction :
In 1867 and 1868, the attention of the writer was fixed by the
experiments of Polli (from 1855 to 1861) upon the Sulphites
and hyposulphites of the alkalies aud the alkaline earths.
• To state briefly, from memory, in these experiments it was
claimed that the sulphites administered to dogs could be
detected in the tissues of the dead animal (still in the form of
sulphite) twenty-four hours or more after the administration of
the salt. From the known effect of sulphurous acid as an
antiseptic and antizymotic, it followed naturally, from these
experiments, that the use of the sulphites should be essayed with
hope in that class of diseases recognized as zymotic ; and Polli
claimed to have achieved success in the treatment of the major
exanthemata with the sulphites and hyposulphites of sodium
and magnesium. It would naturally suggest itself, from these
reputed successes, that if the sulphites are potent to arrest
this class of diseases after the patient has become technically
“ sick,”' they would be still more potent to prevent them,
provided the salts could t>e taken without harm to the
individual.
As the results of Polli’s experiments upon dogs have been
controverted by subsequent experimenters, and as the success
claimed by him in the treatment of zymotic diseases has not
been experienced by later therapeutists, the administration of
the sulphites has fallen into disuse, and they are now regarded
as a class of remedies possessing valuable powers, but as
inferior in any given direction to other agents at our disposal.
An opportunity was afforded the writer for testing the
Elliott — Prevention of Disease.
671
1880]
powers of the sulphite of sodium, as a prophylactic, in 1876,
in an epidemic of scarlet fever. In this test, the sulphite,
having achieved all that could be expected of it by the most
earnest advocate of its power, subsequent experiments upon
men and animals were undertaken to explain the mode of its
action, and account for the results. In order to present the
subject in logical sequence, the chronological order of the
therapeutical and physiological experiments will be reversed in
stating them.
In seeking to learn the mode of action of sodium sulphite, the
first question that presents itself for solution is: Does the
sulphite of sodium remain in the blood as sulphite for any
length of time after its absorption into the circulation?
This was claimed by Polli, while it was denied by Rabuteau ;
Polli, as has been stated, claiming that the sulphite could bo
found still as sulphite in the tissues of animals who had taken
the salt. Rabuteau did not accept the results of Polli, as he
could find no sulphite in the urine ot patients taking sulphite
(in therapeutic doses); his inference from this failure being
that the sulphite was rapidly transformed into sulphate as soon
os it entered the circulation.
To answer this first query, the following experiments were
tried :
The first experiment was made upon a healthy dog whose
estimated weight was 40 pounds. The salt used was the
normal sodium sulphite, Na, SO;,, 701T3. The reaction
relied upon for the detection of the sulphite was its decomposi¬
tion by nascent hydrogen liberated from hydrochloric acid
(HC1.) by chemically pure zinc. The reaction may be stated
os follows :
1st. 3Zn + 6HOI=3Zn 01, 4- Hfl ;
and, 2nd, Ha* SO, + Ht;=SlI, + OH* + 2 Ha.OH.
lu other words, the nascent hydrogen liberates sulphide of
hydrogen, and the presence of the latter is then easily
demonstrated by bringing it into contact with lead acetate in
solution, when lead sulphide is deposited. By this reaction,
one grain of sodium sulphite can l>e readily detected in thirty
thousand grains of water.
672
Original Communication*.
[January
Before administering the sodium sulphite to the dog au
ounce of blood was drawn from its hind leg and submitted to
the identical chemical process intended for the blood after the
administration of the salt. This was done to be assured that
there was no compound in the blood that could produce the
hydrogen sulphide expected from the decomposition of the
sulphite.
To simplify the experiment and avoid all possible change in
the blood from manipulation or contact with the gir, the blood
was drawn from the leg into the vessel, (a large sized glass
beaker), in which the test was to be made, and a little water
was added to dilute the blood. A piece of chemically pure
zinc was then dropped into the blood, enough hydrochloric
acid was poured in upon it to cause brisk evolution of hydro¬
gen, and the mouth of the beaker closed with a piece of filter¬
ing paper wetted with a solution of lead acetate.
This simplification of the experiment was arrived at after
one or two failures in the effort to perform the experiment in a
closed vessel and to force the gas (SIT.) through a solution of
lead acetate by bubbling.
The failures arose from the fact that the heat of the chemi¬
cal reaction, together with the direct effect of the acid caused
a coagulation of the albuminoid constituents' of the blood and
a consequent swelling up of the contents of the vessel into a
frothy mass which prevented the escape of the gas. The
frothy mass would pass over through the delivery tube into the
solution of lead acetate and seriously complicate the results.
In the simplified form the same frothy mass resulted, but be¬
fore filling the large beaker the distended bubbles would burst
and set the SH, free directly in the presence of the lead
acetate in solution on the filtering paper closing the mouth of
the beaker. In the preliminary experiment upon the blood of
the dog, before the sodium sulphite was administered, no SH*
was generated. No trace of lead sulphide could be seen upon
the filtering paper.
Pre-assurance against this fallacy being had, thirty grains of
sodium sulphite was given to the dog between two slices of
fresh meat. In an half hour afterwards au ounce of blood
1880] Elliott — Prevention of Disease. 673
was drawn from the hind leg and immediately submitted to
the same test as the first specimen.
In this case the surface of the filtering paper became com¬
pletely covered with a heavy deposit of lead sulphide. After
this experiment the dog was kept confined, and six hours sub¬
sequent to the administration of the sulphite another ounce of
blood was drawn and again tested with like results. The pre¬
cipitate of lead sulphide was, in the second case, not so heavy
as in the first, but was sufficiently heavy to be prominently
visible. These results support the conclusions of Polli, and
warrant the conclusion that the sulphite of sodium remained
still as sulphite in the blood of the dog six hours after its
administration.
The second experiment was tried upon a robust and healthy
mau, who submitted himself for the trial, A. J. Short, 27 years
of age ; weight, 166 pounds ; height, 5 feet, 7 inches. As in
the former experiment, a half ounce of blood was drawn by
means of cups from the left shoulder, and submitted to the
test of Hcl. and Zu. before the administration of the sulphite,
and with the same negative result. Upon the prepared filtering
paper there was no trace of lead sulphide. Twenty grains of
sodium sulphite was then administered in aqueous solution.
Estimating that the body of the patient contained 12 pounds
of blood, the quantity of sulphite administered would give a
solution in the blood of 1-4200. An half hour after the sulphite
was administered, a second half ouuce of blood was drawn .
from the same shoulder and immediately submitted to the same
test. A plentiful precipitate of lead sulphide was formed upon
the filtering paper. Four hours after the administration of the
sulphite, a third half ounce of blood was drawn from the same
shoulder and tested, when a clearly perceptible precipitate of
lead sulphide was formed.
As a fallacy might underlie the above experiment in the fact
that hydrochloric acid will liberate hydrogen sulphide from a
sulphide ; an experiment was tried to cover this point. A
patient suffering from chronic bronchitis was given 20 grains
of sodium sulphite and in fifteen minutes a half ounce of blood
was drawn and tested with hydrochloric without the addition
674 Original Communications. [January
of zinc, no sulphide was formed. The same blood was then
tested with the zinc and hydrochloric acid and a copious precip¬
itate of sulphide formed.
A second experiment was performed (in this case) six hours
after the administration of the sulphite when no sulphite could
be found.
This series of experiments serves to show that sodium sul¬
phite remains as sulphite in the blood of man somewhat longer
than four hours, but not so long as six hours, after the admin¬
istration of a 20 grain dose.
An experiment was also tried after the method of Rabuteau
in order to test the action of the sulphite of sodium upon the
processes of combustion in the body, and also to note the effect
upon the quantity of sulphate in the urine. A young physi¬
cian kindly ottered himself for this experiment. The direct
object of the experiment, was to determine, 1st, the effect upon
the quantity of urine excreted ; 2d, the effect upon the urea
excreted ; 3d, the effect upon the sulphates in the urine.
In order to arrive at a normal mean of these excreta the
patient was placed upon a regulated diet, containing but little
nitrogenous food, and the urine for each twenty-four hours was
carefully collected and measured for four days before the
administration of the sulphite was begun. The results of this
preliminary test were as follows :
X>ays. Urine in grains. Urea in grains.
1st day . 16103 293.76
2d day . 14492 273.81
3d day . 13669 285.01
4th day . 23691 361.60
Mean . 17061.5 304.3
The experiment was performed in May. The weather from
the beginning of the experiment continued increasing in
warmth until the third day, as is well indicated by the dimin¬
ishing quantity of urine. On the third day there was a sud¬
den change to very cool weather. Means were not avail¬
able for the careful measurement of the sulphates by proper
drying and weighing. They could only be approximately esti-
1880]
Elliott — Prevention of Disease.
675
mated by precipitation with barium chloride, filtering, wash¬
ing and air drying. As this could give only approximate
results, the record is not entered, as the temperature of the
day and the aqueous vapor present made the results vary.
On the fifth day the patient began taking 20 grains of sodium
sulphite in aqueous solution three times a day. The urine
was collected and tested as upon the previous days ; the diet
being the same as during the first four days:
Days. Urine in grains. Urea in grains.
5th day . 14581. 293.83
6th day . 8201. 232.70
7th day . . 10024. 268.53
8tli day . 11391. 255.53
9th day . 16759. 295.29
Mean . 12191. 269.1#
The sulphites were estimated as in the first period and were
largely increased — apparently doubled. On the fifth day there
was a warm change in the weather, and on the sixth day the
weather was very warm, as the urine and urea indicate. The
urine was collected on the two days following the 9th, the
diet being continued, but the sulphite stopped.
Bays. Urine in grains.- Urea in grains.
LOth day . 8657 202.00
11th day . 7746 187.34
The eleventh day was noted as weather hot, temperature
F. 87°.
A comparison of the two periods gives the following :
Urine. Urea.
1st period . 17064.5 304.30
2d period . . 12101.6 269.17
The comparison of the means for the two periods shows
diminution of urine and urea for the period of medication. A
careful comparison of the tables, with the notes of temperature
of the dates, will show, however, that the weather seems to
have had a greater effect than the sulphite. The excess of
676 Original Communications. [January
urine in the first period is due to the cool change on the fourth
day, while during the period of medication the quantity of
urine and urea increased from the sixth day to the ninth. The
results are rather negative iu regard to the excretion of urine
and urea, while the sulphates were, as above stated, apparently
nearly doubled.
During the period of medication, the urine was tested for
sodium sulphite, but none could be detected. This accords
with the experience of M. Rabuteau when therapeutic doses
were administered.
The inferences to be drawn from the above series of
experiments are the following:
1st, Experiments on man. The sulphite of sodium can be
detected in the blood as sulphite four hours after the adminis¬
tration of a twenty grain dose.
2d^ Upon its entrance into the circulation, it begins to
undergo oxidation to sulphate, which process is apparently
completed before the lapse of six hours after the administration
of a twenty grain dose.
3d. The sulphites in the urine, are largely increased during
the administration of sodium sulphite.
4th. The effect of the salt upon the excretion of urine and
urea cannot be pronounced from the single experiment tried.
From the fact that it is an alkaline salt it may be judged
that it would slightly diminish combustion upon long con¬
tinued use. From practical experience, to be submitted imme¬
diately, I feel sate in the assertion that its continued use
in therapeutic doses does no harm to the individual.
The thei apeutical experiment was tried in the fall and winter
of 1876, and was undertaken from a conviction of the sound¬
ness of Polli’s views in regard to the sulphites. The following
is a brief outline of the experience:
The epidemic which afforded the opportunity occurred at
Sewanee, Tenn., the site of the University of the South.
Sewauee is a town that has grown up around the University,
and has a population of about eight hundred souls. Added to
this population of residents are the University students, about
1880J Elliott — Prevention of Disease. 677
two hundred in number. A portion of these students are
young boys from ten to twelve years of age, attending the
grammar: school attached to the University. Sewanee is situ¬
ated upon the Cumberland table land in middle Tennessee, at
an elevation of 2000 feet above the sea.
In August, 1876, a case of measles appeared in the person
of a servant girl attached as a nurse to one of the resident
families. This girl had come from a neighboring town where
measles prevailed, and developed the disease one week after
she had reached the mountains: The case was fully developed
when first seen, and her condition was considered too critical
to warrant removal. In a few days all of the children she had
been attending, four in number, developed the disease. They
were all placed upon sodium sulphite, 7.5 grains three times a
day, and little other treatment adopted. The same dose
of the sulphite was given to each child, (aged from
two to eight years), irrespective of age, and the cases
were milder as the age of the patient was less, or as
the ratio of the dose to the age increased. The house
was quarantined and no further spread occurred. Being-
in constant contact with my own children, (four in number,
from infancy to six years of age), and my residence being just
opposite to the infected house, my own children were put upon
the sulphite in the same doses. This was the first essay at
prophylaxis in person.
About two weeks after this 1 was summoned to a family in
the centre of the community to see two children who had been
suffering for some diys from the enlargement of all the glands
about the throat, accompanied with persistent stiffness of the
muscles of the neck. Neither of these children had been sick
enough to go to. bed or even to be much noticed by those about
them. No suspicion of serious disease was entertained. In a
few days, however, a summons came to see a case in a neigh¬
boring family, and another case in the family of the children
with enlarged glands.
Both patients (children) had high fever, and from the fact
that measles had already appeared in the community it was
expected that these cases would develop as such. The appear-
678 Original Communications. [January
auce of the eruption, however, accompanied with severe
angiuose affections showed that a formidable type of scarlet
fever had to be dealt with. fSTo history of the infection could
be traced.
As soon as fully satisfied of the nature of the disease, an
attempt at arrest by prophylaxis in person was determined
upon. The conviction was forced that isolation of the houses
alone could not prevent the spread of the disease, as there
were ten children in the two families who had never had scarlet
fever and had already been exposed to infection. There were
besides many young people in the neighboring houses who had
never had scarlet fever. The children in both of these houses,
and also all the young persons and children in the neighbor¬
hood were put upon the sulphite in doses from seven to ten grains
three times a day. The two sick children were treated with
the same salt in double doses, and the following was also
used :
Potass. Chlorat,
3ii
Acid. Hydrochlor,
gtt. XX
Glycerine,
?ii
Aqum,
3xii
tit S. Dessertspoonful every 4 hours.*
Both of the cases made good recoveries, and although the
children of the respective families were not altogether excluded
from the rooms of the patients, no other cases occurred in either
family or in the neighborhood.
After this outbreak the disease disappeared for some weeks,
and the hope was entertained that the epidemic had been
stamped out, when a summons came for me to see a sick child
in a family one mile distant from the houses where the last cases
had occurred. A child was found sick with a violent case of
scarlet fever, the eruption being well out and the case fully de¬
veloped.
*[' This proscription was essayed from the great benefit derived from its use by Dr. Baruch,
of South Carolina, in an epidemic of diphtheria. It is a modification of the formula of
Watson. When the chlorate of potassium is rubbed up in a mortar and the hydrochloric
acid added, decomposition takes place with the solution of the euchlorine of Davy, now
known to bo free chlorine and per-oxide of chlorine (CIO2). The glycerine and water
are added quickly while rubbing. The above formula and mode of preparation were found
very efficacious. A more complete decomposition would take place by using one drachm
of the chlorate to one half drachm of hydrochloric acid, but a smaller dose should then be
given. |
1880] ELLIOTT — Prevention of Disease. 079
No connection could be traced between this and the former
cases.
The sick child was put upon the sulphite and the per oxide
of chlorine mixture. The only other child in the family was put
upon the sulphite of sodium. Two days elapsed before any
effect of the medication could be noticed in the sick child, then
it began to improve, and afterwards rapidly recovered. The
other child, although always iu the sick room, escaped infection,
while a child from a neighboring family, not taking sulphite,
and who had been in the sick room, contracted the disease.
The children in the family of this second case, (three in number),
were put upon the sulphite and all escaped.
The next case appeared in the body of the town among chil¬
dren who were not taking the sulphite. Later iu the epidemic
a case occurred iu a house near my own, in the person of a
young girl who had taken no sulphite. Iu the same house were
five children who had never taken the disease; they were all
put upon the sulphite and all escaped. In my own house a case
occurred in a young lady who was not taking sulphite ; the case
was severe ; all of my own children who were taking the sul¬
phite escaped, although some of them had access to the sick
room. The above enumerated cases are the only ones around
whom the opportunity for a trial of prophylaxis was afforded.
In reviewing the many cases attended through the epidemic, no
one is on record in which the disease was contracted while the
sulphite was being taken. The fact that iu six different fami¬
lies, aggregating, exclusive of the patients, twenty-three
children, the disease was checked with the first case, and that
outside of these families none others who were taking the sul¬
phite contracted the disease, seems to point strongly to one
conclusion. Whether these results we mere coincidences, or
true effects of an efficient cause, remains to be proved by still
further trial. The experience was sufficiently invariable to im¬
press upon the mind of the writer the conviction of the relation
of cause and effect between the sulphite and exemption from
disease. In addition to the recovery of the cases treated through
the epidemic, some of which were of the severest form, in no
680 Original Communications. [January
case was there a single after effect of disease noticed. The re¬
coveries were rapid and convalescence was complete.
It is well to add that in severe cases where the patieuts were
not seen before the third or fourth day, it was some time be¬
fore any beneficial effects from the sulphites could be noticed,
and the certainty was felt that if the experience afforded by
these cases had been relied upon for a judgment of the efficacy
of the sulphite, great doubts would have been entertained as
to its usefulness. This experience during the disease has prob¬
ably caused the discredit that has fallen upon the sulphites.
The value of the remedy lies in its power to prevent. Just as
it will under ordinary atmospheric conditions arrest the process
of fermentation by checking the propagation of the organisms
which produce that transformation, so in the blood of the
animal body, where it still remains as sulphite, the conviction
is entertained that it can with equal certainty arrest the propa¬
gation of some disease poisous.
When we pass from the particular diseases considered to
speculate upon the further usefulness of the sulphites in other
forms of epidemic diseases, we pass into a field of conjecture
where nothing can be determined save by experiment.
Believing that epidemic diseases are caused by the propaga¬
tion in the blood of living organisms, it is still a natural
conclusion that as these organisms undoubtedly differ,
so must they stand in different relations to a given
antizymotic. Because a given remedy will arrest the
development of one species of germ, we have no valid
ground for asserting a priori that it will arrest the
development of all others. These details must ever
remain a matter to be determined by experience. Some inter¬
esting notes have been received of experiments with the sul¬
phite during the past two years in yellow fever, but the collec¬
tion of written data is not yet sufficient to warrant the publi¬
cation of the favorable notes so far received,
As to the quantity of the sulphite to be taken in experi¬
mental prophylaxis, the following considerations will serve as a
guide. In the practical experiments in prophylaxis essayed in
the epidemic cited above, seven and a half grains of the sul-
681
1880] Dugas — Treatment of Fractures.
phite of sodium was given three times a day to children under
ten years of age. This, in the blood of a child of fifty pounds
weight would give a solution of about 1-3500, with a steadily
diminishing strength of the solution through four hours. This
amount was given to my own children for two months consecu¬
tively and with a short interval continued through another
month with no bad effect and with some supposed ben¬
efit to their general health. For adults the correspond¬
ing dose would be about twenty grains or more. From
such experimental data as are recorded of the effects
of sulphurous acid upon low forms of life, it would
seem that one large dose would be more efficacious than
repeated small ones. One large dose once a day would render
the blood, at least once in the twenty-four hours, less fitted for
the development of low orders of organisms. Twenty grains
morning and night could be safely essayed by an adult uuder
the eye of a physician, and would be a legitimate test of the
sodium sulphite as a prophylactic in any given epidemic. Any
evil effects of the remedy would be slow, and would probably
be evidenced by some loss of the red globules of the blood.
This could be easily remedied by some ferruginous preparation.
On the Treatment of Fractures of the Clavicle and of
Acute Orchitis.
By L. A. DUGAS, M.D., L.L.D.,
Professor of Surgery in the Medical College of Georgia.
FRACTURES OF THE CLAVICLE TREATED WITH A SLING BAND¬
AGE AND WITHOUT AXILLARY PAD.
There is no fracture for the treatment of which so many
plans have been devised as that of the clavicle, and yet it is of
all fractures that which is most easily, and I may say, success¬
fully managed. The complicated system of bandaging with
axillary pad, proposed by Desault, was in vogue for a long
time, and has been gradually superseded by simpler means of
various degrees of merit. The writer was among tbe first who
took a stand against the axillary pad as not only absurd, but
682 Original Communications. [January
positively injurious. Its pressure upon the nerves and blood
vessels of the arm, whenever applied so firmly as to accom¬
plish the purpose in view, must always render it intolerable
and consequently impracticable. The patient will not rest
until he has relieved himself from the pressure of the axillary
pad, and therefore made the whole apparatus worthless. Hence
it is that any plan of treatment which includes the axillary
pad must fail to accomplish the desired result. One trial of
Desault’s apparatus by the writer in the early days of his pro¬
fessional career satisfied him of its defects, and led him to
devise a plan by which the shoulder might be forced upwards,
backwards and outwards, and maintained in that position
without serious inconvenience to the patient. Without dwell,
ing upon the sling bandages suggested by others, I will pro¬
ceed to describe the one 1 have long been in the habit of using.
After carefully reducing the displacement of the fragments,
by bringing the elbow of the injured side against the thorax
and forcing it up so as to carry the shoulder upwards, back¬
wards and outwards, and also acting if necessary upon the
fragments directly, the next step will be to secure the limb in
this position. For this purpose procure a square yard of
unbleached shirting (this being softer than bleached fabrics),
and eut it diagonally in two so as to obtain a triangular bit, to
the acute angles of which should be sewed strips of the same
material three inches wide and from two to four yards long,
according to the size of the patient. Apply the middle of the
base, or long side of the triangle, beneath the elbow as it rests
against the chest, having a margin of about four inches be¬
hind, and carry the obtuse angle towards the fingers. One
of the acute angles, with its strip, will now be carried between
the arm and chest, up to the fractured clavicle, around the
back of the neck, over the sound shoulder in front, and be¬
neath the axilla, and finally around the chest, including the
arm just above the elbow. The other end of the strip should
be then carried in front of the forearm, up to the sound
shoulder, behind and beneath the axilla, and around the chest
and arm, so as to meet its fellow' and be tied to it. Finally, the
margin left projecting behind the elbow,, should then be eleva-
1880] Dugas — Treatment of Fractures. 683
ted, doubled and so secured with stitches, as to prevent the
elbow from sliding- out of the sling in that direction. The
portion of the triangle situated along the forearm should be
also folded around it, and thus secured. Lastly, the strips
encircling the chest and arm should be stitched to prevent
their upwards or downwards displacement. If it be necessary
to press down one of the fragments, this can be effectually
done by interposing a small pad or compass between the bone
and the bandage which passes over it. It is scarcely neces¬
sary to add that the precise order in which the roller bandage
is applied may be varied to suit the views of the surgeon.
The advantages of this bandage are to be found in its per¬
fect adaptation to the necessities of the case, in its great sim¬
plicity, in the facility with which it may be made secure, and
in the very slight inconvenience to which it subjects the
patient. Children as well as adults bear it without a murmur,
and if it becomes necessary for the purpose of cleanliness, to
remove it, any intelligent mother or nurse may re-apply it if
the physician be not accessible. While it cannot be denied
that under any plan of treatment, there may occasionally
remain some unevenness or deformity at the seat of fracture, I
must say that I have rarely seen anything of the kind in cases
treated on this plan, notwithstanding the tact that 1 have, not
unfrequently, after applying the bandage over in presence of
the mother, left the subsequent management entirely to her¬
self. (See Southern Medical and Surgical Journal for July,
1852, page 75.)
.1
ACUTE ORCHITIS TREATED WITH THE ROLLER BANDAGE.
Gonorrhoeal orchitis is so common an affection and one
attended with so much pain that any treatment that allays the
pain should be considered a boon by the profession. It is well
known that when treated with fomentations and poultices, hot
or cold, leeching, etc., the subsidence of the tumefaction is
very slow and the suffering of the patient correspondingly
great. The pain is evidenty occasioned by the destention to
which the tissues are subjected, and can therefore be relieved
3
684 Original Communications. [January
only by lessening or overcoming this tension more or less com-
pletely. The object of this paper is not to pass in review the
various plans of treatment proposed, and more or less gener¬
ally practiced, but simply to direct attention to what I con¬
ceive to be the best plan. Compression in some way or other
in the treatment of orchitis is not new, but is more or less
effectual according to the way in which it is done. If at¬
tempted by means of adhesive plaster the inconvenience of its
use more than counterbalances its advantages. The scrotum
must be shaved (no easy matter), and the plaster taken off and
replaced at least once a day. This is quite painful in conse¬
quence of#the chafing aud pulling of the skin. The roller band¬
age is not amenable to any of these objections. The writer pro¬
vides a bandage of bleached shirting an inch wide and four (4)
yards long, which is to be imbued with starch just before being
applied. The patient lying upon his back, with his knees
separated, the surgeon should seize the affected gland with the
left hand in such a way that the neck of the tumor will be
firmly encircled by the thumb and iudex finger. This puts the
skin of the scrotum ou the stretch and allows the roller band¬
age to be passed around the neck of the tumor three or four
times and then over the tumor itself in such a manner as to
affect its uniform compression. This procedure must neces¬
sarily be left to the skill of the surgeon. As soon as the band¬
aging has been completed the patient will express himself as
completely relieved from pain. The patient should be kept in
bed, and if possible, have the bandage re-applied morning and
night, as it will usually be then very loose in consequence of
the subsidence of the tumefaction. No other treatment is
needed, and in a few days the swelling will be entirely removed,
but the bandage should be continued a little longer in order to
prevent a relapse.
The simplicity and efficacy of this plan of treatment should
recommend it to the general practitioner.
Augusta, Gra., November, 1879.
1880J New Orleans Medical and /Surgical Association,
685
Proceedings of the New Orleans Medical and Surgical
Association.
ANNUAL ORATION, DECEMBER 1, 1879.
By WM. P. BREWER, M.D.
Mr. President and Gentlemen :
On this, the sixth anniversary of our association, I know of
no subject which could prove more interesting or entertaining
than a short review of its history during the past few years.
Six years ago a small number of the younger physicians of the
city of New Orleans, feeling the necessity of concert of action on
the part of the working members of the profession, for our mutua^
interest and advancement, proposed the formation of an asso¬
ciation where we could regularly meet for the purpose of dis¬
cussing all subjects pertaining to medicine and surgery. With
this purpose in view, we met in the office of one of our number,
with Dr. Loeber in the chair. Soon an increasing roll of mem¬
bership forced us to seek a more spacious room, and in conse¬
quence thereof, we met in the reception rooms of the Touro
Infirmary, an out of the way place, ’tis true, for the members
to reach ; but, with the determination worthy of the great
cause in which we had embarked, we overcame all obstacles,
intent, only on the prosecution of our, to us, great work, until
by the courtesy of the Faculty of the University of Louisiana,
our present comfortable and central hall was tendered to, and
accepted by us. And now, at the end of six years, we find
an increasing roll forces us to look for a yet larger and more
spacious hall.
At first we labored under many disadvantages. Many
wished us success, but predicted an early failure, because, for¬
sooth, other similar organizations in this city had been unable
to sustain themselves for any length of time. We had seen
our predecessors break up, because of want of energy, of bick¬
erings, and of extravagance. With such experience before us,
we, in framing our Constitution and By-Laws, in the first
place, avoided embodying any Code of Ethics for our guidance,
as we well knew that those who would be governed by such
Code , needed none ; and those who would not do what is right
686 Proceedings of the [January
and proper at all times and under all circumstances, would
never be governed by any Code. In the second place, our
article on membership, which is strictly enforced, dissolves all
title to membership after an absence, without sufficient excuse
from three consecutive meetings ; and further, any member
whose turn it is to read a paper is dropped, unless he is present
and reads at the appointed time.
Our rules being imperative, force one who wishes to remain
a member, to perform his duty to the organization. We have
our rules, and they must be obeyed. The consequence is, we
have no ornamental membership to increase numbers. With
“ Labor emus v as our motto, we insist, and imperatively demand
labor of one and all. Each feels that his voice on our floor is
entitled to a hearing, and also feels that there is no single
member so important to our organization that his place cannot
be supplied; but, on the contrary, that he cannot well do with¬
out the association. We have avoided all extravagance, mak¬
ing our dues small, and drawing on our treasury only for the
purpose of advancing the work of our body.
In the beginning our papers and discussions were not pre¬
sented with that decision which at present marks our work ;
but, as we progress and become more interested, each and every
member strives to do his utmost to sustain the organization.
And, to-night, in taking a retrospective glance over the past,
we find what, six years ago, was but a puny nursling, devel¬
oped into a healthy and vigorous child, giving fair promise to
become in the near future a strong and robust adult. The
Journal teems with the many able productions of the mem¬
bers of the association, and our minutes would prove a rich
field in which to roam for medical facts and experience.
Within the past year our committees on various sanitary
subjects, have labored assiduously to perform their duties in
such a manner as to be of benefit to the whole community;
and so highly were their reports appreciated, that the Auxil¬
iary Sanitary Association, deeming them of special service in
their great work, have had them published at their own
expense, and scattered broad-cast throughout the land. In¬
deed, so well have our efforts in favor of public health been
687
1880] Neic Orleans Medical and Surgical Association.
appreciated, that we have received attention from distinguished
sanitarians, and in our hall have listened to the views of engi¬
neers regarding that, to us, grave matter, the best means of
improving the sanitary condition of this, our beautiful city.
Within the past month we have been represented, and heard
on the floor of the 11 American Public Health Association ,”
through our committee. We presented a report in answer to
various questions propounded by that body, and, as one of the
committee, I must say that the report was most flatteringly
received. It was the most thorough and complete report
offered, and on all sides could be heard complimentary
comments.
But while we have great cause for congratulation on the pro¬
gress and standing of our association, still there is much to be
done. We must strive to do our utmost to render it one of
the foremost bodies of its kind, and that can only be done by
the most untiring energy and perseverance on the part of each
member. We must at all times bear in mind our simple motto
“ Laboremus ,” anli keep up to it. Allow no work of this asso¬
ciation to be published, until, after the most rigid scrutiny of
the Publishing Committee, it is deemed worthy of the body from
which it emanates.
And now, gentlemen, while uttering congratulations on
account of the success already attained by this association,
permit me to digress for a moment, in order to call your
attention to a matter of the utmost importance to us, and that
is the establishment of a “Training school for nurses.” There
is no single member of our profession who is not at times in
need of an intelligent and thoroughly trained nurse, in whose
care a patient can be placed. We all recognize the fact that
oftentimes, through ignorant nurses, we lose patients, who, had
they been carefully and intelligently attended, might have been
saved. Now, knowing this, and feeling the necessity for a
remedy, it behoves us to unite as one man, and use our utmost
endeavors to carry out. such plan as may have the desired
effect. With grand institutions like the Charity Hospital,
Hotel Dieu and Touro Infirmary, there can be no excuse for
this negligence. Urge the formation of classes in these insti-
688 New Orleans Medical and Surgical Association. [January
tutions, and we shall have a host of applicants for positions.
Let a record be kept of each nurse, and his or her fitness, with
residence, etc., to which the physician may at any time refer,
and from which he may select. In times of epidemics urge
benevolent associations of various kinds to demand of appli¬
cants for service under them, a certificate from the institution
in which the nurse was trained, and then can we hope to see
a lessening of the death-rate from epidemic disease. Should we
do this many a life will be saved, and wherever there is dis¬
ease and suffering, heartfelt thanks and prayers will ascend
for those through whom snch an institution was thought of
and perfected.
This is no visionary scheme. The necessity has been met in
New York, and we hear of the success following the introduc¬
tion of such school, is there one within hearing of my voice,
who, in epidemics lias not felt how inadequate his science and
skill have been, when the nursing has been left to the igno¬
rant, and alas ! too frequently the brutal and drunken class,
who, under the name of nurses, present themselves at such
times to the various benevolent associations that require
nurses for the objects of their relief.
In addition to what has already been suggested, I would
advise that our efforts be directed to the publication of our
proceedings in an annual volume. Not only will such volume
be a work of reference to each member of this association, but
with it we shall be able to make exchanges with similar organ¬
izations throughout the country, and in a short time shall have
acquired a library of immense value. This can be done by
subscription, and I have no doubt that each one of us will
take pride in the work.
As we feel satisfied with our progress up to date, still if we
pursue the above course, we may hope that our organization
will continue to grow in future years according to the develop¬
ment it has alieady made, and that it will attain to that distin¬
guished eminence and usefulness which our labor and our
aspirations entitle us to believe it will do, until finally it will
rank with the highest institutions of its kind in the land,
1880]
Current Medical Literature.
689
URRENT
ED1CAL
ITERATURE,
ON ARTIFICIAL FORMATION OF PERITONEAL ADHESIONS.
( Translation.)
Dr. Studsgaard recommends to adopt a method — at first tried
by Volkmann — to open cy stoic tumors located in the abdomen,
but not adherent to its wall. When an abdominal tumor is of
such a character that it cannot be extirpated, the treatment
will consist in tapping the sack, evacuating its contents aad
trying to get the sack obliterated ; the method may find appli¬
cation in abscess of the liver, echinococci, hydronephrosis, ova¬
rian cysts, etc. The methods used hitherto to obtain this result
are not satisfactory, being either dangerous or allowing the
tapped cyst to refill.
In simply tapping, the sack is in most cases soon again filled
with fluid ; injecting iodine after tapping is often followed by
suppuration and peritonitis. Leaving the canula in the sack
after tapping it, suppuration sets in in course of two to three
days, but the pus cannot escape, stagnates and exposes the
patient to all the dangers of septicaemia. To perform laparot¬
omy, make incision into the sack, and suturate the walls of the
sack to the abdomial wall, is one of the most dangerous meth¬
ods, as it is hardly possible to avoid the contents of the sack to
escape into the peritoneal cavity before saturating. Compara¬
tively safe is Recamier’s method of cauterizing previous to
opening the sack ; this method is, however, inconvenient, in so
far, that it takes a long time (from two weeks to six months) to
form adhesions, and these adhesions are not always strong
and reliable.
In a case of echinococcus, which Volkmann (1876) ope¬
rated on according to Simon’s method, — he left several canula
in the sack, and found only very weak adhesions around the
canula, when he made his incisions through the abdominal
wall on the ninth day after the application of the canula. In
the bottom of the wound, which had opened the abdominal
cavity, the surface of the liver presented itself, moving at
every respiration ; he then filled the wound with carbolized
gauze, so that the lips of the wound were kept apart, dressed
it antiseptically, and on the seventh day found the entire sur¬
face of the liver attached to the wound ; he cut through a thin
layer of hepatic tissue and opened the sack. The patient re¬
covered. This accidental experience, which seemed to show,
that an antiseptic incision opening peritoneum could be done
without incurring any danger and produce just enough irrita¬
tion for the formation of solid adhesions, induced Volkmann to
use the same method on another patient, also suffering from
an echinococcus in the liver, and this patient also recovered.
690 Current Medical Literature. [January
This way of making the incision has now been tried
many times and seems to be the best of all other methods,
excluding all possibility of an escape of the contents
of the cyst into the peritouial cavity ; for safety’s sake
some sutures may be passed through the abdominal wall and
the wall of the sack, immediately before opening the latter, in
order to prevent the adhesions eventually to give way by
the traction exerted upon them, as the cyst is getting emptied.
In such gastrotomies and enterotomies, where the operation
can be postponed for some days, the formation of adhesions
may be used with advantage, suturating the stomach or the
intestinum to the abdominal wall some days previous to mak¬
ing the incision; an escape of the contents into peritoneum
would be prevented with so much greater certainty.
Dr. S. describes two cases, in which he employed this method
with satisfactory results, as to the formation of strong adhe¬
sions. In the first case, where the patient was suffering from a
large echinococcus hepatis, a longitudinal incision 7 centim. long
was made July 13th, at the outer margin of muse, rectus
through the abdominal wall and peritoneum ; the liver pre¬
sented itself in the opening, and the wound was filled with
carbolized gauze ; nine days later when the entire wound was
found granulating a troiscart was plunged into the liver 5 to
6 centims. deep, however, without reaching the cyst. The
wound was dressed and healing in a few days. Juty 30th, an¬
other incision was made in the same manner on the left muse:
rectus, but neither here nor close under the right costal curva¬
ture, where a third incision was made November 5th, the cyst
was reached. The wounds healed easily. A slight rising of
temperature (101.3° F.) followed the incisions. The patient lost
her strength gradually, the urine became albuminous, ascites
increased and she died December 8, 1878. The autopsy showed
that an enormous cyst containing echinococci had compressed
the right kidney. Between the wall of the abdomen and the
surface of the liver were found solid, tough adhesions. On
the upper surface of the liver the hepatic tissue had disap¬
peared and the very thick capsule of the cyst presented itself
here.
The repeated attempts to reach the cyst are instructive as to
the innocuousness of the incisions and as to the character of
the adhesions resulting therefrom.
In the second case the patient (a man, 38 years of age), was
suffering from a cystic degeneration of the gall-bladder. On
February 25th, an incision 5 centim. long was made through
the wall of the abdomen, and peritoneum and the tumor pre¬
sented itself in the wound. The temperature did not rise at
all. March 5th, an incision into the cyst was made and a large
quantity of clear fluid escaped. The patient died April 9th
of general emaciation, and the autopsy showed cancerous
degeneration of several organs in the abdomen. ( Hospitals
Tidende , June 18, 1879.)
1880] Current Medical Literature. 691
THE RELATION OF THE STATE TO THE INDIVIDUAL, IN MATTERS
PERTAINING TO SANITARY ADMINISTRATION.
By Oscar C. DeWolf, A M., M.D., Commissioner ol Health, Chicago.
[Read before the Chicago Medical Society, October 6, 1879. J
In a country like ours, where government interference with
supposed personal rights is always sure to be sharply ques¬
tioned, and where, happily, the enforcement of such interfer¬
ence is impossible, unless the public opinion of its usefulness
has approached to conviction, it becomes necessary for the offi¬
cial to appear before that public to justify and defend his judg¬
ment and his acts. It generally happens in our neighborhood
that the officer especially charged with the function of sanitary
administration has received a medical education, and unless he
commands the large confidence of his professional brethren,
with whose labors his own come in constant contact,
he will most certainly fail. The medical profession, therefore,
is my public ; for to it, as a body of specially educated men,
should be committed the hual adjustment of all questions
touching the necessity or propriety of sanitary measures.
Sanitary work, at best, is beset with antagonisms and obsta¬
cles of a peculiar nature, and perhaps nowhere more so than
in our own city of Chicago. One generation of men have not
yet passed away since our site was only known as a trading-
post on the Indian frontier, and on this quagmire 500,000
people now find prosperous and salubrious homes. A few
years since the burden of sanitary administration here was
resting upon the shoulders of a board of health, composed of
five members ; in later years the responsibilities of the office
have been transferred to a single individual. The commis¬
sioner of health should, and does, invite the assistance and
criticism of every medical gentleman in the city ; but is it too
much to ask that this criticism should be something else than
misrepresentation ?*
*As a sample of critical .statement the following facts may be of interest. The Fifth
Annnai Session of the American Public Health Association was held in Chicago, Septem¬
ber 25-28, 1877. That distinguished sanitarian, Dr. Elisha Hauls, of New York, — Presi¬
dent of the Association, — in a report of the meeting, published in the Sanitarian, Novem¬
ber, 1877, says, speaking of a visit to the stock-yards : *• The stock-yaid* and flesh-lood
packing of that largest food depot in the world, have so accumulated the offensive and
insalubrious accessories of such business, that sanitary and economical problems of enor¬
mous magnitude must be treated with masterly skill ; and to this subject the health offi¬
cers in attendance at the meeting gave special attention. Dr. Folsom, the keen-sighted
Secretary of the Massachusetts State Board, expressed the conviction of all of us who
have studied these matters, when, in concluding the inspection of them, he said : ‘ Chi¬
cago must expect frequent and fatal visitations of preventable epidemics, especially de¬
structive to young children, so long as the present degree and kind of defilement of the
atmosphere of the city continues.’ ”
During the year 18771 devoted myself to procuring evidence against the parties who
were thus defiling our atmosphere, I secured indictmeuts against twenty-seven of the prin
cipal offenders, and in June, 1878, they were brought to trial before the Criminal Court of
this county. Under instructions of the court the prosecution was confined entirely to
the question : Are these noxious emanations from the stock-yards prejudicial to the
health of our citizens ? Seven representative medical gentlemen of Chicago, among them
the senior editor of the journal publishing this review, Dr. W. H. Byford, testified in the
most emphatic manner, and from personal observation and experience, that they were.
4
692
Current Medical Literature.
[January
Filth, Disease, Crime, are well called the three furies of our
age and of our civilization ; and sanitary science, dealing with
the individual man more than with the destiny of the race, seeks
to relieve him from the immediate influence of the one, and thus
to hinder the tendency toward the other. How shall it be best
accomplished? An eminent school of philosophers talks of
the “ survival of the fittest ” as the key to all progress that
man attains. Says Mr. Gregg, M.P., in discussing the public
Health &ets of 1875 : “ Sanitary science is mitigating suffering
and achieving success in its warfare against disease ; but, at
the same time, it enables the diseased to live. It reduces the
aggregate mortality by sanitary improvements and precau¬
tions, but those whom it saves from dying prematurely it pre¬
serves to propagate useless aud imperfect lives.” Mr. Herbert
Spencer, in one of the most suggestive books of our day,
says : “ This conflict —the development of the individual —
ensures the final attainment of the highest form of this (his)
maintenance, a form in which the amount of life shall be the
greatest possible, and deaths the fewest possible.” By this
rule the natural process of advancement is founded on limit¬
less waste ; u the growth of life is in the soil of boundless
death.” The man who makes his home in the tenement house,
so constructed as to serve as a bell-jar over the sewer, who
thereby sees the wife “ cut down like the lily at noon-day, and
the violet childreu hidden away in the valley,” bas learned a
lesson which he may transmit to his kind as a protecting influ¬
ence in the final development of the race. By this rule “ the
intelligent aud energetic members of society, who prefer and
are able to provide for themselves in all the ordinary exigen¬
cies of life,” may survive ; but, to the ignorant, the poor, the
unfortunate, who are always with us, it says, work out your
own sanitary salvation ; perish or survive, as the result may be ;
you are worthless of yourselves, and if allowed to multiply
you perpetuate helplessness and increase misery.
To secure for you, by legal enactments and by sanitary
administration, healthful homes ; to protect you, so far as is
possible, from devastating epidemics; to insist with energy,
aud by legal processes, if necessary, that you shall not, bv
sottish personal habits begotten of your ignorance, nor by
greed of gain, imperil your own lives aud those of your neigh¬
bors, all this is declared to be “ interfering with the operation
of the wholesome monitory laws of nature.” Let us admit, in
On this testimony conviction was secured in every case. Now, in the face of this opinion
of the distinguished experts cited by Dr. Harris, and the sworn testimony of our local
physicians, a reviewer in the September number of the Chicago Medical Journal and Ex¬
aminer deliberately puts in print aud writes his initials alter such a statement as this :
“ It is, however, to he regretted that from this gallant conflict the officials did not emerge
with hands thoroughly clean ; . there is not the slightest shadow of evidence that it
(Brideport odor) was dangerous to the health of the city. We have no doubt that many
delicate persons have experienced an increase of suffering, in consequence of reading and
hearing so much about the dangerous character of the slaughter-house gasses. Nor this
the slaughter-houses are not so much to blame as the ignorance or the zeal which propa¬
gated such errors.”
1880] Current Medical Literature. 693
the first instance, that man in his structural development is
the result of this law, and let ns admit again that in his sani¬
tary evolutions in course of ages — ages so long that the eye of
science, watching for centuries, could discover but little move¬
ment — he might finally come to a proper recognition and
observance of sanitary laws ; yet we must observe that the
ordinary and practical forces, which we find at work in the
elevation of the moral and physical nature of man, are at
war with this law. The moral law, all legal codes, the instinct
and affection of the family, and the organization of
society in civilized lite, all proclaim the opposite principle.
This principle, protecting the weak and succoring the needy,
is not a pernicious force, tending to the degeneration of the
race, but is the introduction into social order of another and
a more potent element of human progress, and an ever-present
protestation against the conditions of the law of natural selec¬
tion as a protecting or educating force in human experience.
But I only design to refer to the legal aspects of the question.
Experience and common sense alike declare that it is as much
the province of government to protect its citizens, in so far as
possible, from disease and death, as it is to guard them against
the depredation of the lawless and criminal clasa. The funda¬
mental object of all government, indeed, is to protect life and
property ; and it is just as essential that the citizens of large
cities be protected by government against the manifold and
mortal dangers of illy-ventilated tenement-house vaults, as
that they should be protected against incendiaries, thieves or
robbers. The poor have no houses to be protected by the fire
department, and no property to be protected by a police de¬
partment. The only property possessed by the great mass of
the poor, who occupy tenement houses, is their health and
ability to work, and, by their daily toil, to earn their bread. Is
it not the duty of their government (for it is the people’s gov¬
ernment after all) to protect, in every proper way, that health
and capacity to labor ? Nor should it be forgotten that such
protection operates as the protection of the rich as well, for the
pestilence that begins in the hut does not stop at the threshold
of wealth. Laws for the enforcement of sanitary measures are
traceable for authority to what is known as the police power.
What is the police power ? “ The acknowledged police power
of a State,” said Chief Justice Marshall, “ extends often to the
destruction of property. A. nuisance may be abated ; every¬
thing prejudicial to the health or morals of a city may be re¬
moved . It is a power essential to self-preservation, and
exists necessarily in every organized community.” Gibbous
vs. Ogden, 9 Wheaton, 589.
“ The police power of the State,” says Judge Bed field, “ ex¬
tends to the protection of the lives, limbs, health, comfort and
quiet of all persons.” Thrope vs. B. & B. B. B. Co., 27 Yt. 149.
u By this general police power of the State, persons and pro-
694 Current Medical Literature. [January
perty are subjected to all kinds of restraints and burdens in
order to secure the general comfort, health and prosperity of
the State. Of the perfect right in the Legislature to do which
no question ever was, or, upon acknowledged principle, can be,
made.” Cooley’s Constitutional Limitations, 327.
Judge Dillon, of the U. S. Circuit Court, in his last edition
of the “ Law of Municipal Corporations,” says (p. 210) : “ Laws
and ordinances relating to the comfort, health, convenience,
good order, and general welfare of the inhabitants, are compre¬
hensively styled ‘ Police Laws or Regulations,’ and it is well
settled that laws and regulations of this character, though they
may disturb the enjoyment of individual rights, are not uncon¬
stitutional, though no provision is made for compensation for such
disturbance. If the i nd i vid ual suffers inj ury , i t i s eith er damnum
absque injuria , or, in the theory of the law, he is compensated
for it by sharing in the general benefits which the regulations
are intended and calculated to secure. The citizen owns his
property absolutely, it is true ; . still he owns it subject to
this restriction, namely : that it must be so used as not to in¬
jure others, and that the sovereign authority may, by police
regulations, so direct the use of it that it shall not prove per¬
nicious to his neighbors, or the citizens generally.”
It would be easy to multiply these quotations. I give you
the final resume of Judge Brainard, in an address delivered
before the New York Medico-Legal Society, December 5, 1877 :
“The limitations which some believe were set upon legislation,
and which hedged about supposed private rights, are yielding
to the needs of the times. This change in judicial view has
now become a settled principle of judicial action. The dispo¬
sition of the Court of Appeals appears in the highest court of
the nation, and they show that the current of judicial ruling in
this country (in administration of health laws) is contrary to
the technical spirit,— the over-squeamish regard for supposed
private rights.” Now let us bring these laws to the test of ap¬
plication. And here, what encouragement and what beauty
appears. How invigorating, mentally and morally, such dis¬
cussion and studies are when conducted with the proper spirit.
Do I misrepresent the sentiment of this society, when 1 say
personalities have no place here ? Science is knowledge —
knowledge can only be perception, discovery, comprehension
of truth. “ All truth is akin, related in some way to every
other truth or fact in the universe, and every fact casts its light
upon, or has its relation with, some other fact or class of facts.
The test of truth, the touchstone of scientific reasoning, is the
harmony of these relations.” Are these opinions of the masters
of jurisprudence in accord with the needs, more, the necessities
of civilized life ? Taking men as we find them in our large
cities — not as one would like them to be — where education and
intelligence would be substituted for vice and misery, and their
concomitants, disease and death — but, as they practically and
Current Medical Literature.
695
1880]
truly exist, the upright and conscientious close neighboring the
vicious and lawless ; are not these legal prohibitions to which
I have referred, salutary and protective to the public good ?
And, when I avow my entire belief in them, and my acceptance
of them, as the proper guide to official duty, am I to be charged
with “ the adoption of the entire communist programme V’
Is it an attempt on my part u to justify the importation
of rude, despotic methods into the quiet repose of civil life V’
I must deny the imputation, while I make haste to declare
that an intelligent appreciation of the ways in which filth is
produced, and becomes destructive in our populous centers,
must take cognizance of the culpable wickedness of some
people, and of the responsibility of the sanitary official to meet
this wickedness with all the legal machinery at his command.
Without such appreciation sanitary acts are waste paper, and
sanitary administration an illusion. Great Britain stands
preeminent in her attention to preventive medicine, and the
eminent names of Chadwick, Farr, Simon, were and are, the
heralds who summon the world to answer for its profligacy of
life. Her public Health Acts of 1848, the Nuisance Removal
Act of 1855, the Local Government Act of 1858, the Sanitary
Act of 1866, the Public Health Act of 1872, and the Public
Health Act of August 11, 1875, surpass in importance any and
all sanitary legislation ever before contemplated; and have
completed and established on a solid foundation an efficient
system of public hygiene, with 15,000 sanitary districts and
the requisite number of sanitary officers. In twenty-four
English cities, excluding London, with populations varying
from 160,000 to 4,000, and whose average number of inhabi¬
tants is 18,000, there was an average of 24.7 deaths per
thousand before the introduction of the sanitary service above
contemplated. Good sewers, good water, improved water
closets, with an efficient supervision of tenement houses, has
reduced this death rate to 21.9, or in round numbers, three
per thousand — an annual saving of 1300 human lives in a
population of 430,000. The commentary by Mr. Simon on
these results was that “ they may serve to fulfill very important
provisional use, not only to confute persons who have despaired
or affected to despair of any great preventability of disease ;
but still more, to justify in the public eye, and to encourage in
some of the noblest human labors, those who for many years
have been spending their powers in this endeavor, and to
whom it will be the best of rewards to see -the demonstration
of the good they have wrought.” in eighteen years the death
rate in London has been reduced from 25.0 to 21.5 per thousand.
In Glascow, in a well-to-do section of the city, a death rate of
23 in 1000 in 1871, has been reduced in 1876 to 17 in 1000;
in another district the death rate has been reduced from 29 to
26 ; in a third from 35 to 26, and in the worst district from 44
696 Current Medical Literature. [January
to 33, tlie mean reduction in that city being from 33 to 25 in
five years. An annual saving of 3745 human beings. In a
remarkable paper read by Mr. Edwin Chadwick, president of
the Health Section, at the twenty -first annual congress of the
British Social Science Association, Aberdeen, September 13,
1877, in which he reviews the result of English sanitary
legislation, and what it may accomplish in the future, submits
the following summary of the chief results obtained of the
progress of the power of sanitation :
1. u That we have gained the power of reducing the sickness
and death rates in most old cities by at least one-third.
2. 11 That in new districts or sites, apart from old urban
sites, we may with a complete system of water supply and sur¬
face cleansing — including measures for the prevention of over¬
crowding — ensure reduction of death rates to less than one-
lialf, or to a mean rate of ten in one thousand, and the sickness
in like proportion.
3. “ That in well-provided and well-regulated institutions for
children from three to fifteen years of age, we may secure them
an immunity from the common children epidemic and reduce
the death rate to a mean rate of about three in a
thousand, or to less by two-thirds of the death rates prevalent
among children of those ages in the general population.” From
this norma of sanitation for the infantile stages of life, may be
established conditions that go to the prevention of 50,000
deaths in the school stages of life in England and Wales.
6. “ That among the general population a reduction by full
one-half of the diseases of the respiratory organs, may be ef¬
fected by general public sanitation.”
The entire address of Mr. Chadwick may be found in the early
numbers of the Sanitarian of 1878, and will well repay a careful
perusal. It is popularly supposed that the excessive mortality
in some great cities is an inevitable evil resulting from den¬
sity of population. This is an error, for the concentration of
preventive resources is amply able to overcome such causes of
insalubrity. This is a fact fully demonstrated in London, where
the death rate has steadily diminished, and the chances of hu¬
man life steadily increased for the past twenty years. And
this has been wholly the result of systematic sanitary improve¬
ments in domiciles, in water supply, in drainage, and in the
sanitary police of that metropolis. That death rate and sick¬
ness rate are increased by density of population will hold true,
except where special and systematic sanitary care increases,
and keeps pace with the population growth ; and if this be
true, can there be any doubt of the duty of the State to
organize by statute laws those agencies and methods which
symbolize a proper concern for the life and social welfare of the
citizen, and can there be any doubt of the duty imposed by
good citizenship to acquiesce in and submit to such legal re-
Current Medical Literature.
697
1880]
straints of personal freedom in business enterprise, or surround¬
ings of domicile, as shall best conserve the public comfort and
well-being ! Society does not submit its destinies, in any of
the great affairs and events of human existence, to the doc¬
trines of chance, nor to the philosophy or theories of evolu¬
tionists, nor to the ecstatic dreams of humanitarians and phil¬
anthropists, — useful though they may all be. In all the trans¬
actions of business life, the civil government justly demands
obedience to formalities which restrain, and, if necessary
coerce. Shall this function of government be limited to the
protection of life, property and order, as suggested by Mr.
Spencer, leaving all other social ends to be achieved by indi¬
vidual activities ? This is not the tendency of recent
practical legislation. Society demands, as of old, protection
to life, property and social order ; but she is emphasizing
louder and louder every day another demand, namely, u the in¬
alienable right of every human being to be supplied with un¬
contaminated air, water, food, soil, and personal surroundings,
and the duty of the State to allow no trespass on this right
from negligence, ignorance, or greed of gain.” And society re¬
cognizes also the progress of medicine, which to-day declares
“ that the causes of many diseases, and of many deaths, can
be as successfully fenced out from their human crop, as domes¬
tic animals can be fenced out from a grain crop;” and it de¬
mands that law shall recognize this progress also, and pro¬
vide for it; and that as “ powder and other explosives are by
legal statutes stored away and guarded, so a small-pox
pistule, potent with greater mischief than a magazine of
dynamite, shall be for greater reasons stored away and
guarded. The officer charged with the sanitary interests
of a great city, under the ordinary conditions of civilized life,
who permits small pox to become epidemic in his neighbor¬
hood, has supplied the best reason in the world for his im¬
mediate displacement. If the local law does not afford an
adequate basis for his personal protection, and aid in his work,
and public sentiment will not sustain him in taking possession of
the person and effects of those infected with small pox, he should
resign his office, placing the responsibility where it belongs ;
for no city can be protected from this loathsome pestilence,
if officers of health must rest under the fatal disadvantage
where any man claims the right to have small pox in his own
domicile and at his neighbor’s door, or to refuse to receive for
himself or his family the protecting influence of vaccination.
L pass for a moment to consider a persistent and obstinate
foe, more to be dreaded than small pox or Asiatic cholera —
scarlet fever. It would be truly fortunate if definite and posi¬
tive prophylactic means were understood, and could be applied
to extinguish or control it ; but because the attempt to master
all the laws and causes that govern the epidemic prevalence of
698 Current Medical Literature. [January
this subtle infection have reached only partial results, or until
that much-wished-for day shall come when an antidote is found
equally effectual as that which Jenner has given the world to
prevent small-pox, there can be no plainer duty than that sani¬
tary authorities, physicians and families, should accept and en¬
force those measures which an enlightened professional judg¬
ment has declared to be useful in limiting the prevalence and
mitigating the fatality of this pest of childhood. The result of
our best means may seem to some doubtful, but the object ac¬
tually aimed at is neither uncertain nor unworthy the labor it
costs. Stimulated to action by the professional opinion of the
leading members of all schools of medicine, that the measure
was wise and judicious, this municipal govercinent, following
the State law, ordained that warning cards should be placed
on every house infected with scarlet fever. The mem¬
bers of this society gave emphatic approval to the law,
and on a memorable occasion — memorable because it was
the early assertion by the profession of this city that
they claimed a hearing in sanitary affairs — you de¬
manded that the law should be executed. In obedience
to this demand, and profoundly convinced of its pro
priety, I have assumed the responsibility which my office
imposes, and have placed the cards. Let us examine for a
moment the facts upon which this action of the state is based.
The one fact which we do generally acknowledge in the history
of scarlet fever is the fact of personal intercourse, and all that
it implies, as an important factor in its propagation and diffu¬
sion. This has been denied, and will be again, still I think it
an opinion very generally entertained by the profession. Now
the warning card is placed, and should be regarded, as the sig¬
nal of danger. It announces to the passer-by that he should
avoid that domicile ; it tells the mother to flee, herself and her
children, from its presence ; it declares to school authorities
that not a child from that house should cross the threshold of
the school -room 5 and above all, it educates the public to the
proper appreciation — which is the professional appreciation —
of the dangers of intercourse with the infected. I judge,
therefore, that the state does well to insist upon the placing of
the card, and my judgment is worth just what my facts and
reasons are worth. Finally, the more closely unsanitary con¬
ditions are examined, the more extensive do their ramifications
appear, and the more evident it will become that the local and
public causes of many destructive diseases are daily endanger¬
ing the loss of lives, which the state should protect and save
by the practical application of sanitary knowledge ; and it will
also appear that the state alone has the adequate power by
just and wise legislative acts to remove or control these causes.
— Chicago Medical Gazette , January 5, 1880.
Current Medical Literature.
699
1880J
INEBRIETY AND ALLIED NERVOUS DISEASES IN AMERICA.
By George M. Beard. M. D., (New York.)
Dr. Beard stated that his interest in the subject was purely
scientific ; that he had been led to study the subject simply be¬
cause it belonged to neurology — a department of science to
which his life was devoted. Inebriety he defined as a functional
disease of the nervous system ; the chief, though not the only,
feature of which is an irresistible desire for stimulants and nar¬
cotics, such as alcoholic liquors, opium, chloral, etc. Other ac¬
companying and preceding symptoms are mental depression,
mental irritability, insomnia, tremors, hallucinations, delusions,
severe neurasthenia (nervous exhaustion), and, in some cases,
alcoholic trance. The disease inebriety is distinguished from
the vice of drunkenness in four ways ; first, by its irresisti¬
bleness ; secondly, by its periodicity or intermittent character ;
thirdly, by its transmissiveness ; and, fourthly, by the above
nervous symptoms associated with it. The vice of drunkenness
is objective ; the disease inebriety is subjective. The disease
inebriety has much the same relation to the habit of drunken¬
ness that some forms of insanity have to eccentricity. The chief
predisposing cause of inebriety is civilization. Savages, semi¬
savages, and barbarians drink far more than enlightened
nations ; and the disease inebriety is always less frequent where
the habit of drinking is most common. The chief exciting
causes of inebriety are alcoholic liquors, opium, chloral, etc.
Another exciting cause is neurasthenia, or nervous exhaustion,
particularly the form cerebrasthenia, or exhaustion of the brain.
Brain-exhaustion, which follows loss of property, bereavement,
or sunstroke, may excite inebriety in one who is predisposed to
that disease. In America, sunstroke is quite a frequent exci¬
ting cause. Injuries to the brain, as railway accidents and the
like, may excite the disease ; so also may salt air ; some inebri¬
ates cannot go to sea, nor near the sea coast, without suffering
an attack with accompanying symptoms, such as headache, neu¬
ralgia, nervousness, etc. Inebriety is more common in America
than in any other country, mainly from climatic reasons ; dry¬
ness of the air, and extremes of heat and cold. For the same
reason, other functional nervous diseases of the family to which
inebriety belongs, such as neurasthenia, general neuralgia, and
hay -fever, are more common in the northern and eastern parts
of America than in the southern. Like every nervous disease
of the family to which it belongs, it pretty steadily diminishes
as we go south — go to the Gulf States ; yet there is more total
abstinence in the north than in the south. There is no country in
the world where there is so much total abstinence from drinking,
and, at the same time, so much inebriety, as among the people
of the northern and eastern parts of the United States. The
habit of drinking has been diminishing for the last half quarter
of a century among the better classes, but the disease inebriety
5
700 Current Medical Literature. [January
lias been increasing at the same time among the same classes.
Inebriety is, to-day, treated on the same principle as other ner¬
vous diseases of the same family to which it belongs ; that is,
first, by keeping the patient away from the exciting causes,
and, secondly, by fortifying the system with sedatives and
tonics. For very many cases, asylums are indispensable, and
legislation is needed, and, in America, is exercised to give
power of holding such cases. The best law, on the whole, is the
law of the State of Connecticut, which is very similar to the
u Habitual Drunkards’ Act,” which has just been passed by the
English Parliament. The best remedies for fortifying the sys¬
tem, and breaking up the habit of drinking, are bromides in
very large doses (3i to 3ii), especially bromide of sodium ; elec¬
tricity in general, and central applications (general faradisation
and central galvanisation), strychnine, quinine and cinchona,
iron, cod-liver oil in emulsion, the preparations of zinc (oxide*
bromide, valerianate) with warm baths. This system of treat¬
ment for opium inebriety, combined with the gradual withdraw¬
ing of the drug, has been wonderfully successful in America.
The American Association for the Cure of Inebriates was or¬
ganized in 1870. There are, in the United States, twenty-six
asylums in practical operation, and charters for fourteen more
that are yet to be built. The movement has been carried on
against the opposition of all forms of ignorance and nou-ex-
pertness, but is every year making progress. The Quarterly
Journal has been in existence three years. Of those who are
committed to asylums, about one-third are cured ; and probably
in the next century, when there shall have been greater pro¬
gress made in the treatment, and patients shall come to the
asylums earlier in the disease, and there shall be greater know¬
ledge and experience in the managemenet of asylums, the re¬
sults will be better. In regard to the criticisms of Dr. Buckmill,
it would seem that some of his strictures are just; but they are
only one side of a complex story. Asylums are not all alike,
and all are imperfect ; but every year they must be making
progress in their management and in their theory and treatment
of the disease. It was clear that Dr. Buckmill did not have any
just notion of what inebriety was, nor of the distinctions between
that disease and the habit of drunkenness. His ideas, also, of
what asylums ought to accomplish were too high. Inebriate
asylums are not specifics for inebriety, any more than insane
asylums are specifics for insanity ; but when they are empow¬
ered with legal authority, and wisely managed, they are the
best means known for the treatment of this terrible and in¬
creasing disease. Both in asylums and out of asylums, more
attention should be given to the sedative and tonic treatment
above described than it has yet received. Too exclusive depend¬
ence is placed in America and Europe on the mere removal
from the one exciting cause by confinement. In this respect,
there is room for progress, and for careful experiments, which
will soon be made. — British Medical Journal , Aug. 23.
1880 1 Current Medical Literature. 701
DELAUNAY ON FECUNDITY AND SEXUALITY.
M. Gaetan Delaunay, in a recent communication, states that
fertility, which is unlimited in the lowest classes, decreases as
the human race is approached. The inferior races are more
fruitful than the superior ; the black, yellow, and other races
being more fertile than the white. Amongst Europeans, the
Russians, Spaniards and Italians, i. e ., the nations which are
the least advanced in civilization, are the most fertile; whilst
the least fertile are those furthest advanced in the scale of
evolution, viz., the French and Swiss. It has been stated that
the relative sterility of France was voluntary, but M. Delaunay
refutes this accusation. Fertility diminishes in a nation as it
becomes more highly civilized. Intellectual persons, and those
who live in towns, have a smaller number of children than the
ignorant and laboring classes. The young and the old are
more fertile than adults, and the same is true of the weak as
opposed to the vigorous. Athletes and persons who perform
much brain work have but few children, as has been shown by
Dr. Drysdale. The lower tissues reproduce themselves more
readily than the higher ones. A plant or animal which receives
too great a supply of food becomes infertile. Thus, dogs be¬
longing to the poor produce more offspring than others of the
same race which belong to the richer class. The wretched and
badly fed are more fruitful than the wealthier, and, therefore,
fertility has no relation to the means of livelihood. Summer
and warm climates increase the fertility. In short, therefore,
fertility being at its maximum in those least advanced upon
the path of evolution, and at its minimum in those furthest
advanced in the same scale, it may be regarded as being in an
inverse ratio to the evolution. Sexuality. — The lower races
produce more females and the higher nations more males.
Young and old animals bear more females than males. From
the age of thirty-five onward a man begets more girls than
boys. The vigorous produce boys, and the weakly girls. Un¬
der the first empire, when all adult males were serving in the
wars, a very large majority of girls were born. Years of
dearth favor the procreation of girls, and years of abundance
of boys. Idleness tends to cause the birth of females. Per¬
sons who perform much mental labor are more liable to pro¬
duce girls than boys. A majority of girls are born in summer
and in warm years, and of boys in winter and cold years. In
short, therefore, an individual of a less high degree of evolu¬
tion produces girls, of a higher degree boys, whilst, at a still
higher degree he again begets girls. In the same way, one
who is fed too little or too much produces girls, boys being
born when he is simply well fed. Upon this communication M.
Galippe remarked that the biological law laid down by M.
Delaunay was wroug, inasmuch as it was unsupported by con¬
clusive facts. It was, moreover, entirely incorrect in regard
to England, the English being certainly far advanced in the
702 Current Medical Literature. [January
scale of evolution, whilst they produce a large number of
children. — London Medical Record , August 15.
FLINT ON THE SOURCE OF MUSCULAR POWER.
Dr. Flint discusses the question as to whether the muscular
power manifested by man and animals is the direct product of
the metamorphosis of the food ingested, or is generated by
changes in the muscular tissue itself. In the latter case, the
muscular substance as such is destroyed, and is discharged
from the body in the form of excrementitious matter, whilst
the waste is repaired by food. In the case of a steam engine,
the latent energy of the fuel is developed into heat by com¬
bustion, and the engine itself serves merely as a convenient
mechanism for translating the heat into actual working force.
In like manner, according to some physiologists, the muscles
and active organs of the body are merely a convenient mechan¬
ism for translating into force the latent energy of the food
which is developed during the metamorphosis of digestion and
assimilation. In opposition to this theory, Dr. Flint analyses
some observations made by Dr. Pavy upon Weston and other
pedestrians, and shows that the estimated force value of food
was sufficient to account for only a small fraction of the muscu¬
lar work actually performed By a further analysis of some
observations of his own, Dr. Flint concludes that the true
origin of musclar power must be sought in the muscles them¬
selves, and that the exercise of these muscles produces a waste
which is measured by the nitrogen excreted. Indirectly the
nitrogenised food is a source of power by repairing waste and
developing capacity for work ; but food is not directly con¬
verted into force in the living body, nor is it a source of mus¬
cular power, except that it maintains the muscular system in a
condition for work. — London Medical Record , August L5.
METRORRHAGIA AND ITS TREATMENT BY PLUGGING THE
CERVICAL CANAL.
By Henry Bknnet, M.D., The Ferns, Weybridge.
In the Journal for July 19th, the Paris correspondent, in re¬
porting a discussion on the treatment of menorrhagia, which
took place at the Clinical Society of Paris, presents ns a novelty
the proposal of M. Panas to meet severe metrorrhagia by plug¬
ging the cervical canal itself, instead of the vagina. As I have
been in the habit of resorting to this treatment for above a
quarter of a century, and believe that I was the first to suggest
and describe it in the fourth edition of my work on Uterine In¬
flammation , published in 1861, 1 send a brief extract (page 422),
not so much from a desire to claim the priority of what really
is a most valuable addition to therapeutics, but because I wish
to draw the attention of the profession to its thoroughly prac¬
tical character.
1880J
Current Medical Literature.
703
u In those cases in which, as we have seen, the haemorrhage
persists after the entire removal of local disease, owing to
enlargement of the uterus, to the presence of a small unrecog¬
nized polypus or uterine tumor in the cavity of the uterus and
its neck, or to the mere haemorrhagic habit, I have for many
years resorted, with encouraging success, to plugging the os
uteri itself j instead of the vagina. It occurred to me that the
usual plan of filling up and distending the vagina by pieces of
sponge or a handkerchief was a clumsy, painful, and inefficient
mode of opposing mechanical resistance to the exit of blood
from the undeveloped uterus, when its orifice could so easily
be brought into sight. Acting on this idea, I have in many
instances brought the cervix uteri into view, and x>assed inside
the os two or three small pieces of cotton, tied to a piece of
thread, which I wedge in firmly, covering the whole cervix with
two or three larger pieces left in close contact with it on the
withdrawal of the instrument. In nearly all the cases in which
1 have resorted to this plan, I have easily arrested the haemor¬
rhage. Indeed, this modification of the usual plan appears to
me so simple and so consonant with common sense, that I can¬
not but think that it will be often adopted in severe cases. In
the ordinary operation of plugging the vagina, that canal has
to be distended by a large mass of sponge or linen, soaked with
clotted blood, which often interferes with the functions of the
bladder and rectum, is invariably a source of great discomfort
to the patient, and is not always efficient. By the plan I de¬
scribe, the end proposed is much more effectually compassed,
with scarcely any annoyance to the patient beyond that which
the use of the speculum occasions.
“ Owing to the natural contractility of the cervical canal, and
the pressure of fluids behind, if the cotton be not well pushed
in it is soon forced out. The plug may be left without renewal
twenty -four or even thirty-six hours ; but, in the latter case, it
is generally expelled spontaneously. A small piece of sponge
may be used, and is more likely to remain in situ owing to its
expansion ; but as it must necessarily be very small, it is more
likely to be permeated by blood. If sponge be used, great care
should be taken to extract the piece passed into the os, to which
a small piece of thread should always be tied, as the os uteri
might not be able to expel it alone, owing to its mode of
expansion.
“ Plugging the os uteri in the way prescribed is by far the
most effectual way of arresting tire hemorrhage which pre¬
cedes and accompanies abortions, when, as sometimes occurs,
it resists the usual treatment, and becomes alarming. The
following case will illustrate this mode of treatment and its
marvellous efficacy. A healthy lady, thirty-two years of age,
came up from the country to consult me. She had been mar¬
ried twelve years, had had five living children, and subse¬
quently four miscarriages. Each miscarriage had been at-
704 Current Medical Literature. [January
tended with gradually increasing haemorrhage. On the last
occasion, she nearly lost her life, and was greatly alarmed at
the idea of again becoming pregnant. She presented uterine
symptoms which led me to discover the existence of extensive
ulcerative diseases of the cervix uteri ; no doubt connected
with one of her pregnancies, and the cause of the miscar¬
riages. I cured the disease, and sent her home. A few months
afterwards, she became pregnant ; and, in her alarm, again
came up to town to be near me, although I rather dissuaded
her from the step, which I did not consider necessary. At
about the termination of the third month of pregnancy,
I was sent for one night with the intimation that flood¬
ing had set in. I went immediately ; and, on my arrival,
found the patient pale, all but pulseless* and lying in a
large pool of blood. The haemorrhage had commenced at
half-past twelve ; it was only two, and yet her state was
alarming ; the haemorrhage was continuing profusely, and the
loss had already been very considerable. I at once placed the
patient on her back, to facilitate manipulation (with half a
dozen candles on a table at the bottom of the bed), introduced
a large conical speculum into the vagina, and, with the specu¬
lum-forceps and large pieces of spone, rapidly cleared the spec¬
ulum, which was full of clots and fluid blood up to the brim.
This accomplished, I got the os uteri into view ; found it rather
open ; from its orifice, a stream of blood was flowing as rapidly
as from an open vein. I at once pushed in several pieces of
cotton tied to threads, holding one down by the sound, whilst
the next was being introduced, to prevent it from being washed
away, and then packed firmly the upper third of the speculum
with cotton around and over the cervix. Lastly, I slowly re¬
moved the speculum, forcibly supporting the cotton packing
inside with the forceps to prevent its being displaced. I had
the mass of blood in which she was lying removed. In the
course of about twenty minutes, the color began to return to
the face, and the pulse began to be more perceptible, and, .in a
few hours, she was nearly herself again, although very weak.
There was not subsequently the slightest haemorrhage; it was
permanently checked. Twenty-four hours after, 1 removed the
plugging, and did not reapply it. No fresh loss of blood was
experienced ; and the next day, after a few uterine pains, a dis¬
eased ovum was expelled. This lady afterwards rallied in a
few days. After the last previous abortion, she was ill for
months.”
The above extract from my work (1861) gives so full and com¬
plete an account of this mode of treatment, and of the manner in
which I usually carry it out, that there is very little to add. I
would remark, however, that I use dry cotton only, and uo styptic
or caustic solution whatever. The perchloride of iron is totally
uncalled for, unnecessary ; for the plugging is in the cervical
canal, and the haemorrhage all but always proceeds from the
Current Medical Literature.
705
1880]
uterine cavity. The treatment is as simple as corking a bottle.
If the cork be well pushed in, no water (blood) can come out ;
the haemorrhage is arrested in a few minutes, and the patient
rallies all but immediately. I have had many similar cases
since this was written, and no longer fear haemorrhage in the
undeveloped or slightly developed uterus. The process also
appears to be entirely devoid of risk or danger. I have never
had a bad symptom. The same cannot be said of uterine injec¬
tions. The wife of one of my colleagues at Mentone died of
tetanus after the injection of perchloride of iron into the uterus,
to arrest haemorrhage in early pregnancy. She would probably
have lived, had plugging of the cervical canal been resorted to
as above. — British Medical Journal , July 26, 1879.
FLINT ON EXPERIMENTS UPON ANIMAL HEAT.
Dr. Flint has recently made some experiments upon himself
as to the mechanism of the production of heat. In normal
nutrition by food, the heat of the body must be maintained by
changes which take place, either directly in the blood or iudi-
directly in the tissues, in the alimentary materials ; and these
changes involve oxidation to a very considerable extent. Under
the ordinary conditions of nutrition, it is assumed that the
food furnishes all the material for maintaining the heat of the
body and for the development of force in work, such as the
muscular work of respiration, circulation, and general mus¬
cular effort. If no food be taken for a certain time, the heat
of the body must be maintained, and the work must be accom¬
plished at the expense of the substance of the body itself, and
the individual loses weight. To furnish a positive scientific
basis for the views above expressed, physiologists have burned
various articles of food in oxygen, and have then calculated their
heat value. The results hitherto obtained from experiments
based upon this method have been somewhat unsatisfactory,
and the conclusions arrived at by Dr. Flint in regard to this
question are as follows: It is probable that nearly all the
animal heat is produced by the oxidation in the body of certain
elements, which are chiefly nitrogen, carbon and hydrogen. It
is probable that this oxidation does not take place entirely in
the blood, but that its seat is in the snbstance of the various
tissues, and that it is connected with the general processes of
nutrition and disassimilation. Heat is thus evolved, and the
final products of the chemical actions involved are mainly
urea, carbonic acid, and water. It must be remembered, how¬
ever, that the oxidation is not necessarily a process identical
with combustion out of the body, but that it is probably con¬
nected with a series of intricate molecular changes which cease
with the life of the tissues, and of which we are able to recog¬
nize only the final results, viz., calorification and certain chemi¬
cal products. Recognizing the products urea, carbonic acid,
and water, as representing probably the evolution of a certain
706 Current Medical Literature. [January
amount of heat, the heat actually produced in the body by the
amount represented by the urea and carbonic acid discharged is
not accounted for. If it be admitted that hydrogen is oxidised
in the body, resulting in the evolution of heat and the produc¬
tion of water, all the heat actually manifested as heat will be
accounted for, whilst an excess will be left which may be con¬
verted into force. Dr. Flint’s experiment show pretty clearly
that, when no food is taken, and when food being taken muscu¬
lar work is performed, so that there is loss of body weight,
water is actually produced in the body. This, and this only,
accounts for all the heat evolved under these conditions. There
is no reason to suppose that the processes involved in the pro¬
duction of heat are radically changed in their character when
enough food and water are taken to maintain a uniform body
weight. Animal heat is produced mainly by the oxidation of
the nitrogen, carbon, and hydrogen of the tissues, the waste of
these elements being supplied by the food. Probably the oxi¬
dation of carbon and hydrogen is a more important factor in
calorification than oxidation of nitrogen ; at least, it is certain
that the heat value of the oxidation of carbon and hydrogen is
greater than that of the oxidation of nitrogen, and the quantity
of heat thus produced is very much greater. Of the two ele¬
ments, carbon and hydrogen, the oxidation of which produces
animal heat, the lieat-value of the hydrogen is by far the
greater. It is probable that there is always a certain amount
of oxidation of hydrogen in the body, and that this is necessary
to maintain the animal temperature ; and it is almost certain
that this occurs during prolonged abstinence from food, and
when the production of heat is much increased by violent and
protracted muscular exertion. It may be, also, that there is an
active and unusal oxidation of hydrogen as well as of carbon in
fevers. — London Medical Record , August 15.
A REBELLIOUS CASE OF VOMITING. IN GESTATION, TREATED
WITH IODINE APPLIED TO THE CERVIX UTERI.
By D. M. Wick, M.D. (New Hartford, Iowa.)
On the 23d of last May, I was called to see Mrs. H - ,
suffering with excessive vomiting in her first pregnancy,
throwing up a black grumous liquid every twenty or thirty
minutes. She bad been troubled thus, some six weeks — four of
which, she was not able to leave her bed — vomiting quite all the
nourishment taken, and consequently was very much emaciated
and weak. Believing that her previous physician (who is a very
intelligent and successful practitioner) had exhausted the whole
list of remedies per orem , I concluded to try iodine to the os,
using the speculum and a camel hair brush, I painted the os
with tinct. of iodine.
In ten or fifteen minutes, slight contractions of womb came
on and continued, at intervals, four or five hours. Ordering for
Current Medical Literature.
707
1880]
nourishment, beef tea and brandy administered by the rectum,
and to slake the thirst, small pieces of ice swallowed entire, I
took my leave.
Next day I found to my great surprise and pleasure, that my
patient had vomited but once or twice since the application.
She rested well during the night and in a few days was able to
retain, in stomach, such nourishment as was given her. She
made a rapid recovery and had no more nausea and vomiting.
As to just how this local treatment arrested the trouble, I
am not fully satisfied ; but nausea and vomiting in the earlier
months of pregnancy, is, I believe, physiological ; due to a re¬
flex action of the spinal cord from the uterus to the stomach.
Now, does not the irritation, set up at mouth of womb by
the application, check this reflex movement ! Sometimes, sim¬
ply dilating the os with the finger will allay the nausea in these
cases.
I do not know how extensively local treatment to the os
uteri, in these cases, has been tried : never saw but one article
on the subject and that was in a foreign medical journal. Bre-
tonneau and Cazeaux recommend ext. belladonna in ointment.
It does seem that we should hope for some form of treatment
that will prevent, in extreme cases, a resort to abortions or the
demise of our patients from exhaustion. — Cincinnati Lancet and
Clinic, Aug. 30.
SELECT FORMULAE.— IMITATION KOUMISS.
The following is said to produce an article equal to the gen¬
uine preparation from mare’s milk : Fill a strong champagne
bottle with good, fresh, unboiled cow’s milk to such a height
that after the addition of thirty grammes (one ounce) of gran¬
ulated or powdered sugar there would still be left at least an
inch of empty space below the cork. Before corking, add a
piece of fresh compressed yeast ; a teaspoonful of good beer
yeast may be taken. The contents of the bottle are well
shaken, repeatedly; then the bottle is placed in the cellar,
where it is turned up and down a few times during the day.
From and after the fifth day the mixture is ready, and may be
drunk to about the twentieth day. It is best to prepare about
six bottles at a time, refilling each after it has been emptied
and cleaned, so that treatment, after being begun, may not be
interrupted. On opening the bottles the contents are very apt
to foam over ; hence the bottle should be opened while held
over a plate. A good milk wine (kurnys or koumiss) have a
homogeneous appearance, of the consistence of thin cocoa ;
should be effervescent when poured out, of an acidulous, agree¬
ably vinous odor and taste ; and should not be full of lumps or
taste like buttermilk. On first using koumiss it produces
looseness of the bowels, but this effect soon passes off,— Boston
Journal of Chemistry , October.
6
708 Current Medical Literature. [January
<
SEA-WEED AS AN “ ANTI-FAT.”
The use of the variety of sea weed botanically known as
Fucus vesiculosus for reducing obesity lias obtained recognition
in professional circles abroad. Dr. Fairbank writes to the
British Medical Journal as follows : “ More than fifteen years
ago, I gave some of the extract in pill (four grains three times
a day) to a very corpulent lady, who in three months lost three
stones in weight without any change of diet. Since then I have
frequently given it tor reducing weight depending on the accu¬
mulation of adipose tissue, and have never found it fail. The
solid extract can be easily made into four-grain pills, which
must, however, be kept in a stoppered bottle, as they readily
absorb moisture from the air. I may say that a patient who
has been lately taking it as an anti-fat, and who has always
suffered very much from rheumatic pains about the body,
has been entirely free from such trouble while she has been
taking the extract, a fact which she quite independently
noted.” — Boston Journal of Chemistry , October.
THE CORN DOCTOR’S PROGRESS.
Dr. Edmund Andrews, of Chicago, who has been dealing-
quackery some telling blows of late in exposing some of the
tricks by which it fleeces the unwary, has turned his attention
to the corn doctor. He does not, however, regard the “ chiro¬
podist” as an unmixed evil, but, on the contrary, thinks he is
cultivating an important field which educated physiaus have,
by default, given over to his exclusive care. Certainly corns,
bunions, and the ailments to which the human foot is liable are
entitled to more intelligent consideration than is usually accord¬
ed them by the average doctor. There is, moreover, scarcely
another section of the human anatomy on the ailments of which
so little has been written as the foot, and, as Dr. Andrews re¬
marks, most of that which has been written is of “ a wretchedly
poor quality, and of such a contradictory character, that the
less it is read the less it will confuse the student. The absurd
and contradictory remarks let slip by some of the most eminent
authors are discreditable to our profession.”
We have in our city a chiropodist who has occasioned some
chagrin to regular physicians, and to some, too, who have a
penchant for surgery, by removing corns and reducing bunions,
and receiving fat fees after they have failed.
Dr. Andrews says of the Chicago corn doctors, that
“ They seem for the most part to be pursuing their business
in an honest and reputable manner, aud some of them have the
very best families of the city and the country among their
patrons. They are rising by degrees towards the rank of a
legitimate and honorable specialty, though at present they are
decidedly lacking in the amount of education which they ought
Current Medical Literature.
709
1880]
to possess. Their work is upon corns, bunions and ingrowing'
nails. For extracting corns the price is from half a dollar to a
dollar each, and they take care of patients by the year for $10
to $20. They have the same obscure and contradictory ideas
about the structure of corns, which exist among authors,
especially on the question whether there are originally any
living papillae running up through the central spike or “ ratine”
of the corn. I have not learned of any investigations among
them to settle the point, other than to note the little blood clots
occasionally enclosed in the u racine.”
Their instruments are simple. One family of chiropodists,
which has branches in New York, Boston. St. Louis and Chicago,
use mostly thin chisels, with the edges running obliquely across
the blade. This is handled with a lateral movement, while a
much narrower kind is used to work around and lift out the
central root. Some instruments have round ends for working
between the toes. After extraction the operator cuts a hole in
a small piece of thick buck skin, and applies it over the spot by
the help of adhesive plaster, and they thus relieve the patient
for two or three months.
They all agree, of course, that faulty shoes are the cause of
the corns, and their uniform direction for correct ones is to make
the heels low, so that the foot shall not slide down upon the
toes ; to have it snug on the instep to hold the foot back, and
to make the toes wide and long. One of them has a shop at¬
tached to his office, where he superintends the construction of
proper shoes for his patrons.
A chiropodist named Willard has an operation for ingrowing
nail, which may be original ; at any rate I have not yet found
it in any book. He asserts, what is pretty nearly true, that the
term ingrowing nail is a misnomer, the nail itself being un¬
changed in form. It is simply an overgrowing of the flesh, with
inflammation. He neither extracts the nail nor slices off the
overlapping flesh, but cuts out a narrow ellipse of tissue near
the nail and parallel to its border, claiming that the border
itself, where it rests against the edge of the nail, has its special
structure adapted to its location, and ought not to be sacrificed.
The removal of the strip of flesh being accomplished, he brings
the edges of the wound together with line sutures, thus drawing
the border away from the nail, and effecting a cure. 1 have not
yet tried the plan, but it seems worthy of being tested.
When the chiropodists have made a further advance in edu¬
cation, they will probably add the treatment of talipes to their
work, but at present they are neither competent for it nor
attempt it, except iu a few instances.
They are now in a transition state, but we may hope in time
to seem them become a well educated class of men, — Michigan
Medical News , August 25.
710
Current Medical Literature.
[January
THE MUTUAL AUTOPSY SOCIETY OF PARIS.
By Henry M. Lyman, M.D., of Chicago.
Considerable amusement was excited, a few years ago, by the
announcement that a society for mutual autopsy had been
formed among the savants of Paris, with a view to advancing
knowledge of the structure and physiology of the brain by a
correlation of intellectual characteristics with post mortem ap¬
pearances. The whole thing was generally regarded as a sci¬
entific joke of more than ordinary magnitude. But the society
appears to have been a genuine fact, and one of its members,
M. Asseline, having recently deceased, his brain was carefully
examined by his surviving associates, who made a full report
of the result to the Anthropological Society of Paris. The
following account of the matter is found in Nature , Aug. 14,
1879, p. 377 :
“ M. Asseline died in 1878, at the age of 49. He was a re¬
publican and a materialist ; was possessed of enormous capacity
for work, great faculty of mental assimilation, and an extraor¬
dinarily retentive memory ; and had a gentle, benevolent dis¬
position, keen susceptibilities, refined taste and subtle wit. As
a writer he had always displayed great learning, unusual force
of style and elegance of diction, and in his intercourse with
others he had been unassuming, sensitive and even timid. Yet
the autopsy showed such coarseness and thickness of the con¬
volutions that M. Broca pronounced them to be characteristic
of an inferior brain. The fossa or depressions, regarded by
Gratiolet as a simian character, and as a sign of cerebral infe¬
riority, which are often found in women, and in some men of
undoubted intellectual inferiority, were very much marked,
especially on the left parietooccipital. But the cranial bones
were at some points so thin as to be translucent ; the cerebral
depressions were deeply marked, the frontal suture was not
wholly ossified, a decided degree of asymmetry was mani¬
fested in the greater prominence of the right frontal, while,
moreover, the brain weighed 1,468 grams, i.e., about 60 grains
above the average given by M. Broca for M. Asseline’s age.
The apparent contradictions between the weight of the brain
and the marked character of the parieto occipital depressions,
attracted much attention, and the members of the Soci6t6
d’Anthropologie have been earnestly invited by M. Hovelacque,
in furtherance of science, to join the Societe d’Autopsie, to
which anthropology is already indebted for many highly im¬
portant observations. This society is forming a collection of
photographs of its members, which are taken in accordance
with certain fixed rules.” — Chicago Med. Jour, and Ex., Oct.
TREATMENT OF THE UMBILICAL CORD AFTER BIRTH.
At a recent meeting of the Medico-Chirurgical Society of
Louisville, Dr. Ed. Yon Donhoff stated that he had been pres-
Current Medical Literature.
711
1880]
ent at the birth of three children recently upon each of which
he had adopted with success, the method of Stokes, of Gray-
ville, Ill., in the treatment of the cord. As soon as the circu¬
lation began to grow feeble the doctor compressed the cord be¬
tween the finger and thumb at the usual distance from the
child’s abdomen, and then severed it with scissors. No liga¬
ture was applied on either side of the cut. No scathing-band
was applied, nor any dressing to the cord, it being left to
shrivel and dry. No bandages were applied to the mothers of
the children. Since this report, l)r. Mayfield, of this city,
reports to the writer that he has recently adopted the Stokes
method in one case with entire success. Dr. J. G. Stokes, of
Illinois, in a lengthy essily on this subject, read before the
Medico-Chirurgical Society by request, stated that he had for
eight years discarded altogether the application of the sicath-
ing-band and that he had frequently omitted to litigate -the
umbilical cord before severing it. In a very extensive obstet¬
rical practice the doctor had not seen a single case of umbilical
hernia, nor an abraded or ulcerated navel. This should lead to
the general adoption of the practice, so successful in the hands
of every one who has tried it. * — The Medical Herald.
THE PROBABLE VALUE OF CHLORIDE OF BARIUM IN INTERNAL
ANEURISM.
I wish to draw the attention of the profession to the action
of the soluble salts of baryta on the heart and blood-vessels,
and to their probable efficacy in the treatment of some varie¬
ties of internal aneurism.
In the middle of February, 1878, it fell to my lot to deal with
an abdominal aneurism.
The patient was an elderly married lady, aged 65 ; she was
not robust, on the contrary, fragile, but of such active habits
in social and pliilantropic work, that she perpetually over¬
taxed her strength ; with the exception, however, of an attack
of pleurisy, and an occasionally very troublesome cough, she
had enjoyed very fair health ; she was the mother of
three children, and had had several miscarriages ; she
had been always temperate in every sense of the word,
and during the greater number of her years had been
a total abstainer from every kind of alcoholic drink ; she
manifested symptoms of inherited gout, and a near relation
gives indications of having divided the inheritance with her.
She confessed that she had often felt throbbing in the body,
and pain there, and also in the back on the left side, but she
had made no complaint about the matter to her medical at¬
tendant, and fulfilled her usual social and domestic duties until
she was, one day in February, 1878, attacked with severe shiv¬
ering, and a sense of severe malaise. On the following morn¬
ing I found her temperature 102°.4, and on searching for the
712 Current Medical Literature. [January
cause of the pyrexia I discovered a pulsating tumor, painful,
situated behind, above, and to the left side of the umbilicus ;
there was a loud systolic bruit heard over the tumor, and in
the course of the common iliacs ; the bruit was heard with the
stethoscope in common use, and also very distinctly with
Spencer’s differential stethoscope, which can be used without
any pressure ; there was also a bruit heard close to the verte¬
bral column on the left side ; pressure on both external iliacs
greatly increased the pulsation, and so distressed the patieut,
that I received a decided impression that it would not be advis¬
able to repeat the experiment ; the throbbing was also greatly
increased by any exertion, and by any excitement or emotion ;
the transverse colon could be felt crossing the tumor, and when
distended with flatus it gave rise to very distressing increase
of throbbing. The pulse varied from 72 to 100, usually about
84 ; at the wrist it was full, compressible, but with a consider¬
able degree of tension, and it had the same character in the
carotids and iliacs. There was a moderate degree of anaemia,
and a worn, distressed appearance of the countenance. No
vomiting, appetite very small, digestion weak, bowels relieved
by enemata ; sleep very much disturbed and scanty.
The case was seen by several professional gentlemen, and in¬
dependently by Mr. J. W. Teale, of this town ; they all agreed
that the case was one of abdominal aneurism.
The patient was put upon Tufnell’s diet, and kept perfectly
at rest in the horizontal position. During this treatment and
at the commencement of it, the urine was examined several
times ; specific gravity usually about 1026 — at first no albumen,
in about one month just a trace of albumen, and after that no
albumen at any examination ; at the end of two or three months
of Tufnell’s treatment the daily average of urine was about one
pint three ounces. The temperature soon fell to normal, and
there was no other cause discoverable to account for its rise ;
during the progress of the case the temperature only very occa¬
sionally rose to 101°, as from any emotional excitement, and
also during a distressing toothache from a necrosed tooth.
At the end of five months of this treatment, which was car¬
ried out by the patient and attendant most conscientiously and
rigidly, there was no improvement in any way 5 the tension of
the pulse remained the same, and the throbbing of the tumor
had rather increased, so that under any excitement, as for in¬
stance, during a thunder-storm, it quite shook the bed ; the
sensations of the patient and my own observations began to
prepare me to expect the worst.
There were reasons for abstaining from the use of large doses
of iodide of potassum, so I did not try it. After careful con¬
sideration 1 selected chloride of barium as a probably useful
remedy, and began to give it in doses of oue-fiftli of a grain
three times a day ; after three or four weeks 1 increased the
dose to two-fifths of a grain, and with the exception of a very
1880]
Current Medical Literature.
713
short trial with three-quarters of a grain, I kept to two-fifths of
a grain during the remainder ot its administration. Within a
fortnight of the use of the chloride there was a very marked
diminution of throbbing both to the sensation of the patient,
and by my own observation ; after five weeks use of it the pa¬
tient was able to bear the removal of a necrosed molar tooth
(which had for a few days given rise to neuralgia in the head
and to distressing face-ache) without an anaesthetic ; the tooth
was, of course, not firmly fixed, but I should not have dared to
allow its extraction previous to the administration of the chlor¬
ide ; and after nearly five months’ continued use of the same
remedy the tumor was so reduced that it could scarcely be felt,
and only a faint systolic murmur could be heard. At tne pres¬
ent time, four or five mouths since the discontinuance of the
chloride of barium, there is still a slight systolic murmur, but
no throbbing ; the pulse is about 72, and has entirely lost its
unnatural tension.
Mr. J. W. Teale has recently seen the case again, and he ex¬
pressed himself highly gratified with the change in the patient’s
state. So that testimony can be borne by an independent
trustworthy practitioner to the accuracy of the diagnosis in the
first place, and to the reliability of the improvement.
It will now be interesting to examine into the modus operandi
of the drug. According to the experiments of Boehm (Ziemssen
vol. xvii. p. 377) it would appear that the salts of baryta in
overwhelming doses paralyze the heart and blood vessels ; but
that in more moderate doses they stimulate or irritate the heart
and blood vessels, so that the pulse is made more rapid, and
the blood-pressure very greatly increased. What are the doses
which will produce the opposite results is not very certain. A
poisonous dose of the chloride is half a grain ; Ringer puts the
dose at from half a grain to a quarter ot a grain, but in the
edition 1 have he does not state for what purpose. Hammond
gives doses of three-quarters of a grain three times a day in
multiple spinal sclerosis — as a nervine stimulant 1 suppose. I
have myself taken about one grain three times a day for several
weeks with a very marked stimulant effect. So that I should
expect the stimulant dose to be somewhere near one grain, and
the paralyzing dose nearer two drachms. The dose I selected
was under that which I suppose could produce a decided stim¬
ulating effect ; and as a most essential improvement occurred
at the beginning of the use of the salt, when I was giving one-
fifth of a grain, 1 should not be surprised to learn that 1 should
have done as well, if not better, by keeping to that quantity.
There was no marked decrease in the rapidity of the pulse, and
no sudden diminution of the impulse ; the throbbing gradually
subsided, and the general improvement went on pari passu with
it. There was not any sign of a paralyzing influence of the
drug on the heart. I regret that I had not in my possession a
714 Current Medical Literature. [January
sphygmograph, and that I cannot, therefore, give any sphyg-
mographic tracings.
The drug appears to have a decided affinity to the muscular
coat of the arterial system ; and I imagine that it restored tone
to the diseased portion of the arterial coat, and thus gave rise
to consolidation of the weakened arterial wall. In my case the
aneurism appeared to be fusiform rather than sacculated, and
therefore deposition of fibrin could not very readily take place.
It may be said that since the chloride of bairum causes an
increase in the blood-pressure, it is not reasonable to expect
that it should do anything but harm in a case of aneurism; no
one, however, who has witnessed the beneficial effects of ipeca¬
cuanha in dyspeptic vomiting, or of arsenic in gastro-enteritis,
or of cantharides in some cases of nephritis (vide Ringer’s The¬
rapeutics), will be deterred by the fact mentioned above from
giving the chloride of bairum in aneurism in an appropriate
dose. Of course it may be asserted that the improvements in
my case arose from the prolonged rest and rigid diet, and was
only coincident with the administration of the chloride ; this is
quite possible, but the progress of the case did not make it ap¬
pear to me at all probable.
The question of the value of the drug in aneurism can only
be decided by repeated trial ; and I report my case as fully as
1 have done, that it may be tried by others in suitable cases.
In my opinion preference should be given to the chloride of
bairum in fusiform aneurisms which have hitherto not been
very amenable to treatment ; also in the aneurisms of advanced
age ; and it might also be tried in any case in which iodide of
potassium is admissible, or does not promise to be useful.
Of course perfect rest is essential to any medical treatment ;
and it would be well to try Tufnell’s diet alone at first, and to
adhere to it as far as possible during the use of the drug. By
F. Flint, M.D. — The Practitioner. — Cincinnati Lancet and Clinic ,
Aug. 23.
THERE IS DANGER IN A KISS.
By R. L. Payne, M\D„ Lexington, N. C.
Very many of the diseases to which we poor mortals are
liable, can be prevented, provided proper efforts are put forth
to meet that most desirable end.
This truth no one will gainsay, still, the subject has not yet
•attracted the attention its importance demands, and it appears
now to be the especial duty and province of those of our pro¬
fession who live in this day of preventive medicine to erect
finger boards along the highways of life, which shall point out
clearly and plainly the known causes of disease, and also the
usual means of propagating and preventing the same, so that
all persons may be able to see and profit thereby.
There is offtentimes danger in a kiss , notwithstanding Lord
Current Medical Literature.
715
1880]
Byron, that prince of poets, in the days gone by, expressed the
wish
“ That womankind had but one rosy mouth,
To kiss them all at once from North to South.”
Ah ! it was a bad wish even for so bad a man, and so faith¬
less a lover as he, yet it does seem that he was not peculiar
in this respect, since in this glorious age of enlightened progress,
such sickly sentimentality is no less popular, and has no fewer
votaries, than in the days of old, because kissing, kissing,
kissing- is still the order of the day.
The ladies kiss each other upon every offered opportunity ;
every flimsy pretext; the poor little children, and even the
babies are made to do likewise in compliance with the require¬
ments of genteel society, and the men too, would do the absurd
thing at every meeting, were it not for the lamentable truth,
that they are obdurate and have not yet been educated up to
the sound, civilized and philanthropic principle of “ dog eat
dog.”
They say they would not enjoy such a proceeding even under
the most auspicious circumstances, and I fully endorse the
sentiment.
However, I am not going to make war upon kissing under all
circumstances, because husbands and wives, and parents and
children, aud lovers, etc., etc., will sometimes resort to the di¬
version, and I am free to admit that under favorable circum¬
stances the practice may be allowed, although it be unnecessary,
yet they all should know of the poison that often lurks in a
kiss.
But it is about kissing in general I want to speak — the fool¬
ish fashion, the idle fancy, — the consummate folly of this age !
There is no doubt of the fact, that, the practice of promis¬
cuous kissing, which is prevalent in many localities, is the
source of untold evil to the human family ; nor can there be a
doubt either; that upon this frivolous altar of fashion, is sacra-
ficed annually a hecatomb of innocent victims.
Every physician of experience knows this to be true, and yet
as a body we have been strangely and culpably reticent upon
the subject.
For the sake of illustration allow me to imagine a case which,
although imaginary in this particular instance, is alas, of fre¬
quent occurrence in every day life. Two ladies meet upon the
street, or elsewhere, by accident, or by design. The one is wan,
delicate, sickly, with slight sores upon her lips, or within her
mouth; the other is vigorous, the very picture of a robust,
healthy woman. Perhaps, both of them are good, innocent and
virtuous women, but the first mentioned, by no sin of her own,
is a victim of that fell destroyer, syphilis.
The fashion of the day, the mawkish custom of polite society
demands that they shall kiss each other.
7
7 16 Current Medical Literature. [January
They may he scarcely more than acquainted, not even friends
in the true acceptation of the term, but all-potent custom re¬
quires it, and the kiss is given.
They part mutually well pleased, and the kiss of empty form
is at once forgotten, but its stealthy sting remains to do its
silent work of ruin.
Soon that lively, healthy, splendid woman loses her bloom,
wilts, withers, and decays, because she too, has been touched
by a poison which if not more instantly fatal, is, at least, far
more subtle, and more lasting in its effects, than is the scor¬
pion’s sting, or the sirocos smothering breath. The kiss was
lightly given, and lightly received, only a passing courtesy, but
God only knows where its effects shall end !
If the woman, per chance, bears children alter inoculation its
results may descend a blighting, withering curse to generations
yet unborn.
This picture is not overdrawn, and has been repeatedly ex¬
emplified in the experience of many of our profession, and
here is another, which many have seen and will recognize as
faithful.
A happy loving husband and wife become strangely diseased ;
the husband consults his physician, and is horrified to learn that
he is suffering from syphilis. He knows that he has ever been
faithful to his wife, and she knows that she has always been true
to him, but the green-eyed fiend distrust enters their bosom, each
suspects the other of a breach of trust ; and the monster sus¬
picion is, perhaps, forever enshrined upon the altar where once
burned only the fires of confidence and love.
Such cases are by no means uncommon, and may sometimes
follow as the consequence of a fashionable kiss.
Kicord, speaking of the means of propagating syphilis,
asserts that, u the organs of the mouth are often the propaga¬
tors of the contagion by a lascivious kiss, by the application of
the lips, or tongue to some part of the mucous membrane, by
suction of the breasts, and especially in suckling.”
S. D. Gross, so often called the nestor of American surgeons,
(than whom I recognize no higher authority) says : “ A chancre
may sometimes form upon the lip ; more frequently the lower
than the upper, as the result either of the contact of chaucrous
matter, or of inoculation with the secretion of a mucous tubercle,
as in act of kissing, smoking, drinking, or glass-blowing,” and
again, “ chancre may be communicated by a sore, or mucous
tubercle upon the lip, or tongue of the child in the act of suck¬
ing.”
Many of the members of the North Carolina Medical Society
will remember an interesting case in point, reported when we
last met in Wilmington,* by our distinguished confrere, Dr. E.
Burke Haywood, of Raleigh, in which a lady contracted a
Transactions for 1870,
Current Medical Literature.
717
1880]
buccal chancre from a secondary mucous tnbercle on the lip of
her lover. The doctor speaks of this case as u a warning- to
lovers would to God that such warnings might be written
everywhere in characters so plain that “even the wayfaring-
man though a fool need not err therein.”
The following cases came under my own treatment last sum¬
mer.
A young man came to me with a neglected case of pox. He
was already in the secondary stage of the disease, and among
other symptoms which presented, had several mucous patches
upon his lip, and within his mouth.
He had a little cousin, a girl child of sixteen months of age,
who was still at its mother’s breast. They were very fond of
each other and he was frequently in the habit of fondling, and
kissing the child.
Of course I knew nothing of this intimacy, or I should have
warned him of the danger. Some weeks after this I was called
to visit the child and its mother. I found the little one with en¬
larged cervical glands, sore mouth, sore eyes, etc., and its
mother said to me, after I had prescribed for the child. “ Doc¬
tor, please look at my nipple, I believe I going to have cancer
of the breast.” Her nipple was sore indeed, and her axillary
lymphatic glands were enlarged and indurated, not from cancer,
however, but from a characteristic chancre.
I treated them all for syphilis, and the good results of the
treatment verified my diagnosis. I have seen many similar
cases during the last twenty-five years, and many more might
be cited from the authorities upon this loathsome disease, but
the above are sufficient for my purpose.
Now let us look at another picture ! A number of ladies are
gathered together in a social party with their younger children,
and infants. As a matter, of course, they all kiss each other,
and each other’s children, and the children are made to do so
too, in accordance with the customs of this Christian land.
All are merry, happy, jubilant even, except one poor child
who sits apart from the others, with quickened pulse, flushed,
or ashen face, slightly swollen throat, and feverish brow.
His eyes are dull and heavy, and he complains of pain in
his back, limbs and head, and slight soreness of his throat. The
poor boy has diptheria, yet all of that jovial company have kissed
him, and have run the risk of that dread contagion !
I know that the authorities are divided with regard to the
contagiousness of this disease, and that the question is still
considered by many as subjudice ; but be that as it may, I have
seen enough with my own eyes, in my own practice, and alas !
even around my own hearth-stone to convince me beyond a
doubt of its contagiousness, and that it can be communicated
by kissing, and although the whole world of physicians should
declare that it is not, I am, from my own experience, stubborn
enough to believe that it is, and such will be my honest con¬
viction until I have more, and better proofs to the contrary.
718 Current Medical Literature. [January
Very many other diseases may be conveyed by the act of
kissing, and I might go on at length enumerating them, and
adducing “ confirmations as strong as proofs of Holy Writ;”
but my object is simply to call attention to the truth which lies
in this direction, and to testify most solemnly against a practice
so fraught with danger, so pregnant with death !
The act of kissing is never under any circumstances in¬
dispensable, and the indiscriminate practice is not only un¬
necessary, but is also foolish, dangerous, and very often
insincere.
Ah, yes ; many an insidious kiss has been given since the
days of Judas ! Then, why longer indulge in a custom so empty,
so meaningless, but yet so potent for evil '?
The people at large are ignorant upon this subject, but medi¬
cal men are not. Let us then as a profession speak for the truth,
although many may say that our words are wasted, and that
we are but “ carrying our coal to Newcastle.” Let us do what
we know to be right, though the heavens fall, being assured
that duty performed brings its own reward.
“ Who does the best his circumstance allows,
Dees well, acts nobly,-— angels could no more.”
North Carolina Medical Journal , Aug.
ARIGO AND FIORANI — A FEMALE MAN.
By Joseph Workman, M.D., Toronto, Canada. [Translated from Ann. TJniv. di Med.,
March, 1879.]
The authors describe the case of a woman presenting virile
appearances, and who died at the hospital of Lodi, aged 08
years. The head was of masculine form, the nose aquiline, the
face oblong, a beard thick and gray; nipples athropied ; no ap¬
pearance of female breasts.
The mons veneris fully developed, and covered with copious
gray hairs ; underneath this was a penis as thick as an ordi¬
nary thumb, and eight centimetres (three and three-twentieths
ins.) long, furnished at its extremity with a reguiar glans, want¬
ing, however, the uretlial aperture ; along the posterior face of
the penis and precisely in the line of the male uretha, between
the corpora cavernosa , there was observed a sulcus, not covered
by skin, but with a mucous coat rendered more consistent by
its exposed situation : this sulcus continued to the root of the
penis, and terminated at an orifice large enough to admit the
passage of a goose quill. Proceeding from the sides of this
orifice and descending to the perineum were two symmetrical
prominences formed in like manner as the labia majora of the
vulva, and covered externally by a few hairs, the interior sur¬
face being covered by a membrane more delicate than the skin,
so that it might be taken for a mucous coating. These prom¬
inences, descending to the perineum* if superficially regarded,
might have been mistaken for a scrotum sulcated by a large
raphe and containing atrophied testicles ; but when examined
1880]
Current Medical Literature.
719
with care, they were found to correspond to the labia majora ;
these were quite impervious, being closed by the membraue
above mentioned, which cut off communication with the inter¬
nal parts.
In the abdomen was found a uterus of virgin figure and vol¬
ume, and of normal conformation, both in its body and in its
neck ; broad ligaments ; Fallopian tubes and ovaries in the or
dinary virgin state. The bladder being opened, a gum catheter
passed through its neck found exit through the orifice at the
root of the penis. The vagina being laid open posteriorly, so
as to display the cervix uteri, this part was seen of small, sylin-
drical, unusual size ; and a second gum catheter being intro¬
duced into the vaginal canal (which was long, consistent and
normally capacious), this found exit through the same orifice
as the other, impinging first against the division between the
two prominences formed by the labia majora, and in its departure
from the orifice it showed a small opening.
We have here treated of a true woman, with perfect internal
organs of generation, a clitoris over-large, a hymen constituted
of the skin which closed up the part comprised between the
labia majora, and also a vagina and urethral canal, which in¬
stead of opening regularly to the exterior, formed a sort of
clouca , with their outlets at the orifice at the base of the clitoris.
So far as regards the physical state of this interesting subject,
the authors were able to ascertain but few particulars. She
kept apart from young men of the same age, preferring to their
amusements prayers and religious observances. She was of a
mild disposition, rather economical, and quite sober. She did
not attend the call for military duty, as she was an only son (so
reported). There appeared to have been some question as to
her sex at the time of baptism. She was, however, baptized
and registered as a male, and as such conducted herself to the
end of life, laboring in the rather heavy work of cheese-making.
— St. Louis Medical and Surgical Journal , Aug.
INTRA-UTERINE MEDICATION.
By Clement Godson, M.D.. Assistant Physician Accoucheur to St. Bartholomew’s Hospi¬
tal . Honorary Secretary of the Obstretical Society of London,
It is with a feeliug of auxiet.y that I see iu the British Medi¬
cal Journal of August 30th, a series of abstracts of papers
which were read at the annual meeting in Cork, advocating the
treatment of certain uterine complaints by means of medica¬
ments applied to the cavity of the body of the womb. This
Journal has such an enormous circulation among all classes of
the profession, that the mere heading will attract the notice of
many who have but little time to do more than glance at the
contents of the papers ; and I fear that, having ascertained
that carbolic acid, iodine, etc., are useful agents in the treatment
of uteriue discharges, many will fly to put their efficacy to the
test, without having learnt to discriminate the class of cases
720 Current Medical Literature. [January
applicable to them, or having attained the skill necessary to
employ them. There is much in fashion. A century ago every
one was bled ; now, venesection is hardly ever practiced. We
have passed from one extreme to the other. A few years since,
in gynaicological practice, division of the cervix by the rnetro-
lome was constantly performed by some physician ; now, this
operation is but rarely undertaken ; indeed, we hear, at least
in one quarter, that sewing up the gaping os uteri is all the
rage. Lately, there has been a discussion on the use of the
forceps and its alternatives in lingering labor, before the Ob-
stretical Society of London. Many eloquent discourses have
been contributed, and the subject has been ably discussed by
several of our eminent leaders in the school of mid wifery.
But, to sum up the whole, at what have we arrived ? The
general impression gained, is that the forceps is used far less
frequently than it might be with advantage to both patient and
practitioner. The result of this will be, unless I am much mis¬
taken, that an authority has been granted for the frequent use
of the instrument, and that we shall find the evil effects of this
from its indiscriminate and unskilful employment. In the out¬
patient female department of St. Bartholomew’s Hospital,
where 1 see from fifty to seventy new patients per week, I
have unusual opportunities of observation. After having
made an examination, I am frequently led to inquire : Were
you delivered with instruments in your confinement? And, in
nine cases out of ten, the answer is in the affirmative. The
reason why I put the question was that I found the cervix
deeply fissured up to its junction with the vaginal wall, along
which extended a cicatrix. This is a clinical fact, which testi¬
fies to the truth of the remark made by Dr. Henry Bennett in
his speech, and objected to by Dr. Barnes in his reply, at the
Obstretical Society’s discussion.
But, with respect to uterine medication, the results are likely
to be much more serious ; and I have already met with instances.
If an application to the cavity of the body of the womb be re¬
quired, there should be an amount of endometritis calling for it;
but, in how many cases of discharges from the os uteri does the
exudation come from above the canal of the cervix — the so-
called internal os 1 I venture to say, in very few. The probe,
covered with cotton-wool saturatod with carbolic acid, is passed
along the cervical canal up to the fundis uteri, and in many
cases good results are obtained — not because the fundis uteri
has been reached, but because the application has been made to the
canal of the cervix ; and, had a zinc-alum point been placed in
this situation, and the uterine cavity had not been reached, the
result would have been equally satisfactory, without the risk of
danger possible to occur from probing the cavity of the womb.
This brings me to the nature of the evil consequences.
One which I have met with is abortion. The possibility of
existing pregnancy has not been thought of. The patient may
Current Medical Literature.
721
1880]
have gone but a few days over her time for menstruation, and,
not having been very regular previously, little heed is paid to
this. Nevertheless, she may have conceived immediately after
her last period, and, if even she have not quite reaehed her next
menstrual epoch, she may yet be pregnant when the applica¬
tion is made. Another danger is that of inflammatory mis¬
chief in and around the uterus. It is well known how the sim¬
ple passage of the ordinary uterine sound is liable to give rise
to this. Surely, then, a probe saturated with carbolic acid or
other agent is equally if not more likely to prodnce such results.
The points, therefore, that I would urge upon my profes¬
sional brethren are these. Before deciding to make applica¬
tion to the cavity of the body of the womb, be satisfied that
this part is affected by disease, and that it is not the cervical
canal only that is involved. Without having determined this,
it would be just as irrational to pass a medicated bougie into a
man’s bladder for every purulent discharge escaping from the
meatus urinarius.
The papers to which I have referred, as published in the Jour¬
nal, fail to my mind to show sufficiently clearly, the symptoms
which give proof of the existence of endometritis. Then, the
application should never be made to a sensitive uterus in which
inflammation is likely to ensue, or pelvic inflammation or
abscess may result ; and a probe should never be passed into the
uterus of a child-bearing woman about the time of an impend¬
ing menstrual period ; indeed, it would be well to make a rule
not to probe the cavity within a week of the catamenia, but to
limit the time for intra-uterine medication to the fortnight sub¬
sequent to the cessation of the flow. — British Medical Journal ,
Nov. 8.
NERVOUS MALADIES OF UNCULTIVATED PEOPLE.
In curious confirmation of the strictures we made on the
theory advocated by Dr. G. M. Beard and others, that increas¬
ing culture entails increase in nervous maladies, is a paper
published in La Presse Med. Beige , August 31st, from the pen
of Dr. Wilmart, on the character of the peasantry of Central
Russia. They are, he says, of the middle height and below
this. They are of very nervous temperament, of slight endur¬
ance, passing rapidly from enthusiam to discouragement. They
will not submit to the slightest operation without chloroform ;
they can bear only small doses of medicine, and even slight
inflammatory affections are soon complicated by delirium, con¬
vulsions, etc. Steeped in ignorance, and possessed of little
power of moral resistance, they readily abandon themselves to
the deepest melancholy, easily yielding to the impulse to sui¬
cide, especially by drowning.
Among the diseases of the peasantry, those of the nervous
system hold the first rank, hysteriform neuroses prevailing
722
Current Medical Literature.
[January
equally among men and women. Pain is a j)rominent symp¬
tom, and large quantities of opium are taken for its relief.
Anaemia is very prevalent, especially among females. — Medical
and Surgical Reporter , November 1st.
RESULTS OF TREATMENT IN VIENNA.
There is strong reason to believe that the modern treatment
of disease in Germany has greatly deteriorated since the days
of Niemeyer. Theorizing, histology and diagnostic refinements
have taken the place of the effort to cure disease by rational
empiricism. Witness the next to worthless therapeutics in
Ziemssen’s Cyclopaedia. A Vienna correspondent in the Can¬
ada Medical and Surgical Journal gives some striking statistics.
In Bamberger’s clinic, of 27 cases of pneumonia, 17 died ; 24
per cent, of all cases of typhoid fever die ; facial erysipelas is
“ frequently fatal,” etc. We do not believe that the case book
of the average American physician shows anything like this
mortality ; and our city hospitals certaiidy do not. It looks as
if medical science in Germany was running to seed. — Medical
and Surgical Reporter , August 23d.
BROWN-SEQUARD’S THEORIES OF THE NERVOUS SYSTEM.
This emiuent teacher continues to announce that his experi¬
ments and researches prove that the doctrines of cerebral local¬
ization are erroneous and based on false assumptions. His
demonstrations are striking. Thus, in an animal in which the
right motor half of the pons varolii was incompletely divided,
the left half of the bulb was afterward cut through, there
remained no other way of communication between the two
halves of the encephalon than by a small portion of the ante¬
rior longitudinal mass of fibres on the right side of the protu¬
berance. Now, in this case, the galvanization of the motor cen¬
tres at the right and at the left caused exactly the same move¬
ments in the limbs of the side opposite to the centres. The
experiment was repeated a number of times, always giving the
same results.
It is observed by M. Grasset that the whole doctrine of Prof.
Brown-Sequard is governed by two entirely new principles, viz :
1. All the phenomena which one ascertains after limited
experimental or clinical lesions of a part of the cerebrum are
produced by action at a distance.
2. There are no agglomerated and circumscribed centres in
the cerebrum for any function. There are certainly special
cells, distinct elements, but these cells are distributed through
the whole mass of the cerebrum. In other terms, there are no
circumscribed, but diffuse centres. — Medical and Surgical
Reporter , November 1st.
1880 J
Current Medical Literature.
723
PERCENTAGES FROM DRUGGISTS.
Our comments, some months back, on the impropriety of
physicians taking percentages on the prescriptions they send
to druggists, has met the approbation of many honorable men
and journals. Tne Chicago Pharmacist speaks of the preva¬
lence of the swindle in that city. It says :
“Many physicians in this city demand as high as forty per
cent on the gross price of their prescriptions to patients, "while
others are content with twenty-five per cent., and yet others
only ask their office rent, while a goodly number only expect
cigars and liquors free. Some degree of collusion between
druggists and physicians exists almost everywhere, and proba¬
bly always will, but the practice of giving any very substantial
inducements to the physician for his influence is commercially
and morally wrong.”
How long shall this discreditable state of things last ? Will
not the medical societies take some action ? — Medical and Surgi¬
cal Reporter , November 1st.
SIMPLE PERFECTED TEST FOR SUGAR.
By L. S. Oppenhkimeb, M.D.
Demonstrator of Histology in the University of Louisville.
Heretofore in this country the favorite qualitative test for
grape sugar in the urine has been the Trommer test ; after this,
as qualitative and quantitative, Fell ling’s test and the fermen¬
tation test. Besides these there are a number of others equally
as good, but not so universally applied. These are Heller’s
More’s, Bottger’s, Frohn’s, Piffard’s and Haynes’s. It is to this
latter that I owe the suggestion that led me to perfect the
sugar-test as here offered. The objections to Haynes’s test are
that it is not a quantitative test, and that the copper is precipi-
ted after standing a short time. Of all the tests Trommer’s is
the least reliable, Fehling’s the most. The only objection to the
latter is its liability to alteration. Professor Flint, Jr., keeps
the various constituents of Fehling’s solution in separate
bottles ; but this, he says, does not prevent the serious decom¬
position of the solution of neutral tartrate of potash. Besides
this the copper solution is apt to undergo change and precipi¬
tate some oxide. Another disadvantage of all of the above
tests, except Frohn’s, is the impossibility of finding sugar if al¬
bumen be present or if the urine be ammoniacal. None of these
are obstacles to the qualitative application of my test, which is
simply a solution of copper sulphate in pure glycerine in this
proportion :
Pure aulpliate-of-copper crystals . grs. 50;
Pure glycerine . . . oz. 1.
This equals six and a quarter graius copper to one dram of
glycerine, and this will reduce one grain of grape sugar in the
8
724
Current Medical Literature.
[ January
presence of a caustic alkali. The glycerine protects the copper
from the action of the caustic alkali, and as well from the
various constituents of the urine. The copper crystals must be
thoroughly triturated with the glycerine in a mortar, and kept
in a clean glass-stoppered bottle.
Qualitative Test. — Two or three drops are dropped into a small
test-tube, and about a half dram of officinal liquor potassa
added, and the whole shaken till the resulting precipitate is
dissolved. The solution will then be of a dark-blue color. It is
then boiled and a few drops of urine dropped into the tube, and
again boiled for a minute or two. If sugar be present in con¬
siderable quantity, the fluid will suddenly become opaque, and
prolonged boiling will turn it by rapid degrees to a canary or
brownish yellow ; and upon cooling the yellow or brown cuprous
oxide w ill be found in the bottom of the tube. During the test,
however, the attention must be kept on the fluid itself, not on
the precipitate. Ammoniacal or albuminous urine wrill not in¬
terfere with this reaction, if a drop or two of a wreak solution of
bichromate of potash be added before testing. If only small
quantities of sugar be present, more urine must be added. If
no copper oxide be precipitated, or if the mixture does not turn
to a definite yellow, not a dirty-green color, after adding an
equal volume of urine with the test-liquid and boiling, no
sugar is present.
Precautions. — The precipitate of cuprous oxide is granular,
not flaky ; and the precipitation of the whitish, grayish or brown¬
ish flocculi of phosphates, which always occurs in alkalized
urine, should never be mistaken for the dense, opaque, yellow¬
ish urine containing cuprous oxide, or the bright, heavy,
granular yellowish or brownish precipitate of the same.
Qualitative Test. — One dram of the test-fluid (= six and a
fourth grains cupr. sulph.) is measured into a flask, and about
two drains of liq. potas. and an equal amount of water added.
This is either put upon the stove or over the lamp, the flask
resting on wire gauze or a tin plate. If the urine contain much
sugar (as indicated by the qualitative test), it should be diluted
with a measured quantity of water, as in Feh ling’s test ; if only
a small quantity is present, no dilution is required. The
measured urine — let us say one-half ounce — and the diluting
agent — say one and half ounces, making two ounces in all — are
dropped from a graduated tube or glass into the test-fluid and
brought to the boiling point, a few drops being added at a time,
and after boiling a few moments allowed to settle for a few
seconds. This is continued till the opaque brownish mixture
becomes yellow. The urine is then more carefully dropped, aud
the fluid allowed to cool a little after each boiling, till a ring of
clear fluid shows itself at the surface, showing that the whole
of the copper has been oxidized and is rapidly precipitating as
yellowish or reddish brown cuprous oxide. This precipitate is
thrown down in the first part of the examination, and increases
Current Medical Literature.
725
1880]
as the reaction is continued. This decolorization terminates the
process. One grain of sugar has been neutralized. Then read
off the graduate how much fluid has been used. Let us suppose
six drams were used. One fourth of this (one and a half drams)
was urine. We therefore have one grain of sugar in one and a
half drams of the urine.
If the examiner have no flask a small morphine, or quinine
bottle will answer perfectly, only half the quantity (half a
dram) of the test-liquid being used if a small bottle be taken ;
this neutralizes, of course, only a half grain of sugar. Albumen
interferes with this test, and must therefore be removed by
coagulating with acetic acid and filtering; the mine is then
neutralized with liq. potass, and used as above. — Louisville
Medical News , Nov. 8.
LOSS OF PERSONAL IDENTITY.
St. Clarisville, O., October 20, 1879.
Dr. E. J. Birmingham ,
Editor Hospital Gazette , New York :
Sir — I herewith send you a note of an interesting case
under my care in County Infirmary. If of sufficient interest
please give it a place in the Gazette.
Respectfully,
A. H. Heweter.
I have had under my care as physician for our County
Infirmary a very interesting case. There is no discoverable
bodily disease, but a very peculiar mental state. The patient
has lost all knowledge of his personal identity ; does not know
who he is, where he came from, or whither he was going. He
became an inmate of our infirmary about nine months since.
The following is his history since takeu in charge by our
county officials. All previous to that is a blank to himself and
entirely unknown to us :
About the time referred to, nine months since, he found him¬
self standing upon the depot in Bellaire city with a little money
in his pocket, and a small travelling bag in his hand. This
bag contained a change of linen, pair of scissors, and some
blank paper like that used by editors. His clothes were quite
genteel and the underwear in his valise was neat and clean.
His entire appearance was that of a well-cared for gentleman
ready for business
There was no name on any property about him indicating
who he was ; entirely nameless, except that on some part of
his effects was the name Ralph. This is what he is called in
the infirmary.
After thinking and thinking while at the depot he at last
went to the nearest hotel and gave the landlord a candid state¬
ment of his very strange condition. He asked for a bed, said
726 Current Medical Literature. [January
he had a little money, that he would be no trouble, and that
he felt sure this strange mental sickness would soon pass off.
The landlord became interested in his case.
The same day a gentleman came to Bellaire to lecture on
temperance. Stopping at the same hotel he soon made the
acquaintance of Ralph and invited him to attend the lecture.
While attentively listening some impulse came over him which
he could not resist, and he found himself out in the street
smashing the saloon windows with a big club. The roughs
ran out, beat and abused him badly, breaking the neck of the
humerus and beating one side all black and blue. This brought
him into the hands of the police. But the lecturer, the doctor,
the landlord and mayor, all became interested in finding out
who he was. They made every effort, but utterly failed.
He certainly is a man of more than the average ability ; lias
had quite an extensive knowledge of business, and is very
expert with the pen. Some think that he must have been con¬
nected with the press. Others, a clerk in some calling in which
the use of the pen and figuring was the daily habit. In this
way alone can they explain his great expertness.
His knowledge is entirely correct upon all matters discon¬
nected with the question of identity. He has the use of his
mental powers in all other directions. ,
I made him, after having the best evidence of his fitness, my
assistant. He has put up all the medicine, etc. I procured
him Parish’s Pharmacy, and in a remarkably short time he was
able to fill any prescription I required, and in many other ways
to assist me.
So great is his general knowledge, and so correct all his
recollections of general events, and all special duties imposed
upon him, that many were skeptical and believed him to be
feigning. But, after nine months close observation, we are all
forced to believe that he is what he says he is — a man with no
knowledge of his personal identity.
He is about fifty (50) years of age ; rather spare ; has dark
hair, well sprinkled with gray, and is quite a gentleman in
appearance. He has made himself so useful, agreeable, and
so anxious to return all he can for the benefits he has received,
that he was presented with a new suit of clothes and directed
to eat at the superintendent’s table.
I report the case both on account of its psychological inter¬
est, and that possibiy it may lead to his identity.
He has been published in our newspapers pretty thoroughly,
but these have a much more limited circulation than a medical
journal like yours. — Hospital Gazette , November 15th.
OOPHORECTOMY PERFORMED SUCCESSFULLY FOR MENSTRUAL
EPILEPSY.
By Lawson Tait, F.R.C.S. Ed., Surgeon to the Birmingham Hospital for Women.
The case of E. E. has already been published in the Obstetri¬
cal Journal for May, 1873, and in my book on Diseases of Wo-
Current Medical Literature.
727
1880]
men, as a typical case of ovarian atrophy arising from exauthe-
niatic oophoritis: a disease to which I was the first to call at¬
tention many years ago, as occurring very frequently as a
sequel of scarlet fever and small pox.
Her history after May, 1873, is that the efforts to induce the
return of the menstrual flow by means of galvanic pessaries
were persevered in, after several relapses, till at last everybody
concerned was wearied of them. The patient ceased her attend¬
ance at the hospital, and I heard of her only occasionally to the
effect that her epilepsy was becoming worse and worse. Oue
of my critics, in alluding to this case, broadly stated that I had
mistaken a bad case of hysteria for one of epilepsy. I wish
he had seen the poor woman as I saw her on February 5th,
1877, in an attack of epileptic mania, covered with bruises of
all kiuds. I urged her friends to commit her to an asylum ;
but to this I could not persuade them, as for at least one week
in every month she was quite rational and comparatively free
from fits. During the other three she had fits almost every
day ; and during the menstrual week, when a faint show gen->
erally appeared for one or two days, her fits were incessant and
her delirium uninterrupted.
This state of umtters lasted till August of this year, when her
friends, completely worn out by her, seemed at last to agree
that she should be placed in an asylum. Before doing that,
however, I urged them to let me cut out the ovaries, in the
hope that this might arrest the disease by removing what I be¬
lieved to be the cause. To this they readily consented, and I
performed the operation on August 11th. There was no par¬
ticular difficulty about the operation, save that the patient was
very fat. The ovaries when removed presented all the charac¬
ters of the atrophy peculiar to inflammatory change of their
true gland-structure. (Diseases of Women , p. 215.) Mr. Alban
Doran has favored me with a report upon the ovaries removed,
which completely confirms the views of the pathology of this
case which I have expressed in my former publication of it.
“ The elongated cells of the stroma are larger than in normal
ovaries: and there are few vessels, the hypertrophy of the walls
of those that remain, and the bundles of fibrous tissue, point to
a cir rhotic change following the exanthematic oophoritis.” One
of the ovaries is now in the museum of the College of Surgeons.
The result of the case so far is very satisfactory, for the fits
have entirely ceased. Three days after the operation, there
came on the pseudo-menstruati m which frequently follows ova¬
rian operations, and this lasted for three days.
On September 18th, she lelt the hospital quite well; and the
house-surgeon’s note is : “ Patient bright and cheerful ; memory
quite returned ; and she is able to reply intelligently to ques¬
tions put to her.”
I saw her on October 13th, when she told me that she was
quite well, and was going toiler home in Peterborough in a few
(lays. — British Medical Journal , Nov. 8.
728 Current Medical Literature. [January
A CASE OF PERSISTENT OVARIAN MENORRHAGIA : OOPHOREC¬
TOMY : RECOVERY.*
By John Meredith, M.D.. Edin., President-Elect, West Somerset Branch oi the British
, Medical Association.
In May, 1877, I had to attend a young woman aged 20, on
account of excessive menstrual discharge, which had been going
on for some weeks.
The previous history of the case was briefly this. The pa¬
tient, as a girl, had alwas been considered delicate up to the
menstrual period (which, with her, began when she was fifteen),
although she was well-formed and tall. Once the courses be¬
came established, she began to gain strength and fatten. The
catemenia were regular, but scanty, only about three diapers at
a period ; still she felt well, and gave this no particular thought.
Her parents are healthy, and so are lier brothers and sisters.
One day in March of the year mentioned (1877), while menstru¬
ating, she assisted to lift a book case. She felt the effort affect¬
ing her; and the discharge, instead of terminating at the ex¬
pected time, went on day after day.
When I saw her, she was in an exhausted condition from the
loss, and suffering pain, etc., in the lower part of the abdomen,
indicating the presence of a certain amount of local inflamma¬
tory action. After the administration of opiates, this condition
of irritability subsided ; and after a while I obtained permission
to make a digital examination of the vagina and cervix u teri.
The information I got from this was, that there was no appre¬
ciable difficulty in introducing the finger; the os uteri was
patulus, with a blood-clot in it, and the cervix elongated. There
was nothing special to note in regard to the condition of the
uterus — no marked version or flexion. Now, a very natural
question suggested itself, and I have no doubt it arises at once
in your minds : namely, Was not the case one of miscarriage ?
A question which I put to the patient sometime afterwards,
bearing on this, was met by a negative answer — -just what I
might have expected. But my duty was to arrest the haemor¬
rhage and bring about recovery, if 1 could. To this end I ad¬
ministered ergot, acids, bromide of potassium, chlorate of pot¬
ash, digitalis, and cannabis Indica. The last-named three, in
combination, seemed to answer well for a while ; then there
would be a relapse. Cloths dipped in vinegar and water were
applied over the vulva and lower part ot the abdomen ; cold
water, vinegar and water, and carbolic acid solution were at
intervals injected into the vagina ; and, of course, absolute rest
in bed was enjoined, with everything cold in the way of food
and drink.
In spite of everything, the discharge continued more or less
until July. At times, there would be nothing but a pink san¬
guineous staining on the clotn. The patient soon learnt to dis-
*Kead before the West Somerset Branch.
1880]
Current Medical Literature.
729
like this appearance, as she had always a good deal of back¬
ache with it, from which she was only relieved after the expul¬
sion of blood-clots. The explanation of this, I take it, was that
the clot formed in the os uteri, and, owing to the flow not be¬
ing enough at times to carry itself off as a whole, the fibrin
separated at the uterine outlet and in the uterus as well, stay¬
ing there gathering in volume ; while the liquor sanguinis es¬
caped, and produced the stains mentioned. The fibrinous part
in thickening rested upon the walls of the os, distending it, and,
as iu labor or any other form of tension at the os uteri, the dis¬
comfort was referred to the sacral region — the region of back¬
ache with many women. After going on in this way for a time,
1 decided to apply pure carbolic acid to the interior of the
uterus. I did this in the usual way, by means of a piece of cot¬
ton-wool wrapped round an ordinary uterine sound. The result
was satisfactory for the time ; the discharge stopped for five
months, the patient recovered strength, and was able again to
go about and enjoy herself.
In the beginning of 1878, the menses reappeared, but nothing
much to complain of at first ; then the loss assumed a more per¬
sistent character. Drugs seemed to have very little influence
now ; nor had the intra- uterine application of carbolic acid the
same arresting influence as at first ; still it exercised a certain
amount of staying power. Thus, matters went on unsatisfactorily
to all concerned. Towards the end of 1878, the loss was not
very great ; still it recurred at short intervals ; but, on Christ¬
mas -eve, she got excited with some of her friends, and then it
came on profusely. There was always tenderness over the
ovaries, at times more over one than the other, and, of course,
the usual sympathetic tenderness along the spine.
Finding that I was unable to afford the relief I wished, I
urged the patient to go to the Women’s Hospital at Birming¬
ham, to be under the care of Mr. Lawson Tait, with whom I
had had some correspondence regarding the case. Accordingly,
on January 15th, she went thither. She was thin, weak, and
anaemic at the time. A few days afterwards, 1 had a note from
Mr. Tait, saying that he could find nothing amiss with the
uterus, only that the fundus was a little enlarged, nothing
more.
A few days after admission, nitrate of silver was applied to
the cavity of the womb, and repeated three times between that
and February 15th. On the 19th, the loss ceased, and no further
application was made. The patient had mixtures given her,
consisting of ergot, bromide of potassium or chlorate of potash,
and, after the cessation of the discharge, dialysed iron.
She left the hospital, apparently recovered, on March 1st, and
went to a convalescent home, where she stayed for a good
while, and was much improved. In due course, she returned
home to Wellington. On the night of her return, the discharge
began again.
730 Current Medical Literature. [January
I knew nothing of her retm n, or of the recurrence of the dis¬
charge, until she had been at borne for some weeks. During
the interval, she tried the effects of medicine which some neigh¬
bors procured for her — getting into a sort of desperation -state,
which we can all pardon under the circumstances, i now tried
the effects of cold water hip-baths, and with some apparent good
results. Mustard poultices over the ovaries were followed by
no marked benefit. Swabbing the interior of the uterus pro¬
duced some relief. After a time, I introduced a piece of nitrate
of silver into the cavity of the uterus, and left it there. This
altered the character of the discharge ; but, in spite of all, the
loss persisted. I frequently left her alone, deeiring her to keep
still and take no medicines at all ; the result was the same, al¬
ways losing.
On July 9th last, I gave her a hypodermic injection of ergot-
ine, which was followed by a stoppage of the discharge for about
three weeks. On August 5th, I again sent her to the Woman’s
Hospital at Birmingham, under the care of Mr. Tait. At the
time, the patient was anaemic, thin and weak, and hardly able
to stand.
I shall give the history of the case, after the patient reached
the hospital, from Mr. Tait’s own report, who has kindly sent it
to me to lay the result before the members of the branch.
The patient was admitted into the hospital on the 5th of
August last. On the 8th, oophorectomy was performed by Mr.
Tait, in the presence of several medical practitioners. Both
ovaries were removed, and the pedicle of each tied by a special
knot — “Tait’s knot.” The ovaries were found enlarged and
flabby, with traces of lymph in their neighborhood. The patient
made a good recovery. The temperature did not once rise
above 101°, although the pulse was 134 on the third day. The
patient returned to her home a few weeks ago, able to walk a
mile or more with ease; and is in every way improving, gaining
strength and feeling well. It is hardly necessary to say that
there has been no menstrual appearance since. — British Medical
Journal , Nov. 3.
A DANGEROUS VICTORY.
In Germany physicians are not permitted to dispense medi¬
cines when there is an apothecary to do it for them. In
Begensbuig three liomceopathic physicians were practising,
when an apothecary came among them und notified them to
send him tlieir prescriptions. Two of them refused to obey, and
v were brought before the court and fined twenty marks. The
case was carried to a higher court, and the medicines (pilules)
were sent to the University of Erlangen for chemical analysis.
The chemists reported that the pilules were made of pure sugar
and did not contain any medicine ; whereupon the judge
reversed the decision of the lower court, and declared there
was no law against physicians distributing sugar-plums as
freely as they chose. — Boston Journal Chemistry , November.
Current Medical Literature.
731
1880 1
THE PREVENTION OF INFANTILE OPHTHALMIA.
A writer in the British Medical Journal advises as follows,
in order to prevent ophthalmia of new born children :
The instant the head is born, and before the child has time to
open its eyes, T wipe away from its eyes every trace of mois¬
ture. In this way the entrance upon the conjunctiva of all
acrid discharge from the vagina is prevented. I have attended
to this point in hundreds of cases, and have never known it to
fail ; while, in the same period, ophthalmia has repeatedly
occurred in those cases where the child has been born before
my arrival. Carefully to wipe the eyes of the child at the
earliest possible moment has now become with me so much a
point of routine that I never omit it, even in forceps cases, or
in the uncommon presentations, and the result is the absence
of the disease alluded to. — Medical and Surgical Reporter, Aug.
TRICHINAE DETECTED BY THE NAKED EYE.
Dr, Francis Vacher, of Birkenhead, Eng., says in a para¬
graph in the London Lancet (dated February 26th), that
“ trichinae in pork can usually be seen without the aid of a
magnifier, the flesh being distinctly speckled. The whiter
specks come out clearly if a thin section of muscle be treated
for a short time with liquor potass* and water (1 to 8), as
recommended by Dr. Parkes. When the capsule is dense, the
same author suggests the addition of a drop of weak hydro¬
chloride acid. To see the coiled up worm itself all that is
necessary is a good pocket lens.” — North Carolina Medical Jour¬
nal, August, 1879.
A Russian physician, M. Malacvsky, struck by the preva¬
lence of short-sightedness among literary men, proposes that
books should be printed in white ink on black paper, and he
has made experiments with fifty persons which tend to confirm
his view. — Weekly London Times.
NOTE ON SULPHUR PRAXTP1TATUM (MILK OF SULPHUR) AS A
TOPICAL APPLICATION IN DIPHTHERIA.
By John A. Kkskinf, Stuart, L.R.C.S.E., Duuse, N. B.
Since writing the former paper on this subject, I have treated
several cases in the same manner, and with like excellent re¬
sults. I now find that to rub the sulphur up with a little water
and apply it on a swab to the throat, is the easiest and safest
method of application, for in blowing the dry substance on the
throat it was sometimes not so easy to get it on to the desired
spot, and besides, the patient, especially if a child, was very apt
to cough up sputa in your face, a most dangerous proceeding.
In addition to this, I am of opinion that the moistened sulphur
9
732
Current, Medical Literature.
[January
sticks better to the throat than the dry substance, and this is,
I think, the advantage which a solid antiseptic has over a fluid,
viz., that it exerts its action for a longer time, and this, I think,
is also in favor of the method of treatment, where powdered
benzoate of soda is blown on to the throat.
In using Sulphur Praecipitatum we get a substance which,
being free from grittiness, is more agreeable to the patient. To
show the rapidity with which the disease disappeared, when
treated in this way, I find that of six cases under this method
successfully treated, the average number of visits required from
me was 2.5, an extraordinary statement, but one which is per¬
fectly correct.
My fqrmer paper has been criticised by both the Medical
Record and Braithwaite’s Retrospect. The writers there both
seem to think that friction is an important factor in the cure ;
but no friction has been used by me.
My belief in this method of treatment is strong, f rom the fact
that I have seen some most sudden deaths from the disease,
where muriate of iron and chlorate of potash were pushed to a
great extent, as also where sulphurous acid was used ; and in
these no benefit seemed to result from their use, whereas every
case 1 have treated with sulphur has made a rapid recovery as
soon as it was tried. — Practitioner , Oct. r79.
SIR WILLIAM GULL'S COUGH MIXTURE.
This preparation, said to be efficacious in whooping-cough r
is composed of equal parts of cod-liver oil, honey, and lemon
Jhice. Dose : a teaspoonful or two, according to age, three
times a day. — Boston Journal of Chemistry, November.
HIGHLAND MALARIAL OR MUSHROOM FEVER.
By J. G. W KSl'MO RKLA-N it , M.D., Atlauta, Ga.
During the past suunnef and up to this time, a fever of pecu¬
liar type and in some neighborhoods of malignant character,
has prevailed in this and several surrounding counties. In
some portions of Paulding, Polk, Cobb and Cherokee counties
tlte mortality has amounted to fifty per cent, of the cases. It
is remarkable that quite a number of cases occurred in Fulton
county, but very few, if any, within the city limits of Atlauta.
It seems, therefore, that in this instance, at any rate, the
densely populated city has proved more healthy than the sur¬
rounding sparsely settled country, where no cesspools nor
stinking sewers are known. Strange, doubtless, this will
appear to those finding fever in every sewer and diphtheria in
every gutter around town.
To those accustomed to marsh malarial fever the disease
referred to comes with surprise. On the highest, dry, and
ordinarily salubrious sections, this fever prevails with severity,
Current Medical Literature.
733
1880]
equal to that of low, damp localities. The great question with
the people and with doctors are, what is it, and from what
cause does it come ? It does not assume the usual character¬
istics of typhoid fever in every respect, nor is it controlled by
quinine so perfectly as intermittent or remittent fever. While
the nervous disturbance somewhat resembles that of typhoid,
yet the usual duration being only two weeks, makes it differ
essentially from this disease.
In 1847 the same fever, exactly, prevailed in some counties
of Middle Georgia, and again in 1866, the identical peculiar¬
ities were observed in a form of fever which prevailed to some
extent in the neighborhood of Atlanta.
During the months of July and August, 1847, and in the
same months of the present year, the greatest number of mush¬
rooms were seen all over the uncultivated land of the forest.
So abundant were they in both of the years referred to that
casual observers wondered at the immense number of u frog-
stools 77 seen in the woods. The experience of 1847 gave the
writer good reason for predicting troublesome fever to follow
the appearance of the large crop of cryptograms in 1879, and
it has been signally verified.
It is, therefore, reasonable to suppose the fever in question
has had its cause in the get-ms or sporules of the numerous
cryptogams mentioned. It is known that the mushrooms is
the growth of a night and has the duration of a day. Falling-
down, the innumerable spores rise and are wafted by the breeze
so as to infect the atmosphere in the neighborhood around.
The fever coming on at a suitable time after the breaking
down and drying of mushrooms, and assuming features differ¬
ent from typhoid and marsh-malarial fevers, the conclusion
seems just that there is something more than coincidence in
these things. The opinion of cause and effect is greatly
strengthened by some co-existing circumstances in 1847 as
well as 1879.
The Salisbury theory of marsh-malarial fever, which has
been ridiculed almost into oblivion, perhaps unjustly, was
founded on its cryptogamous origin. If true, the fungus is, of
course, belonging to a different variety than that found on the
hills producing the two- weeks fever, the name of which heads
this article; or undergoes modification by being drifted by
washings of fields and current of streams to the marsh, from
which its spores are wafted through the atmosphere. This
difference or modification is seen in the difference of character
in the disease produced by them. While marsh-malarial fever
is intermittent or remittent, and cut short by quinine, the high¬
land malarial or mushroom fever runs its usual course despite
large quantities of quinine, and does not usually observe diur¬
nal intermissions or remissions. No abortive treatment has
yet been discovered for the highland two-weeks fever. The
course found most satisfactory is that of mercurials to a limited
734 Current Medical Literature. [January
extent, blisters to nape of the neck, veratrum, and unloading
the bowels by enemata.
The various varieties of “ the fever ” certainly are the result
of a poisoned or in some way deranged condition of the nerv¬
ous centres at some point, as poisons as well as mild remedies
affect some particular portion of the body by an elective tendency
to that organ. Not only is their action confined to a particular
organ, but even to a particular part of a system. Thus strych¬
nine affects the spinal centre of the nervous system, while
opium, hyocyamus and chloroform affect the cranial contre.
Now, it may be that the different poisons or their modification,
affect particular portions of the nervous system or even a differ¬
ent part of the same centre. While marsh -malarial deranges
the spinal cord, the cause of typhoid fever evidently impresses
some of the cranial centres. One being intermittent of one
week’s duration, and cured by spinal tonics, the other con¬
tinued and runs a period of three weeks. May not the high¬
land cryptogams affect an intermediate point, and hence in¬
termediate in duration, etc t — Atlanta Medical and Surgical
Journal , Nov-ember.
THE DECAY OF THE EMOTIONS.
In reading history, one cannot but be struck with the decay
of the emotions which has taken place in the last few centuries,
say since the rise of national literatures. Men do not love or
fear, hate or enjoy, with the violence they ouce did. The
whole tone of modern life is against such emotional excess.
We see in this age the charge of the Light Brigade through a
valley raked by cannon shot; but the individual soldier is
seized by no such fury as the Berserker tcuth of the Northmen.
Men pursue their purposes with no less tenacity, and with un-
dimiuished unscrupulousness, but the passion of revenge,
which played such a prominent part in the days of yore, is
now next to obsolete. In the autobiography of Benvenuto
Gellini, that great artist informs us that after an insult he was
seized with a sort of fever or delirium, which could not be ap¬
peased until he had wreaked his resentment.
Many instances are on record of persons dying outright from
grief, or joy, or disappointment, while now a days such occur¬
rences are extremely rare. Several such are recorded in the
Memoires of the Marechal de Vielleville, a leading French Gen¬
eral of the Sixteenth century On one occasion lie had sur¬
prised and captured a young Spaniard who had charge of an
outlying post. It was under circumstances of a nature to
entail severe censure on the captive, for carelessness. Although
unhurt and in good health, he died, of mere grief, the first night
of his captivity. Examples are not rare where a courtier for¬
bidden the royal presence presently died of mortification.
They seemed less able to hold out against moral reverses
than now.
1880 1
Current Medical Literature.
735
It is evident that to-day men are less apt to act on impulse
than formerly. They weigh and ponder more. This power¬
fully affects their viability, and is unquestionably an import¬
ant factor in the longer lives that modern generations have.
With this comes a much greater tolerance of disease and of
unhealthy surroundings. Less easily ' depressed, with more
hope and better grounds for it, they do not yield to the de¬
pressing and often fatal effects of fear and despair.
Evidently, therefore, the decay of the emotions is a hygienic
advantage. It means the increased power of the intellectual
elements of mind. It is a sign of progress, and as closely
associated with greater tenacity of life, is one which the physi¬
cian should foster. In marked neurotic temperaments the con¬
trol of the emotion is the most difficult lesson to learn, but is
essential to safety. Self-government is not attained until the
actions are guided by thought rather than impulse ; and the
improvement of the individual or the race is conditioned on
personal self government. — Med. and Surg. Reporter , Nov. 29.
AN ARGUMENT FOR THE GERM THEORY.
It is curious to note how often very unwholesome conditions
are found to be coexistent in a district with a low death-rate
and an immunity from fatal infectious disease. One such in¬
stance, at Lyinington, we alluded to not very long ago, and two
other cases of the same kind have been recently reported to the
Local Government Board by Dr. Blaxall and Mr. T. C. Langdon,
as existing at Okehampton and in the Wells Rural Sanitary
District respectively. At Okehampton the water-supply is ex¬
posed to pollution from the direct communication which exists
between the mains of the closets, and the sewerage is most de¬
fective and imperfect. The sewers are unventilated, and the
arrangements for flushing are for the most part unsatisfactory.
The privies, which are used where sewers do not exist, are of
the most objectionable description, differing only in degree of
unwholesomeness. The contents are allowed to accumulate for
an indefinite period, while the privv-structures generally present
every stage of delapidation. Pigs are very commonly kept, often
in unwholesome relation to dwellings, and usually in a very
filthy and neglected condition. The floors of many of the
dwellings are damp, which probably accounts for the excep¬
tional prevalence of rheumatism in the town. Certain of the
houses are very delapidated, and most of them are surrounded
by conditions greatly prejudicial to the health. Yet the death-
rate for the two years 1879 and 1878 was 17 per 1,000, and that
for the intermediate year only 12.5 per 1,000, zymotic diseases
being conspicuous by their absence. As Dr. Blaxall points out,
however, this* favorable result must not be allowed to lull the
authority into a sense of false security, seeing that the conditions
revealed as every where present in their midst are the very con
736
Editorial.
[January
ditiom which are recognized as favorable to the development and
spread of infectious disease , especially cholera and enteric
fevers ; and these diseases introduced into the town would be
liable at any time, with the existing state of things, to become
widespread and fatal.
In his report on the Wells Rural District, Mr. Langdon shows
that, notwithstanding the low death-rate of the district (14 per
1,000), many unwholesome conditions exist that may foster the
recurrence of preventable diseases. The water-supply of some
parts of the districts is much contaminated, and in others so
circumstanced that it is liable to pollution by means of excre-
mental and surface soakage. Although there is in many places
an abundance of water, yet it is often not available for the pur¬
poses of the population, and where springs are used they are
not sufficiently protected. Very generally the means of sewer¬
age and drainage are defective. The privies are faulty in con¬
struction. and occasion much nuisance ; and indeed the action
of the sanitary authority seems to have been generally very im¬
perfect.
[The heading of this extract from the British Medical Journal
sounds like a sarcasm. The facts cited are curious, but not
corroborative of the prevalent belief in the necessity of drain¬
age and pure drinking-water to secure health.] — Louisville
Medical News, Nov. 8.
f
DITORIAL.
We offer our subscribers the customary New Year’s compli¬
ments and good wishes for themselves and “ theirs;” employ¬
ing the last word in its most inclusive sense. If 1880 should
only perpetuate through its course, the peaceful prosperity of
its predecessor, our profession may go on advancing in useful¬
ness and knowledge without any distraction or impediment.
Indeed the opportunity is offered in 1880 to gather the greatest
amount, and most valuable of medical statistics ever obtained
in this country. As our readers are aware it is the decade
upon which our national census is to be taken. The excellent
superintendent includes in the statistics required an amount,
and character of information upon medical subjects, never be¬
fore sought to be obtained. The success or failure of his efforts
depends so much upon the co-operation of our profession that
Editorial.
737
1880]
the responsibility of the result may be chargeable to us. Let
us endeavor to secure the best attainable results.
Those of our readers who have not been supplied with the
census circular to physicians, can obtain them by addressing
Gen. Walker, Superintendent of Census Bureau, Washington,
D. C.
DOUBLE PNEUMONIA AND ABORTION.
On the 1 1th of March 1 was called to see, with another phys¬
ician, a white woman, aged 33 years ; skin very hot, both
cheeks flushed, eyes suffused, respiration about 23, pulse 120.
Complained of severe pain in both sides of the chest. Cough
constantly. Both sides dull on percussion, right, side more in¬
volved. Respiratory murmur at upper part of both lungs very
loud, accompanied by some tine crepitation. Tongue very
broad and flat, deeply furrowed in centre, base covered with a
dense, dirty, brownish fur, lips red, breath very offensive.
Diagnosed double pneumonia. Ordered a large mush poultice,
to cover both sides of the thorax, to be as hot as the patient
could endure it. Acetate of ammonia, in one drachm doses,
to be given every three hours. Five grains of dextro-quiuine
every six hours. Eleven A. M. next day pulse was 120.
Right lung more involved, pain more acute, respiration more
rapid, mouth dry, tongue more brown, fissure deeper, heat of
skin 103J. Ordered poultice to be continued, and increased
my dose of dextro-quiuine to twelve grains, to be given at once,
and repeated in four hours. At nine P. M. saw the patient ;
complained of diarrhoea. Three doses of dextro-quinine were
taken, and the symptoms were much improved. For the
diarrhoea a few drops of MonselPs solution of iron were
ordered every hour. Nourishment principally consisting of
milk. Dextro-quinine was given only twice during the night.
On the morning of the 12th symptoms much improved,
though the dullness was as great, but heat and restlessness
abated somewhat; diarrhoea under control. During the next
two days the acetate of ammonia was continued in one-drachm
doses, every four hours, five grains of dextro-quinine to be
given three times a day.
738 Editorial. [January
On the loth I was. called in haste to her. Found pulse 135,
respiration very rapid, skin very hot ; two slight convulsions
came on while I was with her. Ordered beef tea and milk to
be given frequently, in small quantities. Tincture of vera-
trum was given in small doses every hour. Four o’clock I saw
her again ; was told that labor pains were on her. She was
four months advanced. Made a vaginal examination, and
found the os dilated, perineum soft and yielding, but little
hemorrhage, and before I feft the house the foetus was expelled
minus the placenta. The shock this abortion inflicted on the
system was fearful ; she became semi-comatose, pulse went up
to 150, small and thready, breathing diaphragmatic. Several
convulsions then came on. Hard ones were on her in twenty
minutes or more. Face was pale, skin of body intensely hot,
while the extremities were cold. Something had to be done
forewith, and as I put about as much faith in dextro-quinine
as most men do in a good brake on an express train, 1 poured
out what I thought to be a good twenty-grain dose of that
drug, which was dissolved in a solution of tartaric acid, and
poured it down her throat. This was repeated in an hour. It
was certainly marvelous to witness the effects produced. In
two hours the pulse was reduced forty beats, and the skin
much cooler. Though the convulsions did not entirely sub¬
side in that time, they were very much lessened. In three
hours mQre I gave her ten grains again ; by night she recov¬
ered her senses. Next day I found, to my surprise, that there
was very much less solidness of lung than at any other time since
I first saw her. I removed the placenta with a hook this day ;
but very little hemorrhage occurred at any time. The dextro-
quinine was now combined with Squibb’s tincture of iron, five
grains to thirty drops every three hours. From this time on
the convalescence went on uninterruptedly. I make no com¬
ments on this case, but would ask the attention of the profes¬
sion to the line of treatment followed, which I believe will, be
found a successful one in cases, both of double pneumonia,
pleuropneumonia, intermittent fever, and allied diseases. —
Medical and Surgical Reporter , December, 1879.
L. A. Rutherford, M.D.
1880J
Obituary.
OBITUARY.
739
Thomas Kennard, M. D.
At a meeting of the St. Louis Medical Society, the following
was pased as an expression of respect to the memory of Dr
Thomas Kennard :
With a deep sense of the sad and irreparable loss we have
sustained in the death of Thomas Kennard, Ex-President and
honored member of this Society, we give expression to grief
and record
IN MEMORIAM
this tribute to his manly virtues and excellencies, and to his
professional capacity, attainments and standing.
Nature cast him in no diminutive mould ; lavish of her gifts,
he was not denied ability to acquire knowledge from books, but
added thereto the capacity to create it by observations and ex-
pierence. Thorough literary training and extensive reading
formed an appropriate basis for his professional education. As¬
siduously he kept pace with the rapid progress of scieucific
medicine ; patiently and energetically he practiced the art with
enviable success.
Cosmopolitan in all of his views, the elevation of the standard
of medicine was near to his heart, and while he inculcated need¬
ful professional reform, he demanded for medicine a more just
recognition of its relations to government, society and the other
noble professions, an enlightened secular and religious press,
and an intelligent public. And for the welfare of profession
and people he desired the safeguards and protection of wise
legislation.
Eminently characteristic of our lamented brother was the
bold and fearless advocacy of his views. He wielded a free
lance, neither giving nor asking quarter. Concise, condensed
and incisive, he grasped the gist and marrow of a subject, and
whether in its presentation or defence wielded with grace and
precision the weapons of debate. As he spoke so did he write,
and his frequent contributions to our Journals and the various
monographs emanating from his pen have elicited merited
praise and remain an enduring monument to the enlarged views
and ability of the writer.
For the administration of affairs he was singularly well
adapted, and whether as President of the Society or Chairman
of its important committee, he exhibited an acquaintance with
parliamentary law and the routine of business which harmon¬
ized action and attained results.
Honest and honorable in all of his dealings, he strictly
obeyed the spirit and letter of our ethics, and in professional
intercourse he was marked by exceeding fairness and respect
for others.
7 40 Proceedings of A ttakapas Medical Association. [ J anuary
Capable, truthful and sceintific himself, he despised quackery
in all its forms, and his deep censure, mingled with contempt,
fell heavily upon hypocrisy and pretension.
A man of strong character, it was not astonishing that he had
devoted friends and decided enemies. The former testify to his
kindly and affectionate nature, while the latter find more to ad¬
mire than to condemn.
Only close association elicited a full knowledge of the gentle,
kindly disposition which underlaid the sometimes harsh and
severe exterior presented by our deceased brother.
He was, without ostentation, charitable, not only in speech,
but in acts.
A strong man has fallen ! A counsellor, friend and leader is
lost to us forever! We sorrow with the family of our deceased
brother, and offering this tribute to his memory, tender our con¬
dolences and express a hope that on u the other shore” he “ rests
from his labors ” and reaps the reward of the just.
Proceedings of the Attakapas Medical Association.
New Iberia, Nov. 27, 1879.
SECOND MEETING.
The Attakapas Medical Association was called to order at 1
o’clock P. M., President Dr. A. Duperier in the chair, and a
quorum present. The minutes of the last meeting were read
and approved.
The Secretary reported that pursuant to orders received at
the last meeting, he had addressed a circular letter to the
several physicians of the Attakapas parishes, inviting them
to attend the next meeting of the association at New Iberia,
on the 27th of November.
The Secretary again reported that several physicians from
the parishes of St. Martin and St. Mary were present, and
were ready to participate in the organization.
The Secretary also reported that quite a number of letters
had been received in answer to his circular address ; all ap¬
proving of the move of the society, and promising support
and co-operation. These letters were read and ordered to be
recorded.
The society then proceeded to complete its permanent or¬
ganization.
On motion, duly made and seconded, it was
Resolved , That a committee on credentials be appointed.
Motion adopted.
The Chair appointed Dr. Colgin and Dr. Woolf, of New
Iberia, on said committee.
1880] Proceedings of Attakapas Medical Association. 741
After the verification of the diplomas by the committee on
credentials, the members came forward and signed the Consti¬
tution and By-Laws.
The meeting then proceeded to regular order of business.
On motion of Dr. Woolf, duly made and seconded, the Sec¬
retary was requested to inform the Louisiana State Medical
Association, and the Kew Orleans Medical Society of the or¬
ganization of this association. Motion adopted.
On motion, duly made and seconded, Dr. J. G. Mestayer
offered the following :
Resolved , That the second article of the Constitution be read.
Motion adopted.
The article was read as follows :
The objects of this association shall be the pursuit aud cul¬
tivation of the practice of medicine, aud the sciences on which
the same is based, together with the defence of rights aud the
elevation of the dignity of the medical profession ; also, the
protection of the professional interests of its members, and the
cultivation of harmony and fraternal feeling among the mem¬
bers of the profession within its boundaries.
On motion of Dr. M. W. Richardson, duly made and sec¬
onded, it was
Resolved , That a committee be appointed, whose duty it shall
be to examine the statutes of the State, and if found necessary,
to draw up a petition to the Legislature, at its next meeting,
requesting that a law be passed for the protection of the qual¬
ified and regular practice of medicine, against quackery, and
the unqualified practice of medicine, midwifery and surgery
within the State.
Resolved , also , That the President of this Society be the
chairman of that committee. Motion adopted.
The Chair appointed on this committee Drs. Richardson and
Colgin, of Iberia ; Dr. Maguire, of St. Mary, and Dr. Thomas,
of St. Martin.
On motion of Dr. Blanchet, duly made and seconded, it was
Resolved, That a committee of three be appointed to draw up
a schedule of regular prizes for the practice of medicine in the
Attakapas parishes. Motion adopted.
The Chair appointed on the committee Drs. Blanchet, A. Ma¬
guire and F. Thomas.
On motion of Dr. Thomas, duly made and seconded, the Sec¬
retary was requested to have the minutes of this meeting pub¬
lished iu the local papers, and to have a copy of the same sent
to the several physicians of Attakapas. Motion adopted.
Dr. Mestayer offered for examination a case of exstrophy of
the bladder.
Dr. Maguire made a verbal report of the cases of yellow
fever in Cypremort, and was invited to make a written report
of those interesting cases to the ^National Board of Health,
and was also requested to present the same at the next meet¬
ing of this Association.
742 Reviews and Book Notices. [January
On a vote of the majority, the society decided to hold the
next meeting in New Iberia.
On motion of Dr. Thomas, duly made and seconded, the
meeting then adjourned until March 4th, 1880.
Dr. G. Blanchet,
Secretary.
Reviews and Book Notices.
Diseases of Women. By Lawson Tait, F. R. C. S., Surgeon to
Birmingham Hospital for Women ; member of the Obstet¬
rical Societies of Londou, Dublin, and Edinburg; author
of the Hastings Essay for 1873, etc. Second edition,
thoroughly revised and enlarged. Specially prepared for
‘‘Woods Library.” 8vo. pp. 192. New York : William
Wood & Co. New Orleans: Armand Hawkins, Medical
Book-seller, 196£ Canal street.
What high-heeled boots are to short men thick paper is to
short books. The volume before us is of the set known gener¬
ally to the profession as Woods Library of Standard Medical
Authors, and corresponds in size and binding to Hilton on
“ Rest and Pain,” which contains 299 pages, We are not find¬
ing fault with the work — for it is a much larger book than it
appears to be. It contains large and important facts, and
systematic and conscientious teachings.
The arrangement of the work is peculiar in some respects.
The various subjects are taken up in the natural following
order: I, Mons Veneris; II, Vulva; III, Vagina; IV, Uterus;
V, Broad Ligaments ; VI, Fallopiau Tubes ; VII, Ovaries; VIII,
Pelvic Bones; IX, Dilatation of the Cervix Uteri by contin¬
uous elastic pressure.
Under these headings the diseases of each locality and organ
are taken up and practically treated. Time and again does the
author give valuable information by citing cases occurring in
his own practice where his mistakes proved valuable lessons.
Tait’s teachings are sound and the ease and simplicity of his
writings will render his work a valuable addition to medical
libraries.
1880]
Re v iew 8 and Boole Notices.
743
A Manual of Midwifery for Midwives and Medical Students.
By Fancourt Barnes, M.D., F. R. 0. P. 12mo. j>p. 201.
Philadelphia : H. C. Lea. New Orleans : Armand Haw¬
kins, Medical Book Store, 196^ Canal street.
This little work from the practical character of its teachings
will meet with favor from those for whom it was written and also
from graduates of medicine. But we believe authors make mis¬
takes in bringing such works to the attention of students for the
reason that brevity and not thoroughness seems to be the object
aimed at, and careful attention only to elaborate treatises on
medical subjects will fit the student for complete appreciation
of the facts brought flippantly to their notice by pocket editions
of special subjects. The work is well and clearly written and,
as far as it goes, had much to recommend it.
Photographic Illustration of Skin Diseases. By George Henry
Fox, A.M., M.D., Clin. Prof. Dermatology, Starling Med.
Col., Columbus. O., Surgeon to N. Y. Dispensary, Depart¬
ment of Skin and Venereal Diseases, etc. 4to. New York:
E. B. Treat. 1879. [Sold by N. D. McDonald & Co., 116
Carondelet street, N. O., and 45 Broad street, Charleston,
S. C.]
The illustrations of this work are executed from negatives
taken of actual cases, and colored by Dr. J. Gaertner, formerly
a student and physician under Hebra at Vienna. These have
been selected from a collection of several thousand taken by
by Mr. O. C. Mason, Photographic Artist to the Bellevue Hospi¬
tal, during the last ten years, and from other sources at the
command of the author.
The work consists of twelve monthly parts, each consisting of
four plates, with two pages of printed matter accompanying
each plate, descriptive of the diseases and suggesting appro¬
priate treatment. The four parts already issued treat of the
following affections : I. Comedo, Acne Vulgaris, Lepra Tube-
rosa, Elephantiasis ; II. Keloid, Rosacea, Psoriasis, Ichthyosis ;
III. Fibroma Pendulum. Varicella, Zoster Pectoralis and Lum-
balis, Eczema Universale ; IV. Leucoderma, Chromophytosis,
Favuo, Capitis and F. Corporis, Eczema Cruris.
The prominent feature of the work is the illustrations, which
744 Books and Pamphlets Received. [January
are far superior to any others that have come under our notice.
By the use of card- board, 10x12 inches, there is ample room
for a large picture, and the skillful coloring of the artist su-
peradded to the fidelity of^the photographic process renders
the illustration the best substitute possible for the living subject.
8. S. H.
Annual Address oj the President of the Kentucky Medical Society,
delivered at Louisville, Ky ., May 10, 1879. By Dr. C. H.
Todd, of Owensboro, By., 8 vo., pp. 8.
The subject of the address is State Medicine, particularly
those branches relating to Public Hygiene and Medical Educa^
tion. It appears that there is in Kentucky a State Board of
Health appointed by the Governor, and Local Boards appointed
by the County Judges ; but these boards are not clothed with
power to enforce sanitary measures. Dr. Todd would vest the
appointment of the State Board in the State Medical Society,
and thai of the Local Boards in the physicians of the several
counties. The members of these several boards should all be
physicians, and the civil authorities should be required to carry
out the instructions of their medical advisers, the Board of
Health.
In the second branch of his subject Dr. Todd makes a plea
for a higher education in our profession, commencing with the
preliminary course.
We like to see this subject of State Medicine agitated in our
profession. Physicians all acknowledge its importance, but it
is only by incessant reiteration of arguments by a few indefati¬
gable workers, that the great mass are ever moved to earnest
effort resulting iu appreciable progress.
Books and Pamphlets Received.
Annual Address before the American Academy of Medicine at
New York, September 1 6th, 1879. By Lewis H. Steiner, A. M.
M. D., of Frederick, Md., President of the Academy, Perma-
1880]
Books and Pamphlets Received.
745
nent Member American Medical Association, Fellow American
Association for Advancement of Science, etc., etc.
Infant Feeding and its Influence on Life or the Causes and Pre.
vention of Inf ant Mortality. By C. H. F. Routh, M. D., M. R. C-
P. L., Fellow of University College, London, of the Medical,
Medico-Chirurgical, and Obstetrical Societies, etc., etc.
Transactions oj the Twenty-ninth Anniversary Meeting of the
Illinois State Medical Society , Session 1879.
Transactions of the Medical Society of the State of Pennsylvania
at its Thirtieth Annual Session. May , 1879.
Transactions of the Mississippi State Medical Association , XII.
Annual Session , April 1st, 2d and 3d, 1879.
Biographical Dictionary of American Physicians and Surgeons.
By William B. Atkinson, M. D., Permanent Secretary of the
American Medical Association, and of the Medical Society of
the State of Pennsylvania, etc., etc.
Report of the Results in Thirty-one Cases of Phthisis, treated at
Aiken , S. C,, during the Season, 1878, 79. By W. H. Geddings,
M. D., Aiken, S. C. Reprint from the Medical Record, Novem¬
ber 15th, 1879.
Ninety- Seventh Annual Catalogue of the Medical School ( Bos¬
ton ) of Harvard University , 1879-80.
A Clinical Inquiry into the Diagnostic Significance of Absent
Patellar Tendon Reflex. By C. H. Hughes, M. D. Reprint from
the Alienist and Neurologist, January, 1880.
Valedictory Address to the Graduating Class of the Medical De¬
partment of the University of California . By W. F. McNutt, M.
D., L. R. C. P. Ed., etc., etc., Professor of Principles and Prac¬
tice of Medicine, Medical Department, University of California.
Reprint from the Western Lancet, December, 1879.
A Case of Complete Inversion of the Uterus , with Remarks upon
the Modern Treatment of Chronic Inversion. By Clifton E. Wing,
\
M. D., Boston.
74<>
Meteorological and Mortality Tables. [January
Meteorological Summary — November, 1879.
Station— New Orleans.
a .
cs is
h-H -t->
3 6
tf
c8 fcl
ss
.2 .2 ns
— i 43 d
Date.
ss 5
fl«
Pi
~ a
CZ
Q E-i
~ a
CG P
QS
■s O.p
*r C
'V
<5 a
Q 'c8
Ph
1
30.30
60.0
59.0
North.
.03
2
30.25
63 0
63.0
N. E.
.18
3
30.27
60.7
53.3
N. E.
4
30.30
57.2
54.3
East.
5
30.22
63.5
74.3
East.
.48
6
30.13
67.0
83.0
S. W.
1.33
7
30.06
67.2
78.0
S. E.
8
30.02
72.0
79.7
S. E.
9
30.15
73.2
86.7
S. E.
10
30.14
73.0
91.7
S. E.
.38
11
30.06
74.5
84.7
S. E.
....
12
30.06
76.0
79.7
S. E.
13
30.08
76.0
77.0
S. E.
14
29.95
75.2
82.3
South
.03
15
29.94
77.2
79.7
S. W.
16
30.04
76.279.7
s- E.
17
30.03
76.0
76.7
S. E.
18
30.23
55.5
62.3
North
.33
19
30.28
53.7
47.3
N. W.
20
30.35
52.2
38.7
North
21
30.32
51.5
51.0
N. E.
22
30.27
54.7
56.0
East.
23
30.31
59.2
61.7
S. E.
24
30.30
61.0
66.7
East.
25
30.28
63.5
67.3
S. E.
26
30.20
66.2
74.7
S. E.
....
27
30.06
70.5
87.0
South
....
28
30.07
68.5
76 0
South
103
29
30.34
53.0
41.7
North
30
31
30.35
50.5
54.0
N. E.
Sums
Means
g
I o
1 CO .
64.9
68.9
1 S. E.
3.79
General Items.
Mean Barometer, 30.179.
Highest Barometer, 30.410, on 21st.
Lowest Barometer, 29.897, on 14th in.
Monthly Range of Barometer, 0.513
Highest Temperature, 82°on 13th, 15th.
Lowest Temperature, 38° on 21st.
Monthly Range of Temperature, 44°.
Greatest Daily Range of Temperature,
23° on 18th.
Least Daily Range of Temp. ,9° on 10th
Mean of Maximum Temperatures, 71.1°
Mean of Minimum Temperatures, 57.3°
Mean Daily Range of Temp., 13.8°.
Prevailing Direction of Wind, S. E.
Total Movement of Wind, 5,983 miles.
Highest Velocity of Wind and Direc¬
tion, 25 miles, North on 18th.
Number of Clear Days, 9.
Number of Fair Days, 10
Number of Cloudy days on which no
Rain fell, 4.
Number of Cloudy Days on which
Rain fell, 7. Total number of days
on which rain fell, 11.
COMPARATIVE TEMPERATURE.
1871 .
. 1
1876 ..
.59.2°
1872 .
1877...
.58.3°
1873 .
.61.2°
1878. . .
.60.8C
1874 .
.66.3°
1879...
.64.9°
1875 .
65.6°
1880. . .
COMPARATIVE
PRECIPITATION.
1871 . .inches.
1 1876. .
4.35 inches
1872 .
U
1 1877 .
6.58
u
1873... 5.95
a
j 1878..
7.78
u
1874. .1.12
u
1 1879..
3.79
u
1875.. 6 79
u
| 1880..
u
Mortality in New Orleans from November 23d, 1879, to
December 21st, 1879, inclusive.
Week Ending.
Yellow
Fever.
Malarial
Fever.
Consump
tion.
Small¬
pox.
Pneu¬
monia.
Total
Mortality.
November 30.
0
1
10
0
3
81
December 7
0
2
15
0
12
100
December 14.
0
l
9
0
6
70
December 21.
0
2
9
0
8
111
Total ....
0
6
43
0
29
362
NEW ORLEANS
Medical jlnd Surgical Journal.
FEBRUARY, 1880.
PAGINAL pOyMyVIUNICATIONS.
Pernicious Fever — Its Varieties and Treatment.
By J. P. DAVIDSON, M.D., New Orleans, La.
( Bead before the New Orleans Medical and Surgical Association .)
The term pernicious is used by continental writers to desig¬
nate a form of malarial fever which, in the Western and South¬
ern parts of the United States, receives the appellation of
congestive fever, and malignant intermittent fever. Both of
these latter names are objectionable, as calculated to lead to
erroneous views of the disease — in the one case implying that
the essential pathological condition is congestion, from which
all the other symptoms are derived, and from which all the
danger is to be apprehended ; in the other, that blood-poison¬
ing and serious alterations of the fluids of the body, such as
occur in typhus and other malignant diseases, would account
for the severity of the disease and its fatality.
The term pernicious, while indicating the gravity of the
disease, does not express any specific morbid condition, and is
therefore free from such objection.
In all malarial regions of both hemisphers, under certain
local conditions, and in seasons marked by a general preva¬
lence of malarial fevers ; when the simple and ordinary variety
of intermittent fever abounds, cases of pernicious fever occur,
748
Original Communications.
[February
and at certain epochs the proportion of cases is more or less
large and the fatality of the disease is great, making it one of
the most dangerous diseases which the physican has to combat.
The disease has always been rife in the valley of the Missis¬
sippi river and its tributaries, and along the southern shores
of the Northern lakes.
During the period of the transformation of the forests into
cultivated fields in Louisiana, Mississippi, Arkansas, Alabama,
Tennessee, and other States, pernicious fevers abounded epidem¬
ically, and though the disease is not now so general as formerly,
they still occur frequently enough to render it a formidable va¬
riety of the endemic miasmatic fevers of our country.
While the simple and ordinary intermittent fever is compar¬
atively void of danger, the disease from the mild type in the
second or third paroxysm, often passes into that of pernicious
fever. The physican should therefore always be on his guard
and resort to such measures as will promptly break up the re¬
currence of the paroxysms.
Fortunately, in no disease involving as much danger as per¬
nicious fever is efficient and timely treatment more successful.
The danger involved in the disease, however mild the
incipiency of the intermittent paroxysms, must never be lost
sight of.
Attacks of pernicious fever may take place at any season of
the year ; they occur, however, most frequently in the autum¬
nal months, and in seasons when malarial fevers have abound¬
ed during the spring and summer.
The term pernicious has been limited commonly in our coun¬
try to those forms of miasmatic fevers characterized by very
sudden and great prostration, in which the innervation is ex¬
tremely and dangerously disturbed, but continental writers
have divided pernicious fever into many varieties, dependent
upon the predominant features of organic disturbance in any
case of malarial disease. Alibert and Contancean swell the
list to as many as twenty varieties, embracing in it, intermit¬
tent fevers, the benignity of which is evident, such as “exan-
themic, rheumatic, dysenteric, icteric,” etc., etc., distinctions
1880J
Davidson — Pernicious Fever.
749
not recognized in our country, and to which the term pernicious
is of doubtful application.
In this city the term pernicious is also applied by some of
our physicians of large experience and great reputation, to
yellow fever, occuring among Creole children during an epi¬
demical prevalence of the disease, and to which they assign
the name of a recognized variety of pernicious miasmatic fever,
the haemorrhagic, contending that children born in the city
are not amenable to yellow fever.
The more commonly recognized divisions of this form of
miasmatic fever ; designating symptomatic features of the
disease in different cases, may be thus classed : The algid in¬
termittent, the remittent, the comatose and the haemorrhagic.
To these a fifth has been added, the continued, or typho-mala-
rial, but it is only after the fever has lasted several days that
it can be said with any propriety to be continued, for, if the
patient survive this period of the disease, it will almost cer¬
tainly put on a paroxysmal type.
Most frequently the fever is either intermittent or remittent,
and though often quotidian, its more common type is tertian.
All observers agree, that in the largest proportion of cases*
pernicious fever begins as a mild and common type of inter¬
mittent fever, without the occurrence of any symptoms denot¬
ing special gravity, the cold stage, or chill, not commonly
severe, or marked, and the hot stage being slight, or imper¬
fectly developed. The period of intermission characterized by
customary health, and a return to usual avocations. The
mildness of the paroxysm preceding the invasion of a pernicious
one, tending to mislead both the physician and patient of any
attendant danger in the disease. Hence, the great importance
at all times, but more particularly whenever cases of perni¬
cious fever are known to prevail, of prompt measures to arrest
the paroxysms. A second paroxysm may occur and if not
arrested, the next one presents all the pernicious symptoms
and may be rapidly fatal.
According to my own observation the third paroxysm is the
one in which most commonly, the pernicious phenomena pre¬
sent themselves ; though instances occur of the algid form in
750 Original Communications. [February
which no reaction takes place from the first chill, the patient
dying in that paroxysm.
The first symptoms of the disease are usually chilliness,
cephalalgia, pains in the small of the back and limbs, intense
thirst, flushes of heat, alternating with perspiration, frequent
and irregular pulse, nausea, and often vomiting, with great
jactation. These may be suddenly followed by more alarm¬
ing symptoms denoting great danger.
The face, hands, and feet present a livid appearance, the
eyes sunken, extremities icy cold, respiration hnrried and
irregular. The body covered with a profuse, cold, clammy
sweat ; the hands and fingers wrinkled as if long immersed
in water, the skin about the ears, back of the neck, and the
extremities purplish, from capillary stasis. The mind is com¬
monly clear and undisturbed by delirium, but the patient is
anxious and restless. Vomiting is frequent; every thing
taken on the stomach being rejected ; the matter ejected is
rarely bilious, chiefly mucus, and sometimes consisting of blood,
and a sense of burning heat or heartburn is complained of.
The sense of internal heat is extreme, and the chest and
abdomen will be found to be warm, while the rest of the body
is of icy coldness. The tongue is commonly pale, broad and
flat, the edges indented by the teeth, and coated with a thick
and whitish fur.
In this condition, the stomach will not usually tolerate stim¬
ulants, though from the feeble and oppressed action of the
heart they are indicated ; their administration, in many instan¬
ces, giving rise to increased heart burn and provoking vomit¬
ing. Owing to the perverted nervous condition, heat applied
to the extremities, even the warmth of the hand, is unpleasant
to the patient. The bowels, though sometimes confined, are
almost always frequently moved, the dejections being copious,
exhausting, watery, pinkish, and resembling in odor and color
the washings of putrid meat.
This condition of collapse in pernicious fever closely resem¬
bles that of cholera, and both are probably due to a similar
pathological condition — a lesion of innervation affectiug the
cerebro-spinal axis.
1880]
Davidson — Pernicious Fever.
751
If no effort at reaction succeeds and remedies fail to bring it
about, the respiration becomes slower and sighing, the cerebral
functions give way, the countenance becomes hippocratic, hic¬
cough takes place, and the patient gradually sinks into death.
It more frequently happens, however, that the symptoms of
collapse, after enduring in a more modified degree than as
above described, for several hours, are followed by symptoms
of reaction, the heat of the body becomes gradually restored,
the pulse acquires strength and volume, the vomiting and
purging, if previously existing, abate or entirely disappear ; a
moderately warm perspiration is set up and the patient falls
into a more or less calm sleep. A somewhat marked exacerba¬
tion takes place, but not always proportionate to the preceding
depression of the vital powers.
This intermission, though it may retain no traces of the
former state, in feelings of languor and nervous prostration, is
only illusive, the disease temporarily receding, as it were, to
return in the next paroxysm with redoubled force and with a
fatal termination probably.
It not unfrequently happens, both in the intermittent and
remittent forms of pernicious fever, that a paroxysm will run
its course as in a mild type of malarial fever, but in the last
stage the perspiration becomes very profuse and exhausting,
the fever passing from a mild and ordinary form into a perni¬
cious one.
The anatomical characters presenting themselves in this dis¬
ease are quoted from the work of Dr. F. C. Maillot on intermit¬
tent fevers as observed by him in France, Corsica and Africa
in 1836.
He found the arachnoid opaque aud injected, the blood ves¬
sels of the brain iujected, the substance of the brain increased
in density and the cortical substance of a deep red color, the
ventricals containing a bloody effusion of serum. The pia
mater of both brain and spinal marrow and the substance of
the spinal marrow generally injected, less firm than in the nat¬
ural state, reddish softening to the extent of 8 or 10 lines from
the edge of the last dorsal vertebra.
The mucous membrane of the stomach softeued over its
752 Original Communications. [February
whole extent, with thickening, and bright red or blackish, and
in some instances the membrane pale. A similar condition of
the mucous membrane of the duodenum and jegunutn was
found, the follicles enlarged without redness either recent or of
long standing ; sometimes patches of redness were observed.
The liver was variously affected, beiug either deep red and
the tissue softened like that of the spleen, or enlarged, yellow¬
ish, dry and readily broken, or of enormous size and engorged
with dark blood, or softened to the consistenee of a paste.
The spleen was always enlarged, either firm or reduced to a
pulp (en uue bouillie) the aspect of which resembled chocolate
paste made with water, and in some instances the spleen was
ruptured. The thoracic viscera were generally perfectly
healthy.
The essential cause of pernicious fever, all writers upon it
agree, is unquestionably the same as in all other forms of
miasmatic fever, and its peculiar character has not been deter¬
mined, but is supposed to “ arise from a more intense action of
the miasmatic poison.”
The symptomatic phenomena in pernicious fever are ascribed
“ to the peculiar state of inuervation, disturbing the due per¬
formance of the organic functions, and to which the conges¬
tion of the interior organs is also due, and not to any inflam¬
matory condition, which is incompatible with the periodic
alterations from disease to comparative health, so notable iu
this as in other forms of malarial fever.”
Maillot states that xM. Guerin de Mamers also regards inter¬
mittent as a neurosity of the cerebro-spinal centres, “ says he,
to a lesion of which belongs (se rattachent) the development
and the reproduction of paroxysms, is not a phlegmasia, not
even an irritation in the proper sense of this term, but only an
abnormal excitation (in other words an unestablished and unde¬
cided irritation) of those parts of them (nerve centres) which
control nervous influx.” He continues : “ The analysis of the
symptoms conducts to the same point of view as the pathol¬
ogical anatomy, and we are thus brought to regard, with M.
M. Royer, Guerin de Mamers, and others, intermittent fevers
as an affection of the cerebro- spinal axis. But our opinion
Davidson — Pernicious Fever.
753
1880J
differs from the learned observers, in that we think that this
affection is something else thau a neurosity. Relying on the
pathological anatomy, we believe that it is an irritation which
has the anatomical character of a hyperemia of the nervous
substance and its envelopes.”
He adds further, in treating of the lesions in the algid form
of pernicious fever: u Very certainly, after all the facts that I
have collected, the lesions in the spinal marrow are more
marked (prononc4es) in the algid thau in the other varieties of
pernicious fever ” — summing up his reflections with this state¬
ment — u The active hyperemic irritation of the cerebro spinal
axis, is therefore what constitutes the nature, the essence of
intermittent fevers, whether we study the mild types, or those
which become pernicious by the direct lesion of the nervous
system, or indeed those complicated with thoracic and abdom¬
inal irritations.’7
Diagnosis. — When we consider the great danger involved in
this fever, over the simple and ordinary form of intermittent
fever, a correct diagnosis is of the very utmost importance to
the life of the patient 5 for, there is, perhaps, no disease in¬
volving equal danger to life in which successful treatment is
more marked than in this.
When the disease is fully developed it can scarcely be mis¬
taken, if the physician is on his guard, and realizes the fact
that in all intermittent fevers, or bilious remittent fevers, per¬
nicious symptoms may take place, and yield to treatment, or
terminate with the paroxysm, only to return in the next with
increased intensity, and when not apprehended, and guarded
against promptly, proves fatal.
Mallot propounds this question : “ Can we determine before¬
hand, and from the first paroxysm, whether an intermittent will
become pernicious ?” “ I think not ; frequently the invasion of a
pernicious paroxysm gives no indication that it will prove of
that character. Undoubtedly, one should apprehend a dan¬
gerous course, whenever the visceral irritations are intense,
etc. For myself, I have often seen in the lapse of a day, with¬
out intermediate indications, pernicious paroxysms succeed the
most benign.”
754 Original Communications. [February
We should be very wrong in supposing that pernicious
fevers are ordinarily only fatal until the third or fourth parox¬
ysms. Nevertheless it does occur, that certain indications of
a threatened pernicious character of the disease frequently reveal
themselves in the first paroxism, and should not be misinter¬
preted or disregarded. “ Such as the absence of any sense
of chilliness, or of rigors, with prolonged coolness of the
extremities, unequal distribution of heat, nausea or vomiting,
with frequent, large and liquid stools, great restlessness, a
small, frequent and irregular pulse, with either wakefulness
and slight delirium or undue somnolency.” During the apyr-
exia, the continuance of any of the above symptoms should
awaken the solicitude and apprehension of the physician, and
induce him to interpose promptly such measures as will avert
the danger of a recurring paroxysm.
Treaiment — Galled to see a patient in the first paroxysm ;
the endeavor should be to bring about reaction as speedily as
possible, and to endeavor to counteract the extreme nervous
depression. Formerly, under the pathological view of conges¬
tion, and under the theory of fevers as inculcated by Brussais,
referring them all to a primary gastric irritation, the abstrac¬
tion of blood was practiced both from the arm and by leeches
to the epigastrium and the temples. Bleeding was also resorted
to during the cold stage with a view to a relief of the congested
vessels. This practice, under later pathological views aud the
want of success, has been wholly abandoned, except in cerebral
cases, marked by coma with a full and corded pulse, iu which
cases the abstraction of blood, both generally and topically, may
be resorted to beneficially, and bladders of ice should be
applied to the head.
Emetics have been recommended to arouse the system and
bring on reaction ; but these are of doubtful benefit and may
do harm, if much gastric irritation and tenderness of the epi¬
gastrium exist.
Under the depressed state of the nervous system, with the
frequent vomiting aud purging so commonly present, cathar¬
tics and all other treatment of a debilitating character are con¬
tra-indicated. Dry heat applied to the extremities with fric-
Davidson — Pernicious Fever.
755
1880J
tions of dry mustard, or mustard and red pepper, will be appro¬
priate ; and, if the stomach will bear it, stimulants may be
administered at short intervals until evidence of reaction is
perceived, when they should be discontinued or be given at
longer intervals. My own experience has been that stimulants
as a general rule are not well borne by the stomach, increase
vomitting and are apt to prove injurious when reaction takes
place.
If the purging is frequent, and the stools large and loose,
resort should be had at once to opium in combination with
quinine. Two grains of quinine and half a grain of opium in
pill may be given every hour until the purging is controlled, and
if the stomach will not tolerate the pill an enema of 40 or 60
drops of laudanum with 10 or 15 grains of tannin, mixed in three
or four ounces of thin starch water, may be given ; dry cups
be applied to the epigastrium and a sinapism be applied over
the whole abdomen. Frictions may be made at the same time
with turpentine along the course of the spine.
Paramount to all other remedies, without waiting for the
evidences of reaction, the sulphate of quinia should be at once
administered, and the amount given at a dose should be appor¬
tioned to the gravity of the symptoms j always bearing in mind
that under the perverted nervous condition of the organism,
absorption is slow and much tolerance of the mediciue may be
relied on as a general rule. Twenty grains in pill form, alone
or combined with capsicum, may be given every two or three
hours until its effects on the nervous system are fully estab¬
lished, as indicated by deafness and tinitus aurium. Should the
quinine not be borne by the stomach, it should be given hypo¬
dermically in doses of sufficient size, not less than five grains,
repeated hourly until cinchonism is fully induced.
The hypodermic administration in my own hands has met
with the objection of almost invariably giving rise to swelling
and abcess, notwithstanding every care to effect a perfect solu¬
tion of the crystals, and adopting the formula of Dr. Seguin,
of New York, and of others of large experience in the hypo¬
dermic use of quinia.
2
750 Original Communications. [February
Eeliance may be placed on the administration of the sulphate
of quiuia by enema when the stomach rejects it. The dose
should be as large as the bowel will be likely to tolerate. Sixty
grains, with the addition of 20 or 40 drops of laudanum and
an ounce of brandy may be mixed in four ounces of thin starch
water or other mucilage, and given by enema at once. It is
best to dissolve the quiuia by the addition of a few drops of
acid to faciliate its absorption. The laudanum, in combination
with the quiuia, is appropriate when the tendency to purgiug
exists and favors the retention of the enema.
The contra-indication of the administration of opium to con¬
trol the purgiug, would be any decided cerebral symptoms, in
which case resort may be had to any of the vegetable astrin¬
gents, combined with chalk or bismuth, and either tannin or
the acetate of lead may be combined with the quiuia given by
enema.
Should reaction be established by these measures, and
the paroxysm pass off, as is often the case in the first paro¬
xysms of the disease, care must be taken, during the a pyrexia,
to continue the quiuia in sufficient amount, from 10 to 20
grains, at intervals of three or four hours, so as to keep up
cinchonism and ward off another paroxysm. The extremities
should be kept warm by the application of heat, and warm
drinks be given, aud thus endeavor to keep off chill.
Under treatment of this kind the paroxysms of a pernicious
tendency may be interrupted ; promptness and boldness in the
administration of quiuia being of the very utmost importance,
but without pushing its exhibition to the herculean doses com¬
mended by some physicians, from which it should be borne in
mind permanent kleafness has ensued.
In cases of the algid form of the disease, in which the symp¬
toms of collapse manifest themselves early, I know of
no plan of treatment calculated to meet the exigencies of the
case, equal to the use of the cold douche. Its use has been
strongly urged by many writers, and was practiced at an
early period of the history of the disease iu the Southern
States.
No time is to be lost in relieving the patient of the lesion of
Davidson — Pernicious Fever.
757
1880J
innervation and bringing about reaction. Delay in experi¬
menting with stimulants, sinapisms, frictions, etc., is time
thrown away, and will commonly disappoint the expectations
of the physician. While the depressed condition of the heart’s
action continues, with the serum of the blood exuding through
the paralyzed capillaries of the whole mucous lining of the
bowels, and the copious transudation through the skin, ex.
hausting the patient, and deepening the collapse, calorification is
difficult to restore ; all means, therefore, of arousing the ener.
gies of the nervous system short of the shock produced by
the cold douche, properly administered, will avail but little.
As the best way of illustrating the procedure practiced by
me in such cases, I cite the following case :
Mr. J. N., a planter, of middle age, robust in form, and of
general good health, was attacked in the month of October,
with a tertian intermittent fever, and was attended by Dr. L.,
a physician of standing and long experience in the profession.
The paroxysms were marked by no special indications of any
tendency to a pernicious form, beyond the continuance, during
the periods of intermission, of some degree of restlessness
and nausea.
His physician had applied wet cups to the epigastrium ;
gave the patient calomel and administered quinia in full doses
during the apyrexia.
In the third paroxysm, which took place early in the fore¬
noon, the patient passed suddenly into a collapsed state, and
about 3 o’clock, P. M., I was called to see the patient in con¬
sultation.
I found him in a calm frame of mind, suffering no acute
pain, but complaining of a sense of oppression and stricture
about the chest ; the respiration was frequent with a double
effort at inspiration. He complained of nausea and heartburn,
attended with a feeling of great internal heat, accompanied
with intense thirst. The pulse thread-like, rapid and hardly
percex>tible at the wrist; eyes sunken, voice puerile, skin be¬
dewed with a cold, clammy sweat ; the extremities very cold,
the skin about the ears, back of the neck atid the extremities
of a purplish, livid hue, and the integuments of the hands and
758 Original Communications. [February
fingers wrinkled, as if they had been immersed in water. The
jactatation was very great, and the bowels running off, the
stools being copious and liquid ; the tongue was coated with a
thick white fur, pale and broad. The surface of the chest
and the abdomen was warm. Under the perverted nervous
condition characteristic of this collapsed state, all warmth
applied to the cold surface was unpleasant, and the patient
complained even of the heat of the hand when applied to the
pulse.
Informed by his physician of the almost hopelessness of his
case, he had summoned his pastor, a Presbyterian minister,
who was at his bed side when I entered the room.
I determined to use the cold douche to which Dr. L. con¬
sented, the patient being left in my charge while the doctor
visited his family. It was practiced in this way :
The patient, perfectly nude, was laid supine on a blanket
stretched upon the floor. A large tub of very cold water, pro¬
cured from an abundant and shaded spring was provided, and
standing at his head, I threw a large bucketful of water with
considerable force from his chest downwards. The shock was
severe, but not unpleasant, as he afterwards informed me.
Four bucketfuls in rapid succession were thus applied, and the
patient replaced in bed upon a sheet, and thoroughly rubbed
dry, after which the sheet was removed and blankets placed
over him. An enema, containing 60 grains of quinine, 40 drops
of laudanum, an ounce of brandy, in 4 ounces of thin starch
water, was thrown up the bowels and a compress held to the
person to assist in its retention. Bottles of hot water were
applied to the feet, and the whole surface of the body and ex¬
tremities rubbed briskly with dry mustard. Brandy toddy
was administered in small draughts, but discontinued, as it
gave rise to burning sensation in the stomach and brought on
nausea.
The immediate effect 'of the douche was evinced in dimin¬
ishing the frequency and irregularity of the respiration, allay¬
ing the thirst and jactatation and temporarily raising the pulse,
which could be felt somewhat more distinctly at the wrist.
The enema was passed in about forty minutes with a con-
1880]
Davidson — Pernicious Fever.
759
siderable thin dejection. Shortly afterwards all the restless¬
ness and disquiet returned with the previous interrupted and
hurried respiration.
The douche was again resorted to, the patient himself anx¬
iously calling for it, and desiring that he should receive it in a
prone position. Four more bucketfuls of water were dashed upon
him, and, when replaced in bed, the enema, with 60 grains of
quinia, 60 drops of laudanum and one ounce of brandy, was at
once given and the dry heat to the extremities aud frictions
repeated as before.
The reaction was somewhat more marked after this douche,
the patient expressing decided relief from the sense of internal
heat, the respiration becoming slower and more regular, and
the pulse could be felt distinctly enough to be counted, with
some feeling of returning power. Though .some retching occa¬
sionally took place no vomiting occured, but the patient spat
off quite frequently an white frothy mucus.
At the expiration of two hours, notwithstanding the persist¬
ent use of the frictions, to the extremities, and with turpentine
along the course of the spine, and a cautious repetition of
the brandy toddy, what was gained by the last douche seemed
to be disappearing. It was again repeated and carried to the
same extent and in the same posture. The enema having been
retained, it was deemed best to repeat the quinia in the same
dose and with the adjuvants before named, care being taken to
have it retained. Heat was applied to the extremities and the
frictions were continued. Not long afterwards the patient fell
into a calm sleep which lasted a short time. Reaction steadily
progressed, the pulse developing and the heat of the trunk
gradually extending to the extremities. From this time forth
all the untoward symptoms, little by little, passed away, and
the escape of the patient, from the peril in which he had been
so suddenly plunged, was assured.
The reaction became full and complete, and the patient,
throughout the next day, was able to take appropriate nourish¬
ment and to retain several doses of quinine, 10 grains being-
given at intervals of three and four hours to keep up cinchonism
and prevent another paroxysm. No further medication was
760 Original Communications. [February
needed in the case beyond a dose of oil to move the bowels
some days afterwards.
The cold douche could not be indiscriminately practiced, and
should be restricted to persons of sufficiently robust constitu¬
tion to bear the shock, and whose vital powers had not been
exhausted by long continuance of malarial or other disease.
In a modified form, however, it could be beneficially used
in many cases with whom the douche would be deemed
hazardous, — as by the wet sheet or by cold sponging the whole
surface of the body, rapidly practiced, and followed imme¬
diately by frictions, the administration of stimulants and the
other measures advised.
Following the divisions of pernicious fever before announced,
though “ these diversities are to be regarded as symptomatic
features of the same malarial disease occuring in pernicious
paroxysms” — the comatose form of pernicious fever will be
considered.
Comatose Form — In this form of pernicious fever the parox¬
ysm is ushered in with drowsiness, severe pain in the head,
coldness of the extremities, a somewhat full and resisting pulse,
either preternaturally slow or quickened and often decided
delirium.
As the fever deveJopes, the cerebral disturbance deepens into
profound coma. The respiration is labored, loud and sterte-
rous, like that of apoplexy, and the pupils are dilated. These
symptoms, as in the algid form of the disease, usually present
themselves in he first paroxysm and may prove fatal.
If the paroxysm pursues its course, as soon as the sweating
stage begins, the cerebral phenomena gradually decline, the
brain is relieved of congestion, the patient returns to conscious¬
ness and a more or less distinct remission or intermission takes
place ; the dullness of mind and soporose feelings pass away.
More commonly, however, there remain with the patient traces
of the cerebral oppression from which he has emerged.
Though the comatose symptoms for the most part, manifest
themselves with the invasion of the cold stage of the first parox¬
ysm, I have known them to be delayed until the third parox-
Davidson — Perniciotis Fever.
761
1880J
ysm, following those of a benign character and ushered in
with convulsions.
Maillot cites instances of epileptic convulsions in the parox¬
ysms of this form of pernicious fever.
If the return of a paroxysm is not prevented, the recurrence
is sure to be violent and is generally fatal.
The pathology of this form of pernicious fever, as far as our
knowledge extends, does not differ from that of other forms of
the disease.
The treatment is essentially the same as in pernicious inter¬
mittent fever. Blood, however, may be taken, either generally
or topically, as the full and forcible condition of the pulse may
warrant. The douche or the wet sheet will prove beneficial,
and bladders of crushed ice should be kept to the head while
the blood is invited to the lower extremeties by warm applica¬
tions, synapisms, etc.
As soon as a remission or intermission begins, no time should
be lost in the administration of quinia in the same way as was
recommended in the algid form of intermittent fever.
PERNICIOUS REMITTENT FEVER.
Pernicious remittent fever is to be regarded as differing from
simple remittent fever, or bilious fever, not attended by any
symptoms of a grave character, bringing it under the designa¬
tion of pernicious. The fever presents the same diversities
as characterise pernicious intermittent fever. The remittent
course of the fever, usually distinctly marked, but often only
denoted by the diminished frequency of the pulse and decline
of malaise and suffering, constitutes the essential difference
between the two diseases, as their causation and pathology
are alike, and in their treatment call for the same remedial
measures.
Pernicious remittent fever is, however, attended with more
danger than pernicious intermittent fever, and is of a very
fatal character.
In the limits of this paper it would be impossible to discuss
the varieties of remittent fever of a pernicious type, as they are
described by authors, under names derived from geographical
762 Original Communications. [February
relations and conditions, such as the “ Bengal fever,” the
“ African fever,” “ Walcheren fever,” etc.
The severe forms of remittent fever may be preceded by
premonitory symptoms, such as languor, chilliness, restless¬
ness, pain in the head, back and loins, pains in the
epigastrium, nausea, and slow, small and irregular pulse.
These symptoms are soon followed by a short cold
stage. In other cases the disease is usually ushered in
with a decided chill ; the pulse is small and frequent, nausea
and vomiting occur, the thirst is considerable and great
malaise is complained of. The duration of the chilly seusa.
tions is very variable, often only for a half hour or so, and
frequently prolonged for one or more hours. The chill, how¬
ever, bears no relation to that usually introducing a paroxysm
of intermittent fever. When the febrile stage is fully devel¬
oped, the heat of the skin is pungent, the face is flushed, the
eyes suffused, the head is hot, respiration hurried, and the
pulse increase in fullness and force. The duration of a parox¬
ysm of remittent fever varies very much and is influenced
by the severity of the attack. When the disease is mild, it
may last no longer than six or seven hours, but if it be severe
the paroxysm may last 12, 24, 36, or even as long as 48 hours.
When the above symptoms begin to decline, the skin becomes
moist, increasing gradually uutil a free and full perspiration is
established.
This indicates the period of remission in the fever. The
duration of this stage is variable, depending a good deal on
the type of the fever, whether it be quotidian or tertian. In
most cases of severe remittent fever, the subsidence of a par¬
oxysm may only be indicated by a reduction of the tempera¬
ture, the difference in the frequency of the pulse and the suf¬
fering of the patient, these being less in the morning than
evening.
The above detail of symptoms applies to the milder forms of
remittent fever.
In the more violent attacks of pernicious remittent fever, the
symptoms, as in the algid form of pernicious intermittent
1880J Davidson — Pernicious Fever. 763
fever, may in the initiatory stage assume a decidedly malig¬
nant form and terminate rapidly in dissolution.
In such cases, to use the language of Dr. Dickson, “ the
system seems to sink at once prostrate before the invasion or
exacerbation, which can scarcely be called febrile. Beaction,
to use our technical phrase, does not take place, or very feebly,
if at all. The skin is cold and covered with clammy sweat, as
in the collapse of cholera, ; the pulse is weak and fluttering ;
the stomach is very irritable, with frequent and painful, but
usually ineffectual efforts to vomit ; the countenance is shrunken,
pale and livid ; there is often low, muttering delirium, with
shivering and fainting. In some cases no complaint is made,
a lethargic insensibility seeming to oppress the patient; in
others the most extreme anguish is endured by the miserable
sufferer, who, in his agony utters groans or loud cries. The
vital powers are speedily and irrevocably exhausted by the
recurrence of a few exacerbations, although the remissions in
this class of cases are usually well defined, and full of tran¬
sient relief and hope. The third, fourth or fifth return of the
train of symptoms delineated, for the most part, puts an end
to the distressing scene.”
The phenomena of pernicious remittent fever are in the
opinion of all writers that I have read, “ the result of defective
innervation, depressing the action of the heart, lungs and
capillaries, the blood accumulating in the internal organs,
imperfectly decarbonized, impairing the full and regular per¬
formance of their functions.”
The morbific impression in this variety of the disease, as in
pernicious intermittent fever, is made most probably primarily
upon the nervous centre, and by diminishing its energy, entail¬
ing all the phenomena of so grave a description which charac¬
terize this particular type of fever.
In the progress of the disease, it often happens that when
the nervous system is aroused from its depressed state, reac¬
tion is restored and the symptoms of congestion are removed,
all the characteristics of bilious remittent fever manifest them¬
selves and run their usual course ; or the disease may assume
3
764 Original Communications. [February
the intermittent type, which is always to be hailed as a favor¬
able indication in the disease.
Limiting the term pernicious strictly to those forms of mias¬
matic fever, whether intermittent or remittent in type, which
present “ a sudden prostration and depravation of the nervous
power ; in which innervation is extremely and dangerously
defective or deranged ” — would exclude from discussion, forms
of remittent fever by no means unfrequently observed, in the
progress of which, and after several days duration, typhoid
symptoms present themselves, attended by very profuse per¬
spiration and great prostration, to which the term “ continued
pernicious fever ” has been commonly applied by continental
writers ; and of late years, in this country, to the same variety
of cases the term typho-malarial fever has been given. This
seems now to be generally accepted as an appropriate one.
The pathology of pernicious remittent fevers being consid¬
ered as essentially the same as that of pernicious intermittent
fevers, they call for the same general principles in their treat¬
ment, and it will not therefore be necessary to go over the
same ground.
“ HEMORRHAGIC MALARIAL FEVER.”
This is defined by Dr. Michel, of Alabama, to be u a malig¬
nant malarial fever, following repeated attacks of intermittent,
characterized by intense nausea and vomiting, very rapid and
complete jaundiced condition of the surface, as well as most of
the internal organs of the body, an impacted gall bladder and
haemorrhage from the kidneys.” “ These phenomena present
themselves in an almost uninterrupted link, attended by remis¬
sions and exacerbations.” It is a fever peculiar to the south,
ern part of the United States.
It is treated of by Dr. McDaniel under the term u Icterode
pernicious fever,” by Dr. Osborn under that of malignant
congestive fever.” Dr. Michel could find no record of the dis¬
ease up to 1867, though he says, “ we are told that this disease
has been observed occasionally in past years occurring acci¬
dentally among other malarial fevers.” There can be no doubt
1880] Davidson — Pernicious Fever. 765
that cases of this disease have been met with in all malarial
regions, occurring in persons whose health was broken down
by long standing malarial fever ; but it is only recently that
the disease has prevailed epidemically in Alabama, and some
other Southern States.
Dr. J. C. Faget, of this city, in his published “ Mdmoires et
Lettres sur la Fievre Jaune, et la Fievre Paludeenne,” devotes a
considerable portion of the work to a description of haemor¬
rhagic malarial fever (fievre paludeenne hemorrhagique), as
observed by him in New Orleans. He uses this language,
after describing the well recognized u engorgement and con¬
gestion ” of the spleen which takes place always in miasmatic
fevers. “ The American physicians have very well seized upon
this congestive character of malarial poisoning. They call
pernicious fevers commonly (d’uue maniere generate) conges¬
tive fever, and the severe (graves) bilious remittents, so com¬
mon during summer in the United States, they designate as
congestive bilious fevers. Moreover, in latitudes not only
warm but humid, it is not exclusively upon the spleen and
liver that malarial engorgements and congestions take place,
after an afflux of blood to the vessels of the mucous mem¬
branes, but it also occurs in a very particular manner in the
general glandular structure, or rather follicular structure of
the mucous membranes, and particularly of the gastrointes¬
tinal.”
u Hence has arisen,” he continues, u an interesting species
of a malarial order (genre) to add to those of a bilious class —
those of a mucous fever (fievres muqueuses), which in hot and
moist regions are accompanied very often, like bilious fevers,
by ksemorrhages of all kinds, with a tendency to a continued
febrile form, which has rendered their being confounded with
yellow fever as prone as that of billious malarial fever with the
same yellow fever.”
Ought we to regard these two definitions as belonging to
the same type of malarial fever ? —
I do not myself regard them either in their symptomatology
or their pathology as the same disease. Dr. Faget asserts that
in the u Fievre paludieenne hemorrhagique,” described by him,
766
Original Communications.
[February
black vomit frequently occurs, and be regards tbe fever attack¬
ing Creole children in New Orleans, during seasons of epidemic
yellow fever as a haemorrhagic malarial fever; Creole children,
in his opinion, enjoying an immunity from the disease. Drs.
Michel, Barnes, Osborn and Weatherby describe haemorrhagic
malarial fever as having haematuria, the prominent morbid
phenomenon, with a characteristic “yellow color,” and no
haemorrhage from the stomach taking place. On this head their
language is very precise and emphatic. “ The matters ejected
from the stomach have been carefully examined, not only
chemically but by aid of the microscope, and no matter what
shade of color they present, whether they be as Dr. Barnes
has described, of a black tarry character, or as Dr. Ghent has
recorded of a red, sometimes green, and in one case blue color ;
or as Dr. Osborn has mentioned, one of his patients vomiting
a greenish fluid and having greenish expectoration, it is no¬
thing more than bile with the muriatic acid of the stomach .”
Dr. Barnes continues :
“ Here we see no dark granular substance with coffee grounds
sediment, no terrible acid accumulations trning litmus paper
promptly red, although some traces of muriatic acid are pres¬
ent. No amorphous granules swimming through the liquid,
no dense opaque mass tinged darkly with hematin, no shreds
or beds of mucus containing epithelial scales, granules and
broken blood disks ; no inspissated, viscid form of mucus, char¬
acterizing what Dr. Middleton Michel has so forcibly por¬
trayed as the marked feature of the “ black vomit ” of yellow
fever. No ; we find biliverdiu, cholesterin, and all tbe elements
of bile, and by the addition of an acid we may readily convert
these ejecta into almost every color of the rainbow, green, red
violet or brown. No ; we have no blood here, no trace of a
haemorrhage from the stomach ; and I would like to disabuse
the public mind from any supposition which would create the
belief that the vomit in this disease resembles the black vomit
of yellow fever in the remotest possible manner. The patient
vomits dark , grumous bile.”
In a recent work by Dr. Berenger-Ferand — “ de la Fievre
Bileuse Melanurique,” — as observed by him in Senegambia and
Davidson — Pernicious Fever.
767
1880J
Chochin China, he describes a variety of miasmatic fever very
closely resembling, if it is not identical with the haemorrhagic
malarial fever of Dr. Michel, and the work is here briefly
referred to, as he very distinctly and positively opposes any
confounding of the two diseases “ melanuric bilious fever ”
and yellow fever.
The names under which the affection described by Berenger-
Ferand, has been variously designated are, “ Fievre bilieuse
grave; Fievre bilieuse liematurique ;” “Fievre Ictero-hemor-
rhagique ;” “ Fievre pernicieuse Icterique ;” “ Acces jaune ;”
“ Fievre remittente bilieuse ;” “ Fievre jaune des Creoles et
des acclimates.”
All writers on haemorrhagic fever regard malaria as the
exclusive cause of the affection. Dr. Barnes describes it as
“ an assemblage of symptoms, — apparently the result of an
impression on the nerve centres, and that impression a pecu¬
liar form of what occurs in a paroxysm of intermittent. It
is always preceded by common chills, or paroxysm of inter¬
mittent, but finally the patient is seized with one during which
the chilly sensation experienced is much more protracted.
From the moment the chill is ushered in, a bloody urine is
discharged from the bladder, and if a blister is applied, bloody
serum collects under the raised cuticle. A very small blood
letting causes syncope, and the blood appears broken down
and dissolved. The patient becomes rapidly jaundiced; he
vomits and purges a great quantity of black, tarry -looking
substance, which when smeared on a sheet leaves a green
stain. If he live long enough, the blistered surface instead of
discharging bloody serum, will discharge green matter, which
colors a poultice like green paint. The sufferings of the patient
are terrible as long as he retains his reason, and finally deli¬
rium, coma and convulsions close the scene.”
“ The most prominent symptoms are the “ yellow color ” and
the hsematuria. The nausea and vomiting is remarkably severe
and persistent. It begins with the chill and ends when the
patient has succumbed to the fell destroyer, or has passed into
convalescence.
768 Original Communications. [February
The haemorrhage tendency is demonstrated occasionally from
other surfaces besides the urinary organs. The tongue is
spoken of by Dr. Osborn as bluish, thick, coated over the
middle with a dirty fur, leaving clean margins and deeply
crimped edges. The condition of the brain in this disease is
variable. As a general rule, the mind is quiet and clear up to
the period of death. Most frequently the bowels are torpid.
The temperature as a general rule does not vary much. Dr. Sholl
says, “We have a temperature varying from 98° to 105°, the
last the highest I have ever found it, falling rapidly 4° to 5°.
The skin sometimes cool.”
“ We find all forms of intermittent fever, quotidian, tertian
and quartan, as well as remittent fever, terminating in this dis¬
ease ; and according to Dr. Ghent one attack predisposes to
another.”
“ The disease is epidemic in certain localities, particularly in
the prairie country of Alabama, occurring in the fall or early
winter, though we hear of cases in almost every month of the
year.” Duration of the disease is variable, from 4 to 12 days.
Dr. Ghent reports a case which terminated fatally within 12
hours.
Diagnosis. — “Diagnosticated readily from bilious , remittent
and intermittent fever by bleeding from the kidneys and the
uncontrollable and unceasing nausea and vomiting.”
From Yellow Fever. — “ By not being continued in type. By
not attacking those who are subject to that disease ; and by
appearing in localities almost unknown to that milder affection.
By the urine being not only bloody but full of bile, and by the
yellow color of the skin, being produced by the deposition of
bile instead of blood under the skin ; and lastly, by the
absence of microscopical black vomit, and many other features
easily recognizable as characteristic of yellow fever.”
From Hepatliic Affections and Especially Jaundice. — By the
initial chill and the sudden change of color in the skin, which
is bronzed instead of saffron yellow, and by its fatality, which
is unknown in jaundice, as well as the liaematuric feature, which
is conspicuous and intermittent.
1880J
Davidson — Pernicious Fever.
769
Prognosis. — The prognosis is very unfavorable. I regard
haemorrhagic malarial fever as the most fatal of all the dis¬
eases which have come under my notice.
I have lost one-half of my cases. The testimony of Dr. Os¬
born and others are to the same effect.
Modes of Death. — The most common mode of death in haem¬
orrhagic malarial fever, is by a gradual exhaustion of the pow¬
ers of life. Sometimes by uraemic poisoning, and in these
cases the mode of death is either by profound stupor or uraemic
intoxication with delirium, coma and convulsions.
Pathology. — On opening the calvarium, the dura mater was
yellow ; brain perfectly natural, but firmer than generally met
with j very little vascularity ; veins almost empty.
Chest. — Yellow color pervading all the tissues, even the peri¬
cardium and the fatty zone around the base of the heart, which
was healthy. The usual quantity of serum in the pericardium
was of a deep bronzed color. Lungs perfectly healthy.
Abdominal Cavity. — Omentum normal but of the yellow
color. Stomach filled with grumous bile. Mucous membrane
thickened and vascular. The intestines normal ; pancreas of
its usual length and bright yellow.
The spleen was almost three times its normal size and instead
of being friable, it was firm and of a solid consistency, occu¬
pying not only its usual resting place, but encroaching upon
the lumbar region aud taking up about half that space.
Weight 19£ ounces, instead of 7 ounces its usual weight.
The kidneys were much enlarged, the normal weight of the
kidneys being 4£ to 6 ounces, while this kidney weighed 10£
ounces. The kidneys presented a most peculiar appearance.
The dense fibro-areolar tissue could be easily peeled off, leaving
the organ smooth and of a pale reddish color, demonstrating
the fact that the organ had passed through no severe inflamma¬
tory action. A transverse section revealed the cortical aud me¬
dullary substance of a dark green color. The supra renal
capsules were perfectly normal.
The blood in the vessels, and the blood in the urine have not,
under the microscope, the remotest resemblance to that fluid,
as presented in a yellow fever patient.
770 Original Communications. [February
Treatment. — All writers on this disease agree, however much
their opinions may differ in other respects, that for success they
must rely upon the administration of calomel and quinine.
The administration of quinine should be governed by the
same therapeutical indications as in pernicious fever.
For the relief of the bloody discharges from the bladder,
astringents, Tannin, Gallic acid, acetate of lead and opium,
Krameria, and the mineral acids are recommended.
Dr. Osborn abandoned the use of astringents as tending to
induce suppression of urine after the haemorrhage was stopped,
and substituted spirits of nitre in half-ounce doses, every three
hours, nitrate of potassa, three grains in a gill of melon-seed
tea, or infusion of buchu, three or four times a day ; also the
acetate of potassa.
Dr. F. 0. Falls, of Selma, Ala., regards hyposulphite of soda,
as the sheet anchor in this disease.
The use of blisters to control the nausea and vomitting is
condemned as never availing to that end, and are hurtful as
producing strangury.
Some physicians advocate the use of opiates, u even large
doses of morphine.” Osborne and Sholl condemn them as
11 positively hurtful.” The latter says : “ Avoid all opiates
unless there is diarrhoea.”
The tincture of iron, mineral acids, elixir of vitriol, decoction
of bark, comp, tinct. Gentian, are recommended as preferable
tonics during convalescence.
Dr. Michel concludes his treatise in the following words : “ It
will be observed from what we have said of Haemorrhagic Mala¬
rial fever, that little has been seen as yet that could be con¬
sidered of benefit in the treatment of this disease. What then
is left us to do ? Reason points to its prevention ; and thank
God who giveth us the victory, something can be done in that
direction. Cure, by the administration of proper doses of quinine
your intermittent fevers , and you stop, and stop forever , this horri¬
ble disease.
1880]
Miles — The Negro Thomas.
771
The Negro Thomas— His Control Over Muscular Move'
ments — The Tricks he Performs.
BY A. B. MILES, M.D..
Demonstrator of Anatomy, University of Louisiana.
Messrs. Editors : By your request, I write an account of
my examination of Thomas, the phenomenal negro, who has
recently visited this city. He is a negro, nearly black, below
medium height, weighing 103 pounds, rather unattractive in
appearance, a limber limbed fellow, with a dwadling gait,
but of fine muscular development, and certainly without a
rival in his art. He has traveled as a showman in this country
and abroad and exhibited himself to the people and to the
profession as an object of curious interest. Prof. Michel, of
Charleston, iu the Boston Medical and Surgical Journal, Octo¬
ber, 1878, lias contributed an interesting article to enhance
this negro’s reputation.
He certainly has the power of controlling to a remarkable
extent the movements of the respiratory and abdominal mus¬
cles ; besides, he can restrain the action of his heart in a new
way. These acknowledged accomplishments he aitfully
turns to profitable account iu the practice of his deceptions.
I. — CONTROL OYER MUSCULAR MOVEMENTS.
When observed unaware, his respiration is about twenty-
four per minute, pulse eighty-six, the respiratory movements
normal. During his performance, he restrains costal respira¬
tion and breathes with the abdominal muscles. The tape
measure shows no expansion of the chest walls, and evidently
the intercostals are controlled in their action. The end of the
finger iu the intercostal spaces feels the muscles relaxed, then,
at will, made rigid in contraction.
The intercostals and abdominal muscles, like many other
voluntary muscles in the body, receiving their nervous im¬
pulses at the same instant, habitually contract together in a
common purpose. Exercise may overcome the co-ordinate
movements of various other groups of muscles. For example,
4
772
Original Communications.
[February
the sui>erficial and deep flexors of the fingers habitually act
together; but many persons have learned to contract one
without the other. So this negro, by constant practice, has
simply acquired the power of restraining one set of respiratory
muscles while he contracts the other.
He has even greater control over the muscles of his abdomen.
It was discovered that he could restrain those of the abdominal
walls, so that their movements were scarcely perceptible by
measurement, while he carried on thoracic respiration. Fur¬
thermore, he has the power of contracting some of the abdomi¬
nal muscles, while he relaxes the rest; of contracting one part
of the same muscle — the rectus — while the other portion is
relaxed.
He can throw the abdominal muscles in a wave-like motion,
the contraction wave traveling for awhile from above down¬
wards, then reversed, and made to roll from below upward.
This movement is accomplished, for the most part, by the
action of the recti muscles, the several sections of which are
separately and successively thrown into rigid contraction.
What may we not expect from such educated muscles ? His
most extraordinary feat consists in formiug his muscles over
the inguinal region in the shape of a tumor, and by rythmical
muscular contraction, imparting to it a pulsatile movement,
which makes the tumor resemble the action of the heart. This
movement is accomplished, for the most part, by the external
oblique muscle, the fleshy part of which is distinctly seen in
rythmical action. All this is done under muscular tension,
which lasts scarcely a quarter of a minute.
The musician’s skill in controlling the muscles of the forearm
and hand is more marvelous ; so also is the power of the bal¬
let-dancer to keep time with the music. We only wonder at
the training of the negro’s muscles, because of the oddity of the
art in which he employs them. The comedian plays on the
muscles of his face for the amusement of his audience ; the
negro plays on the muscles of his abdomen.
This negro also has the power of restraining his heart’s action,
so that the sounds are scarcely audible. He does this in forci¬
ble, prolonged expiration, for he takes a full breath immediately
1880J
Miles — The Negro Thomas.
773
after. Thus, the pulmonary circulation is clogged, and the
right heart is distended on one side, while, on the other, the
left has lost its usual stimulus. Then, the heart sounds are
feeble at best. Furthermore, the act is accomplished under
great muscular effort, by which the anterior wall of the chest
is markedly depressed. By the elevation of the diaphragm and
the depression of the chest, the heart recedes in the cavity of
the thorax. So, the heart sounds are heard at a dis¬
tance. The sounds, then, feeble at best, and heard at
a distance, are the more indistinct, as they are con¬
fused with the sounds of muscular contraction. The heart is
greatly restrained, but in such a short time, not entirely
arrested in its action. While the heart is only partially re¬
strained, he is in the habit, at the same time, of completely
checking his radial pulse. This is, of course, easily done by
such a muscular man. He holds his forearms prone, contracts
his muscles strougly and draws the bicipital fascia tightly
across the brachial artery.
Many persons have learned to control the heart’s action by
forcible and prolonged inspiration. In Vol. XVI, 1859, of the
Xew Orleans Medical and Surgical Journal, I find
reported by Prof. Chailff), tbe case of M. Groux, who visited
this city about twenty years ago, aud exhibited this power of
controlling the heart under great exertion, and after a full,
forcible inspiration. Prof. Chaille himself, has the same
power over his heart, which time and again, in my day, I saw
him illustrate before the medical class of the University, and ex¬
plain as the simple result of mechanical pressure of the heart by
the forcibly expanded lungs. From the position of the heart,
as it rests on the central tendon of the diaphragm, embraced be¬
tween the concave surfaces of the lungs and overlapped by
their anterior borders, it is well known how inspiration modi-
ifies and expiration facilitates its action. With a little prac¬
tice, I am sure, most persons could acquire a certain control
over the heart’s action.
Again, some persons can suspend the heart’s action under a
prolonged cessation of respiration, without any undue muscu¬
lar effort. Physiology explains how unaerated blood is-
774
Original Communications.
[February
retarded in its flow through the systemic capillaries. The
arteries are in consequence unduly distended, the blood is
dammed back and fills the left heart to its utmost capacity.
The muscular fibres of the heart are for the time paralyzed
from over distension, and the organ lies powerless, as in
asphyxia. This process of arresting the heart requires some
minutes for its completion, and, of course, is attended with
great danger. We are told that the great Hunter could volun¬
tarily suspend respiration, and, in this way, control his heart
until its action almost ceased. Colonel Townshend, whose case
is familiar to your readers, recorded in our text-books aud
accepted by many physiologists, on one occasion, in the pres¬
ence of three medical gentlemen, suspended respiration and
the action of his heart, and held these functions in abeyance
for half an hour.
Mr. Braid, in his Observations on Trance, or Human Hiber¬
nation, gives an account of those startling statements of British
officers in regard to the performances of the Indian Fakeers.
Some of them, it is said, can voluntarily suspend respiration
and the heart’s action, bring themselves into a condition resem¬
bling profound collapse, and remain in this state for ten days
and even six weeks ! It is furthermore said that some of those
people have been buried in underground cells lined with ma¬
sonry and covered with slabs of stone, remained interred for
three days, ten days and longer, aud then been restored to per¬
fect health ! ! These incredible accounts are most likely based
upon the fact that it is a common accomplishment among those
people to be able to suspend for awhile respiration and the ac¬
tion of the heart.
So, there are three ways of controlling the heart’s action,
and for an illustration of one of these we are indebted to
Thomas, the hero of our story.
The power he has over the movements of the intercostal and
abdominal muscles and the action of his heart he employs in
the practice of some very ingenious deceptions.
II.— THE TRICKS THE NEGRO PERFORMS.
He claims to have no pericardium — no diaphragm, and all
his tricks are performed to verify this assumption.
1880J
Miles — The Negro Thomas.
775
Act 1st. — He exposes the front of the abdomen and
chest, restrains thoracic respiration, and makes the abdom¬
inal muscles rise and fall in a forced respiration to convey the
idea (in one sense correct), that upon these he depends for his
living. This performance itself would demonstrate the action
of a perfect diaphragm. If it were wanting, or even imperfect,
the more imperative would be the necessity of costal respiration.
Act 2d. — He claims to have a li false sternum” within,
which, for convenience sake, he carries in the upper part of the
common cavity, just behind the true sternum. This is brought
down by the rolling motion of the abdomen and shown below
in the rigidly contracted recti muscles. Only a stupid audience
would fail to appreciate the farce in the second act.
Act 3d. — This is the specialty which has brought him re¬
nown. By the same rolling motion of the front of the abdomen
he pretends to throw his heart first in one inguinal region, then
in the other, and make it pulsate there perceptibly and audibly.
As before described, a tumor is formed in the inguinal region
by the transversalis, internal and external oblique, and by the ♦
rythmical contraction of these muscles, mainly the external
oblique, a pulsatile movement is imparted to it.
A sound is, iudeed, heard over the region of this tumor ; but
it does not resemble in character the heart sound. It is simply
the result of muscular contraction, and is diffused over the
front of the abdomen.
At first, while the heart is supposed to be pulsating below,
the radial pulse is good, only a little hurried. Now, every
energy is concentrated in his master feat. To carry out the
pretence of having his heart in the lower abdomen, he sup¬
presses the normal sounds, as above described, so that an ex¬
amination, if made too hurriedly, fails to detect them. As be¬
fore mentioned, whenever he restrains his heart, he is in the
habit of completely checking his pulse ; and here he commits
the indiscretion of checking his radial pulse, while the heart is
strongly beating in the iliac region. However, with the excep¬
tion of a few blunders* it must be acknowledged, that, with all
his other accomplishments, the fellow is a very clever trickster.
At the conclusion of bis performance, he appears in citizen’s
776
Original Communications.
[February
dress aud carrying a walking cane, which is made of a three-
quarter inch bar of iron. This is first bent by striking violent
blows over the muscles of the forearm, then straightened in the
same way.
Failing in Thomas, it will, perhaps, be of interest to your
readers to recall from the old records of anatomy some of those
singular cases of congenital malformation of the diaphragm.
Reptiles and fishes have no diaphragm ; and in the very young
foetus, before the development of this muscle, the thorax and
abdomen form a common cavity. If its development be arrested
at this age, the diaphragm may be entirely wanting. A case
of the kind is recorded, in which the subject reached the age of
seven years, aud with the exception of a cough, is said to have
suffered no inconvenience from the deformity. The dissection
was made by Diemorbroeck, and the case is accepted upon his
authority.
The diaphragm develops from the circumference to the center.
An arrest in its development may result in a deficiency at or
near its center. Such malformations are not uncommon ; and
I find three cases of the kind recorded, in which, post mortem,
the heart lay in the cavity of the abdomen. Mr. Wilson (Phil.
Trans., 1798) has reported a case, in which the heart rested in
a tissue on the convex surface of the liver — the child lived seven
days. Ramel (Journal de Medicine, Chir. et Pharm., vol.
XLTX) found the heart in a little girl, ten years of age, situ¬
ated in the epigastric region. She suffered of frequent palpi¬
tations. Iu the remarkable case, dissected and recorded by
Deschamps (Journal General de Medicine, vol. XXVI), the
heart occupied the place of the left kidney, which was wanting.
The subject was an old soldier, who had seen service and en¬
joyed good health, with the exception of some suffering of
nephritic pains. The vessels connected with the heart passed
through the opeuing in the diaphragm into the chest.
Observe in the cases reported the symptoms referable to the
misplaced heart. The little girl, with her heart in the epigas¬
trium, had frequent palpitations ; the old soldier, whose heart
rested iu the region of the kidney, suffered of severe nephritic
pains. Again, observe that in one of the cases, the upper sur-
Miles — The Negro Thomas.
777
1880J
face of the liver was fissured, in another the left kidney was
wanting, all giving evidence that the heart habitually remained
with the abdominal organs.
Now, the negro’s heart, is a little enlarged and hurried in its
action ; but this condition is not uncommon among those who
live on their muscle. Again, he carries his heart in the right
place, only dislodging it, as he says, upon occasions.
Cases of cleft diaphragm are always attended with a protru¬
sion of some of the abdominal viscera into the thorax. It is
commonly observed in wounds of this muscle, how often a dia¬
phragmatic hernia follows, even though the opening be small.
In rupture of the diaphragm, during violent muscular exertion,
sudden death has usually followed, caused no doubt by the
entrance of the abdominal organs, arresting almost immedi¬
ately the action of the lungs and heart.
The negro can not even have a u hare-lip diaphragm,” for there
is no evidence of the viscera of the abdomen ever invading the
thorax. If only the heart crosses the border line, exactly how,
is as yet unexplained. Since it rests behind the chest wall, no
rolling motion of the abdominal wall could roll it down, even
if the diaphragm were wanting ; and a gubernaculum cordis,
of such elasticity, is not known in our anatomy,
It has been suggested by many that the diaphragm in this
case is developed proportionately with the other muscles, and
is, therefore, capable of descending deeply in a forced inspira¬
tion 5 that the heart is pulled after it, and, in this way, made to
pulsate in the lower abdomen. Haller says he once saw a case,
in which the diaphragm, in forcible inspiration, presented a
convex surface to the abdomen. The statement is scarcely
credible. If the diaphragm in the negro were capable of
such an action, imagine the enormous extent to which
the blood vessels, especially the superior cava and pulmonary
vessels, would be stretched. Blood vessels may yield consid¬
erably if the stretching be gradual. I once found the left
kidney resting in the pelvic cavity, to the left of the rectum,
and supported by the levator ani muscle, the renal artery
arising and the vein emptying at the usual points. The organ
was small and deformed in shape. If vessels so far from the
778
Original Communications.
[February
heart can undergo such an amount of stretching, it is not im¬
possible that those near the heart, where there is so much
elastic tissue in their coats, should yield more. Deschamp’s
case verifies this possibility of a gradual stretching. It is too
much to ask us to believe that the negro’s vessels are suddenly
stretched to such an extent, and as suddenly restored to a
normal condition. It may be imagined that the vessels near
the heart are relaxed and redundant to admit of the sudden
dislocation of the organ. If this were so, the heart, which is
naturally suspended by its vessels, would easily topple out of
place, and disturbance in the circulation would be inevitable.
But the negro’s heart remains in position, although a little
enlarged, and the circulation goes on well.
The upper organs of the abdomen are attached to the
diaphragm and by it mainly held in position. If this muscle
in the negro were capable of such latitude of motion, these
organs, especially the liver, so frequently dislodged, would be
unstable in their position. The negro’s organs remain in
proper place.
Even the left inguinal region is low down for a reversed
diaphragm to admit the heart ; but when the darkey pretends
to put his heart in the right ! iliac region, as well as the left,
he explodes the reversed diaphragm theory. If there were no
other obstacle, the liver would occupy the place where he
claims to put his heart.
At last, after giving him the benefit of every possibility in
anatomy, his tricks are reduced to absurdities. He is only
indebted to nature for a complete set of organs like others
have ; the rest he has done himself, and, by constant practice,
acquired an art all his own.
Menorrhagia Treated by Plugging the Uterus.
By W. P. BREWER, M.D.
Read before the New Orleans Medical and Surgical Association in 1874.
I mention this case to show the advantage of local applica¬
tions to internal surface of the uterus when general treatment
fails to arrest the haemorrhage.
1880J Bickham — A Case of Puerperal Mania.
779
A. T., female, aged about 38 years; habit scrofulous; has
had four living children and several miscarriages. The uterus
was large, heavy aud indurated. Internal mucous membrane
granular and bleeding easily. At time of periods the loss of
blood was great. In the interum there was some loss, but not
constant, or in as great abundance as at the period. This loss
of blood which had been going on for a length of time had
seriously impaired her general health, aud esp daily did the
nervous system suffer. After trying the tampon tents, and all
the astringents I could think, read or hear of, and failing to
relieve my patient, but finding her about to giv up the ghost,
concluded to try plugging the uterus as a dernier resort. I
made several pledgits of cotton dipped in a solution of ferri
sesquichl and attached to silk thread for purpose of with¬
drawal. Using speculum and sound, I carefully introduced my
pledgits into uterus and allowed them to remain 24 hours,
withdrew and repeated until haemorrhage ceased. The iron
prevented unpleasant consequences from decomposition. I
was compelled to pursue this treatment for a fortnight, at the
same time sustaining my patient’s strength by food and tonics.
At the next return of the menstrual period, the discharge was
nearly normal, and at the one following it was normal with
general health much improved. I think this treatment origin¬
ated with Dr. Benuet.
A Case of Puerperal Mania.
By C. J. BICKHAM, M. I)., New Orleans, La.
( Read befoi'e the New Orleans Medical and Surgical Associative :n December, 1879.)
Mrs. N. was confined on November 8th, 1879, giving birth to
a fine healthy female child, which was her third. Her previous
health had been only moderately good, not so good, as during
the carrying of her two previous children. She was more anae¬
mic than usual and thinner in flesh. There was no difficulty
in this confinement. The child was born quickly, the placenta
and membranes came promptly and cleanly, and all did well.
4
780 Original Communications. [February
For two (lays the locliial discharge was free, and everything
went well, until on the third morning, just forty-eight hours
after delivery, when she had a chill followed by high fever,
apparently without any reason whatever. She had taken no
cold, nor had anything occurred to produce such a state as far
as could be seen.
The fever was high, the temperature ranging from 103i° to
104£° for nearly six days, with a pulse from 90 to 120 a minute,
and with almost all the time a freely perspirable skin. The
lochial discharge, as such, ceased almost entirely as soon as
the chill occurred, and what little there was was almost color¬
less and slightly offensive. There was no enlargement of the
womb, no meteorism, no tenderness, no pressure, or very little,
and no sign of inflammation anywhere, nor delirium.
For this fever, viewed as the effect of septicaemia, appro¬
priate febrifuge means were used, the patient was sustained,
and carefully applied local detergents, and disinfectants w ere
instituted. About the fifth day of the fever, the lochial dis¬
charge proper, that is, a bloody discharge, returned freely, and
the fever subsided by the end of the sixth day, when she
seemed much improved, and began to nourish well. From this
time the patient in every way appeared to be doing well.
She nourished well, the excretions were regular and good,
and she seemed fairly convalescing, until, on the fourth day
after the fever subsided, the thirteenth from her confinement,
it was observed she appeared to be unusually talkative and
happy. She was in a good humor with herself and all around
her; was very communicative, her former marked reserve was
in a manner laid aside ; at night she did not sleep quite so
well, and observed in the morning that her mind had been very
active, running on . many things, as, for example, how she
would make the clothes for her children, etc., and was worried
by many things. It was curious and interesting to observe
and hear her in this peculiar exalted ecstatic mental state.
She was highly educated and accomplished, and possessing
naturally an active and sprightly mind, it was very entertaining
often to sit and listen to her talk. She was perfectly coherent,
expressed herself fluently and well, but would talk incessantly
1880] Bickham — A Case of Puerperal Mania. 781
and pass rapidly from one subject to another. This increased,
until, by the expiration of the second week of the confinement,
and the fifth day of the observation of her unusual loquacity,
she imagined she had died, and her death and funeral were
announced in the papers, but they would not let her read it.
Later at times, she imagined many strange and unreal things,
as, that she was half horse and half woman, or, that she was a
pig or some other animal, and that they were continually stuff¬
ing her with food.
She was withal quite hysterical at times, and would sob and
cry, especially if her whim, whatever it might be, was not
gratified at once, then she would talk rapidly for a few mo¬
ments, and becoming exhausted soon, she would recognize and
remark it herself, and stop a moment to rest, and then proceed
again. I viewed it that the chill and fever were the result of
septiciemia from the womb, and that this loquacious, nervous
state, was the effect of anaemia, combined probably with more
or less taexornia still remaining, and that time, good nourish¬
ment, stimulants, quiet and good sleep, would avail in reliev¬
ing her, and so expressed myself, but the case being tedious
and observing the family were anxious, 1 suggested counsel,
and Dr. D. C. Holliday was called, who viewed it as entirely a
no n-intla minatory condition of the brain and its membranes,
and that she was in this state from not only impoverished
blood, but iu all probability septicmmic blood as well ; this
abnormally exalted state of the brain and general nervous sys¬
tem being another phase of, and the result, in part at least, of
the primary cause of the fever.
He urged good nourishment and plenty of it, iron, and
soothing agents to produce quiet and sleep, and after a few
days he suggested phosphorus combined with the iron.
Fortunately she ate freely, relished and digested it, and be¬
sides generous food of beefsteak, eggs, milk, soup, etc , she
took during the twenty-four hours some eight or ten ounces of
good brandy in the form of milk punch. This had a soothing
rather than an exciting effect. To procure reasonable quiet
during the day, solution of valerionate of ammonia and assa-
fcetidai were given, and to insure sufficient sleep at night thirty
782 Original Communications. [February
grains of bromide of potassium combined with twenty grains
of hydrate of chloral were given, and repeated if necessary.
This acted very happily.
Opiates were avoided on account of idiosyncrasy, obstruct¬
ing the excretions, and as being calculated to impair appetite
and digestion, t he sheet-anchors in this case.
On this course she steadily improved, and now, five weeks
after the birth of the child, she is almost perfectly well ; the
secretion of milk, which had been almost stopped, having re¬
turned, and all the functions of the body having resumed their
wonted action.
I would also observe that she never at any time during this
state of mental aberration and exaltation had any undue heat
of head or body, but her pulse at the most excited time was
132 to 138 per minute, accelerated of course, by mental or physi¬
cal exertion. There was no defined cause in this case from in¬
heritance. The cause must have been a poisoned and anminic
state of the blood.
\
A possible factor in the production of this state ot the func¬
tion of the brain and nervous system in this case, suggested by
Dr. Holliday, might have been a slight fissure detected in the
external uterine os, thereby inducing reflex irritability.
Authors do attribute puerperal mania to such causes. -But,
what is the explanation in this case?
Inherited influence, shock, anaemia, uterine irritation and
inflammation, are the chief causes assigned by authors and
observers, but we see many cases much more anaemic escape
it. It is not common following puerperal fever, and we have
thousands of cases of great shock, and various forms of
uterine disturbance without it. In my own practice, now
extending over a space of 25 years, or nearly so, I have never
met with a case before, and this would naturally lead one to
cast about, and ask not only for its exact causes, but its
frequency in different localities. What are the statistics in
various States and countries on the subject ? What influence
has climate m its production? What influence has edu¬
cation, or kinds of education, or no education at all in
its production ? What influence has peculiarity of nervous con-
Correspondence.
783
1880]
stitution ? Does a callous uneducated person often have it, as
compared to those of high and tine nervous organization well
educated! Is it not more frequent in persons of active,
refined and sensitive natures ? whose thoughts and imagina¬
tions are active ?
I am much inclined to thinks so. These and other kindred
questions are pertinent, and very naturally occur to one.
CORRESPONDENCE.
Plantersville, Morehouse Parish, La., \
August 3, 1879. J
S. M. Bemiss, M. D.
Dear Sir — I thought the following report of a curious case
would interest you :
July 20th called to see a child 18 months old ; quadroon ; had
been sprightly all the morning, but at about 11 o’clock, A. M.,
was taken with fever and in about half an hour had a spasm,
which lasted fifteen minutes ; saw it at 2 P. M., had had four
convulsions. Fever high, pulse quick, but small and thready,
skin hot, insensible, but pawing the air with both feet aud
hands (kicking out its legs and striking alternately with its
hands), pupil of eye small, and occasionally licking out the
tongue, abdomen swollen and tense, tympanitic, had one action
in the morning that was reported not unnatural. I gave it a
dose of chloral, 1 gr., and repeated it in an hour, also alter¬
nately calomel and quinine, every half hour. It became more
quiet and at 8 P. M. had a full calomel stool, fever cooler ;
passed a quiet night until about 12 o’clock, when the fever
again rose and the same symptoms all again appeared as de.
scribed above, and in addition the head was extremely hot.
I tried inhalation of chloroform \Vith only temporary effect and
fell back again on the chloral and morphine with quinine, cold
cloths to head (warm poultices, or flannel cloths soaked in oil
and turpentine on the abdomen seemed to increase the rest¬
lessness and convulsiveness of movement). The fever and
other symptoms seemed to be augmented about 11 o’clock, A.
M., 24th, and at about 2 P. M. the mucous rattling in the
784 Correspondence. [February
throat, short difficult respiration, palid face and sunken eyes,
seemed to tell me that death was there. So hot was the whole
surface and head that it seemed almost to scorch the hand. I
was satisfied that it could not live above an hour as all power of
motion was gone and the tongue quivered when the mouth was
opened.
As a last resort I caused a tub of cold water to be brought
into the room and immersed the child in it except the head,
and on it I poured cold water in a full douche from a quart cup.
For the first minute it was as if dead, but in two minutes more
it kicked manfully and cried out. It was then placed upon the
bed aud in a few seconds fell into a perfectly natural sleep,
skin cool, pulse (which was before almost like a hair and too
quick to count) became soft, full and natural. In about fifteen
minutes a gentle perspiration cqme out on the skin, and in an
hour it woke up and prattled to its father and seemed conscious
of its surroundings, drank freely and took some broth or soup.
Afterwards, becoming restless, I had its head and body
covered with a single cloth, wet in a weak mixture of
whisky and water and fanned continually. It passed a good
night, but the fever in spite of quinine, returned at 8 o’clock
next morning slightly, and the spasmodic motion of feet and
hands, tumid abdomen, etc. Santonine and calomel given,
brought away one small lumbricordia about 14 inches long .
quinine was kept up, fever did not return, and the child seemed
to be doing well, except that when last seen, yesterday, August
2d, it seemed not to have good use of itself, as if it were
slightly paralyzed, otherwise, its bodily functions are all
properly performed. I have reported this case simply because
from the symptoms, I was unable to make my mind clearly
the cause of its sickness and why the resulting paralysis.
It could not have been worms, nor inflammation of the bowels,
as there were no watery discharges (though the last action
from calomel and santonine brought away a full, dark, rather
foetid stool). Could it have been a sudden attack of conjes-
tion of the brain, with exudation ? Quinine seemed not to
control until the third fever, and at the last abated it. I have
seen many cases of conjestion of the braiu, but it followed the
Correspondence.
785
1880 1
secoud or third fever and not the first attack, and in so very
short a period, half an hour. Could this have been a case of
infantile apoplexy (so-called) ? I had never seen before nor
heard of any cases where the immersion in cold bath was
practiced, and in this case I should not have done it had I not
been so sure, that in case of failure, I should only be shorten¬
ing its life a few minutes. But the change which took place
seemed to me almost magical, and so far beyond my expecta¬
tion that I could not realize that the child was so much better
in so short a time.
I would like to ask you what mode of treatment would
be likely to be successful in a disease of the month, of which
there are several in my section. The part disordered is the
gums, which are of a dark red, have a tendency to bleed
easily, cleaves from the teeth, making them look unnaturally
long, the breath is disagreeable and the patient does not seem
to suffer much inconvenience from it except at times when the
disease seems to be particularly increased ? I notice that they
drink, smoke, chew tobacco, etc., and eat as others do. There
is no unusual salivation, but when they bleed it seems to be
from a surface, not from any crack or fissure. The parties are
not of syplialitic character. It goes under the name of
“scurvy,” and is very difficult to cure. I have never cured a
case yet and I tried acids, neutral salts astringents, locally
together with iodide of potash internally. Is it a constitu¬
tional disease ? is it hereditary ? In one family the father, GO
years of age, has had it 30 years off and on, and two sons, one
18 years, the other 14 years of age, have it. The girls are not
troubled. In another family, one son only, though the girls,
all grown, have unsound teeth. In another family, an only
daughter, whose father and mother, neither of them have it.
There is no scrofulous taint in any of these families, nor do
the children of the third generation appear to have it.
Have I made myself sufficiently plain in my description f
Trusting that your city may escape the threatened disease
this year,
I am truly yours,
Ben. H. Brodnax.
786
Current Medical Literature.
[February
P
URRENT
EDICAL
ITERATURE.
BRIGHT’S DISEASE.
[Principal conclusions of the interesting paper read before the Interna¬
tional Medical Congress of Amsterdam, September, 1879, by Prof. Semmola,
of Naples.]
Translated from Oxornale Internationale— della Scxenze Mediche di Napoli.
By Dr. John Dell’Orto.
1st. My first researches on Bright’s disease date as early as
1850. I believe that nobody before me has ever tried to prove
the special influence of alimentation aud diet on the quantity
of albumen excreted by the kidneys in this disease.
2d. This influence of a nitrogenous or non-uitrogeneous diet
upon a relative proportion of albumen in the urine, or upon its
absence therefrom, was the starting point of all my investiga¬
tions, and has led me to the conclusion, that our attention
should not be limited only to the study of renal lesions, but
also to the general derangement of nutrition, that prevents the
destructive metamorphosis of the albuminoid principles.
3d. This idea of mine on the pathogeny of Bright’s disease
has been confirmed by another classical fact, wholly unknown
up to the present date, l mean the notable and progressive
decrease in the quantity of urea in the very beginning of the
sickness.
4th. I consider this fact as of the most vital importance to
the physiology and pathology of the disease. During many
years 1 have insisted upon this point in my frequent communica¬
tions to the Academies of Medicine of Paris and Naples. I spoke
of it at the Medical Congresses of Paris (1801-67) and of Brux¬
elles (1875) ; and now 1 am convinced more than ever by a
large experience of three hundred observations, that this
decrease of urea at the commencement of Bright’s disease is
owing to deficiency of assimilations, and defect of oxidation of
the albuminous matter.
It is a note worthy fact, that the defect of formation of
urea is the result of the diminution or total suppression of
the functions of the skin. Inconsequence of which two chem¬
ical changes, essentially linked together in a biological point
of view, appear, that is, alteration and non-assimilation of the
albuminoids, and absence of their combustion. These two
changes are immediately followed by diminution in the forma¬
tion of urea — a fact, that can be experimentally reproduced by
varnishing the skin of a dog.
Leaving to physiologists the explanation of these phenomena,
I only indicate them as a proof, that the true chronic Bright’s
Disease is a general disease, it is a deeply seated defect of nu¬
trition, in which the anatomical alterations of the kidneys (from
Current Medical Literature.
787
1880 J
hypercemia clown to cirrhosis and atrophy), do not nor cannot
constitute the primitive pathogenic cause of the principal
symptoms of the disease. In fact it would be impossible to
demonstrate with the assistance of physiology how a morbific
process limited to the kidneys in its origin — that is at a mo¬
ment when their function as depuratory organs is not altered —
could exercise such an influence in the formation of urea as to
react on the work of nutrition of the whole organism.
I call the special attention of my colleagues to this point,
which has been neglected on account of being only observed in
the first stage of the illness, and in the patients of the Hospitals.
5th. In the other kinds of albuminuria, this diminution in
the production of urea is not fuind at the commencement of
albuminous filtration. It is consequently necessary to separate
these different albuminurias, in order to avoid an error which
still exists, and which would lead to much danger, if introduced
in teaching and practice.
6th. The diminution of urea in other albuminurias has no
relation of causation with regard to albuminous filtration. It
may exist sometimes, but modified, according to the peculiar
disease that has caused the albuminuria, and at the same time
has altered the general nutrition, as for instaucethe diseases of
the heart ; but the diminution of urea in these cases has noth¬
ing to do with the appearance of the albuminuria — the album¬
inuria runs quite a different course, and it is only at the last
stage of the disease, when the kidney is deeply altered
(cardiacns kidney, amylaceous kidney), that a considerable
diminution of urea is noticed in the urine through functional
defect. Such diminution is then a mechanical fact, that imme¬
diately causes the accumulation of urea in the blood, with all
its fatal consequences.
7th. In Bright’s disease, properly so-called, the diminution
of urea is the result of two causes. In the first stage it is due
to defective combustion on account of a deteriorated general
nutrition from suppressed cutaneous functions. Subsequently
during the progress of renal disease, we meet again decrease
of urea, which is brought about by deficiency in excretion.
8th. The exaggeration of the pathological modification, of
the kidneys has so preoccupied the minds of practitioner s as to
neglect the general and chemical nature of the disease, and a
conclusion quite paradoxical for scientific pathology has been
the result, that is a clinical unity with multiform anatomical
changes (large white kidneys, amylaceous kidneys, etc.).
We cannot indeed understand how a general constitutional
disease, produced by the same causes, presenting the same
symptoms may finally terminate with so different pathological
results. This final difference in the lesions of the kidneys
should lead us to acknowledge a difference also in the nature
of the preceding morbific processss. It is only by carefully com¬
paring the evolution of all the symptoms, the mechanism of the
o
788 Current Medical Literature. [February
clinical form in relation to the peculiar causes, that we will be
able to distinguish the albuminuria of Bright’s disease from
other albuminurias, so as to make it a characteristic patholog¬
ical entity.
9th. The presence of albumen in the urine can be accounted
for by the three physiological factors which preside over the
renal function :
a — Chemical conditions of the blood,
b — Degree of pressure.
c — Conditions of the histological elements of the kidneys.
10th. There are in consequence three kinds of albuminurias,
a — Discrasic albuminuria, by excess or alteration of the
albuminoids of the blood,
b — Mechanical albuminuria.
c — Irritative albuminuria caused by local irritation of the
elements that reach the kidneys, either coming from
outside or formed in the organism.
These three species of albuminuria are in perfect accord with
the anatomical condition of the kidney, that is, if each of them
has only been a temporary symptom, the structural state of the
kidney may either remain normal, and quite foreign to the albu¬
minous filtration (as in class a), or undergo a little provisory
modification, but soon return to its normal state: — if on the
contrary, the pathological condition that causes albuminaria
has been constant, then the kidneys become gradually altered,
until a precise and special lesion proper to each cause results,
but the lesion is always in relation with each of the three
factors, that have so modified the renal functions, as to bring
about the filtration of albumen.
We have thus the following table:
table :
cod’n of kidneys.
UREA.
Kidney normal.
Maximum of
nrea, of sulphates
aud phosphates in
the urine.
Irritative hyper-
ssmia more or less
intensive accord-
Progressive di¬
minution of urea
in urine with ac-
Causes.
Chemical con¬
ditions of the
blood.
Discrasic al¬
buminuria.
f Presence in the
| blood of an excess
of albu m in o i d 8
coming from ali¬
mentation.
Excess of albu¬
minoids in the
blood, due to de¬
fect in their c m-
bustion.
Alteration in the
chemical constitu¬
tion of the circu¬
lating albuminoids
ing to the organ, cumulation in the
the function of
which has been
distu: bed, as the
skin, the lungs, e*c.
blood : defect
production.
of
Fatty degenera¬
tion.
so that they can-, Amylaceous de-
not be assimilated generation,
^(cachexias).
Diminution o f
urea according to
Igra v i t y of the
! cause of cachexia.
1880]
Current Medical Literature.
789
Degree of
pressure of the
current of the
blood.
Mecha n i c a 1
albuminuria.
f Several neuroses
due to some influ
ences on the vaso¬
motor-system.
Pregnancy and
generally all the
causes pressing on
{ the inferior vena
cava and on
renal veins.
the
The disease of
Renal congestion
of a short duration
Renal congestion
of a long duration.
the heart arrived] Permanent con-
at the stage of in¬
sufficiency, that is
of the inversion of
| the arterial and
t venous tensions.
gestion
Cyanotic kidney.
Cardiacus k i d-
ney.
Histologi cal
changes of the
kidneys.
f Nephritis a n d I
| all the irritative
| causes of the kid-
1 neysin their difler-
| ent degrees.
The albuminous
I filtration is iu pro-
I portion with the
Irritative al-<( function and with
buminuria.
the influence that
the inflamed ele¬
ment have on the
mechanic ism of
urinary secretion.
All the anatomi¬
cal consequences
o f inflammation
from the simple
congestion and de¬
generation of epi¬
theliums down to
sclerosis and atro¬
phy of the kidney.
Urea almost nor¬
mal.
Urea in relation
with causes o f
compression.
Diminution o f
urea in relation
with the disease.
Urea normal, or
a little increased
in proportion to
fever (acute state).
Diminution o f
urea without caus¬
ing accumulation
in the blood — in
relation with the
general defect of
combustion.
I Diminution o f
urea on account of
defective fi 1 1 r a -
tion ; consequently
accumulation of it
in the blood.
If we compare the clinical history of Bright’s disease with the
above related causes and considerations, we have to conclude
that it does not exclusively belong to any of these three albu¬
minurias ; on the contrary, it comprises all of them ; it is a
mixed albuminuria.
Studied from this point of view, Bright’s disease represents
a constant evolution, and a perfect harmony exists between the
nature of the causes, the symptons and the clinical form, which
is characterized by the following facts, succeeding one another:
a — Exposure to cold and wet. .
b — Failure in the functions of the skin ; that is immediately
followed by
1 Cutaneous ischaemia,
2 Accumulation in the blood of the exremen titious cutaneous
substances.
3 Alteration of the albuminoids — and non-assimilation of the
new albuminoids proceeding from the peptones.
4 Decrease of combustion of the albuminoids ; consequently
diminution in the production of urea.
790 Current Medical Literature. [February
During this first phase the kidneys remain completely
strangers to the disease. At a later stage they become altered
and present the following anatomical and chemical changes:
1st. Hypersemia.
2d. Irritative effect of this hypersemia (inflammatory results).
3d. Elimination of albumen.
4th. Progressive diminution of urea, as the consequence of the
primitive defect of production.
Thus we have two classes of phenomena, that appear with
insensible gradations, and are intimately connected with each
other.
In the first class we have the symptoms of a general altera¬
tion of nutrition.
In the second we observe the signs of the anatomical changes
of the kidneys, commencing with a very slow inflammatory pro¬
cess, and terminating with the gravest pathological modifica¬
tions, which are constantly found in both kidneys.
This bilateral renal alteration is characteristic of Bright’s Dis¬
ease, and ought to be called Bright’s Kidneys.
Bright’s Disease then cannot be confused with the other
albuminurias, whatever the causes that produce them, may be.
I believe, in consequence, that the opinion of certain authors
in admitting some forms of Bright’s Disease caused by alcohol,
gout, syphilis, etc., is ’not exact. Alcohol, gout, etc., may pro¬
duce albuminura ; but these albuminurias are the result of a
general derangement peculiar to each cause, and can not be
considered as Bright’s Disease.
DIABETES MELLITUS.
By M. Hardy, Gazette dee Hospitaux, November 18.
Gentlemen — The patient before you is that of a man aged
48 years. He is an old soldier who has been on duty up to his
entrance in the hospital. Vigorous and well-built, he perceived
since two years, that his strength was failing and that he was
losing flesh. He had more thirst than usual and was forced
to drink from four to five quarts of liquid per day ; however
he is not a tipler, and drank only to allay his exaggerated
thirst, at times of pure water, at others of vinous water and of
coco. He soon perceived that his appetite became as insatiable
as his thirst; he eat more than two pounds of bread per day,
with much meat and potatoes to satisfy his craving appetite.
He urinated much and had constant desire to urinate, and was
compelled to evacuate his bladder several times each night,
and rendered about four to five quarts of urine per twenty-four
hours.
Nevertheless his strength still diminished, and he grew
weaker each day; he consulted a physician, who from the ex¬
amination of his urine recognized a diabetic affection. He was
1880 1
Current Medical Literature.
791
put upon appropriate treatment, prescribed a special regimen,
eliminating bread, potatoes and sugar, and was advised to eat
nothing else but meat and green vegetables. Under this happy
influence, he improved somewhat, but did not recover complete
health ; he, however, resumed his painful duties.
Still some few months ago, he began to decline again in
strength, and found his thirst and appetite increasing ; being
unable to persevere with his duties, he entered the hospital.
You may perceive that he is still, apparently a vigorous man ;
but he has lost flesh, his skin is loose and flabby, not stretched
upon the muscular tissues, which indicates a considerable dif¬
ference between his present and former state, a comparison
which no physician should neglect to establish, if he wishes to
strictly satisfy himself between the progress of a disease and
its effects.
With the diabetic the skin is usualjy dry ; with our patient
we have a slight difference ; he perspires a great deal at night.
His thirst is always acute, but he now drinks about two to two
and a half quarts of liquid in the twenty-four hours, nis ap¬
petite is at present less voracious, he is able to appease it. His
venereal appetites are not as acute as formerly. The troubles
of vision which we observe in him are more complex, because
he is affected with serious disorders of refraction.
Finally, I point out a phenomenon which is scarce ever want¬
ing with the diabetic, though it is almost negative in our pa¬
tient : the diabetic has usually an acid mouth ; the saliva has
an acid reaction, which we are able to detect by means of blue
litmus paper. The saliva in its normal state gives a neutral
reaction ; you may perceive that moistened in the mouth of
my interne, the litmus paper scarcely reddens, whilst that
which I place in the mouth of our patient is sufficiently red¬
dened. His teeth are quite good and his gums not softened.
But he presents a phenomonon, to which I especially call your
attention, it is the redness and the hitcliiness of his genital
organs ; the gland presents in a high degree the characteristics
of preputial herpes (which is not herpes, but eczema); the hitch¬
ing is acute and the secretions are profuse.
I here present you a second case of diabetes from the wards
of Prof. Vulpiau. He is a man aged 28 years, and has been a
porter. He is quite strong and very vigorous. He is ill since
only four months. Within the two past months only, has he
perceived his strength failing and is losing flesh. He has lost
more than twenty pounds in weight within the few past weeks.
You may perceive that his muscular system is already affected,
and that his skin is too loose and may be easily folded; this is
a proof of a loss of flesh. His mouth is dry and sweet; he is
continually hungry and thirsty. His thirst is so great that he
is obliged to drink from seven to eight quarts of water per day ;
his thirst is so acute, he says u that were it uriue I would drink
it.” He passed eleven quarts of urine in the twenty-four hours.
792
Current Medical Literature.
[February
His tongue presents no characteristic symptoms ; the reaction
of the saliva is acid. Erotic desires are completely wanting
since he entered the hospital. The symptoms have caused us
to look for glycosuria. The urine is clear, limpid, abundant
(five quarts) in twenty-four hours, with great density, 1.034 ;
this would suffice to make the diagnosis. In fact, in intersti-
tal nephritis, we find also a pale urine, uncolored, but its den¬
sity does not range beyond 1.005 or 1.010. The examination of
the urine with the liquor of Fehlinghas given the characteristic
reaction of the presence of sugar.
The weight by the process of Bouchardat has given 290
grammes of sugar ; the more exact one, by means of the sac-
cliarometer, has given 342 grammes of sugar eliminated in the
twenty-four hours. On certain days, the amount attains 400 or
500 grammes.
We have here an acutp case of diabetes, which in a few
mouths, will bring our patient to the most profound cachexia,
if we do not succeed in arresting the progress of the disease.
Here we have two diabetic patients who have attained two
different periods of the disease, and I deem it useful to take
advantage of this opportunity to make a study with you of this
to-day very common disease. As the examination of the urine
and the dosage (weight) of the sugar in diabetes mellitus, are
such important operations, that all physicians should be able
to make, at least quite approximatively ; I will now enter into
the study of this question, before touching upon its clinical
relations.
If the examination of the urine is a rule in all diseases, the
greater the reason why it should in diabetes. The quantity of
the urine is already an important sign: it is sometimes in¬
creased to considerable proportions in diabetes. Our patient
renders actually three quarts of urine, whilst that of M. Vul-
pian renders scarcely less than from six to eight quarts in the
twenty -four hours.
The density is also greatly increased ; taking by means of the
areometer ot Bouchardat, it is in minimum with these two pa¬
tients, 1.040. The color of the urine is in general, passibly pale ;
with our patients it is relatively, still sufficiently colored.
The main point in the examination of the urine of diabetes,
is the search for the presence of sugar. Numerous processes
have been imagined for this purpose. All are more or less de¬
fective ; we will here only occupy ourselves with those wThich
are accessible to the clinician.
A. The oldest is that of Moohr. We introduce some urine
into a tube, and add two or three pastiles of caustic potash to
it. We heat slightly the lower portion of the tube ; the potash
melts, then the inferior portion becomes of a brown color. This
coloration becomes gradually of a sufficiently thick brown-red,
and invades the total extent of the liquid. After a few mo¬
ments of cooling, it becomes more brown, resembling much in
color to old Malaga wine.
Current Medical Literature.
793
1880]
This process is still one of the best for the practitioner. With
a coloration as brown as this which we find in the particular
case, we may rest assured that the urine contains at least 40
grammes of sugar per quart ; if the red tints were clearer, in
examining the urine by means of transparency, we could still
count about 30 grmnmes per quart. If the coloration be black
as coffee, we can accept it as being more than 50 grammes per
quart.
B. Let us examine the process of Luton, of Reims, without
recommending it, but only to point out its defects, It consists
in adding bichromate of potash and sulphuric acid to the
urine, the urine becomes of a magnificent emerald-green colora¬
tion, when it contains sugar. But all ternary substances can
produce this reaction. It only suffices that an individual should
have made an excess of drink, for his urine thus treated to pro¬
duce such an intensity of coloration. You perceive that with
pure water, to which I added a trace of alcohol, I obtain this
reaction, which is not at all characteristic of sugar.
C. Here is another process, which possesses a certain
amount of value ; we introduce some sub-nitrate of bismuth in
a tube, two pastiles of potassa, then the urine. We heat the
lower portion of the tube; the liquid passes from a white to a
black color, to a real tint of the powder of charcoal, due to the
metallic reduction of bismuth in presence of sugar.
With nitrate of silver, we obtain the same effect. But there
are two causes of error: 1st. The presence of albumen, which
reduces the metallic salts in'presence of potash. We should
separate the albumen by coagulating it by heat; and, in filter¬
ing it before seeking for glyeose. 2d. Should the urine contain
much uric acid, we obtain the same reduction. For uric acid is
sufficiently difficult to separate from urine.
D. I come to the procedure of Barreswill, which rests upon
the reduction of the cupro-potassie liquor. The liquor of Fehl-
ing (sulpha! e of copper, sel de saignette, lye of soda) is shown
in such a manner that 10 cubic centimeters of this liqdor cor¬
responds to 5 centigrammes of glyeose. To seek for the pres¬
ence of sugar, we pour the blue liquid in and we heat. This
liquid, in fict, being very liable to decompose, we should ascer¬
tain by ebullition that it is not self reduced. If it remains
limpid we introduce the urine in the tube (half less of urine
than of the blue liquid), and we heat the superior portion of the
tube. You immediately perceive a red coloration, yellow,
greenish, intense, then the whole liquid takes or manifests an
orange like coloration, characteristic of the presence of sugar.
The errors of this process pertains, 1st. To the presence of
albumen, which may mark its reaction in reducing the liquid to
a violet magma, we should then firstly eliminate the albumen
by heat and filtration ; 2d. in presence of substances which
thus reduces the oxyde of copper, such as chloroform which
passes in nature in urine, or creatinine in excess (but there
794
Current Medical Literature.
[February
should be an immense quantity, at least 10 grammes per quart
to produce so considerable a reduction, and it is quite seldom
that we meet with 2 grammes per quart) ; 3d. in the presence
of uric acid in excess, but the reduction is not the same. We
meet here a pulverulent mass that light does not traverse, pos¬
sessing a pure yellow orange tint, while uric acid produces a
flocky reduction of large flakes leaving free intervals of space
which light can traverse, and the reduction has more of a
blackish-brown tint ; the flakes are quite light and require
from one to two hours to deposit, whilst that in glycosuria, the
precipitate is abundant and falls rapidly to the bottom of the
tube.
It may be interesting in a clinic to show the sugar in nature,
to extract the glycose from the urine and to show it in its amor¬
phous state. Here is a simple process, but which its lack of
strict accuracy renders only satisfactory for the clinic. Take
200 cubic centimeters of urine, evaporate to dryness in a water
bath in a porcelain capsule. The residue is washed with 50'cu-
bic centimeters of alcohol, which carries off and dissolves the
urea, the extractive materials, the salts and the chloride of
sodium. This washing is repeated two 'or three times. Then
treat the residue with ether, which carries off the fatty matters.
There remains the glycose mixed to a very small quantity of
insoluble mineral salts. Take up the residue by water raised
progressively to the temperature of 40° or 50°. Filter and
evaporate to a syropy consistency. By cooling the sugar de¬
posits on the bottom of the capsules and finally we obtain in
nature the chrystallized sugar which was contained in the 200
cubic centimeters of urine.
The dosage of the sugar contained in the urine may be ob¬
tained by four processes of quite different value :
1st. It can be made by means of the polarimeter. We in¬
troduce 100 cubic centimeters of urine in a balloon, and we add
10 cubic centimeters of a solution of the acetate of lead to deo¬
dorize the urine, which soon produces an enormous precipitate,
which carries down the coloring matters and we filter. The
filtered liquor is introduced in the tube of the polarimeter (tube
let us say, of “ 22 centimeters ” on account of its length), then
we close the tube with the index of glass slipt laterally and
obliquely, in order to prevent the introduction of bubbles of
air, and we screw the metallic index.
This tube filled with distilled water is first put in place in
front of the lamp ; we look in the eye-glass, and we see a circle
divided into two unequal parts by a black line, these two parts
having different colors. We turn the screw situated beneath
the eye-glass (from left to right), until that the two discs have
an equal coloration. It is the zero of the gradation of the index.
There is no sugar in the liquid of this tube (distilled water), we
replace then this tube, by the tube filled with urine, and when
we look iu the eye-glass, we perceive that the two discs have
Current Medical Literature.
795
1880 1
changed coloration and are not equal. We turn the screw in
an inverse manner until the coloration be equal, pale rose, from
both rides. We read the corresponding division on the index ;
in the particular case, we read the number 25. For each de¬
gree of the saccharometer corresponds to 2 gr., 256 of sugar per
quart; then 25x2 gr. 256=56 gr., 400 of sugar per quart; and,
as the patient renders 2500 grammes of urine in the twenty -four
hours, we will have 56 gr., 400x2500=141 grammes of glycose.
This patient rendered 141 grammes of sugar in twenty-four
hours. Before his treatment he rendered 225 grammees.
The dosage by the saccharometer is, of all processes the most
certain and exact. J. H. W.
I TO BE CONTINUED NEXT MONTH.]
THERAPEUTIC ACTION OF THE FOUR ALKALIES OF THE GRAN¬
ATUM (or Pomegranate), DESIGNATED UNDER THE NAME
OF PELLETltfRINE AS A TAENIFUGE.
By Dr. BekengeE Febaud, Phyaieian-in-Chief of the French Marine.
From the Bulletin Genorale de Therapeutiyue Medicale et Chirurgicale, October 30th,
1879, ^and November 15th, 1879.)
Tue Doctor, after having experimented upon 138 subjects, '
and with acquired experience of various doses and combina¬
tions, seems to have arrived at a very promising and satisfac¬
tory result. He considers that a solution of 50 centigrammes
of the sulphate of pellethirine, to which is added a solutiou of
1 gr. 60 of tannin, is much more effective than the pelletidrine
when given by itself; that is, in putting the two bodies in suit¬
able conditions to produce a real tannate of pelletierine, we
obtain a solution which is not repugnant to the taste joined to
a greatly enhanced efficiency.
Mr. Tanret in his researches upon the granatum has called
pelletierine the active principle of the bark. He has discovered
since that the granatum contained not only one alkaloid, but
in reality, four, which he has isolated, and characterized by
their action upon polarized light. Whilst awaiting the com¬
pletion of the study which he is actively pursuing, we will after
his method, call pelletierines a and 6, the two alkalies of which
the sulphates are not decomposable by the bicarbonate of soda.
These two alkalies are liquid and volatile ; the first, a, is with¬
out action on polarized light, and the other, 5, is laevigore
(that is, deviates to the left the plan of polarization). The two
other alkaloids, of which the sulphates are decomposable by
the bicarbonate of soda, will be the pelletierines g and d; the
first, g , is volatile, crystallized and without action on polarized
light; the second, d , is liquid, volatile and dextrogyre. It
seems, then, natural that we should question whether each of
these bodies possess alike taenifuge action, and the matter is
not a simple scientifical curiosity ; here may rest an important
practical question, as we shall soon see. In fact, should one
6
790 Current Medical Literature. [February
or two of the diverse elements of the pelletierine not possess a
taenifuge action, depending upon this or that condition of
vegetation, or, according as this or that vegetable part is ex¬
amined, the respective proportions of a, 6, g and d , differing,
it might happen that for the same dose of the drug derived
from such or such source, there might happen a different
result. He, in consequence, experimented with the various
precipitated alkalies, and we here append the result of ac¬
quired facts :
1. That the tannate of the alkali a, produced 17 undoubted
successes out of 22 cases.
2. That the sulphate b , succeeded only in one case out
of five, which corroborates my opinion that the sulphate, when
not mixed with tannin, is a bad taenifuge preparation.
3. That the tannate b (sulphate to which taunin is added in
the proportion of 4 to 5, or of 1 gr. 60 of tannin — one gramme
and sixty centigrammes of tannin to fifty centigrammes of pel¬
letierine) has produced 7 good results to 9 trials. It is, then,
I believe, a sufficiently good preparation, though less effective
than the tannate a.
4. That the tannate a, b, has furnished 24 undoubted suc¬
cesses, 2 probable favorable terminations, and 4 failures;
but these last four may be attributed in greater part to the
patients more than to the passive action of the medicine.
5. That the sulphate g and the sulphate d, or yet again the
sulphate g and d united, have failed each time, so that we are
disposed to consider these alkaloids as having no taenifuge
property whatever.
6. That the tannate g and the tannate d, or even again the
tannate g and d united, are absolutely in the same condition.
From which we conclude that:
A. The pure sulphate, ‘pares cum paribus,’ is not affective in
the expulsion of the taenia.
B. The sulphate, to which tauniu is superadded in the pro¬
portions above cited, and in particular 50 centigrammes of
pelletierine for 1 gr. 60 of tannin, is on the contrary quite pre¬
ferable.
C. The alkalies a and &, or a, b united, are good taenifuge ;
a seems to me superior to b in its effects.
D. The alkalies g and d. or g d united, do not possess
this taenifuge action.
This result being obtained, i. e ., finding that the alkalies a
and 5, under the form of a tannate, have a very happy expul¬
sive effect under certain precautions to be taken. To obtain
this result I have given the pelletierine a. in the quantity of 30
centigrammes (sulphate 30 centigrammes : tannin 1 gr. 20) six
times, I produced the head five times.
In another series of experiments, I gave the pelletierine a. b.
in the dose of 30 centigrammes, eight times, and I obtained the
head seven times.
Current Medical Literature.
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1880]
From various results, I consider that the dose of pelletierine,
a, is able to expel the taenia in the majority of cases, in the
dose of 25 to 30 centigrammes; that the one of a and b
united is 30 to 40 centigrammes.
In the dose of 30 centigrammes the sulphate of pelletierine,
additioned with 1 g. 20 of tannier, produces such light phe¬
nomena of intoxication, that I think that we might venture to
give the drug to children above the age of ten years. I have
no experience, however, my field being limited to observations
of adult males.
In the various experiments, rendered above, I necessarily en¬
deavored to find out which were the best conditions, to be suc¬
cessful, and I successively endeavored to solve:
1. The precautions to be taken on the day preceding its ad¬
ministration.
2. The variety of pelletierine which would most likely suc¬
ceed.
3. The combination which should be given.
4. The dose of the pelletierine.
5. The manner of giving it.
6. The purgative to be employed.
7. What should be done during the action.
8. When should we renew the dose after an unsuccessful
administration.
I enter into these details, for I consider that there exists an
infinity of small precautions, upon which the success depends
much more than upon the massivity of the taenifuge which we
are administering.
1. Precautions to be taken on the day preceeding the one in
which the pelletierine is administered. Usually on the day pre¬
ceding the ingestion of the pelletierine, I only allow for all
aliment one or two quarts of milk and a small amount of bread.
At the debut, I attached great importance to this and as in
some few cases it happened that I had nevertheless succeeded
in the expulsion of the taenia. It was mooted by me, whether
it was not preferable to set aside this little precaution, for
though not difficult of execution, it complicated the treatment
somewhat, and might at times retard an urgent medication to
a succeeding day. I am convinced to say that it is very im¬
portant that we should put the patient upon an exclusive milk
diet on the day preceding the giving of the pelletierine. I
would even say that I would scarce advise the allowance of
even a small portion of bread to the milk.
To test the question upon this little point. I gave an identi¬
cal preparation of pelletierine to a certain number of patients,
and this was the tannate a , />, (in the dose of 40 centigrammes
of the sulphate to lg, 00 of tannin), which 1 selected. These
doses were from the same chemists, were given in the same
manner ; in a word, 1 endeavored to place things in a strictly
alike condition. Well ! 1 administered the drug eight times
798 Current Medical Literature. [February
without a preceding milk regimen, and I obtained six incom¬
plete expulsions ; — again, eight times I gave the preceding
milk regimen, and in seven I obtained the taenia with the head.
The eighth, which I relate as unsuccessful, is even doubtful, and
pleads even to a strict milk regimen, for though the patient
had taken milk, it is true ; but being an enaemic, returning
from Cochin China with a phagedenic ulcer, I allowed him a
free regimen, he took also some meat-broth and ate a cluster of
grapes. Such results convinces me that one of the important
factors, in the taenifuge medication by pelletierine, is a strict
milk diet on the day preceding its expulsion. A want of strict
attention to this rule, might expose to a reasonable failure.
Why is it that success depends upon this procedure ? is difficult
to answer ; yet I am disposed to think that in placing pure
milk in contact with the animal, we place it in osmotic condi¬
tions favorable to its more complete intoxication. Besides,
what may be the explanation, let it suffice to say that expe¬
rience has demonstrated a comparative result to react upon
practice. Therefore, I recommend that milk as a strict aliment
should be given on the day preceding, or at least for the even¬
ing meal preceding the injestion of the pelletierine.
"1. Of the variety of the pelletierine which ice should preferably
use. — It is likely, if 1 rely upon my judgment, that the various
results observed in the taenifuge action of the pelletierine de¬
pends upon variable proportions of the diverse alkalies a , ft, g,
d of which we have just spoken. M. Tauret has observed
that the alkalies are found in quantities relatively different, ac¬
cording as we operate with such or such vegetable part of the
vegetable, in such or such season, with older or younger vege¬
tables, and with more or less vigorous ones. Then, it is evi¬
dent, since g and d have no marked taenifuge action, that if, by
accident, they are found more abundant in a sample than in
another, we might be liable to obtain different results in believ¬
ing that we are acting in identical conditions.
The alkalies a and ft, on the contrary, possessing an effect¬
ive action, towards the expulsion of the taenia, I believe that
we should preferably employ them instead of the whole pelle¬
tierine, and using the terms of M. Tauret, I will say that it is
desirable that we should only make use of the alkalies of the
granatum “ which are not displaced by the bicarbonate of
soda.” The alkaloid a has seemed to me sensibly more effect¬
ive than the ft, so that I am predisposed in its favor and will¬
ing to class it as first. But yet, I would add, that the pellet-
idrines a and ft united have produced such good results, that
I think, that I am able to accept their combinations as the
preparation to be made use of in ordinary times, should the
exclusion of the ft be the cause of greatly raising the price of
the dose of the drug,
3. The form in which we should give the Pelletierine. — The re¬
sults forementioned indicate that the pure sulphate is much
Current Medical Literature.
799
1880]
less active than when tannin is added to it. What, by abbre¬
viation, I have in the preceding article called, somewhat im¬
properly, tannate (when I referred to the proportions of 50
centigrammes of pelletierine for 40 centigrammes of tannin),
is infinitely preferable. I know that, theoretically, a tannate
would require three times more of tannin, be it said, 50 centi¬
grammes of pelletierine and 1 gr. GO of tannin, and we have an
excellent, active taenifuge. I feared, at the starting point,
that such a preparation would be too disagreeable to take, and
it is why I added so small a proportion of tannin to the sul¬
phate. The proportion of tannin which I made use of then,
was of excellent effect, truly effective, and of easy ingestion ;
but I have siuce learned that in increasing the tannin, the
liquor could still be taken without too great repugnance.
4. The dose of pelletierine to he given. — As I just remarked, I
tried to give 20 centigrammes of the sulphate united to Go cent¬
igrammes of tannin, and I have come to the conclusion, by
established facts, that the minimum dose for an adult should
be 40 to 50 centigrammes of the sulphate of pelletierine a
and b, united to 35 or 40 centigrammes of pelletierine a added
to lg 40 to lg 50 of tannin.
5. The manner of administering the pelletierine. — I have given
it in various ways: in fractional doses at a quarter, a half and
an hour’s distance. I have finally adopted the plan of giving
the whole dose at one time, and at the same moment to give
the purgative. I have often given it in this wise : 1st. In a glass
the sulphate of pelletierine and the tannin to which is added
some pure water. 2d. Immediately the purgative: 3rd. A
glass of pure water immediately, to remove the bad taste.
In this manner the ingestion is sooner finished, and with less
chance of being rejected.
6. The hind of purgative to he given. — I have tried several pur¬
gatives : Sulphate of soda, citrate of magnesia, castor oil, tinc¬
ture of jalap, (eau de vie allemande, Leroy’s purgatif, etc., etc.,)
infusion of the follicles or leaves of senna, and I adopted the
latter for many reasons: 1st. In infusing 10 or 20 grammes of
senna in 100 grammes of water, we obtain a brown liquid, bear¬
ing much resemblance to black coffee, to which 30 grammes of
orange peel are added and at need a few drops of the tincture
of pepermint, is infinitely less disagreeable to take than other
purgatives. 2d. Because the elective action of senna upon the
intestinal muscular fibre seems to recommend this drug in
preference to many other purgatives, on account of the peculiar
paresia which the pellieteriue pronduces upon these fibres.
7. What should he done during the action of the medicine. —
When I employed the salts of soda, castor oil and even dastric
tinctures, I sought by every means to promote the above evac¬
uations, and I must confess, that I was not always successful
even with the assistance of croton oil, purgative injections and
even 8 to 10 emollient enemas. Since I have adopted the
800
Current Medical Literature.
[February
senna, I obtain evacuations with greater facility, so that pur¬
gatives and emollient injections have become less needful.
Nevertheless I have recource to enemas three hours after the
ingestion of the tanifuge if there is no teudeney to purgation,
for I hold that the chances of expulsion are in great manner
dependant upon the rapidity of the abvine motions.
8. W hen should, we attempt aneic the medication after an un¬
successful attempt? In my experience I have often given doses
and varieties of the pelleti^rine, which were either too weak
or powerless to expel the worm, and it was natural that I should
endeavor to find out how long we should wait before making a
new trial. I have found out, that when we have succeeded in
the expulsion of a greater or lesser portion of the taenia, by
means of an alkali of the granatum, or when we have fruit¬
lessly administered the <7, or the />, we should wait a fortnight
at least, even a month, before renewing. It is thus, for in¬
stance, that I have seen absolutely identical doses of the pelle-
thirine a. h. prove unsuccessful, when they were administered,
two, four, eight days after an unsuccessful attempt ; on the con¬
trary, when tried fifteen days or three weeks later they were
sure to succeed. It is customary, to think that when unsuc¬
cessful with a taenifuge, that we should wait until the worm
had obtained a sufficient amount of new' development before
attempting anew the treatment. Whether the failure be due
to a paresial effect upon the intestine by the pelleti^rine, or
whether it depends upon a special state of the worm, which af¬
fords it a certain amount of immunity to the intoxication.
Maturer experience of the effects of the drug upon the tae¬
nia, has led me to believe that it produces a rapid action upon
the w orm, producing a toxic effect, which prevents it from hold¬
ing good by its cups during the space of a few7 hours. Should
a proper purgative be administered at this moment, the pe¬
ristaltic action of the intestines would carry it away, before it
had regained sufficient vital energy to enable it to attach itself a-
new upon the walls of the intestines. Should this purgative action
be otherwise too long delayed, or imperfectly carried on ; this
toxic state being dissipated, the head attaches itself de novo,
and should the peristaltic action then take place with force,
or the taenicide action prolonged, or be it, by the fact of the
combination of these two phenomena, and the worm be broken
towards its middle portion or at its slender or tapering portion,
or at the beginning of its narrowing, and then, in spite of the
expulsion of a greater or lesser length of the animal, we may
comprehend that the parasite remains in the body, and will af¬
ter a few months have acquired a length sufficiently great for
the situation to be relatively in like conditions as it was prior
to the use of the taenifuge. Therefore, the problem consists
for me, to combine the twro actions taenecide and purgative in
order to obtain success ; and it is for this that 1 prefer the tan-
nate to the sulphate of pelletierine, for the reason that it is
Current Medical Literature.
801
1880 1
easier to produce a purgative action with the tannate than with
the sulphate.
Action of the pelletierine upon the intestines. — It seems to exer¬
cise a special paresic action upon the intestines, a true paresia
or momentary and partial paralysis of the intestines, having
for effect to arrest the course of matters contained within its
cavity. The sulphate enjoys this property more so than the
tannate ; though the tannate possesses it also but in a less de¬
gree ; so that with certain individuals predisposed to sluggish¬
ness of the bowels, the intestines remained unmoved, which
somehow predisposes to a failure.
Why is the tannate more successjul than the sulphate. — M. Tan-
ret thinks that it is less rapidly absorbed by the stomach, so
that a greater amount of the medicine reaches the intestines,
and he believes also that being carried into the channels of the
circulation, it is not as apt to provoke paralysis of the bowels,
which is evidently one of the unfortunate conditions prevent¬
ing the expulsion of the helminthe. On my part, I am quite
disposed to adopt this view, iuasinuch as it explains the good
effects of the senna purgative, and as in toto, the results accord
with the theory. Be the hypothesis correct or not, still it ac¬
cords with our purpose in the great end, that is, that it brings
forth the taenia (head and tail.) J. H. W.
THE PHYSICAL CAUSE OF INTERMITTENT FEVER.
The July number of the Zeitschrift , editedby Professor Klebs,
contains some particulars of an investigation into the physi¬
cal cause or poison to which marsh or intermittent fever is due.
The inquiry was conducted by Prof. Klebs, of Prague, in
conjunction with Signor Tommassi, professor of Pathological
Anatomy at Rome. The two investigators spent several weeks
during the spring season in the Agro Romano, which is no¬
torious for the prevalence of this particular kind of fever. They
examined minutely' uhe lower strata of the atmosphere of the
district in question, as well as its soil and stagnaut waters, and
in the two former they discovered a microscopic fungus, con¬
sisting of numerous movable shining spores of a longish oval
shape. This fungus was found to be artificially generated in
various kinds of soil. The fluid matter obtained was filtrated
and repeatedly washed, and the residuum left after filtration
was introduced under the skin of healthy dogs. The auimals
experimented on all had the fever with the regular typical
course.
After explaining minutely the results of their various inves¬
tigations and experiments, these gentlemen are of the opinion
that they have discovered the real cause of the disease in ques¬
tion. As the fungus grows into the shape of small rods, Tom¬
massi and Klebs have given it the name of Bacillus Malaria. —
Medical Times and Gazette, Oct. 18, 1879.
802 Current Medical Literature. [February
THE CONDITION OF THE CERVIX UTERI IN CASES OF PLACENTA
PREVIA.
Dr. George Roper, Physician to the Royal Maternity, Lou-
don, calis attention ( Lancet , Oct. 25th, 1879) to a hitherto unre¬
corded fact, which consists in a peculiar induration of the os
or cervix uteri, at the site of the placental attachment, de¬
pendant on an alteration of the uterine texture of that part on
which the placenta is implanted. From clinical observation it
may be said, that wherever the placenta grows, whether on the
fundus or elsewhere on the inner uterine surface, the area of
attachment is marked by induration and thickening of the
uterine tissue, and in Dr. Roper’s experience the induration has
constituted one of the greatest difficulties in the way of safely
effecting forced delivery.
If we have to deal with a case of placenta prcevia in which
the placenta is centrally placed, then there is induration of the
entire circumference of the inner os ; if with one of a partial
kind, then we have a demonstrative proof, in that we are able
to compare that part of the os internum to which the placenta
is attached, with that portion to which it is not attached ; the
former will be found indurated and unyielding, the latter soft
and elastic.
Dr. Roper does not wish to be understood as overlooking the
undeveloped state of the lower part of the uterus in these
cases, occuring as they mostly do before full term : and in
speaking of the os or cervix uteri, he means the os or margin
of the orifice of the uterus proper. A great distinction is to
be drawn — the os internum, which is firm and thick, and the
thin flabby cervix with its soft outer os.
The limits of Dr. Roper’s paper did not permit him to dwell
on the importance of this condition in reference both to the
treatment of placenta prsevia and its prognosis after forced de¬
livery.
THE THERAPEUTIC VALUE OF CROTON CHLORAL,
In a very interesting paper read before the Ulster Medical
Society, Dr. Riddell ( Dublin Medical Jaurnal April, 1879),
reports his experiences of the great therapeutical value of
croton (batyl) chloral.
He mentions a case of severe paroxysmal headache ineffect¬
ually treated for many years by all the usual remedies of the
Pharmacopeia, but cured by 5 grains of batyl chloral twice
daily and 10 grains taken at night, dissolved in spirits of wine
and glycerine, with a little acid and syrup of orauge to cover
the flavor. The patient continues the 5 grain doses at night,
and now enjoys better health than she has done for years.
Since that case, Dr. Riddle says he has used it largely — some¬
times failing — sometimes relieving — till, by keeping an account
of all his cases, it began to be clear which were most benefited
1880]
Current Medical Literature.
803
by the drug. Since then the number of cases relieved (some per¬
manently) has increased. These cases are : Headache iu
females from mental distress ; those case of headache frequent
at the menopause — in fact, all those called neuralgia, except a
few arising from internal mischief are benefited, and in mauy
instances cured. In that distressing species of neuralgia called
tic-douleureux, he has found it in many instances acting like a
charm. Of course he does not include any arising from cranial or
intracranial causes. He has tried it iu neuralgia of the ovaries
but no good resulted.
In insomnia, it is not so reliable as the hydrate : but in
some cases, where the loss of, or inability to, sleep is accom¬
panied by a week or fatty heart, it is to be preferred, as it has
no weakening effect on the central organ of the circulation.
In one case of delirium tremens, where the circulation was
very feeble, the combination of croton chloral with digitalis
had a wonderful effect, and it seemed as if the drugs could be
given together in much smaller doses to produce the same
results than singly. In this case he pushed it from teu to
thirty grains every three hours, with drachm and two drachm
doses of the infusion of digitalis. In pain arising from caries
of teeth, he has found it useless in most cases, and iu all to
Richardson’s “ tiuctura G-elsemini,” but in one case, of a nerv¬
ous young lady, by giving her two teu grain doses, he was able
to extract a tooth next to painlessly, to her great satisfaction.
It is in affections of those parts supplied by the fifth pair of
nerves that it is of most use ; but to be of service, the drug
must be given in far larger doses than prescribed in the phar¬
macopoeia for adults, five grains three or four times daily, grad¬
ually increasing if required; if stimulants be wanted, dis¬
solve it in rectified spirits; if not iu glycerine. Iu all cases
complicated with hemorrhoids, give in glycerine, If ancemia
exists, combine it with iron, or, what he believes better, ar¬
senic ; then gradually lessen the chloral. Iu all cases he has
found it better to give it in solution than iu powder or pill.
Dr. Riddell mentions also severe pain with photophobia
and blepharospasm after injury, in which atropia failed, but
ten grains of butyl-chloral repeated in an hour gave complete
relief; and a case of acute painful facial carbuncle, iu which
the effect of teu grains doses every 3 hours was “ simply
marvellous,” the disease going through its frequent stages al¬
most without the patient knowing anything of the matter from
the sense of feeling. — British Med. Journal, May, 1879.
DEFRIBINATED BLOOD FOR RECTAL ALIMENTATION.
At a late meeting of the Therapeutical Society of New
York, Dr. Agnew H. Smith, Chairm in of the. Committee on
Restoratives, presented a report (New York Med. Journal,
April, 1879) on this subject. From the facts before them the
7
804 Current Medical Literature. [February
Committee felt warranted in drawing the following con¬
clusions : —
1. That defibrinated blood is admirably adapted for use for
rectal alimentation ;
2. That in doses of two to six ounces it is usually retained
without any inconvenience, and is frequently so completely ab¬
sorbed that very little trace of it can be discovered in the de¬
jections;
3. That administered in this way once or twice a day, it
produces, in about one-third of the cases, for the first few days,
more or less constipation of the bowels.
4. That in a small proportion of cases the constipation per¬
sists, and even becomes more decided the longer the euemata
are continued.
5. That in a small percentage of cases irritability of the
bowels attends its protracted use.
6. That it is a valuable aid to the stomach whenever the
latter is inadequate to a complete nutrition of the system.
7. That its use is indicated in all cases not involving the
large intestine, and requiring a tonic influence which cannot
readily be obtained by remedies employed in the usual way.
8. That in favorable cases it is capable of giving an im¬
pulse to nutrition, which is rarely if ever obtained from the
employment of other remedies.
9. That its use is wholly unattended by danger.
ON THE USE OF ETHER WITH COD LIVER OIL.
The same committee (ibid.) from an investigation of the evi¬
dence before them felt warranted in drawing the following
conclusions :
1. That the addition of ether to cod liver oil in about the
proportion of 15 minims to each half ounce (or an equivalent
amount of the comp, spirit of ether) will succeed in the vast
majority of cases in enabling the patient to take the oil, even
though it previously disagreed.
2. That in some cases in which the oil still disagreed after
the addition of the ether, the difficulty may be overcome by
giving the ether separately from fifteen minutes to half an
hour after the oil is taken.
No facts have been laid before the committee having a bear¬
ing upon the question as to whether the etherized oil is supe¬
rior to the plain oil in its ultimate effect upon nutrition, sup¬
posing them equally well tolerated by the stomach.
EFFECTS OF CHLOROFORM, ETHIDENE AND ETHER IN BLOOD
PRESSURE.
Drs. Joseph Goats, William Kamsay and John G. McKen-
drick, of the Committee on Anaesthetics of the British Medical
Association, report (Jour, of Anat. and Phy ., April, 1879), that
Current Medical Literature.
805
1880 1
the facts obtained from their researches seem to them to war¬
rant the following conclusions :
1. Both chloroform and ethedine administered to animals
have a decided effect in reducing the blood pressure, while
ether has no appreciable effect of this kind.
2. Chloroform reduces the pressure much more rapidly and
to a greater extent than ethedine.
3. Chloroform has sometimes an unexpected and apparently
capricious effect on the heart’s action, the pressure being re¬
duced with great rapidity almost to nil , while the pulsations
are greatly retarded, or even stopped. The occurrence of
these sudden and unlooked for effects on the heart’s action
seems to be a source of serious danger to life, all the more
that in two instances they occurred more than a minute after
chloroform had ceased to be administered, and after the re¬
covery of the blood pressure.
4. Ethidene reduces the blood pressure by regular grad a-
tions, and not, so far as observed, by these sudden and unex¬
pected depressions.
5. Chloroform may cause death in dogs either by primarily
paralyzing the heart or the respiration. The variations in
this respect seem to depend to some extent on individual pe¬
culiarities of the auimals ; in some the cardiac centres are
more readily effected, in others the respiratory. But pecu¬
liarities in the condition of the same animal very probably have
some effect in determining the vulnerability ot these two cen¬
tres respectively, and they may both fail simultaneously.
6. In most cases respiration stops before the heart’s action;
but there was one instance in which respiration continued
while the heart had stopped, and only failed a considerable
number of seconds after the heart had resumed.
7. The use of artificial respiration was very effective in
restoring animals in danger of dying from the influence ot
chloroform. In one instance its prolonged use produced re¬
covery e*en when the heart had ceased beating tor a consid¬
erable time.
8. Under the use of ethidene there was on no single oc¬
casion an absolute cessation of the heart’s action, or of respi¬
ration, although they were sometimes very much reduced. It
can therefore be said that, though not free from danger on the
side of the heart and respiration, this agent is in a very high
degree safer than chloroform.
9. The results confirm and amplify those stated in a pre¬
vious report, to the effect that ethidene does not compromise
the heart, as does chloroform. By the methods of experimen¬
tation theu employed, the effect on the blood-pressure could
not be determined, and altogether the results here obtained
are more exact and unequivocal.
It may be added that, since last report, ethidene has been
given to a number of patients of all ages, with results which
may be described as satisfactory.
806 Current Medical Literature. [February
Given freely at first, it produced anaesthesia as rapidly as
chloroform, and the effect could readily be kept up by compara¬
tively small subsequent doses. The only drawback is that in
some cases it produced vomiting ; but it is not determined that
it does so more frequently than chloroform, over which it has
the further advantage of producing less excitement, and being
more agreeable to the patients.
Iso butyl chloride was given to three patients, but it pro¬
duced considerable excitement, and proved an imperfect an¬
aesthetic. It has therefore beeu abandoned.
THE TREATMENT OF POST-PARTUM HEMORRHAGE.
This brings me to the discussion of the agent to which I wish
to call the attention of the Fellows of this Society as the
remedy for post partum hemorrhage, occuring under the con¬
ditions I have laid down, and in cases when the ordinary reme¬
dies of friction, pressure, ergot, cold, etc., etc., have failed.
This remedy is common vinegar. I claim no originality in sug¬
gesting it. I will merely state that I have used it, alone, as my
last resort, both in hospital and private practice, in many (ap¬
parently desperate) cases of post partum hemorrhage, and in¬
variably with successful results. I have taught the use of vine¬
gar to my classes since 1854, and though I am in constant re¬
ceipt of reports of cases from my former pupils in which they
have relied on vinegar — often in seemingly hopeless condi¬
tions — in all these years I have received the report of but one
case where the remedy failed to check the hemorrhage. Iu
this instance, my friend happened to have access to a galvanic
battery, and the electrical current at last proved the needed
stimulant to secure uterine contraction.
Vinegar I have found not only a certain remedy for post-par-
tum hemorrhage, but a remedy as safe as it is certain to cure.
In the many very bad cases where I have, used it the hemorr¬
hage was always arrested, and in but one instance did the
woman subsequently die, and in this case neither I nor the im¬
mediate attendant (my friend Prof. John Neill) had any reason
to attribute the woman’s death (neither did we) to the vinegar
I had used to check a most appalling case of flooding. In the
many reports which I have received from my former pupils on
this subject, I have yet received none where any unfortunate
results have followed the application of vinegar.
Vinegar presents the following advantages as an invaluable
remedy in the treatment of obstinate cases of post-partum
hemorrhage, where the difficulty to be overcome is a want of
shrinkage in the uterine muscle. In the first place, it can al¬
ways be easily obtained — every household, even the humblest,
having a vinegar cruet. In the second place, it can be applied
instantly, and without any apparatus. Iu the third place, it
always cures the hemorrhage, or rather, I should say, it lias
never failed to do so in my practice. It is sufficiently irritating
Current Medical Literature.
807
1880]
to excite the most benumbed and sluggish uterus to contract,
while, at the same time, it is not so irritating that its subse¬
quent effects are injurious. Fourthly, it is an admirable anti¬
septic. Professor Zweifel, of Erlangen, in his recent paper on
the prevention of puerperal fever, considers vinegar an excel¬
lent substitute for carbolic or salicylic acids.1 Fifthly, it acts
on the lining membrane of the uterus, and on the gaping ori¬
fices of the torn utero placental vessels ‘ as a valuable astrin¬
gent. Vinegar I suggest, then, to the Fellows of this Society,
as a most valuable remedy in post-partum hemorrhage depend¬
ing on inertia, possessing the advantage of the solutions of the
persalts of iron, of the tincture of iodine, and, may I not add,
even also all the advantages of the actual cautery ; while its use
is attended by none of the difficulties, and followed by none of
the dangers that attach to these remedies.
I have just stated that vinegar may be applied instantly and
without apparatus— perhaps I should mention precisely my
method of using it. I pour a few tablespoonfuls into a vessel,
dip into it some clean rag or a clean pocket handerchief. I
then carry the saturated rag with my hand into the cavity of
the uterus and squeeze it; the effect of the vinegar flowing
over the sides of the cavity of the uterus and through the
vagina is magical. The relaxed and flabby uterine muscle in¬
stantly responds. The organ at once assumes, what I will
term, its gizzard-like feel, shrinking down upon and compress¬
ing the operating hand, and in the vast majority of cases all
hemorrhage ceases instantly; should one application of vinegar
fail to secure sufficient contraction, the hand can be withdrawn,
and a second or even a third application can be made, until the
uterus shall contract sufficiently to stop the flow of blood.
Had I time, it would have been desirable to discuss this in¬
teresting subject at greater length and more completely. Thus
it may be asked, suppose you should meet with a case of hem¬
orrhage where vinegar failed to excite sufficient uterine irrita¬
tion, and, consequently failed to arrest the flooding — what
should be done ? My reply is, that, while such a case is sup-
posable, it is extremely improbable. I ha ve never met with one,
and but one has been reported to me. My treatment, however,
in a case where vinegar failed, would be at once to resort to the
application of the solution of the persalts of iron. I should do
so too with confidence that the remedy would stop the hemorr¬
hage, but, at the same time, I should consider my patient
placed in great additional danger by the use of my cure, and i
would employ it only on the ground that desperate diseases
justify the employment of heroic measures. If this view be
accepted, we are to consider the persalts of iron as the last and
extreme remedy to be resorted to in case of flooding ; never to
be used save in those cases of uterine inertia where the simpler
(t). Monthly Abstract of Medical Science, .Tune, 1878.
808
Current Medical Literature.
| February
and safer remedy of vinegar has failed ; and, inasmuch as vine¬
gar seldom or never fails to cure uterine inertia, the persalts of
iron are seldom or never to be employed in its treatment. — Dr.
It. A. Penrose, Gynecological Transactions, Yol. 3.
LEGISLATION FOR INEBRRIATES.
There is in England a “ Society for Promoting Legislation
for the Control and Cure of Habitual Drunkards.” Its objects
are to secure the enactment of statutes under which confirmed
and habitual drunkards can be sent, by municipal and other
local authorities, to “ retreats, ” or institutions especially de¬
signed for this class, where they will receive regular and ap¬
propriate treatment.
The objections which have been urged to these aspirations
are that such enactments encroach on individual liberty, which
is so dear to all English speaking people ; that they would be
liable to abuse, for the sake of gain ; that they involve the
maintenance of large and costly institutions ; that confirmed
inebriates are almost never really li cured ” by treatment in
such institutions ; that owing to domestic inconveniences such
laws would be but partially taken advantage of; that drunk¬
enness is a moral perversity, and ought to be met by moral and
religious teaching rather than physical restraint ; that the
diagnosis of “ habitual drunkenness ” is vague and uncertain;
and the like.
It is not worth while to do more than mention these various
objections. Their consideration is occupying the attention of
specialists of this branch in most civilized countries. The im¬
portance of taking some active steps to foil “ the demon in¬
temperance ” is very generally recognized.
There are not wanting enlightened and thoughtful men in
this country who have espoused the cause with enthusiasm ;
and were the powerful temperauce organizations which flour¬
ish among us enlisted in the struggle, we should not wait long
to see such enactments spread on the statute books. The edit¬
or of the Quarterly Journal of Inebriety says, in his last
issue —
“ The time has come for an intelligent recognition of all the
means of relief. Every town and city is menaced by an army
of inebriates, who are rushing down to ruin, breaking up all
order, morals and industry, and leaving entailments of disease
and degradation that centuries cannot eradicate.
“The great principle of self-protection must be recognized
practically in this statement, that whenever a person habitu¬
ally fails to exercise self-control in the use of alcohol and other
narcotics, he is either a dangerous person or a public nuisauce.
It is the duty of the authorities to take care of such men, to
protect them and society from the consequences of their ex¬
cesses. They should be isolated in asylums, the same as in
Current Medical Literature.
809
1880 1
cases of infectious diseases, and if to this can be added means
of self-support, it is demanded, as a measure of the highest
wisdom and economy to all.
“Inebriety must be regarded as a physical disease, if we
would understand the hidden forces which govern its march
along the lines of civilization.”
This last sentence is not quite clearly expressed. In physi¬
cal diseases we do not forcibly shut up patients ; rather let us
say that the inebriate suffers from a mental disease, that he is
of alienated mind, in the eye of the law, non compos mentis.
True enough, that advanced alienists claim mental disease as
merely a sign of cerebral pathology ; but we now use terms in
their ordinary and legal senses.
As a dangerous person, the confirmed drunkard should be
isolated, less for his own benefit than for the safety of those
around him, less as a means of promoting temperance than for
the protection of the social state. The excuse for every violent
encroachment by government on individual liberty, it must al¬
ways be borne in mind, is not “ to make an example,” nor to
reform, but solely to protect the well doing in their legitimate
pursuits. As the occasional inebriate, when “drunken and
disorderly,” is forthwith shut up in the station house until he
grows sober, so the constant inebriate, w ho is drunk and more
or less dangerous substantially all the time, should, with like
legality, be put behind the bars for a much longer time. Take
the instance of a woman, a girl, or a wife and mother who is
an habitual sot ; what disgrace and destruction to herself and
her family she may work ! Yet no one has the strict legal
power to remove her from the temptation she cannot resist. If
she is of good family, a point will be stretched, and she will be
sent to a private asylum, on a certificate of insanity ; but if
poor, she will drag down with her all her family. What phy¬
sician of extended practice cannot recall various examples of
this kind ? They call loudly for action by the properly consti¬
tuted authorities. — Philadelphia Medical and Surgical Reporter ,
December 6.
WATSON ON THE EXTERNAL ORGANS OF GENERATION IN ANI¬
MALS AND IN HERMAPHRODITES.*
Whilst the comparative anatomy of the internal genital
organs has thrown much light on the nature of foetal relics in
those structures in our own species, the study of the external
genitalia in the lower animals is of particular interest in the
explanation of complicated forms of herinaplirodism. Their
structure and variations, however, explain rather than prove ;
for, as Professor Watson remarks, the only true reliable sexual
characteristic is the nature of the genital gland. If that body
*T1ig Homology of the Sexual Organs illustrated by Comparative Anatomy and
Pathology. (Journal of Anatomy and Physiology, vol. xiv, p. 55). See also London Med*
ical Record, Nov. 1879, p, 429.
810
Current Medical TAterature.
[February
display the characters of a testicle, the subject is a male; but,
on the other hand, if it be histologically an ovary, the so-called
hermaphrodite is strictly female.
Early in foetal life, in our species, the cloaca becomes divided
into two parts by a partition. The posterior division, repre¬
senting the portion of the sac of the allantois which communi¬
cates with the alimentary canal, now becomes the outlet of that
canal, an invagination and subsequent opening of the integu¬
ment forming the anus. Every surgeon knows that any degree
of arrest of this process of development, from absence of the rec¬
tum to simple atresia ani, may exist without auy malformation
of the genitals. The anterior division of the cloaca is the geni¬
tal fissure. A projection buds from its front part ; this is the
penis or clitoris. The margins of the genital fissure in the
male coalesce, receive the testicles, and become the scrotum ;
in the female, they do not unite, but remain apart as the labia
externa. The projection, too, in the male, closes inferiorly, a
part of the urethra running between the first formed or bud¬
ding, and the inferior or coalescent portions. Hence the spongy
portion of the urethra and the corpus spongiosum are added on
to the primitive organ. In the human female, this organ
remains undeveloped. Its lower surface is grooved, and the
margins, not coalescing, become the labia minora. Hence, in
women there is no spongy portion of the urethra. Close to the
base of the genital member a gland is developed on each side.
The pair are Cowper’s glands in the male, Bartholini’s in the
female. Professor Watson considers them to be important
landmarks in determing homologies.
The female urethra, which has the vagina behind it, repre¬
sents the upper portion of the prostatic part of the male urethra,
which bears the verumontanum on its floor. Oil this eminence
lies the vesicula prostatica, the liomologue of both uterus and
vagina. Between the female meatus urinarius and the orfices
of Bartholini’s glands is the vestibule, representing that part
of the male urethra which lies between the vesicula and the
openings of Cowper’s glands ; in short, the vestibule is homolo¬
gous with the lower part of the prostatic, the whole of the mem¬
branous, and a short segment of the spongy part of the urethra.
The extreme shortness of the vestibule in woman, compared to
the length of its liomologue iu man, is remarkable; but in
many animals it is very long, and its homology is therefore
much plainer.
The homologies of the external male organs are elucidated
by comparative anatomy and by teratology. In the penis of the
opossum we see, among mammals, the closest approach to the
female homologues of its constituent parts, for not only does
the glans remain bifid, but the corpus spongiosum is double
throughout life, closely resembling the vaginal bulbs. Non-
coalescence of the margins of the genital fissu re in men exists
as the deformity termed hypospadias ; but here the floor of the
Current Medical Literature.
811
1880]
urethra is deficient, which is not the case in the opossum. In
the most extreme forms of hypospadias, the whole of the
spongy part of the urethra is practically absent, its upper wall
alone remaining as a groove along the lower border of the
penis. This member is in such instances very small and ill-
developed, resembling a clitoris ; the bulb is absent, and repre¬
sented by two folds like the female labia minora ; the testes are
undescended ; and the scrotum is undeveloped, two external
labia existing in its stead. Yet the internal organs retain the
male type. Between the labia minora a cul-de-sac may be
sometimes found, an involution of integument made to meet a
vagina which does not exist. A little reflection on this extreme
form of hypospadias shows, as Professor Watson remarks,
u that the narrow elongated uro genital canal of the male may
be occasionally transformed into the characteristic vestibule of
the female.” The deformity constitutes transverse hermaphro-
dism, the inner parts being male, the outer female.
The homologies of the vestibule in the human female are
thus made more clear when the elements of the male organ are
imperfectly developed. It is the shallowness of the vestibule
that makes comparison so difficult, since it is but one inch
deep, the vagina measuring about six inches. But science
again clears the difficulty, as it does in the case of males. In
many animals the vestibule is very long. Owen has shown that
in the American monkeys it equals in length the vagina. It Is
in these animals, too, that the clitoris is of great length ; in the
spider-monkeys it is pendent, and closely resembles a penis,
but it remains simply grooved underneath, as in some cases of
hypospadias in man. In some of the lemurs, the grove of the
clitoris closes in below ; this is also the case in the mole, and in
some rodents. Thus that organ serves for micturition like a
penis. In the hyaena, the urethra traverses the clitoris also,
and its floor is not formed by a mere coalescence of the mar¬
gins of the groove in the upper part, but actually of what in other
, female animals would be the nymph*. The whole organ is
elongated and pendulous, and provided with a prepuce, closely
resembling the penis of a male hyena. But the erectile tissue
of the vaginal bulbs remains bilateral in the female
Again, in human female monstrosities, the clitoris is some¬
times found to be abnormally grooved beneath and largely
developed. By the pure light of science a large clitoris is
merely a sign of inferior type, just as certain, ape like charac¬
teristics are sometimes seen in man, even among civilized races
and refined individuals. A careful study of Professor Watson’s
paper ought to correct certain mischievous and repulsive ideas
still prevalent in the medical profession, and more than once
the cause of discreditable practices among its members. It
seems to us as illogical and unfair to attribute enlargement of the
clitoris to bad habits, as it is to explain the traditionally violent
sexual instincts of the male goat to the fact that his vesicula
8
812 Current Medical Literature. ■ [February
prostatica is much more like a female uterus and vagina than
that of any other male animal. None of the variations in the
organs of normal animals, as described above, bear any relation
to the variations in their sexual appetites.
Professor Watson concludes his highly instructive mono¬
graph with remarks on the more complicated varieties, her¬
maphrodites, basing the determination of sex, as we have
already observed, entirely on the presence of ovaries or of tes¬
ticles. ' ALBAN DORAN.
London Medical Record , Dec. 15.
RETENTION OF URINE IN ELDERLY MEN.
Dr. S. W. Grouley {New Yorlc Medical Record , vol. xvi., No. 8,
1879), in a clinical lecture ou this subject, speaks as follows :
A safe rule for your guidance in the management of cases of
acute retention of urine of forty-eight hours’ duration, is never
to draw off more than one-third of the contents of the bladder
and to do this very slowly, by half closing the distal end of the
catheter, so that the urine will flow in a very small stream.
Having collected half a pint, close the catheter for a quarter of
an hour, then let another half-pint flow, and so on until the re¬
quired quantity has been obtained. In two hours repeat the
catheterism if the first has been easy, — otherwise the catheter
should be closed, and left in for twenty-four hours, — and re¬
move again the same quantity very gradual^, and at the ex¬
piration of another period of two hours you may completely
empty the bladder, always slowly ; and in this way you will
have taken the necessary precautions to avoid both cystor-
rhagia and polyuria. Every three hours after the last catheter-
ism the urine should be drawn off* until the patient can pass it
spontaneously ; if he cannot do so, of course the catheter will
have to be resorted to at such intervals as mey be found neces¬
sary. You will aiso have to treat the existing vesical inflam¬
mation and atony. For general medication I would recommend
the tincture of chloride of iron in five- minim doses three times
daily, and also diluent drinks, such as thirty grains of citrate
of soda or potash in half a glass of water three times daily,
and in a few days, for a change, dog-grass tea, etc. Topi¬
cally, lumps of ice the size of the last joint of the thumb
should be introduced into the rectum in rapid succession as fast
as they melt, for an hour, night and morning. A bag of ice
may be afterwards applied alternately to the perineum and hy-
pogastrium for an hour or more. Each time the bladder is
emptied by the catheter, a couple of ounces of cold borax solu¬
tion, from five to ten grains to the ounce, should be thrown in
and allowed to run out slowly, then two more, and two more
ounces which should be left in and the catheter withdrawn ;
this can be accomplished in five minutes. No preparation gives
me more satisfaction than the borax solution for cleansing
Current Medical Literature.
813
1880]
bladders which contain offensive purulent urine. It is as well
to have in readiness a strong solution of borax in glycerin ; one
ounce of the biborate of soda will be readily dissolved by six
ounces of glycerin, each drachm of such a solution being equal
to ten grains of biborate. In a week or thereabouts, if the
case should progress well, the irrigations may be diminished in
number until only one is used each day. In some cases a mild
faradic current is serviceable.
Besides hemorrhage, polyuria, as I have already said, is very
apt to follow the sudden evacuation of an overdistended blad¬
der, and you will generally prevent its occurrence by observing
the caution that has just been given. I know of a case of poly¬
uria which followed the withdrawal of three pints of urine in
the course of one hour, one pint at a time, the third pint com¬
pletely emptying the bladder. The catheter was left in, and
every hour for twenty-seven consecutive hours one pint of urine
was drawn. After this the amount of urine gradually dimin¬
ished, until only six pints were removed each twenty-four
hours. At the end of three months it was reduced to four
pints daily.
The case just cited is exceptional, for ordinarily it is safe to
empty the bladder— slowly, of course — at one catheterism,
when the patient is seen during the first twenty-four hours of
an attack of acute retention. — Philadelphia Medical Times.
THE BELLEVUE TRAINING SCHOOL FOR NURSES.
The annual meeting of this excellent institution was held on
the 11th of December at the Nurses’ Home, adjoining Bellevue
Hospital, New York. Mr. William E. Dodge, Jr., presided, and
a considerable portion of the visiting and house staff' of the hos¬
pital were present in the large audience. Mr. Dodge read the
annual report, in which it was stated that the hope entertained
at the commencement of the work in 1872, that the school might
become a college for the training of nurses and one of the recog¬
nized institutions of the country, had been realized. The pupils
on entering were required to pass a preliminary examination in
reading, writing, arithmetic, and English dictation. At the end
of the first year they passed a second examination on the prac¬
tical and theoretical duties of a nurse, and at the completion of
the two years’ course a final examination, of similar character,
before a board composed of distinguished physicians and sur¬
geons. Since the regular establishment of the school in May,
1873, ninety nurses have been graduated from it. Of this num¬
ber two are in responsible positions as heads of training schools
or matrons of hospitals, two are nurses among the poor, two
have entered sisterhoods, and fifty-nine are still professional
nurses. From this record, the report continues, it will be seen
that the school has given an honorable, self-supporting occupa¬
tion to a class of women whose intelligence and disposition
814
Current Medical Literature.
[February
have proved them to be fitted for it, while the eontinued and
increasing demand for their services in hospitals and private
families speaks favorably for the quality of the service they
render.
All the female wards of Bellevue Hospital, two male wards,
the Sturgis Pavilion, and the lying-in department are now
nursed by the pupils of the school. In the Lying-In Hospital
there have been one hundred and thirty-three births, and only
one death from puerperal fever has occurred during the year.
In the words of one of the visiting physicians, “ The patients
confined within its walls have enjoyed as great an immunity
from infectious puerperal diseases as in the best private practice.
The accomplishment of such results has beeu rendered possible
only by the faithful, conscientious, and intelligent care render¬
ed by your nurses, to whom I am glad to present my grateful
thanks.” The building appropriated to this hospital, having
originally been an engine house, was in many respects unsuit¬
able for its present uses, but in consequence of the liberality of
Mrs. Wm. n. Osborn, such additions and alterations were made
that it is now as comfortable and convenient as could be de¬
sired. To the same benevolent source Bellevue owes the erec¬
tion of the Sturgis Pavilion, for the treatment of acute surgical
cases. A record is kept by the superintendent of the conduct
and efficiency of each nurse during her two years’ training, and
after she leaves the school, if she wishes to continue her con¬
nection with the society, and obtain employment through its
means, she is required to report at stated periods, in order that
her diploma may be renewed.
In the original plan of the school was included the work of
nursing among the poor, and it has never been lost sight of,
though the managers have not yet been able to carry it to the
extent they desire. They report, however, that the work has
been successfully begun by the female branch ot the New York
City Mission, and by the Society of Ethical Culture, presided
over by the Rev. Dr. Felix Adler. There is appended to their
report a letter from Dr. Adler on the beneficial results of trained
nursing among the poor, aqd this contains the following ex¬
tract from the report of one of the district physicians of the
Demilt Dispensary in regard to the services of the nurse work¬
ing under his direction : “ She has a quick perception of what
is needed, and she readily and cheerfully does it, no matter how
repulsive the task may be. She visits patients intrusted to her
care at unexpected times, that she may see them as they are
from the beginning to the end of their sickness. One must take
time to win the confidence of these people, and find out the
secrets of their poverty and distress, and so know how not only
to alleviate but often to prevent misery. This work the nurse
is doing steadily and faithfully, and the information she brings
me is invaluable. The only wonder to me now is how I got on
with these cases without a woman’s help. She visits from morn-
Current Medical Literature.
815
1880 1
ing to night, seeing that my medicines are given as directed,
inaugurating and enforcing much needed sanitary measures,
often making with her own hands articles of clothing for the
sick, while she distributes with judgment the articles so gener¬
ously supplied by your society. Surely the blessings of many
ready .to perish will be hers, for not one of them speaks of her
but with the kindest expressions of gratitude and regard.”
The good health that the pupils of the school have enjoyed
proves that their occupation, when properly conducted, is not
injurious. Only two deaths have taken place in seven years,
and dining the past summer there was not a case of illness in
the school. Care is taken that the nurses shall not be over¬
worked, and that the diet shall be generous and good, while the
bright and comfortable home in which they live when not en¬
gaged in the hospital no doubt contributes largely to the main¬
tenance of their health.
In concluding their report the managers offer their thanks to
the head nurses and to the graduates : to the former for their
loyal devotion to their work, not only in instructing their
pupils, but in the example they set of a faithful and tender
performance of painful and at times repugnant duties; and to
the latter for the good work that they have done wherever their
lot has been cast, among the rich or poor, in hospitals or
asylums, thus reflecting credit upon the school, to which they
always gratefully acknowledge their obligations.
On this occasion diplomas were awarded to twenty-three
graduates, twelve of whom were from New York, two from
New Jersey, one from Massachusetts, one from Maryland, one
from North Carolina, one from Tennessee, one from Ohio, one
from Michigan, one from Connecticut, one from Canada, and
one from Holland. Each graduate was also presented with a
pocket-case of instruments. The annual address was delivered
by Dr. William M. Polk, professor of obstetrics in the University
Medical College, and in the course of it he contrasted the present
condition of hospital nursing and the advantages for obtaining
good nurses with the state of affairs that existed when he
entered the medical profession, ouly a few years ago.
It is expected that during the next year there will be one
hundred and fifty pupils in the* school, applications for admis¬
sion having been received from all parts of the country. —
Boston Medical and Surgical Journal , Jan. 1.
KAVA-KAVA AND ITS BLENNOSTATIC PROPERTIES.
In a recent thesis on this subject, Dr. Dupuy states that the
Kava plant contains a resin, which seems to constitute its es¬
sential therapeutic principle. The following are his conclu¬
sions concerning its medicinal properties :
1. Kava-Kava is a sialagogue.
2. Its action on the stomach is that of a bitter tonic; it im-
816
Current Medical Literature.
[February
proves the appetite without producing either diarrhoea or con¬
stipation, and perhaps acts as a prophylactic to catarrhal affec¬
tions of the upper part of the digestive canal. Its taste is
agreeable.
3. It exerts a special stimulating effect on the central ner¬
vous system ; this stimulation differs essentially from alcoholic
iutoxication, and is called by Dr. Dupuy, kavaic stimulation.
4. It is not a sudorific.
5. It increases very markedly the excretion of water in the
urine, and may be classed among the most efficacious of diu¬
retics.
6. It does not produce priapism, as has been stated, but, on
the contrary, it prevents it.
7. It is endowed with remarkable blennostatic properties,
which manifest themselves very promptly. A chronic urethral
discharge is first rendered more profuse, and is then promptly
cured.
8. It is very efficacious in cases of acute urethritis or vagi¬
nitis, calming the inflammatory condition, controlling the pain
during micturition, and suppressing the muco purulent dis¬
charge from the urethro- vesical mucous membrane.
These results are probably due to the combined diuretic and
blennostatic actions of the drug.
The anti-catarrhal action seems to be due to the resin, and
the diuretic effects to a neutral, crystallizable principle called
kavaine, and perhaps also to an alkaloid not yet discovered,
whose presence would explain more satifactorily the phenomena
excited in the central nervous system, as well as the alterations
in the circulation and secretions of the uro genital apparatus.
It possesses over other blennostatic agents, according to Dr.
Dupuy, marked advantages, inasmuch as it produces neither
diarrhoea nor constipation, is taken with pleasure, increases the
appetite, relieves or controls entirely the pain during micturi¬
tion, changes completely the nature of the discharge, and pro¬
duces a cure in a very short space of time — ten days. — La.
Tribune Medicate , April 13th. — Medical Record , April 13.
CHOLERA— A TRUE NEUROSIS.
By Hknky Kaymond Rogers, M. D.
In the study of this mysterious disease, physicians in all the
ages have been but too apt to allow' themselves to be guided
by the literal evidences of ! heir senses, and the superficial ap¬
pearance of things.
The prominent symptoms disclosed by the primee vice have
caused those parts to be regarded as the primary location of
the disease. Nothing can be more erroneous in fact or more
misleading in practice. It is, therefore, not surprising that
every form of treatment employed, until a recent period, has re¬
sulted in failure. Success iu its future management must,
Currenx Medical Literature.
817
1880]
therefore, depend upon abetter appreciation of its intimate na¬
ture, and a truer conception of the inode of its operation upon
the human system.
The fact that this disease is capable of making; its invasion
and proceeding to a fatal termination in the space of twenty or
thirty minutes, is conclusive evidence against the theory of
germs, decompositions, or specific poisons. We are thus led to
regard it as a true neurosis.
A careful review of its prominent symptoms abundantly sus¬
tains this conclusion.
The distinguishing characteristic in this disease is the re¬
versal of the action of the mucous surfaces of the stomach and intes¬
tines. The normal action of those surfaces is to take up the
fluid contents of those organs, and to convey the same on then-
way to the systemic circulating current in the blood-vessels.
In this disease this normal process (termed endosmosis) gives
place to a reverse current in which the watery element of the
blood passes with greater or less rapidity into those cavities.
This element constitutes the so-called rice-water evacuations.
These transudations into the stomach and intestinal canal in
their profuseness, and painlessness, can by no possibility oc¬
cur, except that the nerves, whose office it is to preside over the
parts implicated, fail to perform their functions in a normal
manner. Xo fluid, however attenuated, can make its way
through the walls of the blood-vessels while the latter preserve
their integrity. Thus the unlocking of the exhalent orifices of
the blood-vessels, permitting the rapid filtration into the stom¬
ach and intestiual canal of the finer elements of the blood, and
sometimes of the blood itself, is a positive evidence of perturba¬
tion in the action of the nerves which supply the vessels and mem¬
branes through which the infiltration takes place.
The cramps arise from purely nervous causes ; the vomiting
is simply regurgitative ; collapse may occur from the initial
force of the disease, although most frequently due to the di¬
minished volume of the vital current. In rapidly fatal cases
the disease expends itself wholly upon the brain and nervous
system, and death occurs before other organic changes can have
taken place. After death no constant and uniform changes
are found in the fluids or tissues of the body which can be re¬
garded as the cause, or the products of the disease.
We may, therefore, consistently ignore all previous theories,
and discard all forms of treatment which have been so fruitless
in results, and seek some other philosophy which shall better
account for the conditions observed, and some other treatment
which may prove more successful.
In viewing this disease from a neurological stand point, the
treatment emerges from the pure empiricism which has ever
characterized it and becomes thoroughly scientific. It also be¬
comes the perfection of simplicity.
In the treatment of this disease there are two great and lead
818 Current Medical Literature. (February
ing indications to be observed. First, to change the perturbed
condition of the nervous system, and thus shut down the flood¬
gates through which the life ebbs away ; and second, to ward off
the effects of the exhaustive drain upon the vital current. The
first may be accomplished by the hypodermic injections of
morphia, and the second by position.
It cannot be too firmly impressed upon the professional mind
that the rapid diminution of the volume of the blood, through
exudation, is attended by the same results which follow a true,
active hemorrhage. From the commencement of this disease
this exudation is in progress in a manifest, or a concealed form,
and with greater or less rapidity, and demands the precautions
and treatment due to active hemorrhage.
In the hypodermic form of medication there is certainty of
retention of the remedies employed and promptness and
efficiency in their action— a very marked contrast with all other
forms of treatment which have ever been employed. The com¬
mendation of this method by those who have employed it is ex¬
pressed in the strongest terms. The reports of cases thus
treated in Asia, Europe, Australia and in various portions of
our own country show almost uniformly favorable results.
The following treatment was employed with successful re¬
sults in my latest cases — twelve in number — the most of which
were grave and typical :
(1.) The hypodermic use of morphia, administered accord¬
ing to the age and condition of the patient, usually in quantity
of ene-eiglith to one-quarter of a grain, and not frequently re¬
peated.
(2.) The horizontal position, or with the head lower than
the body.
(3.) For the mouth , nothing hut ice , and that ad libitum. When
this cannot be obtained, the coldest water may be given, and
frequently repeated, in small quantities,
(4.) External heat, frictions, etc.
The following case, as illustrating the above treatment, may
be deemed apropos: Mr. T. was seized at midnight, and at early
morning was found to be on the verge of collapse. In his con¬
dition of almost complete exhaustion, with pulse almost imper
ceptible, the use of morphia was contra-indicated. The first
duty, therefore, was to stimulate the brain and heart to action
by sending to those organs a current of blood by gravitation.
The head was quickly placed many inches lower than the body
and extremities, and the other measures resorted to. At the
end of one hour the pulse had perceptibly improved, and a
quarter of a grain of morphia was hypodermically administered.
The inclined position was continued several hours. The result
was favorable.
The same treatment applied to cholera- morbus is also prompt
and favorable in its results.
A more full explanation of the views of the writer regarding
Current Medical Literature.
819
1880]
the origin, dissemination, pathology and treatment of this dis¬
ease may be found in the “Transactions of the American Medi¬
cal Association, 1876.” — Hospital Gazette , Aug. 9.
HYPODERMIC INJECTIONS OF ETHER IN SCIATICA.
Having seen and read in the Lancet and Clinic Professor
Comegys’ experience with hypodermic injections of ether in
sciatica, and also that of a physician of Ottawa, Illinois, with
the drug upon himself, we were struck with the seeming happy
etfect and resolved to put the remedy to the test on the first oc¬
casion. Soon after a case of sciatica, which had resisted the or¬
dinary treatment for that disease, such as quinia, hypodermic
injections of morphia, iron, iodide of potassium, arsenic, bella¬
donna, wine of colchicum, electricity and counter-irritation, gave
us the desired opportunity.
J. McG-., married, 30 years of age, farmer, nervous tempera¬
ment. Present condition emaciated, loss of appetite, loss of
sleep, intense pain along the whole tract of the left sciatic nerve,
and radiating upward from the exit of the nerve under the
pyriformis muscle to the sacral and lumbar regions. Muscles
of the leg and hip considerably atrophied ; temperature much
reduced, so much so that the patient complains of coldness and
numbness. The system under the influence of morphia, which
has been kept up about a month.
The morphia was immediately withdrawn and injections
of ether commenced. First injection of fifteen minims
immediately produced warmth and reduced the pain, and
patient slept soundly that night for the first in two weeks.
Afterwards used five injections on the five days succeeding, one
each day, averaging twenty-five minims each. Improvement
continued steadily. Patient put on comp, plios. pil. and iron.
Appetite immediately returned, sleep returned ; use of leg
gradually returned, muscular atrophy disappearing and he is
now well. No abscess formed, only slight callous forming
around the puncture.
Drs. Whittaker & Maris.
West Mansfield, O., Nov. 15, 1879. — Cincinnati Laneet and Clinic ,
Nov. 29.
BLOOD AS A STIMULANT AND FOOD.
By M. Czartoryski, M. D.
Having read in No. 20 of your valuable periodcal the admi¬
rable paper of Ilr. C. G. Polk on consumption, I would respect¬
fully call the attention of the profession to a most valuable diet
— therapeutic article — in all cases where progressive consump¬
tion of bodily tissue, antemia and nervous prostration are prom¬
inent symptoms, or whenever, from any cause, the circulating
medium is deficient in quantity or in its constituents. The
9
820 Current Medical Literature. [February
article to which I refer is the first drawn blood of healthy
chickens, pigeons or other poultry, drawn from the wound
direct and well mixed with warm wine or milk punch, or with
warm lemonade, milk or coffee, and flavored to taste, and taken
immediately by patient before it becomes cold or coagulated.
It is a well known fact that the blood of the fowl is rich in red
corpuscles, and consequently in the phosphates. It acts with
the most surprising promptitude, relieving symptoms of ex¬
treme prostration : for instance, in cases of extreme floodings,
during and after the parturient act, when the patient is com¬
pletely exhausted, and when every hope is abandoned, I have
seen it quickly restore warmth and circulation, and, at the
same time, allay nervous and gastric irritation. The patient in
this condition generally, about 8 to 20 minutes after taking the
dose, falls into a sound, healthy sleep. On awaking, of course,
the dose is repeated — taking the blood of one to three healthy
chickens in the tweuty-four hours, always in warm drinks, until
the patient is restored to health. It is an article easily obtained
anywhere, one that can never do any harm, and that acts bet¬
ter and more promptly than the transfusion of blood from vein
to vein. I have given it with the most gratifying results to
small, puny or scrofulous babies, who were considered almost
unfit to live and only a few days old, as well as to the aged, down
with the prostration of old age. It always acts most promptly
if taken on an empty stomach.
Anyone may satisfy himself of its prompt effect if tired and
worn out by fatigue. Within three minutes after taking a dose
a pleasant warmth and pleasurable sensation is felt, extending
from the stomach over to the solar plexus, gradually pervading
the whole system to end of toes and tips of fingers ; at the
same time the pulse quickens and bodily and mental fatigue
disappear. It has always done good service in my hands, and
other physicians ought to give it a trial for humanity’s sake.
The dose of blood of poultry is perfectly in the hands of the
attending physician. Good healthy poultry is easily recognized
and always attainable. The taste resembles milk and may be
flavored to suit. The most delicate woman may take it without
leaving her parlor and without repugnance. She needs to see
nothing of the killing or of the death struggle of the bird. The
killing should always be done in a warm place — best near a
warm stove — where no draft of air can strike the streaming
blood, which is to be well stirred direct into the warm punch or
other liquid ordered by the medical attendant. If the patient
can overcome the repugnance, the blood may be sucked
directly from the wound. It should be drunk by patient as
soon as the blood ceases to flow and before the bird is properly
dead.
The blood of poultry is in every respect preferable to that of
cattle, sheep, etc., as it is much richer in red corpuscles and
phosphates ; it is more easily obtained, and the certainty of its
Current Medical Literature.
821
1880]
coming from a healthy bird is greater: besides the patient
avoids seeing the disgusting and terrible sight so often seen in
slaughter-houses, or smelling their offensive odor, or running
the dangers consequent to the killing of large, maddened and
frightened animals — sights, smells and dangers that many
patients would rather die than encounter.
Well do I recollect as a student in the medical department of
the University of Breslau, Germany, reading in the old reading
hall of the University, the following passage from an old Latin
manuscript of the medical works of the celebrated Avicenna,
one of the most celebrated physicians of olden times, which I
give in a free translation from memory :
“ If thou hast an patient that from wound or disease has lost
his or her good blood, as even an woman that from childbirth
or other cause has flooded almost to death, or an man or woman
whose blood, by long-standing disease, has dried up, and thou
desirest to give both health and life to thy patient, then call to
thine help a pure, strong virgin — an pure maid is an well-be¬
loved, true priestess to the Almighty God and to his angels of
execution. Let her well sharpen an bright, keen cutting knife,
and with this cut the neck through the big veins on each side
of an healthy chicken — an rooster for a man, and pullet or heu
for a woman or girl — in the name of the Almighty God as an
sacrifice to him. Do not cut windpipe or gullet, as this might
cause vomiting. Let her cut it that it will bleed very well, and
take and stir with the knife the blood in an glass half filled
with good warmed wine, as hot that it just may be drunk. Do
not press the windpipe of the chicken, but let it breathe while
it bleeds that the blood may squirt well and more red. Let the
virgin do this in an warm place, free of draught, as near to thy
patient as possible that he may drink it warm from her hand.
Let him drink it as soon as the chicken ceases bleeding, in
the name and with an prayer to the great Almighty God that
gives life and health, and thou startest o’er with wonder how
quick, if thou givest it often enough and as thine patient needs,
he will be restored to new health and life. For only in the blood
is the life, and good, healthy, young blood gives to men healthy
blood if taken in proper manner. As the virgin — and only
such should do it — draws the blood from the chicken, she
brings an welcome sacrifice of the life to Almighty God and his
holy angels and spirits. She alone is fit to kill for sacrifice, and
every woman that knows how to kill well is his true, well-
beloved priestess, and his holy blessing will rest on her and
her work forever. As she does her holy work the angel of
death leaves your patient and Almighty God grants him a nsw
term of life. Try it and do as I have often and often done, and
thou shalt see and do such wonders that all mankind will be
surprised at thine cures and praise the Almighty for his great¬
ness, and give thee great name over all countries.”
I hope you will find this worthy of a corner in your valuable
Current Medical Literature.
822
[February
journal. I can only repeat with old Avicenna, “ try it”— it can
do no harm and may save valuable life. I shall always be
ready to give any information on the subject that may be
desired by anybody. — [Michigan News, Dec. 10.
Stockton, San Joaquin County, California.
THE SALISBURY PLAN IN CONSUMPTION.
By Ephkaim Cutter, M.D.
Prelude. — The position of the writer is that of witness.
As such he feels compelled to state the truth. If his testi¬
mony proves a testimonial, it is still testimony. All
that is asked is a fair hearing and a suspension of
judgment until the evidence is all in. Moreover, as the
subject is one of the most momentous that can engage the
mind of a medical man, it demands that it should be treated
according to the rules of good breediug and high professional
morals.
In 1867 I became acquainted with Dr. Salisbury. I learned
that he had a work ready for the press on the Causes and
Treatment of Consumption. He told me of its scope. It
seemed like an idle tale. The great fact that influenced me
in its favor was that he was the only person I knew of who
had showed the synthesis of the disease by feeding hogs,
killing them by the food and verifying the disease by autop¬
sies. I have read the records of 110 post-mortem examina¬
tions of such hogs. Dr. Salisbury studied the complaint on a
much larger number of animals, some 2000. The following
points are prominent in the Salisbury plan :
1. Consumption is a constitutional blood disease.
2. It is a condition caused by a yeast plant developing first
in the digestive apparatus, then in the blood glands, and
finally in the white blood corpuscles and in the serum.
3. The spores of this vegetation constitute the hereditary
taint, — the primary cause.
4. They may remain latent for a long time.
5. Tubercles are a more secondary product, having their
origin and development in aggregations, groups and masses of
yeast spores, with colorless corpuscles of blood and fibrin fila¬
ments, when they start and develope inside the capillary
vessels ; of yeast spores and mucus cells and filaments, when
they start and develope in the epithelial follicles and air cells ;
and of yeast spores and connective tissue cells and filaments,
when they originate and develope in connective tissue, outside
of the blood vessels.
6. The morphology of the blood in consumption embraces
the following :
1. Red corpuscles, pale, thin, softened, sticky, aggregated,
not arranged in rouleaux.
2. Enlarged white corpuscles, more or less softened and dis-
1880]
Current Medical Literature.
823
tended with entophytal growths. Sometimes they burst and
scatter the spores, forming.
3. Spore collects.
4. Spores, white in color.
5. Fibrin filaments, shortened, increased in diameter and
more or less soft and rotten — so to speak, — these states vary¬
ing with the progress of the disease.
6. Massal white corpuscles.
7. This collection of morphological elements is not found in
healthy blood.
8. He has taken men and hired them to eat the peculiar
food — has produced the morphology in their blood — and as
has been stated, pushing the diet in hogs has verified the full
culmination of the disease by post-mortems.
9. Dr. Salisbury, by pursuing a plan opposite to the synthe¬
sis, has produced the cure. This he has done, and I have seen
some of the cases alive and well.
10. For ten years past I have carefully followed the Salis¬
bury plan, and my experience is embodied in three corrobora¬
tive Fasciculi :
I. A new physical sign of the pretubercular state.
II The morphology of consumptive blood.
III. The treatment on the Salisbury plan ; 19 cases not
arrested, 26 cases temporary arrests, 28 cases arrested so that
if it was any other disease they would be called cures.
These fasciculi would have been published but for a promise
that I wait till Dr. S. had published his. Now that article I,
September (1879), Virginia Medical Monthly , has been pub¬
lished, my 73 cases are in the hands of the editor of the
American Journal of Medical Sciences for promulgation. Both
Dr. Salisbury’s work and mine will be given, to the world as
soon as he sees fit to permit.
As a witness, I say that I have used every means within my
power to make known the plan privately. Among those who
have perused one or all fasculi are Drs. N. S. Davis, A.
Fisher, J. N. Hyde, F. H. Davis et al., of Chicago ; Prof.
Yandeveer and Dr. W. H. Bailey, Albany, N. Y. ; Dr. L. B.
Edwards, Dr. M. L. James, Richmond ; Judge Dobbin, Balti¬
more; Dr. H. I. Bowditch, Boston; Dr. John Clough, Wo¬
burn ; Rev. Joseph Cook, Boston ; Prof. Paulus F. Reinsch,
Erlangeu ; Dr. George B. Harriman, Boston ; Prof. L. Whit¬
ing Mason, Boston ; Mr. W. E. Baker, Boston ; Benjamin
Cutter, Stuttgart, Germany ; Dr. R. U. Piper, Chicago ; Dr.
M. G. Wheeler, Chelsea.
Besides, I have photographed the morphology of consump¬
tive blood and explained it briefly in over sixty lectures, illus¬
trated by the sciopticon with microphotographs, taken with
powers ranging from one-fifth to one seventy -fifth. This was
done to show what I believe to be the truth and valuable to
mankind. Among the societies are the following : Maryland
824 Current Medical Literature . [February
and Baltimore Dental Association ; Baltimore Medical and
Surgical Society ; American Medical Association, Buffalo ;
Hampden County Medical Society, Massachusetts ; Middlesex
Eastern District Medical Society, Massachusetts ; New York
Academy of Sciences ; Chicago Medical Society ; Chicago
Western Medical Association ; Academy of Medicine, Rich¬
mond, Ya. ; Gynecological Society, Boston. Individuals : Dr.
James R. Nichols, Haverhill, Mass. ; Prof. Lewis A. Sayre,
New York ; George M. Beard, New York ; Dr. E. Engals,
Chicago; Judge Dobbin, Baltimore; Prof. O. W. Holmes,
Prof. R. H. Fitz, Boston ; Prof. Moses C. White, New Haven ;
Rev. Daniel March, D.D., Woburn ; Dr. L. Elsburg, New
York ; Dr. S. Lawton, Springfield, Mass, etc.
Note. — These societies and individuals simply saw what I
showed and heard what I had to say. I thus know of what I
am affirming. I regard my work as that of seed sowing. I have
never asked to be endorsed. I am willing to wait for the seed
to take root.
I further testify that 1 have for the past ten years implored
Dr. Salisbury to publish this work, but, as he says, he has
been deterred “by a fear of not pursuing a course that in¬
cludes the most right and the least wrong.” Now that he has
at least yielded, and published his treatment, I intend to use
every legitimate and honorable means to promulgate his
views, because
(а) I believe therm to be true from my own experience.
(б) Because, “ if the experience of Dr. Salisbury and myself
should be realized by all physicians in the United States, at
least 13,000 lives annually could be saved by detecting the
pretubercular state alone.”
(c) I believe that Dr. Salisbury has waited long enough.
Twenty years of a life is, in this age, a Century under the old
time usages.
(d) Because Dr. Salisbury and myself (as an humble disciple)
are both ready and willing to let this be tested by any who
may be willing to come and see.
(e) Finally, I do as I have done, that it cannot be said in
future time that I have not done all I could to put this, in my
opinion, grandest contribution to the medical knowledge of
this age, in the hands of the profession. If I don’t succeed
in so doing, I shall have the consciousness of having acted up
to my intense convictions of duty.
N. B. — See my paper iu Southern Clinic , 1879, on the Mor¬
phology of Diseased Blood, for more facts about Dr. Salisbury.
His published works number over 70. — Michigan Medical News ,
November 25. E. 0.
94 Tremont street, Boston, November, 1879.
Current Medical Literature.
825
1880]
TREATMENT OF VESICAL ATONY BY ERGOTINE INJECTIONS.
In three cases of vesical atony observed in old patients, Pro¬
fessor Langenbeck has obtained the best results from hy-
podemic injections of ergotine. Immediately after the injection
the contractile power of the bladder was augmented and the
patients micturated more abundantly. At the end of some
days the bladder emptied itself almost entirely. In an old man,
sixty-two years of age, who three or four times per day expelled
about thirty grammes of urine when his bladder contained more
than half a litre, the very same day on which a hypodermic of
twelve centigrammes of Bonjean’s ergotine was employed, mic¬
turition was accomplished most satisfactorily. The prostate
soon diminished in volume and after four injections the cure was
complete. — LP Union Medicale. — Canadian Journal Medical Science.
WEIGHT OF CALIFORNIAN AND AUSTRALIAN BABIES.
Is it a general fact that children are larger at birth in newly
settled countries than in older countries? We have no doubt
of it in regard to California. It was long ago observed that the
new States in the Mississippi valley produced a larger race of
men than the old Atlantic States. New populations emigrating
from crowded localities, acquire, under favorable physical con¬
ditions, a stimulus to development, which shows itself both in
an enlarged ratio of increase, and in an invigoration of the
stock. Twenty and thirty years ago the average weight of Cali¬
fornia babies was over eight pounds, and we are not certain that
it has diminished. Infants weighing ten and eleven pounds have
fallen into the hands of every accoucheur of moderate practice.
Twelve and thirteen pounds is not a very uncommon weight,
and a case of eighteen pounds is on record, well authenticated.
It would seem that Australia is not behind in this respect. The
Australian Medical Journal for September, 1879, contains a list
of 182 births which occurred in the Melbourne Hospital in the
first four months of the year, the maximum weight being 12£
pounds, and the average about 8 pounds. As the births were in
a hospital, and one-half were illegitimate, it may be presumed
that the circumstances were not the most favorable to physical
development. There were 5 couplets, 2 breech presentations,
one of the foot, one of the arm and two of the face — Pacific
Medical and Surgical Journal , Nov., 1879.
PILOCARPINE IN THE PRURITUS OF PREGNANCY. .
“ A country doctor’7 writes to the British Medical Journal that
a single dose of one-third of a grain of nitrate of pilocarpine, by
the mouth, served to bring on profuse sweating and salivation with
complete relief of intolerable and persistent itching, which had
lasted throughout pregnancy and recurred after delivery.
— Medical Times.
1880]
Editorial.
826
DITOPvIAL.
THE LOUISIANA STATE MEDICAL SOCIETY.
The annual meeting of this body, which will take place on
the last Wednesday in March, is so near at hand, that a few
remarks apropos of the occasion may not be inappropriate.
Nearly all the States of the Union, including the most recently
settled, have similar organizations, and their utility is no
longer a matter of question, outside our own borders. In
Louisiana, however, as regards the great majority of the med¬
ical profession, the matter seems either to be decided in the
negative or to be still unsettled, from the evidence afforded.
The number of local medical societies is so small, that it was
found impracticable to organize the State Society as a repre¬
sentative body 5 while its individual membership throughout
the State is only 106 altogether, out of 876 practitioners whose
names have been reported.
Again, of this number several disclaim membership, when
asked for their annual dues, while no less than 40 have failed to
make any response. The consequence of the delinquency is,
that the society still owes more than $180 for printing the last
volume of its Transactions and has only about $30 in the
treasury.
When this volume was printed, a circular was sent to all the
regular practitioners in the State, so far as known, inviting
and urging them to join and sustain the organization, but not
more than half-a-dozen additional medical men have responded.
These plain facts are now stated, so that our readers may be
warned in season of the danger of dissolution which seriously
threatens our State Medical Society.
Let it not be forgotten that one of the principal objects of
the Society is the advancement of State Medicine. Although
its interests concern the public at large, and our profession
only as members of the general public, still medical men must
take the lead and most of the labor in advocating its claims,
and on them rests the responsibility. It is our business
Editorial.
827
1880]
then, to look after the improvement of medical educa¬
tion and of public hygiene; but how can this be done to any
good effect without organization ?
Again, the protection of the public from the dangers of
quackery is properly regarded as a matter of particular inter¬
est to physicians. We consider it a great mistake to suppose
that this evil is to be met with by prohibitory laws. Quack¬
ery may be outlawed, like gambling and prostitution ; and,
while the two latter may be driven into secret places and ren¬
dered disreputable, the first will flourish openly, for respect¬
able people will continue to patronize it. For its exposure and
discouragement the British plan is the most effectual, and the
only proper one for English-speaking people. It consists in sep¬
arating properly qualified medical men into a distinct class, so
that the public may be able to distinguish between them and
pretenders ; then the public are left free to choose between
them. This plan is carried out by the organization of local
branches of one grand body, styled the British Medical Asso¬
ciation, and the publication of a register, which contains the
names of all qualified practitioners, with a description of their
credentials, and open to public inspection.
This, we maintain, is the proper course to pursue in Louis¬
iana, and is substantially what is contemplated in the regula¬
tions of our State Medical Society. It is neither necessarv
nor proper for us to apply to the Legislature for any class
legislation ; and there is no likelihood that it would be granted,
if asked. The plain truth is, if the medical profession cannot
protect its interests and command the respect of the public
without special legislation, it would fail with all the aid it
might ask ; and, in any event, it will deserve just what it may
experience at the hands of the public. It is no part of free
government either to foster or oppress religion and science.
Friendly, antagonistic, or indifferent to each other, the State
should keep its hands off, and let them work out their own
progress, so long as they do not disturb the public peace.
These remarks are not intended either as an appeal or a
reproach. They are an expression of our opinion, and a dis-
10
828 Reviews and Boole Notices. [February
charge of what we regard a duty as medical journalists. If
State Medicine should languish and medical men continue to
be insignificant members of society in Louisiana, we wish it
undei stood that we have not been derelict by failure to point
out the responsibility and the remedy.
MERITED PROMOTION.
The medical officers of the United States Army have cause
to congratulate themselves that merit is appreciated and hero¬
ism acknowledged. Passed-assistant-surgeon John W. Ross has
been promoted eight numbers in his present grade for extra¬
ordinary heroism, as provided for in section 1506 of the
Revised Statutes.
This promotion is for services rendered by I)r. Ross at the
imminent risk of his life at Holly Springs and Memphis in
1878, during the epidemic of yellow fever.
Reviews and Book Notices.
A Treatise on the Theory and Practice of Medicine. By John
Syer Bristowe, M.D., London, Fellow and formerly Censor,
Roy. Col. Phys. ; Sen. Phys. to and joint Lecturer on
Medicine, St. Thomas Hospital ; Lecturer on General
Pathology and on Phys., St. Thomas Hospital, etc. Sec¬
ond American edition revised by the author. With notes
and additions by James H. Hutchinson, M.D., etc. 8vo.,
pp. 1081. Philadelphia: Henry C. Lea. 1879. [Sold by
Armand Hawkins, Medical Bookseller, 196£ Canal street,
ISTew Orleans j.
This work is already so well and so favorably known, that
no extended notice of its contents or criticism of its merits is
necessary. The author having determined to limit his book to
a single volume, and to include in its scope several subjects
usually relegated to treatises on surgery or on special branches
of medicine, is under the necessity of refraining entirely from
allusion to clinical cases and of confining himself to a very
concise didactic view of each subject.
Reviews and Book Notices.
829
1880J
Having devoted rather more than 90 pages to general pathol¬
ogy, the author proceeds in part II to consider special diseases
in classified groups, as follows : (1) specific febrile diseases ;
(2) diseases of the skin ; (3) diseases of the respiratory organs ;
(4) diseases of the vascular organs; (5) diseases of the diges¬
tive organs ; (6) diseases of the genito-urinary organs ; (7) dis¬
eases of the organs of locomotion; (8) diseases of the nervous
system.
Those not already familiar with Dr. Bristowe’s views on cer¬
tain points where medical opinion is divided, may be interested
to learn that he does not adopt the late German notions on the
nature of tubercle and its connection with pulmonary con¬
sumption. The caseous product he regards as an advanced
stage of tubercle, commencing with the miliary form, which is
universally admitted as tuberculous in nature. Some of his
reasons for rejecting the identity of the cheesy infiltration with
the epithelial deposits of catarrhal or lobular pneumonia are
very forcible ; as for instance, that these caseous masses of
phthisis do not affect specially the favorite seats of either
lobar or lobular pneumonia, but rather the summit of the lungs,
where miliary tubercles are wont to appear ; also that caseous
deposits are constantly associated with tuberculous formations
in other regions, particularly of the miliary form.
A s might be supposed, he recognizes no essential patholo¬
gical distinction between the two forms of pneumonia, distin¬
guished in the German classification as croupous and catarrhal,
but which he prefers to call lobar and lobular, or diffused and
patchy. The former indeed he regards as idiopatic in origin,
and the latter secondary to affections of the air-passages ; but
he avers that each may pass into the other.
On the subject of dengue he is much at variance, on several
important points, with the late Prof. Dickson. Dr. Bristowe
traces its first appearance to the East Indies in 1824, while
Dr. Dickson finds an identity between dengue and a disease
which prevailed at Philadelphia in 1780, called break-bone fever
by Dr. Bush. Our author also states that this disease does
not appear to have extended to temperate regions ; which is
certainly incorrect, as it has appeared in many parts of this
830 Reviews and Boole Notices. [February
country at different times during the memory of people still
living.
Syphilis, usually omitted from works on medicine proper, is
briefly treated as a specific affection, in some respects resem¬
bling the exanthemata. The theory of its American origin is
rejected, and he believes that it has prevailed from remote an¬
tiquity in the Old World. Local venereal sores, not affecting
the general system, are not mentioned in this work, and conse¬
quently are not regarded by the author as syphilitic in
nature.
The plan and scope of this work adapt it specially to the
needs of students rather than practitioners of medicine, and
-such a purpose it well fulfills. The views of the author are ex¬
pressed with precision and sufficient positiveness to impress
the student with the weight of his authority 5 and, should the
medical professor differ on any subject from his doctrines, he
will need to find strong arguments to carry his class to the op¬
posite conclusion. S. S. H.
A Text Boole of Physiology. By M. Foster, M. A., M. D., F. R.
S., Praelector in Physiology and Fellow of Trinity Col¬
lege, Cambridge. With illustrations. Third edition, re¬
vised, 8vo., pp. 720. London : Macmillan & Co. 1879.
This edition, following the second at an interval of less than
two years, which in turn rapidly succeeded the first, indicates
the popularity of the work among the British medical public,
without allowing much room for improvement in successive
issues.
Although Dr. Foster is a medical teacher, he displays in his
book none of the dogmatism which necessarily attaches to the
professor’s chair, and is quite apt to appear in the professor’s
written efforts. References to authorities are found at the foot
ot most pages, and the author is quite cautious throughout in
the expression of opinions not established by general consent.
As 110 claims to original research are set up, the book can on¬
ly be regarded as an exponent of what is commonly known ;
and in this respect it is just to concede that the work is well
done.
In an examination of certain subjects as treated in this book,
Reviews and Book Notices.
831
1880]
we have found some passages which we regard suitable for
special remark. For instance, respecting the first sound of
the heart, he characteristically avoids expressing an opinion of
its causation, while finding objections to both muscular action
and the influence of the valves on the blood-current. Any
one who will compare the sound given forth through the steth¬
oscope by the rythmical contraction of the biceps or the bun -
die of flexors in the forearm with the first sound of the heart,
cannot fail, we think, to observe the substantial identity in
mode of production. An argument is made in favor of valv¬
ular agency in the normal first sound, because the diseased
valves so obscure and change the sound. In case of aneurism
we find very decided murmurs produced by interference with
the blood-flow, while no sound whatever can be found over the
healthy arteries, and there is equal reason for supposing that
healthy valves present no resistance to forward movement
which would give rise to any sound.
In regard to the sugar-producing function of the liver, Dr.
Foster leans to the view of Pavy in preference to that of Ber¬
nard ; but supposes that the glycogen elaborated by that organ
is retained there as a reserve, which is transformed to hepatic
sugar as the needs of the system make requisition for this
substance in the intervals between ingestion of amylaceous or
saccharine food. He does not attempt to account for the path¬
ology of diabetes mellitus, being content with remarking that
“ Sugar in the urine means an excess of sugar in the blood.’?
The view of Tscherinoff, quoted by Memeyer, is quite in har¬
mony with the glycogen-function of the liver, as proposed by
Dr. Foster. Tscherinoff ’s supposition is, that the liver trans¬
forms the sugar which arrives in its circulating blood into gly¬
cogen ; but that, when this function fails, the sugar passes
through the liver unchanged, to be filtered out through the
kidneys.
With regard to urea, he supposes that it is contained in the
blood before it reaches the kidneys, its antecedents being
partly the kreatin formed in muscle and elsewhere, partly the
leucin and other like bodies formed in the alimentary canal as
well as in various tissues.” The transformation of these sub-
832 Reviews and Book Notices. [February
stances into urea he conjectures may take place in the liver,
and possibly in the spleen, but of this he is not positive.
Considerable space is devoted to the discussion of localiza¬
tion of the functions of the cerebral convolutions, with copious
references to late experiments, particularly the recent ones of
Ferrier by means of the galvanic current j but the author is
not sanguine of the discovery of positive results thus far.
An appendix contains about 40 pages on the Chemical Basis
of the Animal Body. The chemistry of the various proximate
principles is briefly described and is convenient for reference by
the reader.
The illustrations consist of 72 wood-cuts, a large portion of
which represent various instruments of precision contrived for
the study of the functions of different organs. A table of con¬
tents and an index facilitate reference to particular subjects,
but the latter has several inaccuracies not noted in the list of
errata.
This edition is furnished at the moderate price of $3.50 in
muslin, or $4.50 in sheep binding. The publishers announce
the early appearance of a cheap “ Students’ edition,” which
will be aeceptable as a companion to the lectures of the class¬
room. S. S. H.
Pocket Therapeutics and Dose Book : with Glassification and
Explanation of the Actions of Medicines ; Min. and Max.
Doses in Troy Weights , with their equivalents in the Metric
Weights ; Index and Definition of Diseases , with Appropri¬
ate Remedies ; Genitive Endings of all Medicines and Pre¬
parations given in italics ; Index of Common and Pharma¬
ceutical Names ; Classification of Symptoms ; Poisons and
their Antidotes ; Useful Hints to the Prescriber. By Morse
Stewart, Jr., B. A., M. D., 32rno., pp. 263. Second edition,-
revised and enlarged. Detroit, Mich.: Geo. D. Stewart.
1878.
It might be supposed that the above title indicates all the
subjects treated in this little book, by one who has not exam¬
ined it; but he would still find other valuable information very
conveniently arranged. The book was intended by the author
as a reminder in case of emergencies. For students of medi¬
cine it is altogether unsuitable, and practitioners should al¬
ways refer to larger works when they have time and opportu-
Reviews and Book Notices.
833
1880J
nity. But occasions will arise wlien such a little friend will
prove extremely welcome, and this is really the best of its
kind that we have met. S. S. H.
Outlines of the Practice of Medicine , with special reference to the
Prognosis and Treatment of Disease. With Appropriate
Formulae and I llustrations. By Samuel Fenwick, M. I).,
Lecturer on Principles and Practice of Medicine at London
Hospital, etc. 12mo., pp. 387. Philadelphia : Lindsay &
Blakiston. 1880. [Sold by Armand Hawkins, 196 £ Canal
street, New Orleans.]
This little book is based ou the notes of a few closing lec¬
tures to his medical class by the author, and designed as a
practical review of the course with special reference to treat¬
ment ot diseases, preparatory to the approaching examination.
This fact suggests its appropriate use by students, as an ad¬
juvant to the process of “ cramming v for examiuatiou. It is
quite general for teachers to condemn “ cramming n for exam¬
inations, as well as the use of translations by students of the
Latin and Greek classics, but it is always in vain contending
with human nature and the law of demand and supply.
It is safe to predict that “ ponies ” will not disappear from
our colleges, nor books like this from our medical schools,
during our time at least. S. S. H.
Infant Feeding and its Influence on Life ; or, the Causes and
Prevention of Infant Mortality. By C. H. Routh, M.D.,
M.R.C.P.L., Fellow of University College, London, Seuior
Physician to the Samaritan Hospital for Women and
Children, etc., etc. Third edition. William Wood & Co.,
New York. Armand Hawkins, medical book store, 196J
Canal street, New Orleans, La.
This work embraces within its pages one of the most inter¬
esting and attractive studies in the range of medicine. The
preservation of infant life must be the constant care of the
physician and philanthropist who recognize the fact that the
large ratio of deaths come under the classification preventable.
The preface to the third edition of this work contains the
following: “In England alone, since the year 1847, over
341,000 babies have died from developmental diseases of
children, and nearly 2500 from want of breast milk. Ever
834 Reviews and Book Notices. [February
since my last edition in 1863, nearly 146,000 children have
died from the former diseases and 12,000 from the latter cause,
and unfortunately these numbers are on the increase.”
The work before us is conveniently arranged into four parts.
The first part is a consideration of the general and special
causes of infantile mortality. Part II relates especially to
lactation, nature of milk and selection of wet nurses. Part
III general deductions in reference to alimentation made from
the composition of milk and its substitutes. Part IV is a con¬
sideration of diseases of the digestive system and their pre¬
vention and treatment. Appendix E containing general and
special rules for the nourishment of children is one of the best
we have seen and is highly recommended.
The work is one of the series known as u Woods’ Library of
Standard Medical Authors,” and is highly creditable to - the
energetic publishers.
Transactions of the American Medical Association. Instituted 1847,
Yol. XXX, 8 vo., pp. 1028. Philadelphia. 1879.
The present, being one of the largest volumes issued by the
Association, contains much matter of the highest interest and
value, and indicates that its vitality is not entering on a decline
with advancing age.
The address of the President, Dr. Theophilus Parvin, is upon
Teleology , in which he takes the ground that the old doctrine of
creative design in the universe is not superseded by the modern
doctrine of evolution, but may be made to harmonize with it.
Abundant quotations from philosophers and men of science
are adduced to support his position, and his paper is interest¬
ing and valuable, though probably not convincing to pro¬
nounced evolutionists.
The address in Practice of Medicine , Ma teria Medica and Phys¬
iology was pronounced by Dr. Thos. F. Rochester, of Buffalo.
Allusion is made to the great yellow fever epidemic of 1878, in
connection with which he takes occasion to recommend the
foundation of a National Health Bureau. The propagation of
typhoid fever, he believes, has an intimate connection with
water supply — a view now generally adopted by pathologists
Reviews and Boole Notices.
835
1880]
and sanitarians. Speaking of sanitaria for consumptive in¬
valids, he quotes from certain writers, to the effect tliat such
resorts lose their reputation by the influx of excessive num¬
bers, which tends to over-crowding and neglect of out door
exercise. The communicability of tuberculosis from one indi¬
vidual to another is supported on the authority of Dr. Bancroft,
of Colorado, who asserts that the natives of certain resorts have
become consumptive since their localities have become the resi¬
dence of persons thus affected.
In a Report on the Prevention of Bowel Affections , Dr. N. S.
Davis takes the ground, that one of the chief features in the
production of bowel derangements, especially in young chil¬
dren, is a continuous high temperature. The evidence is the
greater prevalence of such complaints on the Atlantic coast
and in the North-western States than along the Pacific and
Gulf coasts. In this view we concur, with the reservation,
that daily range of temperature, between day and night, is also
an important consideration.
Dr. Charles Denison, of Denver, Col., contributes a very
candid article on Experience of Consumptives in Colorado , and
some of the Aero-hygienics of Elevation above the Sea ; with
Conclusions.
The address in Obstetrics and Diseases of Women and Chil¬
dren was made by Dr. E. S. Lewis, of New Orleans, ai d gives
the progress made in this branch during the current year.
Dr. Ephraim Cutter, of Boston, makes a Report on Electrolysis
of Uterine Fibroids , favorable to the claims of the operation.
The same writer contributes a paper in support of his intra¬
uterine stem pessary, illustrated by clinical cases.
The Address in State Medicine and Hygiene was made by Dr.
John S. Billings, U. S. A. He strongly advocates the utility
of the registration not only of deaths but of diseases, as fur¬
nishing a more accurate index of the state of the public
health than simple mortuary statistics. In this he is undoubt¬
edly right, but we fear that his scheme will never become prac¬
ticable in our day.
11
830 Reviews and Boole Notices. [February
Dr. H. O. Johnson, of Chicago, gives a favorable account of
The Regulation of Medical Practice by State Boards of Health , as
exemplified by the Execution of the Law in Illinois.
A very instructive paper follows, on State Medicine and State
Medical Societies , by Dr. Stanford E. Cliaill6, of New Orleans.
Dr. Horatio It. Storer, of Newport, R. I., furnishes a paper
on Protective Sanitation , exemplified by the voluntary associa¬
tion lately formed for this purpose at Newport. This differs
from the sanitary associations inaugurated at Memphis and
New Orleans in 1879, in respect of being devoted to domestic
rather than public sanitation.
On the subject of operations for cataract there are three
articles, contributed severally by Drs. B. A. Pope, of New
Orleans, A. W. Calhoun, of Atlanta, and H. Knapp, of New
York ; the last of them also makes the Report on the Progress of
Ophthalmology and Otology.
In the Address fin Surgery and Anatomy , Dr. Moses Gunn, of
Chicago, treats chiefly of pus, and endeavors to relieve it par¬
tially of the weight of obloquy heaped on it by most surgeons
of our day.
Dr. J. R. Weist, of Richmond, Ind., discusses Treatment of
Hemorrhoids by Injection of Carbolic Acid , for which he makes a
rather favorable showing.
Dr. Henry O. Marcy, of Cambridge, Mass., gives his own and
other testimony in favor of Aspiration of the Knee Joint.
Dr. H. F. Campbell, of Augusta, Ga., contributes a long and
elaborate paper on Urinary Calculus. In part I. he gives a
synopsis of a large number of cases operated on by the bi:
lateral method, his favorite plan. The general indictment
against this method, on the ground of its destroying the virility
of the subject, he disposes of by instances of the retention of
this power after the operation. In part II. he discusses its
etiology and pathology, and his conclusions we regard of suffi¬
cient interest to quote at large :
u Having thus carefully presented the anatomical and physio¬
logical relations of t his portion of our subject, we may summarize
a few facts, some of which appear to exclude the hard water
1 heory of lithogenesis, while they strongly corroborate that of
the neuro-dynamic origin of calculus.
Reviews and Boole Notices.
837
1880J
First. The largest proportion of subjects being infants at
nursery periods of life, the calcareous solutions are not taken by
them to furnish the lime for calculous concretions, while the
adult, who rarely originates stone, drinks freely of them.
Secondly. As heretofore shown, uric acid forming the nucleus
of nearly all calculi, so far from being favored by solutions of
lime, would rather be dissolved by them.
Thirdly. The food of the nursing infant being largely albu¬
minous — as in the case of the sucking lierbivora, uric acid is
found to predominate in the blood and urine. This uric acid,
which in the adult exists in less proportion and is probably dis¬
solved in liard-water districts, in the infant forms a nucleus
without the chance of solution in the absence of alkaline drinks.
Fourthly. The albuminous food of infancy furnishing abund¬
ant material out of which uric acid may be produced, the one
overshadowing influence instrumental in its production and in
the formation of idiogenic nuclei is the functional disturbance
of the liver — hepatic paresis — which during this period is pro¬
duced by reflected dental irritation as heretofore demonstrated.
As glycogenesis is artificially produced in the experimental de¬
monstration of Claude Bernard by irritating the floor of the
fourth ventricle, so lithogenesis in the nursing infant is morbidly
produced by reflected dental irritation of the fifth pair implanted
in the same nerve-centre. Imperfect disintegration and imper¬
fect oxidation of albuminous material in the liver is the result
of the hepatic paresis thus superinduced. Hence, idiogenic nu¬
clei and, consequently, calculi, are abundant at this period.
Fifthly. After nuclear agglomeration has taken place , another
excitor of reflex irritation, and new avenues of transmission, are
established. The idiogenic nucleus and the xenegenic, from this
time, have a common history ; both excite, in a like degree and
in the same manner, the elimination from the blood and pre¬
cipitation of the calcareous elements in the further development
and growth of the stone. Calcareous solutions, as drinking
water, probably, now add considerably to the rapidity of ac¬
cretion.
Sixthly. Although we regard dental irritation, as heretofore
described, to be the chief originator of the uric acid nucleus and
therefore of the vast majority of autogenic calculi, we cannot ex¬
clude the recognition of other influences as giving rise to calculi
both in the infant and adult; as all xenogenic nuclei are known
to originate calculi and to become covered with calcareous — not
often uric acid — strata, by a process of reflex irritation, begin¬
ning in the bladder. Irritation of the uretha, of the prostate
gland, of the prepuce, all, as we have shown, originate nuclei
and promote precipitation ; under the influence of spinal injury
we have seen immense productions of calcareous deposits con¬
tinued in one case — O’Bannon’s — for over thirty-nine years.
Seventhly. The influence of living in malarial districts may
well and rationally be accepted as acting most potently in the
838
Hooka and Pamphlets Received.
[February
neuro-dynamic origination of calculus. Whether in hard- water
districts or free stone regions it is known that the nervous
system sustains serious impairment of its controlling functions
over the secretory organs through malarial blood-intoxication.
No organ suffers greater functional derangement than the liver,
and on rational grounds we may predicate the abundant pro¬
duction of uric acid and the nuclear agglomeration of idiogeuic
nuclei. The “ critical discharge” of every paroxysm is but the
throwing down of earthy phosphates, the ashes of the burnt up
tissues of the body. Thus, under nervous aberration in mala¬
rial fever too, we have the production of the uric acid nucleus
and also the limy phosphates for super-stratification.”
More than 130 pages are occupied by Dr. L. A. Sayre, of New
York, in support of his treatment of Pott’s disease of the
spine by suspension from the head and the application of the
phi ster-of-paris jacket. Notes are given of 10.9 cases, many of
which are illustrated by wood-cuts of the individuals, to illus¬
trate the degree of the deformity. Dr. Sayre may fairly claim
that his plan of treatment is established on a firm basis.
Dr. J. M. Toner furnishes the Report on American Medical
Necrology , which is especially valuable in containing probably
the most complete list extant of the medical men who fell dur¬
ing the great epidemic of 1878, including many brief biograph¬
ical sketches.
The volume closes with a prize essay extending through 80
pages, entitled A Consideration of Certain Forms of Primary
and ( Local J Secondarg Degeneration of the Lateral Columns of
the Spinal Cord , with especial reference to an infantile rare
form : By Allan McLane Hamilton, M. D. If the author had
brought his essay within the compass of twenty pages, using
more system in the arrangement of his matter and more
perspicuity of expression, it would be much easier and more
profitable reading than we find it. S. S. H.
Books and Pamphlets Received.
A Treatise on the Science and Practice of Midwifery. By W.
S. Playfair, M.D., F.E.C.P., Physician- Accoucheur to H. I. and
R. H., the Duchess ot Edinburgh. Professor of Obstetrics, etc.
Books and Pamphlets Received.
839
1880J
The Theory and Practice of Medicine. By Frederick T. Rob¬
erts, M.D., B.Sc., F.R.O.P., Professor of Materia Medica and
Therapeutics at University College, etc., etc.
A Manual of the Practice of Surgery. By W. Fairlie Clarke,
M.A. and M.B. (Oxon), F.R.C.S., Assistant-Surgeon to Char¬
ing Cross Hospital.
Lectures on Practical Surgery. By H. H. Tolaml, M.D., Pro¬
fessor of the Principles and Practice of Surgery and Clinical
Surgery in the Medical Department of the University of Cali¬
fornia.
Pocket Therapeutics and Dose-Book. By Morse Stewart, Jr.,
B.A., M.D., Detroit, Mich.
Twenty fourth Annual Report of the Trustees of the State
Lunatic Hospital at Northampton for the year ending September
30, 1879.
Vick’s Floral Guide. Rochester, N. Y.
Notes of Work by Students of Practical Chemistry in the
Laboratory of the University of Virginia. Communicated by J.
W. Mallet, M.D., Professor of General and Applied Chemistry
in the University.
Cholera of 1873. By W. R. Sevier, M.D., Jonesboro, Ten¬
nessee.
The Second Annual Report of the Presbyterian Eye and Ear
Charity Hospital, Baltimore , Md.
The Sanitation of Small Cities. — Soil, Drainage , Sewerage and
the Disposal of Sewage. By David Prince, M.D. Reprint from
the Transactions of the Illinois State Medical Society for 1879.
Transactions of the Medical Association of the State of
Missouri , 1879.
The Treatment of Fracture of the Lower End of the Radius .
By R. J. Levis, M.D., Surgeon to the Pennsylvania Hospital
and to the Jefferson College Hospital. Reprint from the
840 Books and Pamphlets Received. [February
Transactions of the Medical Society of the State of Pennsyl¬
vania.
Tobacco Poisoning and its Effects Upon the Eye Sight. By A.
W. Calhoun, M.D., Atlanta, Ga., Professor of Eye and Ear
and Throat Diseases in the Atlanta Medical College. Re¬
print from Transactions Medical Association of Georgia.
The Extirpation of the Ovaries for some of the Disorders of
Menstrual Life. By William Goodell, A.M., M.D. Extracted
from the Transactions of the Medical Society of the State of
Pennsylvania.
- Annual Address of the President of the Kentucky Medical
Society , delivered at Danville , Ky., May 13, 1879. By Dr. C. H.
Todd, of Owensboro, Ky.
Physiological Antagonism. — The Therapeutic Laic of Cure.
By Electus B. Ward, M.D., Assistant to the Chair of Practice
of Medicine in the Long Island College Hospital, Brooklyn,
New York.
Detroit Medical College, Catalogue of Changes in its Method of
Teaching , etc., etc.
The Therapeutic Society of New York. Reprint from the New
York Medical Journal, June and July, 1879.
Analysis of Air. By Wm. Van Slooten, C.E. Reprint from
the Journal of the Americau Chemical Society, Yol. 1.
Buffalo Lithia Water of Mecklenburg County , Va.
An Examination of the Usual Signs of Dislocation of the Rip.
Also an Inquiry into the Proper Mode of Procedure When Dislo¬
cation of the Hip is Accompanied with’ Fracture of the Femur.
By Oscar H. Allis, M.D., Surgeon to the Presbyterian Hospital.
Transactions of the Massachusetts Medico-Legal Society , Vol. 1,
Number 2, 1879. -
1880]
Meteorological and Mortality Tables.
841
Meteorological Summary — December, 1879.
Station— New Orleans.
Date.
Daily Mean
Barometer
Daily Me an
Temp’ture.
Daily Mean
Humidity.
Prevailing
Direction
ofWind.
Daily
Rain-fall.
1
30.26
54.7
73.0
East.
2
30.12
61 2 90.3
East.
3
30.10
64.2 83.3
S. W.
4
30.07
64.0
88.7
S. E.
5
29.84
65.0
82.0
South
.61
6
29.94
59.0
62.7
N. W.
7
29.98
62.2
63.7
South
8
30.08
66.7
84.3
S. E.
.23
9
30.04
68.0
92.7
South
.27
10
29.94
71.7
84.7
South
.04
11
30.10
51.0
66.7
North
11
12
30.23
47.5
37.3
N. e.
13
30.11
48.0
78.7
N. E.
i .32
14
30.02
54.2
88.7
West
.21
15
30.25
51.2
69.7
North
16
30.22
55.2 63.0
S. E.
17
30.23
59.0
69.7
S. E.
18
30.27
61.2
71.0
S. E.
19
30.25
61.5
76.7
East.
20
30.20
65.7
80.7
South
21
30.12
68.5
86.7
South
....
22
30.08
70.5
85.3
South
.02
23
30.10
71.2
82.7
S. E.
24
30 17
74.0
83.0
South
25
30.37
48.2
71.0
N, W.
North
.09
26
30.44
39 -C
42.7
27
30.30
46.7
63 3
N. E.
28
30.20
55-5
78 7
S. E.
....
29
30.21
61.0
80.0
S‘ E.
30
30.24
62.7
92.7
>S. E.
31
30.33
64.2
90.7
East.
....
Sums
Means
30.156
59.8
76. !:
S. E.
2.90
General Items.
Mean Barometer, 30.156.
Highest Barometer, 30.530, on 26th.
Lowest Barometer, 29.790, on 5th.
Monthly Range of Barometer, .740
Highest Temperature, 78° on 24th.
Lowest Temperature, 32° on 26th.
Monthly Range of Temperature, 46°.
Greatest Daily Range of Temperature,
34° on 25th.
Least Daily Range of Temp., 7° on 9th
Mean of Maximum Temperatures, 66.7°
Mean of Minimum Temperatures, 52.5°
Mean Daily Range of Temp., 14.2°.
Prevailing Direction of Wind, S. E.
Total Movement of Wind, 5,386 miles.
Highest Velocity of Wind and Direc¬
tion, 22 miles, North on 25th.
Number of Clear Days, 6.
Number of Fair Days, 9
Number of Cloudy days on which no
Rain fell, 6.
! Number of Cloudy Days on which
Rain fell, 8. Total number of days
on which rain fell, 10.
COMPARATIVE TEMPERATURE.
1871 .
1 1876 . .
..48.1°
1872 .
j 1877...
..55.5°
1873 .
1 1878. . .
. . 51. 2C
1874 . .
..58.8°
| 1879...
..59.8°
1875 . .
. 61.5°
| 1880. .
COMPARATIVE
PRECIPITATION
1871 . inches.
1 1876..
9.57
inc lies
1872 .
“
1 1877 .
4.96
1873... 1.79
U
j 1878..
8.69
U
1874.. 3.27
u
1 1879..
2.90
a
1875.. 5 15
u
| 1880..
a
Mortality in New Orleans from December 21st, 1879, to
January 18th, 1879, inclusive.
Week Ending.
Yellow
Fever.
Malarial
Fever.
Con sump
tion.
Small¬
pox.
Pneu-
mouia.
Total
Mortality.
December 28
0
3
10
0
9
82
January 4
0
2
17
0
7
110
January 11
0
4
17
0
11
90
January 18
0
1
10
0
9
97
Total.. . .
0
10
54
0
36
379
NEW ORLEANS
Medical Sougicjil Journal
MARCH, 1880.
Ppv]
IGINAL j3oy\iyVl UNI CATIONS.
1/
Toxemic Diseases and Their Treatment.
By W. R. SEVIER, M. D., Jonesboro’, Tenn.
I deferentially submit to my professional brethren, the fol¬
lowing affirmative propositions :
In doing so I beg to express my entire confidence in their
truth ; and the hope, better defined perhaps as an assured
belief, that, when practically recognized, we shall occupy a more
advantageous stand point — shall witness more uniform and
satisfactory results from the treatment of that class of diseases
to which they refer — shall enjoy a more general and abundant
success in our efforts to relieve human suffering.
1st. Except in the suppressed condition of certain functions,
there exists no resemblance between the symptoms of cholera
and those of yellow fever 5 yet the latter is not less distinctly
a form of toxemia, or blood poisoning, than is the former.
2d. If these diseases, so dissimilar in many leading features,
are to be so considered, we are forced to regard in the same
light all those forms of fever which owe their existence to ma¬
larial or miasmatic causes ; the creative influences having, in
each instance, a like form of existence, are alike inappreciable
by the senses or by any known method of chemical analysis, en¬
ter the system through the same medium, aud, presumably at
844 Original Communications. [March
least, operate in the same manner — by contaminating the
blood. I have so regarded and, when practicable, have so
treated the various forms of fever so produced, since the cholera
period of 1873. The results have been eminently satisfactory.
3d. The effective agent employed in both the preventive and
the remedial treatment of cholera was chlorine in the form of
the tr. sesq. chlor. ferri to subserve the former, and a hyper-
chlorinated form of the same agent the latter purpose. Each,
the prophylactic and the remedy, appeared perfect in its
sphere. Hydrochloric acid alone, in a sufficiency of water, or
the formula employed in cholera, omitting in some instances
the tr. opii, has been employed, as the different features of in¬
dividual cases have suggested, in the treatment of the fevers
mentioned, since the period referred to.
4th. That certain organs do alienate from the system poisons,
which, if retained, would not only prove hurtful to health, but
often destructive of life, is admitted as a physiological and
pathological truth. But when it is maintained that it is only
through such media that relief from such influences can be ob¬
tained, support is given to a dogma at once untenable, absurd
and of most mischievous tendency ; inasmuch as the phys¬
ician, operating under implicit belief in the generally asserted
and accepted truth of the proposition, wastes the precious mo¬
ments of his patient’s life — the golden season of opportunity —
in the effort, generally fruitless, to arouse such organs to ac¬
tion. But their functions are suppressed by reason of the
poisoned condition of the blood, and we cannot, very reason¬
ably, hope for their restoration* until the offending cause is re¬
moved. Special excitants, such as calomel, dover’s powder,
digitalis, &c., &c., addressed to the liver, skin and kidneys,
may suffice in cases- of merely impaired function, but will gen¬
erally be found unavailing and unreliable in complete suppres¬
sion, such as is found in well developed cases of both cholera
and yellow fever. Hence the pernicious effect of the dogma ;
and hence, too, the unsatisfactory results which have attended
the various plans adopted in the treatment of these diseases,
respectively. There is, I conceive, no error of the present pe-
845
1880J Sevier — Toxemic Diseases and their Treatment.
riod which more gravely affects the public welfare, or which so
seriously impairs the success of the physician.
5th. The doctrine of “ personal disinfection,” as it has been
termed, asserts that if poisons of the character mentioned may
enter the circulation, so also may the agent designed for their cor¬
rection ; that these toxical agents are, respectively, chemical
entities of some sort, and, as such, are amenable to chemical laws
and influences ; that these poisons may be neutralized and des¬
troyed prior to and independenly of the action of eliminative
organs. The theory is in strict harmony with the beauty, wis¬
dom and general perfection of the Creator’s works ; with the
facts long since ascertained by Fodera, Mayer, Mitchell and
others ; with the well-known fact that medicines administered
per orem ” or u per anum, ” by inunction or inhalation, are
often found present in the secretions and excretions of the
body. It is abundantly sustained by the phenomena observed
in cholera, as well as in the various forms of fever which have
been treated on the disinfectant plan. The different salts
found present in the blood give, moreover, additional indication
of the truth of the theory.
6th. Poisons of the character mentioned, whether material
or gaseous, are the products of animal or vegetable decomposi¬
tion.
7th. The premises conceded, it follows that we should
select as remedies, in the treatment of diseases produced by
causes of this character, agents of general and strongly pro¬
nounced disinfectant and antiseptic qualities.*
8th. Chlorine is destructive of all animal and vegetable
odors and exhalations ; and, by reason of this property, as well
as the multiplied forms in which it may be used, it is perhaps
better adapted to the purpose than is any other- agent we
possess. But, as this element, in its gaseous state, is not avail-
* Dunglison (Med. Dictionary), with questionable propriety, I think, uses these terms
synonymously. For instance : The nitrate of potassa (KO. N05) is an agent of strongly
marked artisiptic virtues, as shown by its effects when employed for the preservation of
meats. When used medicinally it increases the flow of urine, and is thus ‘pro tanto”
depurative But it is certainly possessed of no disinfectant quality, whatever, in the
proper sense of the term. The chlorate of potassa, ("KO, CLOo) on’ the other hand, is
both anteseptic and disinfectant. The latter quality is prehaps less distinctly observable
than in compounds abounding more largely in chlorine ; but is nevertheless a manifest
and an admitted property.
846 Original Communications. [March
able for the disinfection of the blood, we should select that
combination in which it most largely abounds, and which can
most readily and safely be employed. Hydrochloric acid
(H Cl ) is best adapted to the purpose, because of the abun¬
dance of the element in comparatively small compass, the ease
with which it may be administered; and is preferable to the
salts of chlorine for the reason that, afier its appropriation to
the wants of the system, there is no residual base, as in the
latter, which might hypothetically serve to increase the alka¬
linity of the stomach observed to exist during the initial stage
of both cholera and yellow fever. The effects of the tr. sesq.
chlor. ferri. as a prophylactic during cholera were perfect.
Of the many hundreds exposed, in this and in other infected
localities, embracing physicians, nurses, members of the same
household, servants, grave-diggers, and others brought in
constant contact with the disease, no one was attacked
who had conformed to the suggestion, made through the
public press, touching the use of the tincture as a pro¬
phylactic. The enfeebling effects of the cholera poison
are generally experienced, to a considerable degree, prior
to the stage of actual development of the disease. This
agent happily subserved the purpose of both a tonic and a
disinfectant. The demand for agencies possessing the same
qualities existed only in more marked and urgent degree
during the attack ; and hence a hyperchlorinated form of the
same agent was employed as the remedy.* This proved not
less efficient and satifactory than did the former ; whilst the
results obtained were altogether too prompt, uniform, gentle
and thorough to be justly, or even plausibly referred to other
agency or influence than the disinfectant quality and action of
the means employed. A series of experiments made by me,
and elsewhere more particularly' mentioned (“ Cholera of
1873 ”), touching the qualities of hydrochloric acid, appeared
fully to sustain the conclusion that the office of this agent, as
it exists in the stomach, is not, as has heretofore been rnain-
*Tlie formula employed was as follows:
fy. Tr. sesq. clilor. ferri 3vi.
Hydrochloric acid 3i-
Tr. opii 3i. M.
S. 15 to 30 drops every half hop r to hour, etc.
847
1880 J Sevier — Toxemic Diseases and their Treatment.
tained by physiologists, to assist in the process of digestion
by acting as a solvent of our food, but, by virtue of its anti¬
septic power, to prevent its decomposition before it is appro¬
priated by the assimilative organs ; and, as previously demon¬
strated, by its use as a prophylactic during cholera, to neutral¬
ize and destroy poisons which are continually entering the
circulation through the medium of the lungs. The fact is fully
attested by such experiments and such use of this agent, in
the form designated, that ozone and chlorine bear an interest¬
ing and important relation to each other — the former operating
to repress and correct poisons in the atmosphere and the latter
to correct and repress poisons in the stomach and blood. Thus
related in property and office, it follows that the absence of
either necessitates, for the purposes of health, the constant
and full presence of the other. That the mur. tr. ferri would
prove as distinctly and thoroughly efficient as a prophylactic
in yellow fever as it did in cholera, I have no doubt whatever ;
but whether there exists a demand, or even a justification for
the use of iron, in this or other form, as a remedy, I do not
know, and therefore defer to the judgment of those who have
enjoyed opportunities for practical observation.* But that
there does exist an absolute and imperious demand for hydro¬
chloric acid appears evident, not only in view of the wonderful
disinfectant power of chlorine, but of facts presently to be
related.
9th. There arises on occasion of the epidemic prevalence of
either cholera or yellow fever a co-operative influence, a the to
human health of formidable strength and proportions — am¬
monia. The absence, or the diminished aud insufficient pres¬
ence of ozone does not imply, at such times, more distinctly or
surely the existence of the pievailiug poison than it does that
of this compound. Were ozone present, in sufficiency, in the
atmosphere, neither could exist ; but its abseuce is the signal
for the prevalence of either or both. This is especially true of
ammonia in cities, towns and crowded communities. Its chief
* I was gratified to learu from Dr. Sternberg, of the U. S. Army, since this article was
written, that he had been informed during his recent oliicial visit to Havana, by the
surgeon in charge of the hospi tal in that city, that better success had attended the treat¬
ment of yellow fever in that institution during the past year than ever before a fact
which he attributed to the liberal use of the mur. tinct. of iron.
848
Original Communications.
[March
and abundant sources of supply are found in animal putre¬
scence, and also, in more limited amount, in vegetable decom¬
position. Fresh meats, at such times, are observed to decom¬
pose earlier and more rapidly than during seasons of health.
The same is true of every sort of animal filth. From the
market house, the meat-house and kitchen ; from sewers, sinks,
privies, stables, &c., &c., arises a constant volume of this most
hurtful agent. Between no two substances in the whole chemi¬
cal world does there exist a more intense or powerful affinity
than that which governs the relations of chlorine and ammonia
to each other. A familiar method of illustrating this fact con¬
sists in placing two unstopped bottles, one containing hydro-
cloric acid and the other ammonia, at an interval of several feet
apart. The fumes are observed to arise and meet in the form of
a dense, white vapor. Were an unstopped bottle of the acid,
alone, placed on the table in a city when either cholera or yel¬
low fever is prevailing, we should witness the same phe¬
nomena — the ammonia being abundantly supplied from the
sources mentioned*. Being of highly diffusible nature, it is
everywhere present. It pervades the mansions of the wealthy
and the cottages of the poor, is in the air respired and in the
water drank, is both breathed and swallowed, until, by the
constant and irrepressible play of affinities alluded to, the
system is robbed of the presence and protection of the hydro¬
chloric acid, naturally existing in the stomach, and the party
exposed falls as easy prey to the prevailing poison. Watson
(Practice of Physic, 4th Am. Ed., Art. Yellow Fever) quotes
Blair as saying in regard to the disease, as it prevailed in
British Guiana, that the patient’s breath and the “black vomit”
both exhaled the smell of ammonia — that in the latter “ its
presence is universal” — “may always be found when looked
for,” and “ may be considered one of the tests ” of that dis¬
charge. These facts, I conceive, are of importance j indicating,
as they do, the presence and effect of an agent not generally
computed among causative influences, and revealing clearly the
plea of treatment necessary to be pursued.
Unless contra-indicated by evidences of organic lesion, hy¬
drochloric acid should be constantly, conspicuously and
1880] Sevier — Toxemic Diseases and their Treatment. 849
predominantly present in all yellow fever prescriptions ; nor
should the administration of this agent be governed by the
doses ordinarily prescribed or required, inasmuch as the de¬
mand is both urgent and inordinate.*
Both the acid and its compound, the muriated tincture of
iron, have been occasionally employed as remedies ; but neither,
so far as I am aware, has ever been suggested as a prophylac¬
tic. The author just quoted from speaks of the tincture as
“ coming to us with such strong testimony in its favor as a
remedy adapted to even the earlier stages of yellow fever, that
it demands further trial. Yet I have seen no statement of the
method in which either has been employed — no explanation of
the circumstances which require their use — no detail of results —
no rationale of treatment. The “ Qui fit” has not been an¬
swered ; and without a correct appreciation of the character
and force of influences which render the use of the agencies
designated not only appropriate but necessary, there appears
good reason to apprehend that they have been employed irre¬
gularly and in doses totally insufficient.
If I am correct in the views expressed touching the practica¬
bility of disinfecting the blood, it will readily occur to the in¬
telligent reader that, in the properly regulated use of the muri¬
ated tincture of iron, with or without a super-addition of hy¬
drochloric acid as may be found best, will be found a plan of
protection from both cholera and yellow fever far more efficient
and reliable than that afforded by quarantine and one, too,
which will not in any measure disturb the peace of society nor
the interests of commerce. I beg that I may not be esteemed
sanguine, without reason, when I express a confident hope that
this fact will be established.
*With the view not of encouraging the needless and indiscriminate use of the means
indicated, but of showing how urgent is the demand for them on such occasions, I beg
leave to reproduce from my paper on cholera the following :
“ The dose suggested may, I am satisfied, in cases requiring it, be safely doubled,
tripled, or even quadrupled. A negro woman, suffering from an attack of cholera, took a
tablespoonfnl of the mixture undiluted. No ill effect nor even inconvenience was sus¬
tained, beyoad copious and loud eructations of gas from the stomach. A gentleman gave
to his child, nine years old, a tea-spoonful. The cholera was, in each case, promptly ar¬
rested, a second dose not having been required by either. The security from ill effects,
in such cases, is doubtless due to the alkalinity referred to.”
850
A Case of Periodic Worm Fever ,
By S. S. HERRICK, M. D.
Original Communications.
[March
%
The Philadelphia Medical and Surgical Reporter of Nov. 1st,
1879, contains the account of a case of supposed congestive
chills caused by lumbrici, from Dr. J. A. Hutchinson, of Sala-
monia, Ind.
The subject was a married woman, 19 years old, who had
lately become a mother. Between Sept. 19th and 27th, she
had daily attacks of great severity, somewhat unlike malarial
paroxysms, but which were supposed to be of that nature by
several physicians. Quinine to the amount of was given
between paroxysms without the slightest effect, until a lum-
bricoid made its appearance in the throat. Sautonine and
calomel were then resorted to, followed by castor oil and tur¬
pentine. The result was the expulsion of nearly a gallon of
lumbrici and the immediate cessation of the paroxysms.
The publication of the above case determines me to report
a similar one, which came under my observation during the
summer of 1879, the subject being a girl eleven years old, pre¬
viously in fair health .
She was first observed to have fever in the evening of May
24, not having felt quite well for several days previously,
though she did not stay away from school. The first remedy
tried was sulphate of cinchonidia, but this disappointed me,
though it had given satisfaction in previous cases. Quinine
was then tried, the fever in the course of a week having
assumed a remittent or almost continued type.
On June 5th the fever, having abated the previous night, was
followed by a very severe paroxysm, and, as it declined towards
night, eighteen grains of salicine were given before bed-time,
followed by nearly forty more in the morning. The paroxysm
returned one hour later and somewhat lighter. The salicine
was continued in increased quantity, but without success.
On the following morning, June 8, she took twenty grains of
quinine and escaped the fever. On the 9th she took fifteen
grains, and again escaped. The medicine was then suspended,
and June 11th fever returned in the evening. The quinine
was resumed, but the fever returned nevertheless. June 14th
she had a paroxysm while fully cinchonized.
1880] Herrick — A Case of Periodic Worm Fever. 852
It was then determined to try the effect of change of air and
scene. June 15th, she was sent to Bay St. Louis, the use of
quiniue being continued. Her mother accompanied her, and
gave favorable accounts of her case during their two week’s
stay. At the expiration of this time I saw her there, and be¬
came satisfied that the daily paroxysms had only diminished in
severity. As it was inconvenient for her mother to remain
there longer, she was brought back to the city June 29th. It
is to be remarked that during the last week she had been tnk-
ing a combination of arsenic, iron, cinchona and strychnine.
After returning she again took quinine daily, in addition to
the above mixture, but the paroxysms returned punctually.
July 3rd, 20 grains of the dextro quinine were given, but were
followed by a high fever. The next day she was sent to the
upper part of the city, to the house of a relative, and had an
evening paroxysm after taking twenty grains of quinine.
No improvement having followed this change, she was brought
home July 7th.
The next day another plan was tried. An ipecac emetic was
administered before breakfast. At 9 and 11, A. M., she took
seven-and-a-half grains of quinine together with one drop of
carbolic acid. From 10, A. M. to 4, P. M., she crossed the river
back aud forth on the Canal street ferry boat. The fever re¬
turned at 6, P. M., and ran up to 104.5°. That night she took
a large dose of calomel. The following morning the calomel
operated aud the emetic was repeated. Twenty-four grains of
quinoidine were given during the day, and the paroxysm de¬
layed its visit until after she was asleep that night.
July 11th, an ostrum called tliennaline was resorted to, sup¬
posed to consist chiefly of quinoidine, and the trips on the ferry¬
boat were continued. The daily paroxysms seemed to diminish
in severity, and to interfere very little from this time with her
appetite, though she was very weak and thin in flesh.
July 13th, she was again taken to Bay St. Louis, where she
remained two weeks, taking the thermaline most of the time.
Though not under my observation, I have no doubt that she had
more or less fever every day. After her return she passed
several hours daily on the ferry-boat, and “ Wilhoft’s tonic”
852 Original Communication s. [March
was given a trial, with about the same effect as in case of the
other antiperiodics. The paroxysms returned almost daily,
though not invariably so, but with less severity than pre¬
viously, and no regularity as to the hour of the day. None was
observed August 6th, but there were paroxysms on the two
following days.
At last it struck me that intestinal worms might be the cause
of the trouble, knowing that she had previously been annoyed
by seat-worms and witnessing the failure of all remedies of
an antimnlarial character. Accordingly, on the night of August
8th, she took some pills containing 4 grains of santonine, the
same of aloes, together with 5 grains of calomel. The following
morning she voided a small quantity of white worms about a
quarter of an inch long. From that time the paroxysms ceased,
and she has never had one since. These worms differ from the
ordinary ascarides in size, being rather longer and larger in
diameter, while they have the odd property of doubling up and
hopping to a consideiable distance, like maggots.
It is an interesting question how far this case was affected
by malarial intiuences, if at all. The child had not been sub¬
ject. to periodic fevers previously, more than other members of
the household ; while other children in the same family have
at times been troubled with ascarides. We are all aware of
the liability of malaria, in this climate, to complicite most of
the diseases which we are called upon to treat, and the neces¬
sity tor resort to the usual antiperiodics. In the present in¬
stance they failed to arrest, though they appeared to mitigate
the paroxysms.
A lemarkable feature of the case was, that these paroxysms,
recurring almost daily for two and a half months, during the
greater part of the time scarcely diminished her appetite, and
she was able, generally, to walk about. Anothei fact is notable,
that she has since been annoyed by the irritation of these little
pests, without any febrile manifestation whatever. If we ac¬
cept the most obvious explanation of the case, on the ground
of reflex action of the vaso motor nerve-centres caused by pe¬
ripheral irritation, and rendered periodic by malarious in¬
fluence, it would be difficult to discover why, under apparently
the same circumstances, the periodic fevers uever appeared
before May 20th. nor subsequent to August 8th, 1879.
1880J Lanng — Remarks on Common Eye-troubles.
Some Remarks on Common Eye-troubles,
By O. R. LANNG, M. D.
(Read before the New Orleans Med. and Surg. Association, Feb. 21, 1880.)
Gentlemen — Imitating a confrere in New York, who some
time ago read a paper on diseases of the eye before a medical
society iu that city, I shall take the liberty to-night, to oiler to
the Association some general remarks on these diseases, and
try to do it in such a way, that they may be acceptable to the
general practitioner, not touching upon such subjects as belong
exclusively to the province of the specialist.
I believe I am right in supposing the existence of specialties
to be justified by the results obtained by them; it stands to
reason that a man, who devotes all his attention and all his
energy to a small field must acquire more experience and
routine, and consequently more success in his specialty, than
one who has his mind occupied with very many different
things. In modern industry this practice is called division of
labor, and the results obtained by it have proved satisfactory.
Nevertheless it will often devolve upon the general practitioner
to give his advice and undertake the treatment of cases, to
which specialists devote themselves, and the public will rely
upon the family -physician ( o point out the beginnings of dis¬
ease of whatever kind. I beg the Association to accept my
observations merely as hints, which may facilitate the under¬
standing of important defects of sight, and help in curing-
diseases of the eye ; and which may induce to recognize the
necessity of making use of particular knowledge.
All ages are subject to defective sight, but, while an adult
will easily detect an acquired deficiency and seek proper
advice, it will devolve upon the parents to notice whether their
child has a good sight or not ; it is easy enough to know when
a child, even a quite young one, is totally blind, from its com¬
plete lack of interest in its surrounding, but it is of importance,
that other deficiencies in its sight should be recognized at an
early period. The child itself has of course no judgment ; it
supposes the sight it has and to which it is accustomed since
iU birth to be as good as that of other people ; this early atten-
854
Original Communications.
[March
tion to the sight of children is of great importance, as other¬
wise the continued existence of a deficiency may prevent the
natural moral development of the child and mar its general
character.
In numerous cases the defective sight is caused by errors in
refraction; some of them as liypermetropia and astigmatism
are usually congenital ; another error viz : myopia or short¬
sightedness is usually acquired later, even if there be a heredi¬
tary disposition to this anomaly; but there is no doubt that
much can be done in order to prevent and check the develop¬
ment of myopia by observing some simple principles. I shall
only mention that in reading, the proper position to occupy,
is to turn the back to the light and to allow the light to fall
upon the book or whatever the object be ; all reading in twi¬
light or at insufficient artificial illumination should be avoided.
In schools it ought to be enforced that the desks and seats be
so constructed that the pupils are kept at a proper distance
and not forced to stoop ; if these conditions be not observed,
the accommodative power is taxed unnecessarily, producing
congestion to the eye and myopia of higher or lower degree.
As an evidence of this statement we find that short-sighted¬
ness is much more common in city populations than among
country people, and that in cities myopia is to be found most
frequently amoug such persons whose vocation it is to read
much.
Although liypermetropia, in contrast to myopia, does not in¬
crease in degree by a faulty opthalmic hygiene, its effects be¬
come more uupleasant the more the eyes are strained ; in the
beginning it will show itself only by some fatigue, but soon the
w riting will present a blurred appearance and an effort to over¬
come the trouble will cause a neuralgic pain around the eyes ;
one step more and we see strabismus brought on by this visual
error ; especially does this often happen by an accidentally oc¬
curring illness. Every practitioner has heard his patients com¬
plain during their convalescence that their eyes have been weak,
by w hich they mean that they cannot see the letters as distinctly
as they could before their illness ; this circumstance is caused by
the weakening effect of the illness on the muscles in general
1880] Lanng — Remarks on Common Eye-troubles. 855
and in easu on the ciliary muscle, which controls the accom¬
modation ; this condition might be termed temporary presby-
opy or far-sightedness. As the body improves in health and
vigor, the ciliary muscle, too, will recuperate its former strength
and the accommodative power will be restored. Illness is of¬
ten the accidental cause of the development of squinting, and
this is the reason why we so often hear parents state that their
child became cross-eyed from having had tbe measles, or bron¬
chitis, or diarrhcea, or from teething, and so forth. The fact is,
that the child was hypermetropic, was born so, and being in
good health had sufficient accommodative power to overcome
the error of refraction ; the accidentally occurring disease
deteriorates the child’s accommodation as well as its geueral
strength ; during the colvalescence it makes efforts to see dis¬
tinctly, and in order to do so, it strains the accommodation un¬
naturally, which, through reflex-action, brings the ocular mus¬
cles into function, and the child squints — in the beginning per¬
iodically when it looks at close objects — later continually and
at all distances.
A judicious use of glasses will do away with the annoying
symptoms, which furthermore may manifest themselves in hy-
permmia of the conjunctiva, redness of the eye lids, blephari¬
tis, sties, etc. We cannot cure the existing visual error, but
we can compensate the faulty refraction by glasses, in the same
manner as a person with one leg shorter than the other, enjoys
more comfort by applying a thick-soled shoe. It is a pop¬
ular opinion, that it is injurious to the eye to make use of glass¬
es ; this opinion is erroneous. I have already mentioned that
very poor sight in children has a bearing upon their character,
which may remain for life; in improving their sight by suitable
glasses, if the dim sight depends upon faulty refraction, things
immediately appear to them in a quite different light, and a
child, who before appeared to be dull, silly and awkward, may
now, under the influence of the new impressions it receives
from the outside, brighten and develop itself in a more favor¬
able manner. But even if the faulty refraction be of a lower
degree, not to make use of glasses is only to inflict upon the
children unnecessary discomfort ; in many cases the use of
856
Original Communications.
[March
glasses can be eluded only at the sacrifice of not using the
eyes for many occupations, as reading, sewing and so forth.
These same remarks may be applied to presbyopia or far-sight¬
edness, the condition which appears with the arrival of middle
life. The first symptoms of this decline of accommodative
power, are well-known ; small objects (small print, fine needle
work, etc.), cannot be seen with such ease or at so short a dis¬
tance as before, but in order to see minute objects more dis¬
tinctly, the patient is obliged to remove them further from the
eye or even to seek a brighter light. But as the retinal images of
these fine objects are very small, on accouut of the distance at
which they are held, he will soon experience a difficulty in
clearly distinguishing them ; print, for instance, will get indis¬
tinct and confused, and the eyes become fatigued and painful.
Far-sighted persons will inflict unnecessary discomfort upon
themselves by postponing the application of slight convex
glasses, and only at the sacrifice of many occupations.
In reference to strabismus as caused by hypermetropia — and
that is in a vast majority the case — I have yet a few words to
say. When monolateral strabismus has existed for some time,
we see that the squinting eye gradually loses its vision from
not being used, in the same way as an arm would iose a con¬
siderable part of its vigor from lack of exercise, if put out of
function for some length of time. An operation performed in
such a case may be considered a kosmetic success, but not as
to sight, which will not be restored by it. A timely use of
glasses would have prevented the subsequent squinting, or if
cross-eyedness had already been established, glasses applied
at an early period would have rendered it possible to obtain
binocular vision by an operation, which might be performed
later. Usually, all that is obtained by an operation for mono¬
lateral strabismus is that the eyes look as if they were working
together, while in reality one eye only is in function, and the
other is following it in its excursions.
Out of the conjunctival affections, I shall only mention the
form which occurs in new-born infants, not because I have any
new suggestions to make in the treatment of this malady, but
as the practitioner necessarily often must come in contact
1880] Lanng — Remarks on Common Eye-tronbles. 857
with it, I think a few words may be of interest, so much the
more as it may depend entirely upon his skill whether his little
patient shall come out of his hands seeing, or blind for life¬
time. The first indication is prevention. The eyes should
be washed with warm water directly after birth, and most
carefully, and this should be repeated frequently. In the
simple catarrhal form, cleanliness and the application of a
weak astringent, as borax or alum, is usually sufficient. But
if the discharge be thick, creamy and abundant in quantity, a
more energetic treatment is of course demanded. The lids
must be thoroughly everted, a manipulation which is not always
an easy thing to do on a new-born baby, and to the red and
swollen membrane a solution of nitrate of silver, 5 to 10 grains
to the ounce, must be well applied; this should be done to both
lids and repeated as the discharge again becomes thick and
abundant. Besides this continuous wiping away of the dis¬
charge, steady application of cold water and washing with a
solution of alum should be practised. In still more severe
cases it is preferable to use the mitigated stick. In ophthal¬
mia neonatum I have so far never seen a case that did not yield
to this treatment, which invariably has checked all threatening
symptoms; on the other hand I have quite often seen sad con¬
sequences of the disease being allowed to run its own course,
under the plea that it was only a cold, which invariably is
treated by the sovereign remedy of squirting a little of the
mother’s milk into the baby’s eyes.
The diseases of the cornea forma rather unsatisfactory chap¬
ter in ophthalmology as to the classification as well as the
treatment. It is difficult to find well marked distinctions be¬
tween the many different forms of keratitis, and as to the
treament, what until quite lately has been looked upon as fun¬
damental, seems to be on the point of being entirely upset.
For years atropine has been considered indispensable in the
treatment of keratitis of whatever kind ; during the acute
stage nobody would think of using anything else, and it is true,
that quite a number of cases of keratitis yield to this treat¬
ment, but thc*[same result might in many cases have been ob¬
tained by a merely expectative treatment, or none at all. But
858
Original Communications.
[March
a good many other cases of keratitis, especially in such where
the cornea is deeply or extensively infiltrated with pus, atropine
seems not to have the slightest effect; in such conditions it is
lately recommended to apply a solution of sulphate of eserine,
a new agent, which possesses the opposite effect of atropine on
the iris; while atropine dilates the pupil and paralyses the ac¬
commodation in acting upon the ciliary muscle, eserine con¬
tracts the pupil and produces spasmodic action of the ciliary
muscle. I have in a few cases lately used this remedy appar¬
ently with good result. En passant, I shall only mention that
in a bad ulcer of the cornea with extensive destruction of the
tissue, complicated with accumulation of lymph and thick pus
in the anterior chamber, nothing can compare in efficacy with
the free division of the structure, horizontally across the
cornea with a fine Graefe’s cataract knife. We owe this method
to Prof. Saemisli in Bonn.
In another sense a reform is taking place in the hitherto
established theory about different ailments of the cornea.
General surgery has undergone a revolution by the introduc¬
tion of antiseptic dressing of wounds, and it is therefore na¬
tural that ophthalmology should also have its share of the
advantages. So, several forms of affliction of the cornea,
especially ulcers, with a free secretion of matter, are looked
upon as being infected and in conformity with this theory such
ulcers are cauterized, with the object to destroy the infection
and by the eschara to protect it temporarily from a fresh in¬
vasion. The cauterization is done by touching the spot with a
strong solution of nitrate of silver, or the stick or even with the
cauteriura actuale; this last agent I have, however, not used
myself.
Butthe reformers do not stop here; the whole grand, antiseptic
apparatus has been introduced into ophthalmic practice; es¬
pecially in cataract extractions, where a severe injury is done
to the cornea, and where it is of great importance that healing
should take place without accompanying inflammation the whole
antiseptic apparatus with carbolic spray before and during the
operation, air-tight, antiseptic bandaging, etc., is proposed and
adopted by some practitioners. But, it seems to me, that how-
85ff
1880] Lanng — Remarks on Common Eye-troubles.
ev er well the field of operation may be disinfected, and how¬
ever well air-tight bandaging may protect it from a fresh in¬
vasion, some sly bacteria might travel through the lacrymal
canal, pass the lacrymal sac and through the lacrymal points
slip inside the disinfected fortress, and the antiseptic appara¬
tus would then be attacked from behind, so to speak. The
friends of the treatment claim that such foul dealing on the
part of the bacteria cannot take place ; they do, however, not
argue the point, but I suppose they must be right or they
would not say so.
Still, based upon the theory that different inflammatory pro¬
cesses of the eye, and especially such as occurring after cataract
extractions, are promoted by an infection, it has been pro¬
posed, quite lately, to make extensive use of ice. Immediately
after the operation, whenever inflammation is anticipated, the
lids should be covered with a piece of linen dipped in a weak
solution of carbolic acid, and ice-cold compresses be applied to
the eye, and changed frequently and gently without removing
the piece of liuen directly covering the lids. This proceeding-
should be kept up for 1 or 2 hours, and repeated whenever cir¬
cumstances should necessitate it. Accepting it as true that some
kind of fermentation is the cause of such inflammation, and
recognizing the faculty of low temperature to check the de¬
velopment of mikrokosmi, there may reasonably be expected a
beneficial effect from the use of ice, as the locality can easily
be put under its influence, and as the layers, which ought to be
acted upon, are quite superficial. The treatment needs, however,
to be tested more extensively before any positive opinion can
be formed about its efficacy.
Before I close, I have yet one form of keratitis to present :
I allude to the so called nail keratitis ; the name does, how¬
ever, not involve that the injury shall always be done
with a finger nail ; any superficial abrasion may have the same
effect ; I have seen it produced by a fan, or a thin card, or a
piece of straw ; the name is derived from the circumstance,
that it often is a child, who, playing with its mother,
with its nail produces a superficial abrasion of the
3
800 Original Communications. [March
epithelium of the cornea. It is characteristic with this lesion,
that, in spite of being apparently very trilling, it often gives
rise to very much pain and when apparently cured may reap¬
pear periodically for months and even for years.
Many more opthalmic subjects might deserve to be treated
and much more might be said about the subjects I have touch¬
ed, but anticipating that the association has had enough of
ophthalmology for to-night, I shall not tax its patience any
further.
Chronic Inversion of the Uterus of Fifteen Months’ Stand¬
ing Reduced by Manipulation and Sustained
Elastic Pressure.
(Case reported to X. O. Medical and Snrgical Association.)
By E. S LEWIS, M. D.,
Professor of Obstetrics and Diseases of Women, University of Louisiana.
In the October number of the New Orleans Medical and Sur¬
gical Journal I reported the successful reduction, by Emmett’s
method, of a chronic inversion of the uterus of five months’
standing. A second case of fifteen months’ duration has been
in my charge and was successfully treated by manipulation
and sustained elastic pressure. The history is as follows :
Mrs. B., from Lafourche parish, La., naturally healthy and
strong, married at 18 years. She gave birth to a large male
child ten months after. The labor was tedious, lasting three
days, and was conducted by a black midwife. During the
close of the second stage she was directed to sit on two chairs,
and in that posture was delivered. She then walked to her
bed aud immediately the placenta was removed by traction on
the cord. Its removal was attended by a frightful hemorrhage
which caused syncope. A physician, Dr. D., was sent for who
arrested the flow by tamponing the vagina with rags saturated
with vinegar. A slight flow continued which was regarded as
not exceeding the ordinary lochial discharge. Her convales¬
cence was tedious. In attempting to rise on the fifteenth day
she fainted. When she could stand and walk, she observed a
red tumor projecting beyond the vulva, which bled. Another
physician, Dr. S., was consulted who diagnosed a complete in-
Lewis — Chronic Inversion of the Uterus.
861
1880]
version. He made no attempt at reduction. Four mouths
later, in company with Dr. S., she came to New Orleans and ap¬
plied to a competent practitioner for relief. This gentleman
attempted reduction by manipulation under chloroform March
5th, 1879, but without success.
He then introduced a Hodge pessary to retain the uterus in
the vagina, which was worn until Jan. 22d, 1880, when she
sought my advice. Her condition was good, not anaemic, and
her weight 1511T>, although she gave a history of frequent hem¬
orrhages, profuse at the menstrual epochs, which she passed
in bed. Notwithstanding the pessary, the uterus protruded
from the vulva in stooping or straining. Vaginal examination,
Jan. 22d, 1880, confirmed the diagnosis of complete inversion,
and showed the uterus of ordinary size.
Jan. 23d a rubber bag was introduced into the vagina and
distended with water, after Tyler Smith’s method. Her men¬
strual period being due, and having the usual symptoms, it
was removed the following day. The menses appeared and
lasted live days.
Jan. 31st the bag was replaced. Feb. 1st, in company with
Prof. Elliot and Mr. Bourgeois, to whom I am indebted for the
notes in the case, she was injected with a fourth of a grain of
morphia and chloroformed. The bag wras then removed and it
was found that the uterus had been j>ressed between it and the
vaginal wall, from its flattened appearance. We then attempted
reposition by Emmett’s method ; but, after an hour and a half’s
wrork, found that though the uterus was smaller from the effects
of pressure with the fingers only, a part of the cervix was reduced.
The bag was again replaced, being removed every second day
to cleanse the vagina, and continued until the following Sun¬
day, Feb. 8th, when a second attempt, under chloroform, was
made at restoration, with but little gain. VTitli the right hand
still in the vagina, pressing the uterus up as far as it could pru¬
dently be pushed, the bag w as then introduced, pressing it with
the left hand along the palmar surface of the right until
it reached the fundus.
It was then injected with wTater, and as it began to disteud,
the right hand was carefully removed from the vagina, whilst
862
Origin a l Communicati o ns.
[March
two fingers of the left hand pressed the inferior extremity
of the bag up to prevent displacement. The bag was then
filled until it became fixed, and did not yield to traction on
the rubber tube attached.
February 10th, it was removed, the vagina was out, and the
bag returned in the same manner.
February 12th, an examination was made, and the uterus
found more than half reduced, the body and fundus within the
cervix. The bag was replaced.
February 15th, Sunday, 1 removed the bag to make a third
attempt under chloroform, but found the uterus completely re¬
duced. With two fingers of my right hand, I explored the ca¬
vity of the body, and found it perfectly normal.
February 17th, I made a speculum examination, found the
uterus measuring 2f inches in length, and the cervical canal
patulous. To stimulate the uterus to contraction, and modify
the condition of the mucous membrane, I scrubbed l he cavity
with Churchill’s tincture of iodine.
The two cases I have seen and reduced, have satisfied me
that sustained elastic pressure, whether with the bag after
Tyler Smith, or with the cup and stem attached by elastic
bands to an abdominal belt as practiced by Lawson Tait, is
safer, more frequently successful and an economy of labor.
In introducing the bag, the uterus should be well pushed up
first, otherwise the pressure is but slight upon the fundus, and
the bag, at the moment of distension, may rise between the
vagina and uterus compressing it laterally.
Re-Union of an Amputated Finger.
By R. A. GREER,
Student in the Medical Department of the University of Louisiana.
Charlie Nilson, an adult male and employee at a steam
shingle-factory, applied at my office (Hawkins, Texas) April
— , 1875, with the third finger of the right hand entirely
severed, half-way the second phalanx. The fragment was pre¬
sented me lying in the palm of the same hand, enveloped in a
coagulum of blood, which had formed while he was walking to
my office, a distance of three-fourths of a mile.
Go rrespondence.
863
1880]
Observing no possible means of obtaining a Hap sufficient to
cover the end of the bone without subjecting him to an opera¬
tion, the thought of attempting to save the finger next occurred.
This I proceeded to carry out by first gently sponging the
I>arts, to remove any foreign substances present. The parts
were then carefully adjusted, two sutures of ordinary flax were
placed on each side, to the depth of the skin, and the finger
was carefully confined by means of a bandage to a splint on
its palmar surface. The time which elapsed, from the accident
to the adjustment of the amputated extremity, was about one
hour. I had some hope of success, and requested the patient
to keep the arm in a sling, in order to ensure perfect rest to the
parts, and to report in four days. The patient reported on the
fourth day, as requested, and, to my very great satisfaction, I
found that perfect union had taken place, and byr the tenth day'
nothing remained to mark the site of injury, save a slight
cicatrix around the line of separation. Thus the fact is again
demonstrated, that the first effort of the surgeon should be to
save a member, even when success is least promising.
CORRESPONDENCE.
Messrs. Editors — Iu two cases of child birth of very receut
date, I practiced Stokes’ method iu the treatment of the cord :
as soon as the circulation began to grow feeble, I compressed
the cord between index finger and thumb, two inches from the
child’s abdomen, and then severed it with scissors. No liga¬
ture was applied on either side of the cut; no swathing band
was applied nor any dressing to the cord, it being left to shrivel
and dry. Both cases are doing as well as any I ever practiced
tying on. Will practice Stokes’ method further, and will report
same to your Journal. Truly yours, etc., E. E. P.
From Our Boston Correspondent.
Messrs. Editors — Iu any move whereby the well-being of the
people may be improved, Massachusetts is habitually to the
fore. But there is a most annoying and unfortunate exception :
86^ Original Communications. [March
we are quack-ridden to an extent which is positively incredi¬
ble. There is no redress against the inroads of the ignorant,
cold-blooded creatures who dare to put out a physician’s sign
unsupported by the smallest knowledge of medicine. These
bare-faced humbugs intrude themselves upon us at every turn.
All unchecked, they have drained the purses of those simple
beings who prefer bombast and claptrap to knowledge and
science. The belief of the laity in some forms of quackery is
as amazing as it is deplorable. Current is the story that the
wife of a Cambridge professor paid a thieving quack iu Boston
s event)! -Ji re dollars for one bottle of his wonderful medicine^
Somewhat triumphantly she submitted it to her family physi¬
cian, a man of such ability and experience, that his name is
known throughout the country. He had the stuff analyzed and
regretfully informed the lady that, far from being composed
of miraculous and heretofore unknown remedies, the elements
of her medicine were known to everybody, its value, about six
cents. If this were the end of the story, it would serve as a
useful comment upon the dishonesty of quacks. But it has a
sequel : The lady finished her bottle of quackery and — at once
paid $75 for another !
Two years ago a gentleman of education fell in love with a
man who calls himself a physician and who has a goodly number
of intelligent patients. The primary difficulty in this gentleman’s
case probably was spasm of the oesophagus. The q;iack pro¬
nounced it diphtheria, then changed his mind to pneumonia,
then to “liver complaint,” and finally settling upon cancer of
the stomach, he “ went for ” his patient. Treatment consisted
of violent emetics every day or every other day for three
months ; baths in hot saleratus water in which the patient was
kept until he began to faint; massage of prolonged and violent
character ; hot water as a steady diet, to the exclusion of good
food, especially milk. Other directions, the most arrant and
impudent nonsense, were given, but the principal features of
the treatment were those I have already mentioned. The gen¬
tleman lost fifty pounds in weight within ten weeks. Then
went abroad looking like a ghost and returned not much im¬
proved in appearance, and at once recommenced emetics, etc.
Summer came again, and found him at his country house, in
1880J Correspondence. 865
a very exhausted condition. One day he took cold, and was
seized with violent pain in the region of the bladder. Saugrado
was called from Boston. His first means of relief was an
emetic. His second, violent massage, especially over the blad¬
der. He remained with the unfortunate patient for two days
and nights, then returned to Boston. The next day a regular
physician almost accidently saw the case ; within ten minutes
he introduced a catheter, and drew from the poor fellow’s
bladder three pints of urine, so rotten, so foul, that it was next
to impossible to stand near it. It ruined the gum catheter, and
wherever a drop touched the patient’s skin, a pustule followed.
The sick man was already in the first stage of coma, but rallied
a little, yet, in spite of everything science could do, died of
blood poisoning. His year of preparation for his last illness,
and his final treatment at the hands of this rascal, render the
patient’s case one of the most pitiful and enraging of all simi¬
lar instances that have ever come to my knowledge. This
quack, however, is still engaged in the work of destroying the
health of valuable people. In a case of rapid consumption, he
stopped all food, and kept the patient on hot water until dis¬
charged by the indignant parents. Amazing as it may seem,
those of his patieuts who are not dead have the utmost faith in
this brute and think his power miraculous. I cite him at
length, because he works among an intelligent class of people
and also as a proof that the laity need to be protected against
their own foolishness.
Unfortunately, however, it must be confessed that the public
opinion of physicians in this country, in too many instances,
has been strongly prejudiced by the blunders of half-educated
men, who are still turned out of our second and third class
schools, nearly by the hundred.
Be that as it may, thoughtful minds in this state have con¬
cluded that charlatanism has held sway in Massachusetts long
enough. I am heartily glad to say that active measures are
being taken to uproot and deliver the state of medical quacks
and quackesses. To this end the health department of the
Social Science Association has resolved to request a member
of the General Court, at its next session, to move that the
866 Correspondence. [March
Health Committee be instructed to consider and report “ an
act to regulate the practice of medicine, for the protection of
the community.” Yon know wliat the severe medical act in
Illinois has accomplished, in ridding that state of quacks. Of
course, when driven from one state, these creatures will em¬
igrate to states unprotected by quackery laws. This is what the
Social Science Association seeks to prevent, so far as Massa¬
chusetts is concerned. The Association not only urges the
matter upon physicians and the public, but has laid the draft
of a proposed law before many leading physicians of the state,
who have authorized the Association committee to state, that
its general purpose and principal features meet with their
approval. Eminent counsel and physicians were consulted in
the preparation of the law.
It provides for the creation of a board of registration, to be
composed of eight physicians of education, and one practitioner
of dentistry in good standing. The board shall meet twice
yearly. Applicants for licenses must be 21 years of age, and show
their knowledge of medicine and ability to practice. Any per¬
son who is a graduate of an accepted school, at the date of
passage of the law, shall be licensed. A license to practice mid¬
wifery may be granted to any person not less than 21 years of
age, who has a good reputation, if found qualified. The same
in case for a dentist’s license, etc. The general purport of the
law is to rid the state of frauds and ignorant pretenders, and
secure properly qualified practitioners. It is to be regretted
that Massachusetts has waited so long before taking this step,
but — better late than never. In England, Germany or France
the quack, concerning whom I have given you details, would
be imprisoned. We have no remedy here. He distributes
cards, one inch square, which informs the public that his spe¬
cialty is the cure of cancer and bears the invitation “come and
C me” (Sic). Is ic not almost beyond belief that such a ninny
can find employment among intelligent people !
You are probably aware that, at their October meeting in ’79,
the Councilors of the Massachusetts Medical Society, by a
small majority, voted in favor of the admission of women to
examination for entrance to the Society. This result naturally
1880 J Correspondence. 867
created jubilation among, the friends of tlie movement, but its
opponents believe that the question was not yet settled. Many
felt that it had not been fully or fairly discussed, and the Cen¬
sors of the Suffolk District, branch of the parent Society, at
once found their position one of grave doubt ; for they saw
in the vote either “an alteration of the by-laws of the Society,”
or “ a new interpretation of the same.” If it be an alter¬
ation of the by-laws, its ratification requires the concurrence of
the whole Society. If it be a new interpretation, it is not bind¬
ing on the Censors unless ratified in general meeting. This last
position is made good by a comparatively recent by-law, viz :
“ No authority exists for interference in the duties and decisions
which, by law, are vested exclusively in the censors.” The
censors, therefore, found themselves obliged to interpret the
laws concerning admission into the society. If they unreason¬
ably exercise this right, a heavy penalty falls upon them. On
the other hand, if they unreasonably refuse to examine a duly
qualified candidate, they subject themselves to a fine of $400.
Their embarrassment and their inability to conform to the re¬
cent vote of the council led them to present their case before
the February meeting of the councilors, holden last week, iu
the form of a respectful protest, which asked for instructions
and gave their reasons for preserving a strict neutrality
until their doubtful position is made clear. The council¬
ors quickly saw the legal point, and the result was a vote
in favor of reconsideration of the October decision. The
matter, therefore, stands precisely as it did before the original
discussion. Since the general Society, sooner or later, will be
drawn into the controversy, we may expect some sharp spar¬
ring. At the councilors’ meeting last week it was moved that
the matter be referred to the Society at its anuual meeting in
June, but this precipitation was overruled by a councilor who
pleaded for more discussion and examination of the subject in
council. Tins led to the vote of reconsideration of the October
vote.
At the same meeting was brought up, for the third time, the
<;ode of ethics, which for nearly three years has been in course
4
Correspondence.
8b8
[ March
of preparation. It is a code intended for the Society, albeit
the need of such a guide seems not to have been greatly felt
during the one hundred years of the society’s life. The orig¬
inal committee of three presented the primary draft of the code
to the council in 1878. it was criticised without mercy and re¬
committed to the Committee, which was reinforced by two ad¬
ditional members. Again, when the matter came up, the com¬
mittee asked for more time, and the result was the presentation
of two codes, one signed by four, the other by one of
the committee. A warm discussion followed, as you may
see by the Journal of Febiuary 12th. Many councilors fav¬
ored the majority code with its profusion of detail, because
they felt that it should provide for all sorts of medical sole¬
cisms and all sorts of queer cases, and endless varieties of
queer men. They felt that young physicians, who are unformed
in the simple courtesies, which are really the foundation of
medical ethics, would gain nothing from a code of ethics, un¬
less it included the ABC of instruction. Their opponents
argued that such a mass of detail, such suggestions of dishon¬
orable, petty and mean and underhanded trickiness as were
contained in the majority code, were unworthy of a liberal pro¬
fession like medicine. They favored the code drawn up Dr. H.
J. Bigelow, and couched in terse, concise terms, but which, it
argued, cover every necessary point, by keeping in mind the
high principle which should govern every physician in his in¬
tercourse with his patients and colleagues.
The minority code carried the day.
Much sympahy was felt for Dr. Colting, the chairman of the
committee and actual author of the majority code. He lias
labored indel'atigably for many months. Has corresponded
with a great number of societies, and read everything in the
shape of a code upon which he could lay his hands. From the
immense quantity of matter thus gathered, he selected such
“live details,” and such only, as he deemed would have a bear¬
ing upon the medical practice of to-day, and meet every possi¬
ble need of physiciaus in their intercourse with, and treatment
of, their patients and each other. Dr. Bigelow took this code,
and rejecting from it everything which seemed unnecessary,
Current Medical Literature.
1880]
and forming the remainder under separate heads, presented it,
and it was accepted. This seemed a defeat which it must be
hard for Dr. Colting to bear. But he is sufficiently philo¬
sophic to see that his code was the basis of the one chosen.
If one had been absent, the other might not have been born.
Moreover, he loves the old Massachusetts Medical Society so
earnestly, that if she thinks the minority code what is needed,
he will only be glad she has found it. H. O.
Boston, February 13th, 188l>.
LECTURES UPON THE MODERN TREATMENT OP SYPHILIS.
By Dr. Carl Sigmund, Knight of Ilanor, &c.
When a veteran like Sigmund speaks, he may well command
the most respectful hearing, and when, after an observation of
syphilis larger than had fallen to the lot of any other man, he
gives his deliberate judgment, in language which evidences the
conscientious thoroughness with which he has studied so im¬
portant a disease, every student is put in possession of a prize
whose worth is beyond computation.
And this is what we find in these lectures. Their subject
matter is a perfect mine of mature thought, and in their man¬
ner there is a transparent fairness which cannot fail to charm,
even should there be a few unconvinced by what has so little
of an argument. At the outset the importance of avoiding the
error of regarding syphilis as a “specialty” is dwelt upon,
and the necessity for the broadest and most thorough education
in considering a disease so wide-spread, so grave and so in¬
timately related to others. After this there is a brief statement
of the separate and distinct natures of gonorrhoea, the simple
venereal ulcer (chancroid) and syphilis, of which the primary
lesion is the chancre. Each he believes to be due to a special
germ, never yet isolated. The repeated occurrence in the same
individual of the former two is contrasted with the exceptional
second attack of the latter, with which is coupled this remark :
“ The extremely few instances of a repeated attack of syphilis
(re-infection) which I have myself observed, have left me much
in doubt as to the entire correctness of the previous or of the
present diagnosis. Further I should add, that I know no case
in my own circle of observation, in which, after an established
Current Medical Literature.
[March
870
attack of syphilis, a later, new and second infection followed.
1 know, of course, cases so designated, a more careful observa¬
tion of which, however, controverted the diagnosis of a second
infection.”
In regard to diagnosis, attention is called to the unreliability
of the patient’s statements, and the indispensability of a thor¬
ough examination by the doctor. As far as possible this should
include every part of his skin, as well as the various inlets and
outlets of the body. In menstruating and lying-in women
there should be no excepting of the sexual organs, notwith¬
standing the established prejudice against such examinations.
Indeed, they are then of special importance. With the exami¬
nation for syphilis proper there should be a most thorough in¬
vestigation for open or latent diseases of other sorts, lest their
appearance during treatment be misconstrued by the physician,
w hieh would be unfortunate for science, or by the patient,
which would be injurious to the doctor. In conducting the
examination, Sigmund recommends the use of all available in¬
struments of precision, including that to which Sir Henry
Thompson has so recently given the cold shoulder — namely the
endoscope.
Of the symptoms he gives the well-known details, and for
convenience divides them into primary, secondary and tertiary,
with the well-known qualification, however, that nature often
disregards this artificial arrangement.
In regard to treatment, he advocates the early destruction of
the initial lesion. This may be by the knife, even to the ex¬
tent of circumcision when the prepuce is its seat, or amputa¬
tion of the labia minora or portio vaginalis of the uterus, if
1 1n* lesion be t here. Aside from the advantage of removing the
beares of the germ and infecting material, these operative pro¬
cedures facilitate the cleansing which is so essential in treating
syphilis, and substitute healthy union tor those tough cicatrices
which result from the action of the. disease.
This is the opening word for an earnest advocacy of local
treatment in the earliest stages. Not only the chancre, but the
first cutaneous and mucous disorders, he would have treated
by direct application of suitable remedies. For the initial
lesion, when the knife, the actual cautery, or strong acids can¬
not be used, carbolic acid of strength suited to the case may
be used, or iodoiorm, which limits suppuration very efficient¬
ly. cases where there is but slight scaling off of the epider¬
mis, or shallow erosions, the chancre may be treated with mer¬
curial ointment, or painted with a solution of conosive subli¬
mate in alcohol or ether. Afterward dry cotton dressings,,
small and neat, such as we have often seen used with brilliant
results in Sigmund’s wards are recommended.
On page GO, the author states that no means are sufficient to
pi event the disease, once inocculated, Irom becoming univer¬
sal, excepting complete exterpation of the initial lesion.
Currenr Medical Literature.
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1 880 j
.lust here we may avail ourselves of the right of individ¬
ual judgment which he concedes to all, to suggest the possi¬
bility that, where this extirpation has seemed to head off con¬
stitutional manifestations, there may have been a mistake as to
the character of the lesion. It would be hard to prove the con¬
trary, for these manifestations are the only absolutely infallible
evidence of syphilis.
In regard to constitutional treatment , the greatest stress is laid
upon cleanliness, hygiene and general building up. With these
and suitable local treatment, 4 per cent, of syphilitic patients
have only very light secondary manifestations ; 10 per cent,
more have but transitory and inconsequential affections of the
skin and fauces, which recover with suitable local treatment;
and the proportion of grave secondary forms is no greater
than in patients treated constitutionally, no matter how. Oth¬
er cases owe their severity chiefly to conditions inherent in the
patient, and it is to them the physician must direct his atten¬
tion, combating them, not as parts of, but as co-operating with
the syphilis in ravaging the system. When not thus compli¬
cated, the most varied forms of syphilis frequently recede spon¬
taneously. In fact in Sigmund’s wards it is taught that syphi¬
lis is not only a curable disease, but one tending under favor¬
able circumstances to a spontaneous cure.
This is an idea now familiar to all who have paid special at¬
tention to the disease ; but it is directly opposed to the views
held and taught by some most distinguished physicians.
The be*t time, then, for instituting constitutional and specially
anti-syphilitic treatment is in the second period of the disease,
and this is only “ when several systems and organs are affected,
or one very gravely, or when the nutrition or functional activ¬
ity of the organism is palpably prejudiced by syphilis alone.
In every period, however, and for every attack of syphilis,
the most scrupulous hygienic and dietetic care, and the simul¬
taneous attention to anti appropriate treatment of other
complicating constitutional affections, are indispensable.”
This is the key note of Sigmund’s teaching, to which he re¬
curs agiiin and again. Relying upon it, he says the thoroughly
investigating and accurately observant physician will not em¬
ploy, out of regard for the anxiety of the patient, or his own
reputation, the so-called humane and unquestionably shrewd
administration of small doses of anti-syphilitic remedies, in the
earliest periods of the disease.
When, however, such treatment is to be emploved, Sigmund
recommends for the lighter forms, erythema and papula, with
general enlargement of the lymphatics, the preparations, of
iodine, iodide of soda, of potassa, and iodoform, as well as the
proto-iodide of mercury, and, when these cannot be used,
inunction of mercurial ointment, or subcutaneous injection of
corrosive sublimate or the bi-cyanuret of mercury, or small
doses of calomel. Of these, unless contra-indicated, he pre-
872
Current Medical Literature.
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fers the iodine salts. For graver forms, with defective nutri¬
tion and strength, palpably due to syphilis alone, or wide¬
spread, pustular, papular, or squamous eruptions, preparations
of mercury must be used. The French teaching that mercury
is best suited to secondary, and the iodides to tertiary syphilis,
he thinks is unsupported by chemical experience. For the
gravest tertiary forms, gummy new formations in the skin, bones,
cartilages, and nervous system, mercury must be used anil
alternated with iodides.
Finally, the author deprecates pushing mercury to the point
of salivation. This he holds to be absolutely injurious to the
patient, and a relic of medical barbarism.
A very interesting part of one of the lectures is devoted to
the matter of prophylaxis, personal and general. In regard to
the former, Sigmund recommends attention to details of clean¬
liness, with the use of disinfecting washes for suspicious cav¬
ities, and anointing the examining finger with carbolic acid
ointment. In regard to public prophylaxis, he expresses a
strong convictiou in favor of daily examination of prostitutes,
“ for which, he says, are fitted only physicians who have,
united with a thorough knowledge of syphilis, a trustworthy
character.” The effect of such police regulation, he believes
to be salutary, protecting the community from disease and
prostitutes from bad treatment.
In support he cites the examples of Italy and Belgium.
American Journal Med. Sciences, for January, 1880.
CONTINUATION OF THE ARTICLE OF M. HARDY ON THE EX¬
AMINATION OF URINE IN DIAB1TES MELLITUS.
2. M. Bouchardat recommends a simple numeric and
prompt method. It consists in taking the density of the
urine, say 1.040, and multiplying the two last numbers by 2,
say 40x2= 80. The number 80 is multiplied by the quantity
of urine in 24 hours — 80x2.500 — 200 grammes. The number
Obtained represents the quantity of “solid materials” elimin¬
ated by the urine. To obtain the quantity of sugar, it suffices
to subtract from the number 200 the number 50, which, after
M. Bouchardat, represents the normal number, almost invari¬
able, of other solid materials eliminated from the urine, besides
the sugar. Then, 200 — 50 — 150 grammes of sugar.
The preceding method gave 141 grammes; the difference
between the two results is not very great. This approxima¬
tion would suffice in a clinical measure, if it was always as
correct; unhappily the differences may vary greatly. Thus,
we have with the polarimeter obtained 128 grammes, and 112
grammes by the procedure of Bouchardat; another day 225
and 150 grammes ; in another patient, the one from the wards
of M. Vulpian, the succharometer indicated 300 grammes, and
the method of Bouchardat, 345 grammes.
Current Medical Literature.
873
1880]
3. The dosage by the process of Fehling, or of Barreswill,
is made by the so-called liquor of Fehling; 10 cubic centimeters
of this liquor corresponds to 5 centimeters of glycose.
In a glass measure we place 10 centigrammes of liquor, and
we pour it in a balloon, where we add 2 or 3 centigrammes of a
concentrated solution of caustic soda; we add distilled water
until we have tilled the balloon to two-thirds, we agitate and
then heat.
On the other hand we measure 10 cubic centimeters of urine
in a graduated glass gauge, we dilute with distilled water until
it reaches the mark 100, in order to obtain a dilution of a 10th —
we agitate and introduce the liquid in a burette of Gay-Lussac,
which we till to t he zero of the large branch. When the liquid
of the balloon has reached ebullition, we add drop by drop
tin* liquid of the burette of Gay-Lussac in the balloon, until dis¬
coloration of the blue liquid of the balloon ; we stop when there
exists no more blue tinge in this liquid, and the red tinges
appear. For instance, I read on the burette which 1 have
poured off 700.8 or 10 cubic centimeters of the liquor of Fehl-
ing=5 centigrammes of glycose. We have then 04
grammes of sugar per quart.
This is an excellent method ; when we are familiar with it, it
never gives an error beyond 2 per cent of the total result.
4. Fermentation furnishes also a means of dosing the amount
of sugar; but this entails expenses of installation beyond even
that of the cost of a saccharometer, and it is not in the reach of
the general practitioner.
It is sufficiently interesting to occupy ourselves with other ma¬
ter ials which exist in the urine of the diabetic, and particularly
with the urea. Your patient eliminates 40 or 45 grammes of
urea in the 24 hours ; the one of M. Vulpian renders 51 and
even <50 grammes. These numbers exceed greatly the nor¬
mal of 25 grammes of those in the state of health. Then this
increase of the eliminated urea is the rule iu all cases of diabetes;
the number decreases only at the end of the second period,
when the consumption is great. But we should distinguish
the increase of urea in the hrst period of diabetes, from that of
the last period. In the first case, when the patient is still
fleshy and robust, the increase is due to much eating; the
amount of urea is in correlation with the quantity of materials
ingested in tbe 24 hours. On the contrary in the second period,
that of wasting, of alteration of the functions, the patient eats
much less, and yet he eliminates always much urea. This urea
does not come from the aliments, but of the materials of the
organism itself. He does not confection sugar with his ali¬
ments as at flrst, but he elaborates it at the expense of his or¬
ganism ; he makes it with his tissues, of which the albuminoid
materials subdivide themselves into sugar and urea.
Thus, at all times, when you will perceive a patient becom¬
ing thinner, whilst he renders much urea, you may conclude
874
Current Medical Literature.
[March
that he is passing from the first to the second period, and that he
is verging towards consumption, until being no longer able to
make sugar, neither with his aliments nor with his tissue-!, he
ceases to eliminate urea and sugar iu appreciable quantities.
A given amount of urea existing, how are, we to determine
whether it b *, due to the aliments or tissues ? When patients
produce sugar from their aliments, the amount of urea is
always less than in the last period, when the sugar is derived
from the exp -use of tissues. Thus, one patient reuderi ig 40
or 45 grammes of urea, he is still in the first period ; whilst
that from the wards of M. Vulpian has reached rhe period of
wasting and eliminates from 50 to (10 grammes of urea in the
twenty-four hours.
We. can, in urology, detennin ■ what shoul l be attributed to
the aliments by the amount of chlorides. We render chlorides
only in proportion to what we eat. The amount of chloride
gives, in a manner, the gauge of alimentation.
Our patient, with 40 grain m *s of urea, eliminates 0 gr. .8
Na Cl. (the normal amount being 8 or L0 grammes). After his
admittance in the hospital and his alimentation by an appro¬
priate and special azotized regimeu, he eliminated 12 gr. .75 of
Na 01., an amount agreeing with the richness of his food.
The second patient, with 50 or (10 grammes of urea, renders
but 8 grammes, or 7 gr. .5 of Na Cl. — a greater part of his urea
is derived already from the destruction of his tissues.
As to other elements, the clinical study of the urine has not
as yet discovered the bearings which one might draw from
their daily variations.
PART IV.
The symptoms which our two patients presented, permitted
a presumptive diagnosis of diabetes; the examination of the
urine, revealing glycosuria, confirmed this hypothesis. Glyco¬
suria is, iu fact, a necessary symptom of diabetes. But we
may have sugar in out urine and not be diabetic. Diabetes is
characterized by other symptoms than glycosuria.
To affirm diabetes, we should first establish a permanent gly-
closnria, for sugar exists probably in a normal state in the
urine, and it may appear momentarily from an alimentation
composed of an excess of sweetened materials ; sugar is found
in the urine of pregnant women, but this is only a momentary
glycosuria, which lias no relation to diabetes.
In order to be able to positively affirm a case of diabetes,
the sugar should exist in sufficient great quantity in the
urine. Normal urine contains about 0 grains, .50 of sugar.
For diabetes there should exist at least about 0, 8, 10 grammes
per day. Should we find a lesser quantity, a id that existing
almost permanently, we should wait before coming to a positive
conclusion. With 2 or 3 grammes of sugar per quart of urine,
we may be at the onset, of an attack of diabetes, but we must
Current Medical Literature.
875
1880 1
not be too positive, for it is in reality not yet a diabetes. It is
not easy to make the diagnosis of diabetes, for we do not
examine the urine of whom we wish. We come to it by some
particular symptom and by other precursory phenomena. It
is seldom that we make our diagnosis accidentally and by the
night vase of our patient ; in general practice, we do not
examine the urine of our patient because we are his physician.
Let us study the diverse phenomena, which will enable* us to
make our diagnosis.
At first the characteristics of the urine will be of great use ;
the urine is slightly syrupy, if there is a strong glycosuria; it
stiffens the clothing ; sometimes you find traces of it on the
clothing, especially on black or woollen cloths. You find white
spots on the pantaloons. I found such upon the clothing of a
magistrate, who thought that he had a venereal affection, be¬
cause he perceived white spots upon his robe, which drew my
attention and was the cause of my finding out a diabetic affec¬
tion.
The urine is usually frothy. In the country you will often
meet a vulgar sign, though still a revealing one ; the Hies are
drawn to the urine of a diabetic, and flies and ants are found
in the night vase.
Let us note a sign which formerly was almost the only one :
dip your finger in the urine and taste it — once is not a habit ;
do not neglect this means, and your diagnosis will be made at
once, and without the aid of any other reagent or analysis.
The quantity of urine is greatly increased ; we find 2, 4
and 6 quarts of urine. When you meet an individual who
urinates much, who cannot remain long without passing urine,
and he has no disease of the bladder, no stricture of the
urethra, think of diabetes. Some years ago, traveling in
company with one of my friends, I noticed that at each station
he was impatient to get out. I asked him if he was not diabetic;
he had his urine examined and found that he was diabetic.
Polydipsia is a natural consequence of this state, in order to
return to the economy the amount of water which one loses by
repeated micturitions. Diabetics drink at every instant ; they
drink all that they find, water, wine, etc.; all drinks are good
to them ; they lose no occasion of drinking; at’ night they
drink several glasses of water before retiring, and they always
place water near their bed ; they drink much alcoholic liquors
without coming notably under its influence ; they drink with im¬
punity large quantities of .wine and brandy; it seems that the
alcohol merely passes through their digestive tubes and urinary
channels without leaving traces of it in the organism.
Appetite is also increased ; diabetics are great eaters ; they
eat much and often, and are never satisfied ; they digest well.
Vulgarly they are said to have the tape-worm; it would be
more in point to say that the greedy are diabetic.
The mouth gives forth a foul breath ; the saliva an acid re-
o
876
Current Medical Literature.
[March
action, calling to mind that of vinegar or sugar. Some patients
accuse a sweet mouth and that the tongue is stuck to the pal¬
ate; that the mouth is dry, and that they have an insatiable
thirst. Some, more seldom, complain of an acrid, bitty and
bitter sensation. When diabetes has existed for some time,
the teeth decay and fall early; they seem longer; the gums
are tumid, fungous and bleed easily ; the tongue is red, smooth
and without elevation of the papillae ; at times muguet exists,
developing with concretions of which the spores are easily
recognized by the microscope.
1 have at times been able to make out a diagnosis of diabetes
by a different series of symptoms. The absence of venereal de¬
sire, especially in men, is a good sign of diabetes. Impotence
is soon manifested, and when a young patient will confide to
you that he has lost his erotic appetite, seek for diabetes.
Women will often complain to you of loss of venereal appetite
in their husbands, and will accuse them of having a mist i ess,
etc.; then look for diabetes. I will relate to you, in this series of
ideas, the history of au ancient professor at the College of
France, L - , who was not married, and whom his friends
never heard speak of women (to such a degree that he was sus¬
pected of having secret or vicious habits). Later all was ex¬
plained: he had spontaneous gangrene of the legs, of which the
diabetic nature was demoustiated by the examination of his
urine. Diabetes causes the eruption often of an interminable
seiies of furuncles and anthrax. Still, we should be on our
guard, for often glycosuria accompanies anthrax, but it only
lasts with the anthrax and disappears with it.
To admit diabetes, the proportion of augar should be suffi¬
ciently great, and the observation should be made during a
certain length of time, for, most often, glycosuria exists only
momentarily. There are other exceptions, also, which give a
great clue to diabetes; especially in men, particularly in those
who have a long prepuce, is the appearance of herpes prepu-
tialis. The more abundant secretion than customary suffices to
bring on this eruption of an eczematous nature, constituted by
vesicles and ulcerations, then a kind of whitish pseudo-mem¬
branous scale upon the gland. The itching becomes then
sufficiently active upon the prepuce, and the pruritus extends
sometimes to the anus. This last symptom was really intoler¬
able, tor two years, in a patient who died of diabetes, and
during the whole of this time he was annoyed also by the most
unbearable anal pruritus.
In women, we observe vulvar erythema, as well as in the
inguinal and inferior portions of the abdomen. It is common
to observe a pruritus of the vulva with au acute redness, and
even at times an oozing. This is not eczema, but erythematous
intertrigo, of which the special selection is particularly in the
external portion of the labia majora and the folds of the groin,
and in fieshy women the inferior plaits of the abdomen. The
1880 J
Current Medical Literature.
877
pruritus is sufficiently acute to prevent sleep. These accidents
have been attributed to the contact of the urine, but they occur
even when the skin has been protected from all contamination.
Though unable to make out the cause, ye we must attach a
certain amount of interest. More than twenty times I have
established a diagnosis of diabetes, by the presence of vulvar
erythema, which remained refractory to all medication habitu¬
ally used in such cases.
Wasting of tlesh and muscular weakness, occurring in an in¬
dividual free from ad pulmonary troubles, or other disease
capable of explaining these symptoms, would be a sufficient in¬
dex to examine the urine and look for glycosuria. The diabetic
are subject to neuralgias (facial and sciatic), of a rebellious and
tenacious nature, which do not yield to ordinary means, and are
very lasting.
Wounds do not heal, ulcers originate from the slightest
cause, and do not heal after many months of treatment. Frac¬
tures do not consolidate. Finally diabetes also predisposes to
gangrene of the extremities. (Landouzy, Sr.)
Here are a great number of symptoms which may assist the
physician in making his diagnosis ; these details are not super¬
fluous, for diabetes is not a disease which strikes you at the
first look. It is revealed by phenomena of a light nature, cir¬
cumstances often trifling, which the physician should always
bear in mind.
Y.
ITS MARCH, DURATION AND TERMINATION.
At the outset diabetes is a latent and insidious disease. We
are never aware when diabetes has begun ; weeks, months and
even years, may elapse before we are attracted by a marked
symptom. Patients can, with difficulty, establish the precise
time, generally not within several months, when occurred the
polydipsia or polyuria.
When developed, it makes itself evident by the thirst, and
by the necessity of ingesting large quantities of liquids and
solids. The urine becomes abundant, the wasting and weak¬
ness characterized, but not always in a marked manner : we
perceive, especially among the wealthy, that they remain fat,
and maintain the look of flourishing health, preserving a
florid tint and well developed muscular strength. Among them
we more often discover the anaphrodisiac state.
Some physicians have endeavored to distinguish the diabetes
of the rich from that of the poor, in order to establish the differ¬
ence which exists in favor of the first ; who is able to lose much
because he repairs much, while the poor workman is doomed
to not restore to his organism the exaggerated expense caused
by the disease.
But a particular phenomenon which is never wanting, is
878 Current Medical Literature. | March
genital im potency : next in order the furuncles, erythemas,
troubles of vision, the soft, cataracts of diabetes, &c.
The diabetic state existing, other phenomena will be ob¬
served ; the mouth and gums are covered with muguet, fungo-
sities, stomatitis ; the fetidity of the breast assumes a peculiar
sourish character, or recalling the sweetened savor of fruits
undergoing decomposition, rotten apples, etc. The respiration
is disturbed in its chemical phenomena by diabetes (Petten-
koflfer) ; the particular slowness of the respiratory functions
has been observed with its necessary consequences, the dimi¬
nution of the absorption of oxygen, the exhalation of carbonic
acid and the vapor of water. While a healtliy man absorbs
750 to 850 grammes of oxygen in 24 hours, the diabetic absorbs
only from 250 to 350 grammes. The combustions are conse¬
quently decreased, and the temperature diminished. The tem¬
perature during the activity of diabetes falls from 37.3 to 37.5,
the normal amount, to the number 36, 35 or even 31. It is
quite important that this should be remembered with regard to
the record of the temperature.
The actuality of diabetes lasts a greater or lesser length of
time. The last period is that of cachexia. The patient until
now, strong and fat, loses both strength and roundness; all
the functions are prostrated ; his appetite is disturbed ; he eats
less, though his losses are in the increase. His wasting or
thinness becomes more marked, and marasmus sets in fatally.
The quantity of the sugar diminishes then, as the sources of
production are exhausted. In extreme cases there exists no
sugar in the ’urine. But the urea does not diminish at the same
time; it continues to secrete by the autophagia of the patient.
The consumption attains its maximum, the body is reduced to
a diaphanic skeleton, the patient can scarcely raise his limbs.
The duration of diabetes is undetermined. The acute form
can bring on marasmus in a few months, especially in the poor
who are not able to repair the exaggerated losses of their or¬
ganism by an appropriate alimentation. But these cases are
rare. Instead of terminating in a few months, sometimes in
less than six months, it usually takes a chronic form and an
undetermined duration, which may at times last 15, 20 and
even 30 years. It is thus that, in my private practice, I have a
number of clients who attend to their avocations, and who en¬
joy comparatively good health, apart from their glycosuria.
Diabetes does not kill in itself, but it breaks down, and renders
liable to various accidents which will kill.
It has been said that there is an “intermittent diabetes”
existing for some months, than disappearing suddenly. More
appropriately it is a chronic diabetes, of which the conse¬
quences are mitigated by an appropr iate alimentation and medi¬
cation. It appears anew as soon as those conditions are
neglected, and from the influence of some excess or other.
As to its rnauner of terminating, the diabetic may be cured ,
Current Medical Literature.
879
1880J
however often the contrary may have been asserted. I can, on
my part, cite five or six cases who have had diabetes, aud in
whom the diabetes has disappeared since five, six and ten
years. This length of time is sufficient to embolden me to
pronounce the word cure. 1 insist upon this affirmation ; may
this consoling idea be propagated, and may it sustain the pa¬
tient in his treatment, and the physician in the exercise of his
mission.
Unhappily, this is still the exception ; usually diabetes ter¬
minates in death. Death may happen by the mere fact of
diabetes, by the influence of progressive marasmus, by troubles
of the respiratory tunctions, by the breaking down and general
debility. It may be sudden in the course of the third period
of diabetes. The patient swoons away suddenly, without our
being able to establish the lesion that produced death. It
may be explained by a syncope happening doubtless on
account of the granular fatty degeneration of the muscular
fibres of the heart. Then we should interdict all fatiguing
labor, all night watching or sitting up, all effort and emotions
to the diabetic. This termination, nevertheless, is sufficiently
rare; oftener he succumbs to an accidental iutercurrent dis¬
ease, which has a relation to the disease, or which even is at
times independent. With the diabetic, whose vital resistance
is so greatly diminished, the slightest disease is a sentence of
death. Still, there is a certain number ot affections which
carry off the diabetic. Let us cite, in first order, fibrinous or
catarrhal pneumonia, which kills the diabetic long before he
has reached the cachectic period. The same may be said of
pulmonary phthisis, for which diabetes is a predisposing cause.
By its debilitating character, it predisposes those who were
not subject 10 phthisis by heredity nor by special anterior
causes, to finally become tuberculous because they are diabetic.
It has been advanced that young subjects were more liable to
this eventuality than the more aged; it is but simply the com¬
mon law of tuberculosis. It has been thought that the poor
were more liable than the rich ; it is again for the same general
reason, and also because the laborer can less easily supply the
wants of a diabetic organism. I have met with a goodly num¬
ber of rich patients with diabetes, who, nevertheless, suc¬
cumbed to an iutercurrent phthisis. Does diabetes impress a
special course to phthisis, a special form, more grave and
rapid ? I do not believe that it does. What has given cause to
this error? Is it that phthisis, setting in upon an economy
already broken down by diabetes, makes greater progress than
it would, had it attacked an as yet uncompromised constitu¬
tion? It is not diabetes that produces the effect, but it is the
state of the economy which predisposes.
It has also been advanced with some good grounds, that a
diabetic phthisis develops tubercules only in the lungs, and not
a general tuberculosis ; still we should not forget that this is
880 Current Medical Literature. | March
also a law of tuberculosis which generalizes itself scarcely but
in children and young subjects.
Gangrene of the lungs is sufficiently common with the dia¬
betic; it is a gangrene of the extremeties of the small bron¬
chia, with fetid sputa, general weakening and adymemic de¬
bilitation. These lesions have been confused with those of
tuberculosis ; it is not tuberculosis, it is but simple ulcerations
of the small bronchia with evacuation of several alveolae, and
of the elastic fibres of the bronchia. It is not a gangrene
which attacks a portion of the lung at the same time, as we
observe it on other occasions. The microscope will demon¬
strate the characteristic fibres and will lead to the differen¬
tial diagnosis of tuberculosis and bronchial gangrene.
Albuminuria with all its consequences attacks, also, the dia¬
betic; itis especially the parenchimatous nephritis, though the in¬
terstitial is not uncommon. We may well understand, under
so great an activity impressed on the kidneys by the glycosuric
elimination, that the inflammation has a greater chance upon
this depressed organ.
These allmminuriae are of a grave character, but they are not
always mortal. I met with a case of grave albuminuria with
considerable anasarca, which lasted for several mouths, and
terminated favorably. The patient lived yet four years with¬
out albuminuria.
Anthrax and furuncles .are common in diabetes; they often
open the way to diagnosis; they are at times of a grave character.
I have met with a certain number of deaths by purulent infection.
The diffuse phlegmon occurs also from the slightest abrasion;
its cure is slow and difficult. Spontaneous gangrene, especially
that of the inferior members, is an endowment of diabetes.
Apart from arterial interruptions, we may say that gangreue
of the inferior members is generally the effect of diabetes.
(Marchal de Calri and Landouzy.)
At the moment that certain diseases complicate diabetes, we
perceive the diabetes disappearing, so that some physicians
pretend, for instance, that albuminuria destroys diabetes. Let
us rather think with Hippocrates : Ex duobus laboribus gravior
obscurat alterum.
VI.
ETIOLOLY. AND TREATMENT OF DIABETES MELLITUS.
We know that diabetes is not more common to-day than for¬
merly ; it is true that we meet with cases more frequently thau
before, but this is simply because physicians are better able
to recognize it to-day than 30 years ago. It was in old times a
very rare disease to physicians, but not a rarity to nature.
The symptoms are better known to-day ; formerly diabetes
was classed under the rubric of phthisis, wasting disease, etc.
Diabetes is a disease of all times, but it is rare in the first
Current Medical Literature.
881
1880]
years ot childhood. At the ages of five and six it is un¬
frequent. It is more common at the ages of thirty to fifty
years. It has been wrongly asserted that it does not occur after
fifty. It is met with in patients at sixty and seventy years, in
whom no prior traces of glycosuria had previously existed. It
is also an affection of both sexes, but with a predominance for
the male sex. Griesmger has found in 23.1 cases 172 for the
male and 53 for the female sex. Temperament does not pre¬
dispose; diabetes affects the most robust as well as the most
delicate. Heredity has a certain influence ; we are diabetic
from father to son, and from mother to daughter. I have re¬
peatedly met several cases of diabetes in the same family.
Thus I think that we should always be on our guard, when we
fiud a member of a family diabetic or we know one of the
family to be so affected.
Diabetes seems to be more common in cold and humid
climates; in tropical countries negroes seem to be exempt.
This may be true for those who remain in their country, but is
not so in Paris, for several years ago I treated a diabetic
negro.
THE PREDISPOSING CAUSES OF DIABETES.
Sedentary and studious habits predispose; whilst in those
who carry on manual pursuits which exercise their muscular
system, the disease is unfrequent. It is rare in our hospitals,
whilst physicians who pursue their profession in the city, may
easily number ten or fifteen in their practice. We may also
attribute to moral influences, profound and lasting grief,
fright and violent emotions, a goodly share in the predisposi¬
tion to the disease.
Alimentation. — The disease has been attributed to a nourish¬
ment too rich in sweetened and starchy materials, to the abuse
of sweetened drinks, of syrups, sweetmeats, bread, etc.
To admit this, we should confound diabetes with glycosuria,
which is totally different. Glycosuria disappears as soon as
we leave off this regimen. I have met with several examples.
This is not diabetes.
Some diseases have been accused of producing diabetes.
Thus phthisis pulmunaris and syphilis. It is an error; syphilis
does not prevent diabetes, and reciprocally ; likewise we may
become phthisical, being affected with diabetes.
It is by a simple theoretical reasoning that it has been said
that diabetes might be a consequence of disease of the liver,
bearing in view the glycogenic function of this organ. But,
with better judgment, it has been allied to gout. It is in fact
,one of the occurrences w hich gouty subjects are most threat¬
ened with. Still diabetes is less serious and yields better to
treatment. It is in these cases that it has occurred that instances
of so-called intermittent diabetes have been seen to alternate
with a good and bad regimen. Finally, diseases of the nervous
882
Current Medical Literature.
[March
system can induce diabetes. We are acquainted with the
experiment of Claude Bernard, who provoked experimental
diabetes in animals, iu pricking the regions neighboring the
table of the fourth ventricle. Certain cerebral diseases (tumors,
sclerosis, exostosis), encroaching upon these same regions, may
be capable of producing a true diabetes, with paralysis and
glycosuria. Agitating palsy, hysteria, mental alienation and
epilepsy have been accused of producing diabetes. This is an
error. There is evidently no opposition between these diseases
and diabetes, but there exists only a coincidence when they occur
in the same individual.
Among the most productive causes, and upon which I more
particularly insist in terminating this subject, I recall to your
memory heredity, sedentary habits, moral influences and
gout
Treatment. — It may be cured, especially if it be not of long
existence. Here is a point which we should remember, so that,
after having employed all means, we do not become discouraged
in our undertaking.
Let us place first in order hygienic prescriptions. You will
regulate the alimentation of the diabetic, in forbidding the use
of all aliments containing sugar, or susceptible of being trans¬
formed into sugar. No sugar, no fecula, no sugar in his
aliments or iu his drinks, no syrups, sweet meats, no cider,
no sweet fruits, and notably raisins, figs, pine-apples,
melons. You will on th<> contrary allow peaches, cherries, cur¬
rants, slightly acid fruits.
You will deprive the diabetic of fecula ; no bread or the
least possible. A peculiar kind has been recommended, bread
of gluten. This is a bad practice, iu which we should place no
trust. In fact, either the bread is really a bread of gluten,
and is very disagreable and unsupportable, or the baker has
added much dour to render it palatable. You will forbid also
all pastry, and all paste in the soups, rice, maccaroni, tapi¬
oca, all starchy substances, as well as all farinacious vege¬
tables, such as potatoes, carrots, leutds, beans, etc.
But, say .you-, what will remain to the diabetic? There re¬
mains yet a bne series of aliments, and you will have a good
idea, when you have read the bill of fare formulated by M.
Bouchardat. To cite some, let us see, for the soup ( without
which iu France there is no good dinner) there remains the
bouillon, with an egg in the soup, the cabbage soup, the potage
a la bisque, &c. Among the meats, we have the choice of all
white or black meats, game, fish, shell-fisb. As to vegetables,
we have green vegetables, chiccory, spinage, asparagus, &c.
No sweetened aliments, particularly no sugar in the tea, nor.
in the coffee; it has at times been substiluted by glycerine.
The coffee or tea is sweetened with glyceriue ; a manufacturer,
probably a diabetic, had the good idea to fabricate all kinds of
liquors with glycerine, which is substituted for sugar. We
Current Medical Literature.
883
1880]
have rum, cura<;oa, anisette, &c., made with glycerine. I tasted
some at one of my clients ; it is not too disagreeable. Wine is
useful for the diabetic ; to supply the wear aiid tear of the or¬
ganism, you will order wines of Bordeaux, Burgundy, espec¬
ially red wines, but not white wines, which are diuretic. You
will forbid sweet wines and the various white wines. They
will drink of mineral alkaline waters, which assist diges¬
tion.
You will be rigid about the regimen, and not permit a re¬
turn to usual aliments but when the glycosuria has completely
disappeared and for several months.
You will add to this regimen other hygienic means, such as
exercise, gymnastics, fatiguing walks, the producing of per¬
spiration, equitation, manual labor; you will induce the patient
to till his own garden, etc. Also, hydrotherapia, cold lotions,
to favor cutaneous perspiration. In internal medication,
let us mention, as first in order, the treatment which has pro¬
duced the most benefit — the treatment by alkalies, the bicar¬
bonate of soda, of lithia, of lime, either in the state of salt, or
under the form of mineral waters. This treatment answers to
the idea of Mialhe, who said that the blood was less alkaline
in diabetes ; it has even been said that the blood became acid,
but the blood is never acid. Be it as it may, alkalies are of
great utility in the treatment of diabetes, especially in the
goaty, where they answer a two-fold purpose.
Some physicians have prescribed alterative medicines, iodine,
iron, arsenic. I have not much faith in the last. The patient
of M. Yulpian was placed under the arsenical medication for a
certain length of time, but his condition has not improved. It is
rather to a restorative medication that we should tend:
Peruvian bark, bitters, after meals, coco, columbo, wines of
Bordeaux and of Burgundy. Tonics are the best assistants in
the treatment of diabetes.
The disorders of the respiratory functions characterized by
a lesser consumption of oxygen at times furnish particular in¬
dications. The respiration of pure oxygen is a rational theoreti¬
cal idea which has sometimes been applied in practice. This
method has succeeded several times, as has been observed in
cases of cardiac degeneration. Five or six quarts of oxygen
are respired each day. To the same end baths of com¬
pressed air, which introduce a little more oxygen in the
lungs, have been recommended. All these means give, so to
say, a greater amount of pabulum to the lungs ; though more
theoretical than practical, some good has resulted at times from
this resource.
The mineral alkaline waters (of Vichy, Yals, Carlsbaden, etc.)
are indicated in diabetes ; but not in the third period, when the
patient is already too far debilitated. They are especially use¬
ful at the onset of the disease, when it is already modified by
6
884 Current Medical Literature. [ March
the regimen. Sea-baths, the sojourning on the sea-shore for
one or two summer months, and during the winter in the sta¬
tions of Algeria in the South, in Egypt, in the islands of Ma¬
deira, etc., are of very great advantage to diabetes.
In combining all these measures, you may expect a cure in
some cases, and more often at least a notable amelioration. You
may prolong at times for ten, even for twenty years, the exist¬
ence of patients who, abandoned to diabetes, would inevitably
have succumbed in two or three years.
J. H. WIENDAHL,
219 Canal street.
CURATIVE INFLUENCE OF MAGNETS IN SOME FORMS OF
HEMIPLEGIA, AND GASTRALGIC ATTACKS WITH
ILEMATEMESIS IN ATAXIC DISEASE.
Reported by P. Lucas-Champoniere, Aneien Interne des Hopitaux.
(Journal de Mededne et Ohirurgie .)
M. Debove has reported to the Medical Society of Hospital
the wonderful results which he has obtained in a series of cases.
Until now the application of metals or of magnets in anaesthe¬
sia of cerebral lesion, or from other sources, seemed to be ef¬
fective only upon nerves of sensation; but M. Debove has
demonstrated that under certain conditions, and in acting
upon certain forms of paralysis of motion, motal activity could
be re-established. We here cite a few examples :
A man aged 35 years, having had an attack of apoplexy to
which no definite cause could be established, was brought to
the hospital, and recovered his mind only on the following day,
but remained with an incomplete hemiplegia and unable to
stand ui) or walk ; at the same time iusensible to pain upon
the whole left side; had anaesthesia of the conjunctiva and of
the retina ; was unable to perceive certain colors. A magnet
was applied to the left arm ; twenty minutes after cutaneous
sensitiveness began to return, perception of colors returned
little by little, and the strength increased rapidly iii the left
side ; about an hour afterwards the patient could walk without
support, with ease, but, however, limping. On the following
day, finding that he was cured, he left the hospital, and no
news was received of him.
A woman aged 62 years, after an attack of apoplexy, re¬
mained with complete anaesthesia of the right half of the body,
implicating the organs of sense and a contraction of the infe¬
rior and superior members of this side, accompanied with
choreic disorder of motility ; this is the affection that M. Char¬
cot has described under the name of hemichorea post-hemi-
plegic. Strength was much diminished also upon that side.
The application of a magnet upon the right arm completely
removed in an hour the anaesthesia, the contraction, the chorea
1880J
Current Medical Literature.
885
and the paralysis of motion. A relapse occurred after a few
days, but a new application of the magnet was as successful as
the first, which this time seemed to be lasting.
Another patient, afflicted probably with a cerebral tumor of
syphilitic origin, presented an anaesthesia of the whole left
side with hemiplegia. The result obtained was more slowly
produced than in the preceding cases ; moreover it was, so to
say, only produced by fractions, and necessitated frequent ap¬
plications of the magnet, and upon various points of the body,
to produce a complete result. The anaethesia and hemiplegia
were completely removed. Finally, in a last trial, the patient
upon whom the trial was made was affected with saturnine
hemiplegia with hemianaesthesia. With this patient the appli¬
cation produced at first but a temporary cure, and did not
maintain itself beyond a few hours. M. Debove made then an
application of 24 hours duration, and renewed the application
an hour each morning. From this moment the cure persisted,
and all symptoms led to the supposition that it will be main¬
tained. The procedure in these two last cases differs greatly
from what was made in the first trials ; in fact it happens often
that, if we do not succeed at the first attempt of an hour’s trial,
the experiment is put aside. M. Debove, on the contrary, in¬
sists much upon the fact that, in many cases, it is necessary to
prolong the action of the magnet for several hours, if not for
several days.
We should be warned that, in most cases, a sufficiently
serious phenomenon is produced, at times even excessively
painful to the patient ; this is an extremely painful cephalalgia,
which has even persisted a long time after a definitive cure of
the paralysis. An other important observation i$, that in no
case did the phenomenon of transfer produce itself ; for we
know that, whilst the production of this phenomenon is the rule
in hysteria, it is entirely exceptional, on the contrary, in cases of
hemi-anmsthesia of cerebral origin.
It is important here to explain the modus operandi, that we
should make use of to obtain this result. According to M.
Debove, all means susceptible of reestablishing sensitiveness,
such as metallotherapia, faradic currents or all other processes
which might be called esthesiogene, could be utilized. But of
all means, the magnet being the most handy and the most sure,
it is to it that we should give the preference. M. Debove takes
a large magnet of 25 to 30 kilogrammes, and places the arm of
the patient at a few millimeters distance from the poles. The ap¬
plication may last a greater or a lesser length of time, be re¬
peated more or less often, as has been mentioned above; it
may be necessary that it should be applied successively to the
various auaesthetized portions of the body : these are condi¬
tions which vary, so to speak, with each patient.
We perceive by this succinct report, that we speak of a the¬
rapeutic means absolutely new and extremely important. From
886 Current Medical Literature. [March
these facts, and from a series of others which have been ob¬
served by M. Debove, the use of the magnet produces a certain
result, not only for the restoring of lost motility of a few days,
but even in cases where the paralysis has existed for a
few years. But one condition is necessary for the production
of this action : it is that the paralysis be accompanied by loss
of sensation ; the trials upon paralyses purely of motion have
always been unsuccessful. For Mr. Debove, in fact, there ex¬
ists a certain number of paralyses of motion, which are allied
to the paralysis of sensation. These cases are, it is true, rela¬
tively speaking, not common ; but are still sufficiently frequent
to excite a considerable amount of interest to be able to cure
them with as great a certainty.
We know that, in a certain number of cases, locomotive
ataxy is long manifested by various disorders before ataxic phe¬
nomena of a pure type are produced. M. Debove reported
recently to the Medical Society of Hospital the history of a
woman in whom there never occurred disorders of locomotion,
and who still was really ataxic, as was demonstrated by the
microscope. The only phenomena which were manifested in
her case, were flying pains of the inferior members, which ex¬
isted since five years, and a sense of constriction of a quite
painful nature at the base of the thorax, and a drooping of the
eyelids ; every other sign of ataxic disease was wanting. But
these signs in themselves were sufficiently characteristic of the
disease to enable one to make out the diagnosis of ataxia ; and
she having died of an intercurrent affection, special lesions of the
spinal marrow indicated ataxic disease. Yet these lesions
were perceptible only by means of the microscope, and with¬
out the aid of this instrument one would have doubted the
presence of any lesions. M. Debove has actually in his wards a
patient whose history is as interesting as the above. This
man commenced more than four years ago to suffer with
very painful gastralgic attacks, which were renewed about
every fifteen days. These phenomena occurred in the midst
of excellent health, without any other stimulus; but yet
already, a short while before, he had suddenly lost the
sight of the right eye ; the first attacks were not usually ac¬
companied by vomitings, but since 2£ months the vomitings
had returned, and had aggravated the symptoms and were re¬
peated oftener. Finally, four months ago, this man, until then
a great walker, discovered some disorder in his locomotion,
which soon assumed perfectly marked symptoms of ataxic dis¬
ease; at this time violent pains also set in in his inferior ex¬
tremities; at last, in the beginning of last September, the vo¬
mitings, which were not until now of any peculiar character,
contained a great deal of blood ; and the patient reports that
he then rendered from four to six pints. From this period
the haematemesis, though less in amount, was renewed several
times, and since his entrance into the hospital. The course of
1880 1
Current Medical Literature.
887
his disease led to many errors ; it caused the physicians who
saw him to vary their diagnosis. We perceive from the
start that, for nearly five years, phenomena common to ataxic
disease, such as the loss of tlm sight of an eye, and gastralgic
attacks, were produced without the least .disorder of motility.
There was here also a phenomenon which, if before recognized,
has at least been so quite seldom ; we refer to haematemesis.
In fact authors, in their description of gastralgic attacks in
ataxic disease, speak of bilous or mucous vomitings, contain¬
ing at times sanginolent materials, but true hmmatemesis is
quite unfrequent. Thus in this case ulcer of the stomach had
several times been suspected. YetM. Debove did not hesitate,
after interrogating the patient, to diagnose it as one of ataxia,
and this only by hearing the cries of pain from this man,
cries which have something of a characteristic nature ; for the
pain of gastralgic attacks of ataxic disease are more severe
than those which we meet in all other forms of gastralgia,
more intense also than those which exist in the most painful
forms of ulcer of the stomach. Here, however, the diagnosis
had become comparatively easy since the disorders of locomo¬
tion had set in, but even if, during the first attacks, these two
facts had been connected, the reproduction more and more
frequent of attacks with intense acuteness of pain and
sudden loss of sight on ono side, the diagnosis of ataxic disease
at its onset conld have been made with some certainty.
J. H, W., 219 Canal street.
MAMMARY TUMORS— THEIR DIFFERENTIAL DIAGNOSIS.
Dr. D. S. Adams, of Manchester, N. H., read before the New
Hampshire Medical Society, June 17, 1879, a most excellent
paper on this subject, of which we make a full abstract : —
Va. Med. Monthly.
The mammary gland is surrounded by a thick layer of adi¬
pose tissue, held in position by reticulated connective tissue,
which penetrates into the interior, subdividing it into lobes ;
but in the ultimate gland structure, and in the nipple and
areola, there is no fatty substance. In this tissue, deep
seated, at the inner and outer border, are lymphatic glands —
the inner opening into the anterior mediastinal glands, the
outer communicating with the axillary glands. These struc¬
tures are derived from the middle germinal layer. The ulti¬
mate gland structure consists of small vesicles, which are
united to form lobules, which are grouped to form lobes, each
of which has a duct leading to the nipple. These glands are
formed by the vesicnlar endings of branched ducts, and they,
together with the ducts, are formed of connective tissues lined
with a single layer of epithelium, which is greatly increased
during lactation, thrown off into the gland and, undergoing
fatty degeneration, forms a part of the milk. They are de-
888 Current Medical Literature. [March
rived from the external germinal layer. Surrounding the
terminal ducts, is a spindle-celled tissue, which separates the
limiting membrane from the stroma. This, I believe, is a
mongrel tissue formed between the two germinal layers, and
from this, I think, the spindle-celled sarcomata originate.
The nipple is composed of the ducts, united by connective
tissue with blood-vessels, lymphatics and nerves. Upon the
surface and beneath the cuticle, is a layer of pigment cells.
The connective tissue contains a large quantity of contractile
fibre, which, when excited to contract, produces a rigidity of
the whole organ. Within the areola are situated hair folli¬
cles and sebaceous glands ; hence, sebaceous tumors are oc¬
casionally developed in this region.
The 2d, 3d, 4th and 5th intercostal branches of the inter¬
nal mammary artery usually convey blood to the internal
segment of the breast ; a branch from the axillary usually
supplies the upper and outer portion, and the inferior and
lateral regions receive a few branches from the intercostal,
which pass with the veins through the middle intercostal
foramina. The lobules have a distinct system of capillaries
of their own, forming a network around the alveoli, which
are comparatively inactive during the resting period of the
breast. The veins usually accompany the arteries and ter¬
minate in the internal mammary and axillary trunks. A pe¬
culiar arrangement of the areolar veins has received the n ame
cir cuius venosus areolce.
The breast, and skin covering the breast, are supplied by
filaments from the anterior branches of the 4th and 5th cer¬
vical nerves. Filaments from the posterior branches of the
same nerves join with others from the superior dorsal nerves.
Filaments from the middle and anterior intercostal branches
of the anterior division of the 2d, 3d, 4th and 5th nerves of
the dorsal plexus supply the breast, and skin over it, chiefly.
A minute examination demonstrates the association between
the 2d intercostal and filaments supplying the skin of the in¬
side of the arm and axilla ; also, the same parts and the skin
about the shoulders from the 3d, and the skin about the scap¬
ula from the 4th and 5th. (Holmes.) These nerve com¬
munications explain the extensive pain in liypermsthesia of the
breast.
I shall be obliged to deal with three conditions of the breast
that are not, strictly speaking, tumors, on account of their
symptoms so closely resembling those of tumors.
By Galactocele , I understand an obstruction of the duct,
whereby there is an accumulation of milk and dilatation, or
rupture of the gland or duct, which forms an encysted milky
tumor, in one of the lobes of the breast.
Congestion with milk is caused by the absence of the more
fluid portion of the milk, on account of which the solid portion
accumulates in the ducts and glands, producing a lobulated
tumor of stony hardness.
Curreni Medical Literature.
889
1880]
Chronic Encysted Abscess is the result of a low chronic inflam¬
mation, which results in the formation of pus, which is sur¬
rounded by a thick, dense, fibrous wall. This frequently
reaches a certain size, and then remains stationary for months.
Adenoma is always in connection with secreting glands, and
is the result of increased growth of the epithelium lining them,
the layer of which is crowded inward by a new layer forming
under it ; and failing to undergo the fatty metamorphosis, fills
up and dilates the gland, by which it may form new gland
structure in some cases. The epithelial growth is always con¬
fined to the iuuer potion of the gland, and does not infect the
surrounding tissue.
Adenoid Cyst is the result of the same process as above, oc¬
curring in one terminal glaud, or as the result of the breaking
down of the intervening tissue between several glands — the
tissue softening to form a mucous mass.
Soft Carcinoma is the result of an increased growth of the
epithelium ; but instead of being thrown off into the gland,
it infects the leucocytes as they approach the epithelium
through the lymphatic lacunae, causing them to develop into
epithelium, thus blocking up the immigration of the leucocytes,
and filling the surrounding tissue with epithelial growth.
Hard Carcinoma in the result of the same process, with an
increased growth of fibrous tissue. The cells of both these,
therefore, lie in the lymphatic lacunae ; and an abundance of
cells occurs in the soft, whereas there is a limited number in
the hard.
Sarcoma. — The spindle-celled, in my opinion, originates in
connection with the spindle-celled tissue which separates the
limiting membrane of the glands from the stroma. The round-
celled has its origin in connection with the lymphatic spaces in
the connective tissue, by an increased growth of the endo¬
thelium lining them, together with an increased growth of the
connective tissue.
Cysto-sarcoma is the same process — only the endothelial
growth takes place in one of the lymphatic spaces dilating it,
or in several, breaking down the intervening tissue between
them — the endothelium softening in the former into a serous
fluid; iu the latter, into a cloudy serous fluid. And if a gland
be implicated, in the latter, into a muco-serous fluid, in which
case the tumor may possess both round and spindle-celled
tissue. The first of these is the simple sero-cyst of some au¬
thors.
Fibroma is a simple increase of the connective tissue, without
the infiltrating cells, confined to a limited portion of the breast,
and is exceedingly rare.
Lipoma is an encysted fatty tumor, arising in connection with
the adipose tissue of the" breast.
Neuroma arises in connection with the nerve tissue, pro¬
ducing a bulbous enlargement of the nerve, and is composed
of newly-formed nerve-fibre and ganglionic cells.
890 Current, Medical Literature. [March
Encliondroma and Osteoma probably take their origin in con¬
nection with the connective tissue, or as a degeneration of
some of the other tumors. But little is known in reference to
their origin in this situation, on account of their rarity.
Hydatid Cyst explains itself, and presents tbe ordinary char¬
acters of deep-seated cyst.
Can one form of a tumor begin in the breast, and after a
time change, or take on another form ? I think this some¬
times occurs ; for instance, an adenoma may be confined for
months to the inner portion of tbe gland, when, from some
renewed action, it blocks up the immigrating leucocytes, and
infects the surrounding tissue, and results in a soft carcinoma.
Also the sarcoma may form independently of the gland, and
later involve the gland so as to produce a mixed tumor; or
most any of the hard tumors may undergo mucous or serous
degeneration, forming a cyst ; or a cartilaginous or an osseous
growth may become an encliondroma or osteoma.
These tumors are auto-inoculable just in proportion as
their epithelium is taken up by the lymphatics ; consequently
the soft carcinoma is the most dangerous, the hard next, and
the spindle-celled sarcoma next, provided they all remain in
the system the same length of time. Broken down epithe¬
lium is more poisonous when taken into the blood than any
other tissue in the system. I do not consider the round-
celled sarcoma, or any of the other tumors above enumerated,
as auto-inoculable, unless the glands and epithelial tissue be
come involved in them.
The adipose tissue is a great hindrance to our physical ex¬
amination, for the most important tumors are usually deep-
seated, and the thick layer of fat so masks them in some
places that it is utterly impossible to tell whether they are
smooth and hard, nodulated, elastic, single or multiple.
Then the more characteristic symptoms do not appear till late
in the disease, and the surgeon that waits for infection of the
surrounding glands, for the retracted nipple with the impli¬
cation of the skin over the breast, or for the adhesion of the
mass to the subjacent tissues, is only allowing his patient to
slip beyond his reach into the stage of general infection, for
which there is no help. But there are some points that aid us
very much in our diagnosis, especially in distinguishing be¬
tween carcinomata and other tumors.
First among these, probably, is age, for about 95 per cent,
of all carcinomata of the breast begin after the age of thirty ;
so if the patient be under that age, the chances are largely
against carcinoma. The majority of the cases of sarcoma,
and nearly all the fibromata, begin after the age of thirty,
while about sixty-two per cent, of the cases of adenoma be¬
gin under the age of thirty. But in connection with this we
must bear in mind that years and days do not truly represent
the age of the patient, as it should be considered here ; for
Currenz Medical Literature.
891
1880]
one woman may be older at twenty-five than another at
thirty-five, aud is, therefore, more liable to have carcinoma;
consequently, the question should be asked, “ Is this woman
prematurely old, or postmaturely young ?”
Next : Was this bunch developed during the passive state of
the breast, or during its functional activity ? If developed
during its functional activity, it is probably either galactocele,
congestion with milk, or chronic abscess, although the latter
may not occur for months after a delivery. It is only in cases of
abortion where the woman tries to conceal the fact are we apt
to be misled on these diseases ; but general activity of local
circulation, fulness of the breast, enlargement of its veins
and darkening of the areola, with more or less activity of
the other breast, will usually enable us to decide.
If developed during the passive state of the breast, did it
follow active inflammation, or has the breast apparently been
free from inflammation ? If the result of the former, it is
probably an abscess or benign tumor, for the more active
forms of iuflammatiou rarely result in the malignant
tumor.
Again: Is it a solid tumor or a cyst? In some cases, we
are able to decide this by the elastic feel of the tumor, but
more commonly when the tumor is deep seated we are una¬
ble to detect any elastic feel ; but, fortunately, puncture never
fails to decide, and when punctured with the harpoon, if it
proves solid, you can remove a piece for the microscope. This
instrument ought to be used where there is any doubt.
In the physical examination of the breast, we are often
aided very much by placing the patient in a recumbent posi¬
tion, with the breast free to tip one way or the other, or to
settle back on to the chest ; for frequently it will divide, as it
were, over the tumor, leaving that more prominent and
nearer the surface than while standing. Is the tumor single
or multiple? When multiple we can sometimes roll one tu¬
mor on the other. If multiple, the worst it can be is sarco¬
ma. for carcinoma is never double. Is the nipple attached
to the tumor or free? By pressing the breast forward over
the tumor, and with the fingers of one hand pressing the tu¬
mor back against the chest, while we pull upon the nipple
with the other hand, we are frequently able to decide by the
fixed condition of the nipple. If it be attached to the tu¬
mor, the tumor is in connection with the glands or ducts ; if
free, it cannot be in connection with them on account of their
close anatomical connection with the nipple. Is there any
discharge from the nipple, or can any be pressed out ? It
there can be, we know it contains fluid within the glands or
ducts. Is it painful, or not? We should let the patient de¬
scribe the pain in her own language. If the pain be lanci-
7
TABLE OF THE DIFFERENTIAL
Galactockle.
CONGESTION V. ITH
Milk.
Chronic Encysted
Abscess.
Adenoma.
1. During the chid
1. Duiiug the child-
1. During the child-
1. Majority of cases
bearing period and the
result of pregnancy.
bearing period and the
result of pregnancy.
bearing period usually
and generally the re¬
sult of pregnancy.
under the age of thirty.
2. No pain.
2. Some dull pain
sometimes, but not
common. .
2. No pain.
2. If painful, pain
dull and most severe
at catamenial period.
3. System not dis-
3. System consider-
3. System not dis-
3. System not much
turbed.
ably disturbed.
turbed.
disturbed.
4. Breast consider
4. Breast very much
4. Breast not much
4. Bi east slightly en-
ably enlarged.
enlarged.
enlarged.
lai ged.
5. Local circulation
5. Local circulation
5. Local circulation
5. Local circulation
active in both breasts.
active in both breasts.
some increased in both
breasts.
some increased in the
breast affected.
G. Tumor quite a
6. Tumor large and
6. Usually small
G. Tumors small
size, bur if it has been
in the breast long it is
not as large as it wa>,
on account of the more
fluid portion being ab¬
sorbed, but harder.
lobulated.
and irregular in s'} ape.
and nodulated.
7. May give an elas¬
tic fbel or fluctuation,
or be hard.
7. Stony hard.
7. May give an elas¬
tic feel, ot herwise hard.
7. Moderately hard.
8. Single.
8. Single.
8. Single.
8. May be single oi
double.
9. Nipple may or
9. Nipple always
9. Nipple may o r
9. Nipple always
may not be connected
•with the tumor. If a
simple dilatation has
taken place it is con¬
nected. If a rupture
it may not be.
connected with tumor.
may not be connected
with the tumor ; usu¬
ally is.
connected with turnon*
10. Freely movable.
10. Not freely mov¬
able.
10. Not freely mov¬
able.
10. Freely movable
11. Skin distended
11. Skin distended
11. More or less ce-
11. Skin normal
over it.
over it.
dema of the areola.
unless tumor ha
reached considerabl
size.
12. Growth rapid ;
Tumor fills every time
the child nurses, then
gradually subsides.
12. Growth rapid to
a certain size then sta¬
tionary.
12. Growth slow.
12. Growth slow un
der the age of thirtj
after that rapid.
DIAGNOSIS OF MAMMARY TUMORS.
Soft Carcinoma.
1. Very rare under
the age of thirty.
2. May or may not
be painful, not usually
painful till skin is im-
olicated, then pain
severe and cutting,
running to shoulder
»nd down the arms.
3. System consider-
ibly disturbed.
4 Breast some en¬
larged and enlarges
rapidly.
5. Local circulation
some increased, in
oreast affected.
6. Tumor quite size,
irregular, and not well
defined.
7. Usually soft with
i doughy feel.
8. Single', but lobn-
iated feel may give the
feel of a multiple tu¬
mor, but you cannot
roll one tumor on the
jjther.
9. Nipple always
jonnected with tumor.
10. Freely movable
it first, but soon be¬
comes adherent.
11. Skin normal at
5rst but implicated
Jarly.
12. Growth rapid.
Hard Carcinoma.
1. Very rare under
the age of thirty.
2. Usually »ot pain¬
ful, till skin is impli¬
cated, then pain severe,
cutting or stabbing,
running to shoulder
and down the arm.
3. System not much
disturbed.
4. Breast normal at
first.
5. Local circulation
apparently normal.
6. Tumor small and
smooth or nodulated.
7. Tumor hard.
8. Single.
9‘ Nipple always
connected with tumor.
10. Freelyj movable
at first.
11. Skin normal ’til
late in disease.
12. Growth slow.
Sarcoma.
1. Majority in pa¬
tients over thirty.
2. May or may not
be paiuful.
3. System usually
some disturbed.
4. Breast slightly
enlarged.
5. Local circulation
slightly increased in
breast affected.
6. Tumor quite size
and irregular.
7. Tumor a little soft
8. Usually single.
9. Nipple may or
may not be connected
with tumor.
10.
Not freely mov-
able.
11.
Skin normal.
12.
Growth usually
rapid.
Primary Cyst.
1. At any age above
puberty. Majority un¬
der thirty.
2* Not painful usual¬
ly-
3. System not dis¬
turbed.
4. Breast a p.p ears
normal.
5. Local circulation
normal.
6. Tnmor small and
may be nodulated.
7. May give an elas¬
tic feel, otherwise hard,
and may be finely nod¬
ulated.
8. Frequently mul¬
tiple, and when so, can
readily roll one tumor
on the other.
9. Nipples may or
may not be connected
with tumor.
10. But little mova¬
ble when deep seated.
11. Skin normal.
12. Growth slowand
may remain small for
years, then grow very
rapidly. May have a
vegetation spring
from its wall, forming
the compound cyst.
TABLE OF THE DIFFERENTIAL
Galactocelk.
Congested with
Milk.
Chronic Encysted
Aijcess.
Adenoma.
13. Nijiple never re¬
tracted.
14. Surrounding
glands never implicat¬
ed.
15. Superficial veins
enlarged in both
breasts.
lfi. Puncture ; chee¬
sy mass or cream.
17. Microscope,
milk or fat globules,
with more or less epi¬
thelial cells undergo-
ingfatty degeneration.
13. Nipple usually
retracted or embeded
in the breast.
14. Surrounding
glands never implicat¬
ed, but may be some
swollen.
15. Superficial veins
enlarged in b o t li
breasts.
16. Puncture, chee¬
sy mass or cream.
17. Microscope the
same as preceding.
13. Nipple usually
flattened or retracted
14. Surrounding
glands may be some
swollen.
15. Superficial veins
may or may not be en¬
larged.
16. Puncture, pus.
17. Microscope, pus
corpuscles.
•
13. Nipple projects.
14. Surrounding
glands never implicat¬
ed.
15. Superficial veins
usually enlarged.
16. Punctnre ; solid,
17. Microscope, epi¬
thelial cells if taken
from the interior of the
acini, otherwise may
get connective tissue.
nating, darting or stabbing, extending up to the shoulder and
down the arm, it points strongly to hard carcinoma; but if it
be free from pain, it is no guarantee against carcinoma, for
carcinoma may exist without pain. Learn if the patient has
been reading about cancer, for frequently after reading the
symptoms she will imagine the disease, and give the doctor
the full list of symptoms.
In the following table I have classed all the symptoms as
one, as there is nothing to distinguish one from another except
the microscopical characters of the walls, and its position in
reference to the gland ; thus, if entirely free from the gland, it
must be a sarcomatous cyst. Also, I have omitted fibroma,
lipoma, neuroma, enchondroma and osteoma, as they are all
exceedingly rare, and the last two are frequently the result of
change in some other tumor.
Fibroma , in its earlier stages, has all the external character¬
istics of hard carcinoma, and can only be distinguished by the
microscope ; even this is very difficult in some cases.
Lipoma is entirely free from the gland, and presents the mi¬
croscopical characteristics of adipose tissue.
Neuroma is usually very small, and may be very painful,
while the surgeon is unable to find any tumor whatever. The
tenderness of the nerve affected, when pressed upon, will be
of some diagnostic value.
DIAGNOSIS OF MAMMARY TUMORS.
Soft Carcinoma.
Hard Carcinoma.
Sarcoma.
13. Nipple projects
it first, but soon be-
jomes retracted.
14. Surrounding
rlaoids soon implicated
is the growth is rapid.
15. Superficial veins
enlarged early.
16. Puncture ; tumor
loft, but no discharge.
17. Epithelial cells
krranged in alveoli
with no connective t.is-
mes separating alveoli
separated by well
marked connective tis¬
sue bundles.
13. Nipple normal
at first, may or may
not be retracted later.
14. Surrounding
glands not implicated
till late in disease
15. Superficial veins
not enlarged till late
in disease.
16. Puncture; solid.
17. Same as soft, ex¬
cept more connective
tissue ajid less cells.
Arrangement of cells
the same.
13. Nipple may or
may not be retracted
14. Surrounding
glands never implicat¬
ed.
15. Superficial veins
may or may not be en¬
larged.
16. Puncture; solid.
17. Spindle-shaped
cells characteristic. If
it be round-celled, the
cells resemble epithe¬
lial cells.
Primary Cyst.
13. Nipple may or
may not be retracted ;
is not usually.
14. Surrounding
glands never implicat¬
ed.
15. Superficial veins
may or may not be en¬
larged.
16. Puncture; fluid.
17. If prijuary, the
walls are simple con¬
nective or gland tissue.
If secondary, same
character as tumor
from which it was
formed.
From the table, we learn that retraction of the nipple is
common to all tumors which implicate the glands or ducts,
and is the result of inflammation and contraction of the con¬
nective tissue surrounding the ducts. This does not always
take place; retraction is more or less accidental.
Hardness is common to all tumors of the breast, except soft
carcinoma and sarcoma, and it may occur in connection with
sarcoma. All the tumors may be irregular in shape, giving a
nodulated feel. Later in the disease, if it be carcinoma, the
severer symptoms become intensified; hence, it is not difficult
to determine that our patient is beyond help ; so our knowledge
is of no benefit. But, fortunately, the harpoon and microscope
enable us to determine the character of these tumors in their
earlier stages, and always ought to be used, and the sooner they
are used the better; but my observation would tell me that
they are not in general use. The use of the harpoon cannot
possibly do any harm in connection with these tumors ; for, if
it prove a benign tumor, or cyst, the inflammation following
its use will frequently cure it. When the surgeon has no har¬
poon, a narrow bladed knife and small pair of forceps will
answer the same purpose ; and if local anaesthesia be used, the
operation is painless.
896 Current Medical Literature. [March
fLEMORRIIAGE FROM THE GENTIAL ORGANS DURING PREGNANCY
AND PARTURITION.
A discussion on this subject was opened with the following-
paper :
Haemorrhage from the Organs of Generation during Pregnancy
and Parturition. By A. V. Macau, M. B. (Dublin). — The points
which the author proposed for discussion were : 1. Menstru¬
ation during pregnancy; 2. The symptoms or conditions
that justify, in a case of threatened abortion, the giving up of
all further attempts at saving the ovum ; 3. Imperfect abor¬
tion, and its treatment ; 4. The treatment of placenta prseva;
5. The prevention and treatment of post partum haemorrhage,
including that described by Gooch as “ a peculiar form of haemor¬
rhage.” After giving briefly the views generally held about men¬
struation during pregnancy, the author noticed at some length
the opinion held by Professor Spiegelberg of Breslau, that all so-
called menstrual discharges were nothing but haemorrhage
from pathological causes, which, as was often noticed also in
the unimpregnated condition, had taken an aperiodical type.
There was no evidence to show that ovulation went on during
pregnancy; and, therefore, as he believed in BiscliofPs theory
of the dependence of menstruation on ovulatiou, he held that
menstruation did not occur during pregnancy. Indeed, the
changes in the mucous membrane of the uterus that accompa¬
nied menstruation were quite incompatible, as he thought, with
the continuance of pregnancy. The second question involved
the determination of the life or death of the ovum; or whether
the mother’s life were in actual danger from the continuance
of the pregnancy (haemorrhage, excessive vomiting, etc.); or
her condition such as to render the continuance of the preg¬
nancy very doubtful (cholera aud the acute axanthemata) ; or,
finally, whether uterine action had gone on so far that it could not
be stopped, or had already led to rupture of the membranes,
or to such extensive detachments as to render it probable that
the ovum would soon perish, even if it were not at once ex¬
pelled. He considered that the determination of these facts,
in individual cases, was one of the most difficult questions the
midwifery practitioner was called on to decide ; and quoted a
case, given by Scanzoni, to illustrate how the ovum might some¬
times survive the most numerous and varied perils. Some
authorities held that the discharge of altered (decolorised)
blood -cots was evidence of the death of the foetus; but
he (Dr. Macau) had lately, through the kindness of the
President, had the opportunity of examining a case in which
this symptom was present, aud, notwithstanding, the fcBtal
heart was heard a fortnight subsequently. The term “ im¬
perfect abortion ” was applied to those cases where all the
ovum was not expelled at the same time, but when part (pla.
centa or membrane) remained in the uterus. He drew atten.
Current Medical Literature.
897
1880J
tion to the great improvements that had lately been introduced
in the treatment of such cases by the use of Thomas’s blunt
wire curette, or the scooys that Simon of Heidelberg intro¬
duced tor the removal of cancer. By this method, the painful
and tedious operation of dilating the cervix might be often
avoided. The question of the treatment of placenta prsevia
was one which, above all others, wrould, he hoped, be benefited
by discussion. There would never be anything like unanimity
on the subject till the knowledge of the true changes that
took place in the cervix during pregnancy and parturi¬
tion become more widely spread ; not only ike fact that the
cervix was not taken up gradually into the body of the uterus
during the latter months of pregnancy, but more especially that
the manner in w hich the cervix became obliterated was very
different, according as the patient was a primipara or a pluri-
para. He thought the term “ cervical zone,” as used by Dr.
Barnes, w as very likely to lead to its being confused with the
cervix itself; and quoted passages from Dr. Barnes to show
that even he was guilty of thus confounding them. The pla¬
centa was never found attached to the cervix, except in some
rare cases, when this condition led to early abortion; and,
therefore, it was not correct to speak of the placenta being de¬
tached from the cervix as the latter became retracted. More¬
over, instead of the interior of the cervix becoming smaller
during the dilation of the os, the fact was that it became im¬
mensely distended in every direction. In primiparte, the
length of the cervix was, on an average, doubled during labor,
as might be seen by the oeautiful plate of Braun’s which Dr.
Playfair reproduced as the fioutispiece to his second volume;
and its diameter was increased from that of the finger, or even
less, to that of the head of the fcetus at full time. The placen¬
ta, wTlien partially praevia, was iuseited into the lower zone of the
body of the uterus, to one or other side of the inner os. There
could be no doubt that the insertion of the placenta into any
part of the circumference of the inner os caused that portion
of the uterus to which it was attached to be less ready to dilate
than the rest of the circumference, w'hich was not in the same
way tied down. It seemed, therefore, plain that, at all events
in a case of partial placenta prsevia, the site of the placenta
would not be so distended as the rest of the circumference of
the inner os. In fact, the same thing took place, though in a
much less degree, as in a case when carcinoma involved a por-
toiu of the circumference of the cervix ; viz., the dilatation took
place at the expense of the sound portion. If this were true,
Dr. Barne’s method of separating the placenta from its attach¬
ments, as far as the fingers could reach, could hardly be the
right one. Again : the mechanism of the separation of the
placenta from around the margin of the inner os during labor
was almost universally misunderstood. For, till the mem¬
branes were ruptured, the effect of an uterine contraction was
898 Current Medical Literature. [March
to detach the whole lower segment of the ovum from the
uterus and force it into the cervix, the margin of the inner os
being at the same time drawn upwauds by the contraction of
the fundus. Of course, when the placenta formed a portion of
the lower segment of the ovum, it must slide downwards more
or less over its seat ot attachment to the uterus. Once, how¬
ever, the membranes were ruptured and separated to a con¬
siderable extent from the lower margin of the placenta, the
ovum was no longer forced downward en manse, and the
placenta was free to move, upwards and outwards, along
with the lower segment of the body, ot the uterus. This at
once explained how rupture of the membranes in placenta pne-
via was often followed by a cessation of the haemorrhage.
Again : it was known that, at the occurrence of each pain, the
circulation was almost entirely arrested in the site of the pla¬
centa, and the uterine souffle disappeared. Ergot caused such
a tonic contraction that the circulation was permanently inter-
ferred with, and the child died, if not suitably delivered, from
asphyxia. Hence, if ergot acted properly, it ought almost to
stop all circulation in the placental site, and thus prevent it in
cases of placenta praevia or accidental haemorrhage. If presen¬
tation were complete, one had only to detach the placenta from
one or other side of the inner os, to tear the membranes freely
away from its edge, and the case, for all practical purposes,
became one of partial placenta praevia. Tins was the great
treatment of placeuta praevia : but, if onee rupture of the mem¬
branes, or separation of one portion of the placeuta, in a case
of complete presentation, weie impracticable, then we must
plug till one or both became possible. It was not requisite to
dwell at any length on the prevention and treatment of post
partum haemorrhage; but the author would draw attention to
that form which was due to rupture of the soft parts, more
especially one or other crus of the elitoris, and to the peculiar
form of haemorrhage described by Gooch, which was simply due
to alternate contraction and relaxation of the uterus. The new¬
est points in treatment were the use of ergot subcutaneously,
the injection of hot water at 110° to 120° Fahr. (not warm water)
into the uterus to arouse it to contract, and use of the various
diffusible stimuli subcutaneously — such as ether, camphor,
musk, or brandy — the first of which was introduced into this
country by the author.
On the prevention and Treatment of Post Partum Haemorrhage.
By Thomas More Madden, M. D., M. It. I. A. (Dublin). In a
long and tolerably extensive obstetric experience in hospital
and private practice, Dr. More Madden had seen but two fatal
instances of post partum haemorrhage. With the advancement
of our art, such cases had gradually become less frequent; and
would probably be altogether unknown in the more perfect
obstretric practice of the future. The author discussed seriatim
the causes of post partum haemorrhage, and the treatment
Current Medical Literature .
890
1880]
required by each of these. Having dwelt on the constitutional
conditions predisposing to flooding, and the preventative mea¬
sures by which this might be warded off, even in those who had
been habitually subject to this accident on former occasions, he
considered the causes of flooding and the management of labour,
so as to prevent subsequent inertia or irregular contraction of
the uterus. The ill effect, in this respect, of the premature
application of the forceps before the full dilation off the os uteri,
and also the production of haemorrhage as the result of undue
delay in the second stage, were next referred to. During
labour, when there was any reason to anticipate flooding, the
preventive measures recommended by the author were : the
rupture of the membranes in the first stage ; the use of stimu¬
lating enemata of a strong infusion of ergot, or the hypodermic
injection ofergotine. in the second stage; and a firm unremit¬
ting manual pressure over the fundus ut-ri, from the time tne
child’s head escaped from the vulva until the completion of the
third stage, which should never be hastened by traction on the
cord, and the permanent contraction of the uterus was secured.
In nineteen cases of flooding, the solution of perchloride of iron
was resorted to ; in eighteen of these, the haemorrhage was thus
arrested, and in one instance it failed. Dr. Madden, however,
considered that the ordinary mode of using this styptic — viz.,
by a syringe passed up to the fundis uteri — was a very hazard¬
ous proceeding, and exposed the patient to great and needless
twofold danger of death from embolism or from peritonitis.
He, therefore, recommended instead the direct application of the
strong liquor ferri perehloridi to the bleeding vessels by a
sponge soked in this fluid, and carried up by the hand into the
uterus, and retained there until a firm contraction was produced.
Some cases was referred to in which haemorrhage, that had
resisted all other treatment, was thus arrested ; and Dr. Mad¬
den, therefore, regarded this as the most effectual method of
treating flooding. At the same time, he admitted that it was
not free from danger, or even to be adopted without grave
necessity. Some of the other remedies employed in the treat¬
ment of post partum haemorrhage, including the hypodermic use
of ergotine, galvanism, and cold and hot injections, were
referred to. The treatment of collapse from flooding by brandy,
opium, stimulating enemata, hypodermic injection of sulphuric
ether, and transfusion, was considered. Dr. Madden related a
case in which a patient, apparently at the last extremity, was
rescued from death by the subcutaneous injection of ether,
which he regarded as beinj> in many instances a substitute for
transfusion. The latter operation was, he considered, destined
to fill an important place in the future practice of midwifery.
But, as yet, no method of transfusion had been suggested
which met the requirements of what, to be useful, should be a
generally feasible as well as an effectual operation. Transfu-
8
000 Current Medical Literature. [March
aion was required for a most serious emergency that might sud¬
denly occur in practice : namely, in cases of collapse from flood¬
ing. Therefore, its success should not be altogether depend¬
ent on the possession of exceptional surgical skill, as some of
its modern advocates insisted. On the contrary, it should be
within the reach of every proper ly educated midwifery prac¬
titioner, who might, at any moment, and perhaps in a remote
district, under unfavorable circumstances, meet with a case in
which this operation was required. In these respects, trans¬
fusion was as yet far from that perfection at which it must
one day arrive ; and, however theoretically improved in a
physiological point by modern authorities, practically speaking
its success was yet hardly greater than was the case under the
ruder methods employed by Dr. Blundell and others, for the
same purpose, half a century ago.
The Treatment of Post Partum Haemorrhage by the Intra uter¬
ine Injection of Hot Water. By William Walter, M. A., M. I).
(Manchester). — Since the method of treating post partum hae¬
morrhage by the injection of hot water was brought uuder notice
by Dr. Attliill early in 1878, Dr. Walter had treated in this way
eleven cases in the Manchester and Salford Lying-in Hospital.
The temperature of the water used ranged from 110° to 120°
Fahr.; and the utmost care was taken that the tube (llaye’s)
reached well up to the fundus ; and that there was afterwards
no impediment to the escape of the water from the uterus.
The results in the eleven cases — particulars of which were giv¬
en — led Dr. Walter to the conclusion that, the hot water treat¬
ment offered some advantages, in being generally accessible
and not disagreable to the patient ; but that, as a means of con¬
tracting the uterus, it was, in his experience, not to be relied
on. Nevertheless, he hoped to continue the method; and he
advised that the temperature of the water should be ascer¬
tained by the thermometer in every case. The recent researches
of Dr. Max Range tended to show that, if success was to fol¬
low the hot water treatment of post partum haemorrhage, the
temperature of the water must not be so high as it was m Dr.
Walter’s cases. In all the cases but one, the injection was fol¬
lowed by relaxation and dilation of the entire uterus; if con¬
traction occurred, it was but temporary ; but, when the tem¬
perature of the water did not exceed 104° F., the uterus con¬
tracted without being afterwards paralysed. No appreciable
effect was produced on the pulse and general condition of the
system. After the failure of the injection, the application
of the iuduced current was successful in several of the
cases.
Hot Water Injection in Post Partum Haemorrhage. By Nor¬
man Kerr, M. D., F. L. 18. (London). —The author was called on
January 5th, 1874, by a midwife, to Mrs. T., aged 25, a primi-
para. The child had been delivered an hour and a half, and
the placenta expelled half an hour, before he was sent for. He
Current Medical Literature.
901
1880J
was told that the patien t was dying, everything that could be
done having been done by the midwife. The patient
was deathly pale, cold, unconscious, and with no per¬
ceptible pulse. The vagina was packed with clots. He hastily
removed most of these and threw up into the vagina (there be¬
ing some difficulty in finding the os uteri) about a quart of hot
water about 110° Fahr., a,n<l had hardly withdrawn the syringe
when a faint tinge of red began to appear on the face, accom¬
panied by a slight warmth of the skin and a faint pulse. In
three minutes more, Dr. Kerr had cleared out the remaining
clots, and thrown a pint and a half of water at 105° Fahr. right
up to the fundus uteri. Ergot, milk, Liebig’s extract, and co¬
coa were administered. Dr. Kerr narrated a second case of
primipara who had serious post partum haemorrhage with col¬
lapse, and in whom repeated hot water injections arrested the
loss and restored ,the strength. From these and other cases,
Dr. Kerr was driven to the conviction that hot water injection
was a most valuable general stimulant; it acted like a charm in
mauy cases where the use of cold was contraindicated. Alco¬
hol was a promj)t and efficient stimulant ; but its use was
fraught with great risk of renewed flooding from the relaxation
of the circulation. The injection of hot water was even more
speedy in operation, and quite devoid of danger, no serious se¬
quelae following its employment. He was convinced that, in
all the haemorrhages of pregnancy and parturition accompa¬
nied by collapse, the injection of hot water would be found a sim¬
ple, ready, and reliable remedy.
Dr. Barnes (London) complained of the misconstruction of
his views on placenta praevia. He said there were cases in
which the uterus had lost all reflex contractility, In these
cases, the application of cold,jthe injection of ice or of warm
water, was of no avail. The immediate application of some
styptic to the gaping veins, such as the perchloride of iron,
would alone arrest the haemorrhage. He had lately attended
a lady in her eighth confinement, in whom the uterus had be¬
come relaxed from successive pregnancies, and had lost the
power of contracting. Knowing this beforehand, he had
adopted every precaution. The hand had never left the uterus
from the moment the child was born, until long after the ex¬
pulsion of the placenta. In spite of all precautions, such as
the subcutaneous injection of ergot and continued pressure on
the uterus, haemorrhage set in. The subcutaneous injection
of brandy, the injection of warm water into the uterus, the
injection of a solution of iodine in the uterus were tried in
succession, but failed to arrest the haemorrhage. The patient
was now blind, deaf, pulseless at the wrist, and almost in ex¬
tremis. The perchloride of iron was injected, and the hiemor-
rhage at once arrested. In half an hour afterwards, the patient
had rallied ; and she made a good recovery. This was a typical
case for the use of of the perchloride ; and it was in such cases
902 Current Medical Literature. [March
as this that he advocated its use. But for the iron, the patient
must have died.
Dr. Dill (Belfast) considered the pouring of cold water from
a height on the abdomen hs most valuable.
Dr. J. Thompson (Leamington) was extremely pleased with
the lucid explanation given him by Dr. Barnes. He believed
with him that it was important to attend well to the ordinary
means for stopping haemorrhage, so that cases requiring the
employment of injections into the uterus should not often
occur. In every instance, he would first apply presure, and
this was most effective if directed to the base rather than to¬
wards tin* neck of the womb. A dash of cold water was doubt¬
less a very powerful means of producing contraction ; and
some practitioners would throw two or three pints, or more,
suddenly over the abdomen when profuse flooding occurred,
but tin* patient was thus placed in a most uncomfortable con¬
dition, though the haemorrhage was stopped; and should this
recur, we could not go on throwing such quantities of cold
water. He had been in the habit of dipping the end of a nap¬
kin in cold water, and, striking this first against the side of a
wash-basin, so as to disengage superfluous water, used it to
flap the naked abdomen, so that each stroke should produce a
little shiver. In this way he had kept a controlling influence
over the uterus for several hours at a time till the disposition
to flooding had ceased; without subjecting the patient to un¬
necessary discomfort. He had attended a case where the pla¬
centa was expelled in a mass before the head of the child came
down, and the labor was completed without further loss of
blood.
Dr, Cordes (Geneva) recommended the subcutaneous injec¬
tion of ether in post partum haemorrhage. He also regarded
the subcutaneous injection of ergotine as valuable. The syn¬
cope could be avoided by the positional treatment, and by the
application of Esmarch’s bandages to the arms and legs.
Dr. Atthill (Dublin) would confine his remarks to the use of
the lour principal agents used for the arrest of post partum
haemorrhage ; namely, ergot, cold water, warm water, and the
perch loride of iron. Ergot was most unreliable ; it took time
to act, and, though valuable if administered to anticipate
haemorrhage, was nearly useless at the time, even if injected
under the skin. Cold was perhaps the most efficient of all
agents, if used in the proper cases and at the right time; that
is, while the patient was warm, and reaction consequently fol¬
lowed. If its use were prolonged, or the patient were cold and
exhausted, it was worse than useless. It was at this stage
that hot water came in with advantage, not to supersede the
use of cold. Dr. Walter recorded cases in which it failed, or
hid actual harm; but he used it too hot, namely, at 120°, in¬
stead of 100°; and the experiments referred to at the conclu¬
sion of his paper showed that not water was efficient in caus-
Current Medical Literature.
903
1880]
in" contraction of the uterine muscular tissue. If used at the
proper temperature, hot water was far from being an absolutely
efficient agent, but it was valuable ; it would not replace the
use of perchloride of iron, but it must sometimes render it un¬
necessary. Perchloride of iron was in some cases absolutely
demanded, and was the most certain means of checking post
partum haemorrhage. It had, in Dr. Atthill’s hands, saved
several lives; but, like all other remedies, it was not absolutely
safe. He knew of one case it which it seemed to cause instan¬
taneous death; but he had known death to follow in a few mo¬
ments from the simple act of syringing the vagina; air entered
the uterus and caused death. Might this not have also been
the cause of death when the perchloride was used 1
Dr. Malins (Birmingham) said there were two conditions
under which post partum haemorrhage appeared to be benefit¬
ed, one. was sickness, the other fainting. The former had
been recognized by Mr. Higginbottom, whose practice it was
to give ipecacuanha until this was produced; but it was a rude
and unsatisfactory mode of treatment, and could not be looked
upon as reliable. As regarded fainting, be had never known
a patient die in this form of haemorrhage who fainted. It was
generally alarming to bystanders ; but it was a wise provision
of nature to arrest the bleeding by lessening the force of the
circulation, and promoting the formation of clots in the open
sinuses. His own plan in so-called flooders,” was always to
insist upon some preliminary treatment of general health ; at
the time of delivery, never to take the hand off the uterus ; to
give a dose of ergot as soon as the head pressed on the peri-
meum ; afterwards, to inject ergotine subcutaneously by a long-
needle into the buttock. If these means were unable to effect
the proper control, he saturated a sponge with solution of per¬
chloride of iron — of Dr. Barnes’s strength — and introduced
it, protected by the hand, into the uterus, the opposite hand
exerting pressure externally. He did not inject the solution,
as, from his own experience, future evils after this plan were
more likely to be avoided.
Dr. More Madden (Dublin) thought the members were
largely indebted to Dr. Macan, for having ably initiated a
discussion which had brought forward the views of mauy ex¬
perienced practitioners, who had given their opinions on the
causation, prevention and treatment of the most serious com¬
plication of labor. With regard to the prevention and treat¬
ment of flooding, he entirely agreed with Dr. Macan, that the
reason they had comparatively so few cases of serious haemor¬
rhage in Dublin was, that there almost every practitioner was
accustomed to follow the uterus down with his hand above the
fundus, from the moment the child’s head began to pass the
vulva until I he third stage was completed, and Arm contrac¬
tion of the uterus secured. No attempt should ever be made
to hasten the expulsion of the placenta by any traction on the
904
Current Medical Literature.
[March
cord. Next in importance, as a prophylactic of haemorrhage,
Dr. More Madden regarded the administration of an enema of
warm infusion of ergot, or the hypodermic injection of a couple
of grains of ergotine, towards the conclusion of the second
stage. In the treatment of severe flooding, Dr. More Madden
had great faith in the introduction of a sponge, saturated with
solution of perchloride of iron, by the hand into the uterine
cavity until hand and sponge were expelled by the contractile
action thus excited. There were many other points which the
time at their disposal prevented them from fully discussing —
such, for instance, as the use of opium under certain circum •
stances, and the value of cold affusion ; or the old Dublin prac¬
tice of slapping the woman’s buttocks with a wet cloth ; and
the use of injections ot iced water, vinegar and water, etc. He
thought the cases reported by Dr. Walter were a very strong
argument against the use of hot water injections ; and, in his
own practice, he would not feel justified in wasting any time,
in a case of serious post partum haemorrhage, in again injecting
hot water, which Dr. Walter had clearly shown to be capable
of producing relaxation of the uterus, and thus of increasing
instead of restraining haemorrhage. In the treatment of col¬
lapse he had derived very great benefit from the hypodermic
injection of sulphuric ether; and he believed that, if this were
generally adopted in the first instance, in the treatment of col¬
lapse, they would have little necessity for falling back on their
last resource — namely, transfusion. For his own part, Dr.
More Madden firmly believed that in most instances they might
prevent flooding, if consulted in time, by the prophylactic
treatment he had described in his paper ; and that, in the im-
proved midwifery practice of the future, and, he hoped, not
distant time, the lamentable spectacle of a woman dying from
haemorrhage after labor would be never witnessed.
Dr. Edis thought that the preventive aspect of the question
had not been sufficiently dwelt upon. Where labor had been
conscientiously and intelligently supervised, the cases of post
partum haemorrhage would be few and far between. Before a
patient was allowed to incur the pains and perils of childbirth,
she should be put into training, the same as an athlete who
was about to perform any severe task calculated to test his
powers of speed, endurance or physical strength. The general
health should be looked after, care being taken that the bodily
functions were kept in as natural a condition as possible, so
that, when the time came, the patient should be strong to labor.
During parturitiou, every means should be resorted to calcu¬
lated to prevent unnecessary delay or suffering. Chloroform,
if administered at all, should only be given during the latter
part of the second stage, and not during the preliminary stage,
unless under special circumstances, as in rigidity of the os
uteri, immoderate pains, etc. On the first evidence of any flag¬
ging power or arrest of the presenting part, timely assistance
Cu r rent M eel i ca l Li ter attire.
905
1S80J
should be rendered, and the patient not allowed to exhaust her
powers uselessly. In a very large percentage of cases, post
partum haemorrhage might be altogether avoided by the judi¬
cious application of the forceps where the natural powers had
been fairly tried and proved to be inadequate to effect delivery
cito, tuto, etjucunde. The misfortune was that, when any spe¬
cial remedy was brought prominently forward as valuable
in certain contingencies, many pracitioners seemed to think it
was the only or the best thing to do, and lulled themselves
into a false security by the thought that they had the remedy
at hand in case it should be needed; attention being thus di¬
verted from what should have been the chief consideration —
the prevention of exhaustion — to which alone the haemorrhage
was due. In those trying cases where post partum hemorrha ge
occurred in spite of all efforts to the contrary, too much praise
could not be accorded to Dr. Barnes for having introduced to
notice a remedy so valuable and so reliable, and which enabled
the obstetrician, as it were, to snatch his patient from the very
jaws of death, when otherwise all his efforts would have been
futile.
The President (Dr. Kidd) said that, before calling on
Dr. Macau to close the debate, he would sum up some
of the more important points that had been touched upon,
with a lew brief comments. Dr. Macau opened his paper
with remarks on the haemorrhages of the early months, and the
so-called menstruation of pregnancy, which ho had' very con¬
clusively shown was not^meustruation at all, but haemorr¬
hage arising from varying causes ; and Dr. Henry Ben-
net had drawn attention to the frequency of inflammation of
the cervix as one of these causes. This was quite in accordance
with his (Dr. Kidd’s) own experience; and, guided by what Dr.
Bennet had said in his work on Inflammation of the Uterus , he
had from an early period made it a rule, in treating cases of
frequently recurring small haemorrhages, or long continued
draining of blood in early pregnancy, to examine the cervix,
wheu he generally found the condition described by Dr Beu-
uet ; and ou curing this the haemorrhage ceased, anil the p lt.ent
went to her full time. Dr. Alac.m said he n ul directed attention
to the recent use of the thermometer as a means of ascertain¬
ing whether the embryo was still alive or had perished. If
the thermometer could afford positive information on this point,
it would render the obstetrician even greater service than it had
conferred on the physician in the treatment of typhoid fever;
but we must still rely ou the old rules of practice, and endeavor,
when the os was not open and no portion of the ovum protruded,
to prevent abortion ; and when it was open and a portion
beginning to protrude, use all the means in our power to has¬
ten its expulsion. Plugging the vagina was a most valuable
method of controlling the haemorrhage; but, so long as there
was any hope of preventing the abortion, no attempt should be
906 Current Medical JAterature. [March
marlo to adopt Dr. Bennet’s suggestion of plugging the os. It
was even doubtful whether the vagina should be plugged under
such circumstances, unless the haemorrhage were excessive.
When the embryo had come away and the membranes remain¬
ed, plugging was a most valuable means of treatment in the
early months. This was a most perplexing condition ; so long
as the membranes were retained, the patient was liable to ex¬
cessive or even fatal haemorrhage at any moment, and they
might be retained for days ; but if the vagina were efficiently
plugged, more especially if Dr. Benuet’s form of plugging the
os, “ bottling up the uterus,” as he called it, were adopted, the
attendant might leave his patient for some hours, satisfied that
no haemorrhage of consequence could take place; and when lie
removed the plug at the end often or twelve hours, he would
probably find the membranes in the vagina and nil risk of
haemorrhage over. Another plan that had been often adopted,
especially when the membranes had not come away with the
first plug and the os was open, was to pass a catheter into the
uterus, and with a syringe throw up a stream of cold water.
This generally caused their expulsion in a few minutes, and he
had never seen any unpleasant consequence arise from the in¬
jection. Placenta praevia was the next subject referred to. He
would only allude to the very interesting points as to the pa¬
thology of this condition, discussed by Dr. Macau and Dr.
Barnes, and would pass on to some of fhe plans of treatment
spoken of by others. Dr. Wallace spoke of plugging the,
vagina as being in common use in Liverpool, and expressed
fear of the practice, lest the haemorrhage should goon in a con¬
cealed manner, blood accumulating in the uterus. Plugging-
had long been the practice adopted in Dublin, but it did nor,
originate there. It was a German practice, introduced in the
last century; and when the membranes were unruptured, or the
case was one of complete placenta praevia, it was a most re¬
markable method of controlling haemorrhage till the os was
sufficiently dilated to allow the completion of labour. If the
placenta were attached all round the os internum, or the mem¬
branes were unbroken, the blood could not accumulate in the
uterus. But plugging was not so much in use in Dublin now
as formerly. Twelve or fourteen years ago, there was a great
debate in the Loudon Obstretrical Society on the treatment of
placenta praevia; and since then the induction of labour as soon
as possible after the discovery of the nature of the case, espec¬
ially if the child were viable, had been more and more adopted
as t he rule of practice. H<‘ had himself been frequently called
to see patients who had been safely conducted through oim or
two early and slight haemorrhages, and then reduced to a state
of so great prostration by a suddeu rush of blood that they
died in the act of delivery, or even before it was attempted;
and therefore he lost no opportunity of urging the induction of
labour as soon as it was clearly ascertained that the case was
1880J
Current Medical Literature.
907
one of placenta praevia. For this purpose, the plugging of the
os after T)r. Bonnet’s plan, with prepared sponge, as suggested
by Dr. Playfair, was the best means of commencing the induc¬
tion of labour, as not only checking the bleeding, but at the
same time dilating the os. Regarding the, treatment of post
partum haemorrhage, DrEdis had drawn attention to the pre¬
ventive treatment, and to the advantage of attending to the
general health of the patient before labour came on. He
had happily compared this to the training and athlete under¬
went before undertaking a race or other great physical ex¬
ertion, and had very wisely urged that women should
be put in training by attention to their general health
for the exertion they were about to undergo. Dr. Malins,
Dr. Dill, Dr. Edis, and others, had further spoken of the im¬
portance of preventing the woman’s powers from being worn
out and exhausted bv prolonged efforts in labour, and advised
that she should be assisted by the use of ergot or by the forceps.
That the undue prolongation of labour was one of the most fre¬
quent causes of post partum haemorrhage could uot be ques¬
tioned, and all must agree with Dr. Edis in recommending the
prompt use of the forceps when delay threatening to exhaust
the patient occurred in the second stage. There was another
means of preventing haemorrhage which had not been spoken
of, that was of not less value : the placing of the hand on the
fundus as soon as the child’s head was expelled, and following
the uterus down, keeping it contracted till not only the placenta
was expelled, but for some time afterwards, to afford time for
the closing of the vessels by Nature’s own processes. This
following down of the uterus was called by Dr. Collins “a duty
of paramount importance,” and was very different from the
method of Crede, which had been mentioned. He tried to expel
the placenta at once by pressure on the uterus. Collins’ or the
Dublin method was to wait till the uterus expelled the placenta
by its own efforts, securing a good contraction all the time ; and
with the same reason one did not extract the child but allowed
it to be expelled, even the feet by the contraction of the uterus and
vagina. The introduction of the hand into the uterus for the
removal of clots, and causing contraction, as a means of check¬
ing haemorrhage, had not been spoken of. It was certainly a
most efficient mode of treatment, and should always precede
the use of injection of any kind. Though an operation that
seemed specially liable to be followed by inflammatory and
septicaemic symptoms, it was certainly not so dangerous as the
use of styptic, or perhaps even simple injections, and in the
majority of cases completely checked the bleeding. Dr. Ma¬
lins spoke of the effect of vomiting in checking the bleed¬
ing and reminded the meeting of Higginbottom’s recommenda¬
tion to administer ipecacuanha in cases of post partum haemorr¬
hage. Of this treatment, the President had no experience j he
9
908 Current Medical Literature. [March
had not tried it because, in the first place, ipecucuana took a con-
siderable time to produce its effects, and he feared the nausea
that preceded the vomiting would be injurious ; but he was
always glad to see vomiting in cases of haemorrhage, and more
than suspected that the greatest benefit derived from the use
of ergot b\r the mouth was caused by the vomiting it often in¬
duced. He had very seldom seen haemorrhage recur after vom¬
iting had taken place. Dr. Walter’s cases proved that the
conditions were not yet known, under which injection of hot
water might be relied on for inducing contraction and check¬
ing bleeding. That it was often useful, and stimulated very
promptly the vital powers when the patient was cold and pros¬
trate, the President was well aware from his own experience.
The injection of a solution of her chloride of iron acted in a differ¬
ent way. The iron both coagulated the blood and corrugated
the uterus, as Dr. Barnes had remarked. Unfortunatelj7, the
coagulation sometimes extended along the vessels, even reach¬
ing the heart, and so killing the patient. In the Coombe Lying-
in -Hospital, they had often tried the introduction of a small
piece of the solid perchloride into the uterus, either leaving it
there or removing it in a few seconds ; and the practice was
probably a safer one than the injection of a solution. Pro¬
fessor Dill and Dr. Cordes had spoken of the advantage of
lowering the patient’s head so as to favor the flow to the brain
of any blood that might still be in the vessels; bandaging the
abdomen, by compressing the vena cava and other large veins,
contributed to the same effect. Not only should the pillow and
bolster be removed, but the foot of the bed should be elevated
so as to give a decided inclination to the blood to gravitate to¬
wards the head. Some years ago, Dr. Wyse, of Kostellan, in
the county Cork, wrote a paper recommending that the arms
and legs should be elevated almost to a right angle with the
body for the same purpose ; and more recently German writers
suggested bandaging the limbs tightly with the same view, and
dignified the process with the name of “ autotransfusiou.” The
last resource was transfusion. Dr. More Madden spoke of this
as a difficult operation ; but, after some experience of it, the
President could state that with due care, and following the
method and directions of Dr. Robert McDonnell, it was not
very difficult. He believed it was one almost entirely devoid
of danger or bad after-consequences, and one that ought to
be had recourse to at a much earlier stage than had hitherto
been doue.
Dr. Macau, in reply, said that he had purposely left out acci¬
dental haemorrhage from his paper, as he considered there
were already quite enough subjects for discussion. In what he
had said with regard to the confusion that has occurred be¬
tween “ the cervix ” and u the cervical zone,” he had not intend¬
ed to convey the impression that Dr. Barnes asserted that the
placenta was inserted into the cervix. On the contrary, he
1880J
Current Medical Literature.
909
knew that Ur. Barnes held the same idea on this point as he
(Dr. Macan) did, but had been led by the similarity of the two
expressions to use them as if they were convertible terms. This
confusion happened more than once in Dr. Barnes’ work. First,
when speaking of the cause of the haemorrhage during the lat¬
ter months of pregnancy, he said : “ The first detachment of
placeuta, then, arises from an excess in rate of growth of the
placenta over that of the cervix, a structure which was not de¬
signed for placental attachments, and which is not fitted to
keep pace with the placenta.” And again, when speaking of
post partum haemorrhage, he said that paralysis of the eervix
was doubly dangerous in cases of placenta praevia, because “ the
cervix is the placental site.” He did not agree with Dr.
Barnes, that one could tell exactly what amount of detachment
of the placenta must take place in each case ; for there could
be no doubt that the implantation of the placenta over any
part of the uterus caused that portion of the uterus to resist
any dilating force more than the surrounding uterine tissue in¬
to which the placeuta was not attached. If, now, the presen
tatiou were marginal, then the expansion of the inner os would
take place chietiy at ihe expense of that portion of the uterine
tissue into which the placenta was not attached. It therefore at
once followed that the placental site had not to dilate as much as
Dr. Barnes’ theory demauded that it should dilate, and there¬
fore one could not tell the exact amount of detachment that
must take place, and should therefore abstain from any attempt
at artitical separation. The analogy that Dr. Barnes gave of
the placenta growing too fast for the site of its insertion in
cases ot tubal gestation held good only if the placenta were
supposed to be attached to the inside of the cervix, which idea
Dr. Barnes repudiated. There was no analogy between the
lower segment of the body of the uterus and the Fallopian
tube ; and to say that the lower segment of the uterus was not
suited for the attachment of the placenta, and therefore did not
grow fast enough for it, was a simple petitio p>incipii; the
whole question in dispute being whether this portion of the
uterus were suited for placental attachment or not . — British
Medical Journal.
TWO CASES OF PECULIAR DELUSIONS.
By Wm. Dewitt, M. I)., Professor of Anatomy, Medical Department, University of
California.
Case 1. I was sent for in great haste to visit Mr. J. W., aged
50 years, who was suffering excruciating pains, owing to the
presence of a pin in the rectum. The patient supposed t hat at
one time in his life he had swallowed a pin, and was positive
he could feel it in his rectum.
I carefully explored the rectum, but was unable to detect
the presence of any foreign body there, and concluded that the
910 Current Medical Literature. [March
pain was entirely imaginary. I endeavored to convince him
that lie was mistaken, but it was of no avail ; he insisted that
the pin was there and he could touch it with his linger, and
was causing him great suffering. I again examined the rec¬
tum, and suddenly withdrawing my finger, informed him that
I had discovered it. Turning from the bed to the table, 1 took
a pin from my coat, bent it upon itself, and guarded the point
by securing it in the blade of my forceps. Introducing my
finger, I inserted the forceps with the pin into the rectum ;
then making a few manipulations, withdrew the forceps with
the pin, at the same time exclaiming, “I have got it!” and
holding it up so that he could see it. He immediately sprang
from the bed, throwing his arms up wit h exclamations of joy,
grasped me around the neck, saying he was entirely relieved
of his pain. He never suffered further inconvenience from
pain in the rectum.
Case 2. Mrs. H., aged about 55, presented herself at the
Medical College, University of Michigan, complaining of severe
pain in the right tibia, and showing a spicula (which she said
was bone), about an mch and a half long and one-eighth wide,
and about a line in thickness, stating that she removed it from
her shin a few days before. On examination there was found
to be no trouble whatever affecting the tibia.
The spicula proved on microscopic examination to be a part
of a sclerosed tendon from the leg of some fowl. She was in¬
formed there was nothing the matter with her, and dismissed.
Some months afterwards she began calling at my office, still
complaining of the same pain, and insisting that there was
more bone to come away, and wishing me to make an opera¬
tion. After refusing repeatedly, 1 finally consented to operate
on the bone.
The operation consisted in making an incision about three
inches long on the anterior surface of the tibia, and, with a
bone-gouge, cutting a groove about a quarter of an inch wide
and about one-eighth of an inch deep in the tibia, and filling
the wound with lint and allowing it to heal by granulation,
which it soon did ; and her pain all disappeared, and she had
no more trouble with her leg.
I have cited these two cases to show that we often have to
minister to minds diseased, and sometimes have to be cruel
to be kind, to relieve such imaginary conditions of our patients,
which cases require more judgment ana tact than some of those
with organic lesions. They are often the most troublesome
cases the physician is called upon to treat and to satisfy.
THE LISTER METHOD.
For his antiseptic method, Lister has in no country been so
severly and unjustly criticised as by some of his English col¬
leagues. The Lancet referring to the surgical address deliv-
Current Medical Literature.
911
1880]
ered at the meeting of the British Medical Association, last
summer, by Mr. Savory, attempts to prove that after an “im¬
partial trial” of the antiseptic method, the statistics resulting
are in no way superior to those obtained from the older and
more simple methods of dressing aud operating, but in some
respects are even inferior. This attack is founded upon statis¬
tics of operations at St. Bartholomew’s Hospital, at London,
during the years 1876, ’77 and ’78. The death rate from second¬
ary wound diseases being, for 1876, from (pysemia 0.49 per
cent.) pyaemia and erysipelas, 1.24 per cent.; for 1877 from
(pyaemia 0.95 per cent) pyaemia and erysipelas, 1.43 per cent. ;
for 1878, from (pyaemia 0.96 per cent) pyaemia and erysipelas,
1.68 per cent. The Lancet therefore concludes that “ if the
Listerians can show better results than these, they are unjust
to themselves and unfaithful to the doctrine they profess if
they any longer withhold the statistical results of their prac¬
tice.” (The Lancet, August 16, 1879, p. 247.) It is true that
the abov e stated results are praiseworthy, and that a new
method, asserting superiority over the old must submit to trial
and to criticism, but the Lancet’s criticism of Lister’s method is
based upon no essential trial, and is therefore illogical. Atrial
should consist of a double series of an equal number of similar
treated by each method simultaneously, and in the same wards
of the same hospital, after which the results should be com¬
pared. This was not done at St. Bartholomew’s. But a num¬
ber of leading surgeons on the continent, neither “ young
enthusiasts of the antiseptic system,” nor yet “ germ theorists,”
but eminent and able men, have tried the methods, compared
the statistics, aud have published the results. It is these sta¬
tistics, and not any enthusiasm for the germ theory, that has
spoken the deciding woid in favor of Lister’s method.
Possibly the hygienic conditions of St. Bartholomew’s Hos¬
pital are almost as good as in private houses, aud therefore the
antiseptic method is not so much needed. The great majority
of hospitals, however, are not so sale against septic infection,
and for these the superiority of antiseptic surgery cannot longer
be disputed. The records from the last Busso-Turkish war
speak volumes for the method. That anti septic surgery has
reached its highest perfection has never been claimed, either
by Lister himself or by others. It wrould, however, be a dan¬
gerous retrograde movement to return to what Mr. Savory calls
“simple means of diessiug.” — Chicago Medical Gazette , January
20th.
A MODIFICATION OF THE OPERATION FOR FISTULA IN ANO.
By J. J. Knott, M. I)., Atlanta, Ga.
The following procedure will be found to do away with some
of the inconveniences, and the most of the pain attending the
operation for fistula in auo. I have tried it in two cases with
perfect satisfaction. Introduce the aual speculum, with the
912 Current Medical Literature. [March
fenestra on a line with the fistulous track, pass the director
through the fistula, allowing the speculum to remain in situ.
With your curved, sharp-pointed bistoury, divide the tissues,
and withdraw the speculum, director, and knife altogether.
You get the following advantages by this method: avoidance
of pain to a great extent; a full view of all the parts; and, so
far in my hands, the avoidance of tenesmus of the rectum,
which is likely to bring on strangury and retention of urine.
The two cases in which this method was adopted were of a
nervous temperament — cases which would call for :wi anaesthe¬
tic to allay pain consequent on the operation by other methods.
— New York Medical Record !, Jan. 10.
A PERTINENT ENQUIRY ABOUT DOCTORS AND CLERGYMEN.
A writer in an Eastern journal is perplexing himself to ascer¬
tain why, when doctors attend gratuitously to clergymen and
their families, without discrimination as to their circumstances,
they should not have the services of clergymen who can afford it
in return. That is to say, when a minister is called to officiate
at the marriage of a doctor or a member of his family why should
the doctor, no matter how poor, be expected to pay a fee to the
minister, no matter how ricli the latter? And when a doctor
attends the minister’s child for a week or a month, the child
getting well, for which he neither receives nor expects pay, the
doctor, when his own child dies, would be expected to pay the
minister for his services at the burial ? And further, when the
minister’s salary is to be raised, why should the doctor who
serves him gratuitously be expected to pay his full quota and
perhaps more? And why should the doctor be expected to pay
a first class pew l ent, when he not only attends the minister and
his family but all the poor of the parish without compensation ?
We have known, in the course of a long practice, a few clergy¬
men who declined accepting our services gratuitously, and com¬
pelled us to take a fee, nolens volens ; but tney were not the rich¬
est of our clerical patrons. — Pacific Medical and Surgical Jour¬
nal , January, 1880.
LACERATED CERVIX UTERI A PROBABLE CAUSE OF RECURRING
ABORTIONS.
By S. V. Clevenger, M. D.
Mrs. X, married in 1865, is the mother of four children : the
last child was burn April 22, 1872. She had experienced no
unusual difficulty previous to, during or after each labor.
August 31, 1873, without any apperent cause, she aborted a
three months foetus; made a good recovery speedily, and upon
the same date the following year, after a long walk, miscarried
again a four and one-half months foetus. Six weeks previous to
this, at the third mouth of pregnancy, began the daily recur¬
rence of vaginal discharges of an ounce or two ounces of blood,
lasting one. or two hours each time. On the 11th of February,
1S80J Current Medical Literature. 013
1876, after moderate exercise, another abortion of a three
months fcetns occurred with such violent haemorrhage as to en¬
danger her life, and cause her confinement in bed two months.
Neurasthenia followed, from which she has never fully recov¬
ered, subinvolution, infiammation and ulceration of the uterus
being the alleged causes of her nervous derangement ; cauter¬
ization of the cervix was advised by skillful gynecologists, but
fortunately was not permitted. This condition, unrelieved, ex¬
isted till December, 1878, when I advised the use of hot water
vaginal injections, and the application of glyceriue plugs. Im¬
mediate benefit to the patient resulted, from thus relieving the
congestion of the parts, and she has since this time en joyed
better, though without fully recovering, health.
In common with many other practitioners, I knew nothing of
Emmet’s demonstration of the pathological importance of cer¬
vical laceration, receiving my first information on the subject
from Dr. E. C. Dudley, in July of last year. An examination
revealed laceration of the cervix, through both ora. Assuming
that this tear occured at the last full term labor in 1872, it
seems probable that the following miscarriages were due to the
want of cervical integrity. The everted edges of the cervix,
with consequent “rolling out” of the intrauterine tissue,
would afford poor support for the contents of a gravid uterus.
The recurrence of the abortion at the third month in the two
cases, and its commencement in one case, would iudicate that
at this period the contents of the sack had acquired sufficient
weight and size to press aside the feebly resisting false cervical
walls, thus permitting the gravitation and expulsion of the
fcetns and its appendages. That placenta praevia did not exist
in the first instance at least is known, nor was there any cause
to suspect death of either foetus previous to expulsion.
That the laceration was the cause, it is now impossible to
assert positively. The lesion may have taken place at any one
of the preceding four labors.
[The history of the lesion as given in the case-books of the
Woman’s Hospital in the State of New York, and in the private
records of Dr. Emmet, and in our own records, proves the cor¬
rectness of the views above expressed, although, so far as we
are aware, these views have not hitherto been specially pub¬
lished. — Ed.J — Chicago Medical Gazette , Jan. 20.
PFLEGER ON THE CEREBRAL PATHOLOGY OF EPILEPSY.
Dr. Ludwig Pfleger* reports that, out of forty-three cases
(seventeen males and twenty-six females) of epilepsy in which
lie has made post mortem examinations, he found the hippocam¬
pus major shrivelled and sclerosed in twenty-five instances
(males 7, females 18), while in two others atrophy, without
sclerosis, was observed. In the course of about three hun-
* Beobachtungen liber Schrnnipfnng nnd Sclerose des Amtnonshornes bei Epilepsie.”
Von. Dr. Ludwig Pfleger. Allg. Zeitschr.fur Psychiatrie, Bd. xxxvi, Heft 9 — 3.
914 Current Medical Literature. [March
dred other necropsies, chiefly of insane patients, he has also
noted the following : Atrophy and sclerosis of both hippocam¬
pi in a woman, aged 49, who had died of paralytic dementia ;
atrophy of both hippocampi in a hysterical woman, aged
78, who had long been subject to convulsions, apparently
not attended by loss of consciousness: adhesion of the an¬
terior portion of the cornu ammonis to the ventricular wall above
it, usually upon both sides, in the following eleven cases : a
man, aged 38, who had one or two epileptoid attacks annually,
and was said to have previously suffered from true epilepsy ;
two male general paralytics, aged 31 and 40, of which the
younger was reported to have once been epileptic ; a man who
had first become epileptic at 22 years of age, whose fits were
very frequent, though generally unaccompanied by loss of con¬
sciousness ; seven cases of death from marasmus senilis, in two
of which attacks of great excitement had been frequent.
Hemkes pointed out (see London Medical Record , March, 1878)
that the lesion of the hippocampus was only observed by him
in patients who had been epileptic before the twelfth year of
life. Ptleger believes this to be so in the great majority of in¬
stances, but draws attention to three of his own cases in which
epilepsy had only commenced at or after twenty years of
age.
Dividing his cases into two groups, the first consisting of
those in which the fits were frequent and severe ; the second,
of those in which they were comparatively infrequent and
slight ; the author finds that the great majority of instances of
lesion of the hippocampus occurs in the first group. Thus, among
eight males with strong and frequent fits, six had sclerosis;
while among niue in whom the disease was milder, only one
showed slight atrophy and sclerosis of the hippocampus,
though marked atrophy of one half of the brain was present in
three cases. Of fifteen women who suffered from the severe
form of the disease, eleven were found to have sclerosis ; and
of eleven belonging to the second group, four had sclerosis, and
two atrophy without sclerosis.
Adding together the cases of Hemkes and Pfieger, it would
appear that a lesion of one or both hippocampi may be ob¬
served in about one-half of the necropsies on insane epileptics.
It appears from anatomical and experimental research, that the
cornu ammonis has no connection with the motor functions ; it
cannot, therefore, be maintained that the morbid change in it
is either the cause, seat, or result of the epilepsy. The author
attributes the lesion to a disturbance of nutrition dependent
upon a change in the mode of circulation of the blood during
and after the epileptic attack, owing to the peculiar distribu¬
tion of the blood-vessels of the hippocampus. It will be seen
that this is quite a different view from that adopted by Hem¬
kes, who regards the appearances as due to “ partial ence¬
phalitic processes with resulting atrophy.” — Chas. S. W. Cob -
bold, M.D. — London Medical Record , November 15th.
1880J Current Medical Literature, 915
PROBABLE CAUSE OF LEPROSY.
A probable cause of leprosy, a disease, both the cause and
remedy of which have hitherto eluded discovery, has been
pointed out by Mr. Manson in a communication to the Lin-
mean Society. Microscopists have discovered in human blood
and in the blood of dogs, swarms of small thread-like worms —
Filaria sanguinis hominis. If they could grow and breed in the
body in which they first appear, that body would soon die. “ If
the brood of embryo file rice, at any one time free in the blood
of a dog moderately well charged with them, were to begin
growing, before they had each attained a hundredth part of
the size of the mature filaria , their aggregate volume would
occupy a bulk manv times greater than the dog itself. I have
calculated,” says Mr. Manson, author of the paper in question,
u that in the blood of certain dogs and men there exists at any
given moment more than two millions of embryos.” This
minute creature is a very formidable parasite. Were it not
that large numbers disintegrate and perish, or are voided with
the secretions, having even been found in the tears, the natural
functions of the blood would be impossible. Nature requires
that for further development the filaria as well as other para¬
sites should enter some other body. Knowing that mosquitoes
suck human blood, Mr. Manson made arrangements by which
he captured a number of the insects which had gorged them¬
selves on the blood of a filarious Chinaman who had been “ per¬
suaded” to sleep in a mosquito chamber. On examining the
insects by aid of the microscope, the subsequent development
of the filaira could be well made out ; it passes through three
stages, iu the last of which “ it becomes endowed with mar¬
velous power and activity. It rushes about the field (of the
microscope), forcing obstacles aside, moving indifferently at
either end, and appears quite at home.” Referring to the pa-
pilae which, appearing at one extremity of the creature are
supposed to be the-boring apparatus, Mr. Manson says : “ This
formidable looking animal is undoubtedly the Filaria sanguinis
hominis equipped for independent life, and ready to leave its
nurse, Jthe mosquito.” The filaria u escaping into the water in
which the mosquito died is, through the medium of this fluid,
brought into contact with the tissues of man, and either pierc¬
ing the integuments, or what is more probable, being swal¬
lowed, it works its way through the alimentary canal to its
final resting-place. Arrived there its development is perfected,
fecundation is effected, and finally the embryo filarice we meet
with in the blood are discharged in successive swarms and in
countless numbers. In warm climates the presence of these micro¬
scopic worms is most to be feared ; and it has been but too
clearly made out, and that its presence is associated with pain¬
ful and disgusting diseases, and u not improbably with leprosy
itself.” — tSceintifie News.
10
910
Editorial.
[March
j^DITOF^IAL.
“ A green Christmas makes a fat church yard.” This has
been an English proverb for generations ; — how many we are
unable to state. The questions which principally concern us,
are, first, if the theorem be true as it respects England, is it
equally applicable to this country? Next, what are the dis¬
eases which are most likely to be protected and fostered by
a green Christmas ? Third, what steps shall the medical pro¬
fession take, to secure exemption from the penalties entailed
by a warm winter ? In reply to the first query, it may be safe¬
ly affirmed, that the two most mischievous morbid pests of this
country are held in abeyance, at least, by low markings of
temperature. It would therefore appear that if the pos¬
tulation was true of England, it was yet the more so of this
country. The evolution of swamp poison is checked by frost,
but the poison is not permanently destroyed, for the warmth of
the ensuing Spring renews the toxic energy of the germs in the
very locality where they were caught by the frosts of winter.
There seems to be a marked difference in the influence which
cold exerts upon the essential cause of the other of the mor¬
bid pests alluded to. Yellow fever poison not only ceases to be
evolved under the influence of frost, but seems subsequently
to be incapable of survival in such form at least as would be
productive of disease. After an epidemic of yellow fever,
chance and a careless disregard of sanitary precautions, fre¬
quently permit the germs to be placed in situations where they
are protected from a sufficient degree of cold to destroy them,
and this even during cold winters. It is quite rational to con¬
clude that the protection afforded by frost would be more or
less general and complete in pretty direct ratio to the degree and
persistence of the cold. The past winter has been too mild to
justify confidence in the belief that yellow fever germs have
been everywhere destroyed by low temperature. The attention
of physicians, in localities of its prevalence last year, should
be earnestly directed to these facts. Through cleansing of all
1880]
Reviews and Book Notices.
917
rooms or quarters which have been infected should be prac¬
tised before the warm weather sets In. Fomites should
be in some manner destroyed ; lastly, and probably more im¬
portant than all, the first cases should be isolated so rigidly
that epidemics maybe prevented, by keeping unprotected per¬
sons out of the range of the poison as we extinguish a fire by
witholding materials for combustion. We think it hardly rash
to assert that the experiences of 1879 justify a declaration that
yellow fever can be stamped if well directed efforts are re¬
sorted to at the beginning of its outbreaks.
Reviews and Book Notices.
A Treatise on the Science and Practice of Midwifery. By W. S.
Playfair, M.D., F.R.C.P., Physician Accoucheur to H. I.
and R. H., the Duchess of Edinburgh, Professor of Obstet¬
ric Medicine in Kings College, etc., etc. Third American
Edition, revised and corrected by the author, with notes
and additions by Robt. P. Harris, M. D. With two plates
and one hundred and eighty-three illustrations. Philadel¬
phia : Henry C. Lea. Kew Orleans : Armaud Hawkins,
medical bookseller, 196| Canal street.
The medical profession has now the opportunity of adding
to their stock of standard medical works one of the best vol¬
umes on midwifery ever published. The subject is taken up
with a master hand. The essentials to correct knowledge, the
anatomy and physiology of the getier itive organs, afford the
student an apportunity to familiarize himself thoroughly with
the groundwork of obstetrics, and step by step he is carried
into the subject of the physiology of pregnancy and parturi¬
tion. The mechanism of labor is made so interesting that this
much neglected, but so important subject need not be looked
upon as au abstruse theorem in geometry. The part devoted
to labor in all the various presentations, the management and
results, is admirably arranged, and the views entertained will
be found essentially modern, and the opinions expreseed trust¬
worthy.
Part IV. is devoted to obstetrical operations, and is valuable
as containing the method of operating and the reasous there-
918 Reviews and Boole Notices. [March
for. The addition, by Dr. Harris, of a review of the use of
forceps in America, adds much to the completeness of the
subject.
The work closes with a section devoted to the study of
diseases of the puerperal state, and is sufficiently in detail to
meet all requirements.
The work abounds with plates illustrating various obstetrical
positions ; they are admirably wrought and afford great assist¬
ance to the student. The publishers have spared nothing in
placing the work before the profession in first class style.
A System of Midwifery , including the Disease of Pregnancy and
the Puepural state. By William Leishman M. D. Begius
Professor of Midwifery in the University of Glasgow ;
Physician for Diseases of Women, and Consulting Physician
to the Obstetrical Department iu the Glasgow Western
Infirmary, etc. Third American edition, revised by the
author. With additions, by John S. Parry, M. D. With
two hundred and five illustrations. Philadelphia : Henry
0. Lea, New Orleans, Armand Hawkins, medical booksel¬
ler, 197£ Canal street. 8 vo. pp. 732.
To the American student the work before us must prove
admirably adapted. Complete in all its parts, essentially
modern in its teachings, and with demonstrations noted for
clearness and precision it will gain in favor and be recognized
as a work of standard merit.
The arrangement of the werk is natural. The introductory
chapter is chiefly historical, but contains, besides, observations
on comparative anatomy illustrating pelvic changes occuring
during the gestation of lower animals. The study of the pelvis
and female organs of generation is taken up methodically, and
the subject of development of ovum, embryo and foetus is
excellently demonstrated.
The chapter on the mechanism of labor are rendered highly
comprehensive by the introduction of engravings showing the
various stages of labor, so arranged that flexion, progression,
rotation and extention are shown on the same plate.
The complications of pregnancy and parturition are fully
given and the chapters on the obstetrical operations and puer-
pural disease are judiciously arranged and the subjects admi¬
rably treat sd.
919
1880] Reviews and Book Notices.
The work caunot fail to be popular and is cordially recom¬
mended.
The publisher’s task has been admirably performed as is tes¬
tified by the durable binding and clear printing,
Sexual Neuroses. By J. T. Kent, A. M., M. D., St. Louis, Mo.
12 mo., pp. 144. From the author. Price, $1 50.
When works devoted to the genito-urinary organs have a
large and important part of their pages filled with the study
of those affections of the nervous system arising from or de¬
pendent upon some vice, local or constitutional, connected with
these organs, we think that special works devoted to sexual
neuroses are not only out of place when they advance nothing
new in therapeutics, but could be as well left unwritten. In
our examination of this work we find some cliuical records that
are given in racy style ; pen pictures, word paintings, in fact.
These cases present typical views of the diseases under con¬
sideration, but are interesting chiefly as clinical curiosities.
The outlines of treatment are laid down. The there peutic
agents are few. and are those usually emyloyed.
The work is well arranged and creditably printed.
Diseases of the Stomach , the varieties of Dyspepsia, their diag¬
nosis and treatment. By S. O. Habershon, M. D., Lon¬
don, Fellow of the Royal College of Physicians, etc.
Third edition. Philadelphia: Lindsay & Blakiston.
New Orleans : Armand Hawkins, medical bookseller, 196£
Canal street. Price, $1 75.
This work embraces within its pages a careful study of the
diseases of one of the most important of organs, and the reader
is presented with the reseach of many years of experience in
hospital and private practice.
The volume contains twenty chapters, devoted to the study
of the various forms of dyspepsia, atomic, inflammatory, he-
jiatic, rheumatic, renal, sympathetic, etc., cancerous diseases
and spasm of the stomach. The symptoms are clearly given,
and approved methods of treatment recommended.
We feel sure that the stomach is more imposed upon by
routine practice than any other organ, and cheerfully recom-
920 Reviews and Boole Notices. [March
mend this work as systematic, and entitled to careful exami¬
nation and close study.
The Throat and the Voice. By J. Solis Cohen, M. D., Lecturer
on Diseases of the Throat and Chest in Jefferson Medical
college, etc. Philadelphia : Lindsay & Blakiston. New
Orleans: Armand Hawkins, medical bookseller, 19Gi
Canal street.
The popular series known as American Health Primers, con¬
tinue to merit the approbation of the profession. The time has
come when hygiene and preventive medicine bid fair to occupy
their proper place, and these primers will assist in the educa¬
tion of the laiety in matters connected with the laws of health.
Among the educated, the charlatan finds a limited field for the
prosecution of his schemes of spoliation.
The little work before us will be popular. It is written with
a view of directing the general reader to some scientific facts,
concerning the throat and the voice. Subjects, ordinarily dry
and uninteresting, will afford pleasure and profit to the general
reader, and the hints on proper care and cultivation of the
vocal organs will be appreciated by teachers and public speak¬
ers especially.
A Guide to Surgical Diagnosis. By Christopher Heath, F. R. C.
S., Holme Professor of Clinical Surgery in University Col¬
lege, London, and Surgeon to University College Hospital,
etc. Philadelphia: Lindsay &' Blakiston. New Orleans
Armand Hawkins, 1964 Canal street. 12 mo. pp. 214.
The author, recognizing the difficulty even a well read stu¬
dent finds iu bringing his knowledge to bear upon the patient
before him, has arranged in this little volume certain landmarks
for his guidance and presents them grouped anatomically so as
readily to fix the attention. The introductory chapter gives
an excellent plan for proper recording cases.
The various parts of the body are taken up in natural order
and the affections of each are pointed out.
The tables illustrating the differential diagnosis of surgical
affections afford a great deal of information in concise form and
are especially valuable.
' The index affords ample opportunity for ready reference.
1880]
Books and Pamphlets Received.
921
Books and Pamphlets Received.
On the Internal Use of Water for the Sick , and on Thirst. A
Clinical Lecture at the Pennsylvania Hospital, October 25,
1879. By J. Forsythe Meigs, M. A., one of the Attending Phy¬
sicians to the Hospital.
The Answer of the New York Neurological Society to the Docu¬
ment known as the Report of the Committee on Public Health Rel¬
ative to Lunatic Asylums.
A Protest Against Meddlesome Midwifery. By H. Gibbons,
Sr., M. D. Bead before the San Frauciseo County Medical
Society.
State Medicine and State Medical Societies. By Stanford E.
Ohaille, A. M., M. D. Extracted from the Transactions of the
American Medical Association.
I
Transactions of the Tenth Annual Session Medical Society of
Virginia , 1879.
Malignant Degeneration of a Fibroid Tumor of the Uterus.
Large False Aneurism in the substance of the Growth. By Drs.
Albert N. Blodgett and Clifton E. Wing. Boston.
Laudable Ambition; An Address delivered before the Philoma-
thian Literary Society of Cooper Institute , Lauderdale County ,
June 20 th, 1877. By A. C. Love, M. D.
Circular of the Legislative Committee of the Louisiana State
Medical Association and of the Board of Health to Physicians
throughout the State.
Annual Report of the Board of Administrators of the Insane
Asylum , State of Louisiana, to the Governor. 1879.
Poquelin? s Thermo -Cautery with Wilson’s Antithermic Shield in
Epithelioma of the Cervix Uteri. By H. P. C. Wilson, M. D.,
Baltimore, Gynecologist to St. Vincent’s Hospital and the
Union Protestant Infirmary, Vice President of the Baltimore
Academy of Medicine, of the Medical and Chirurgical Faculty
of Maryland, and ex-Vice President of the American Gyneco¬
logical Society, etc., etc.
Annals of the Anatomical and Surgical Society , Brooklyn , N. Y.
Color-Blindness arid Defective Sight among Railroad Employes.
922 Meteorological and Mortality Tables. [March
Meteorological Summary— January, 1880.
Station — New Orleans.
Date.
Daily Mean
Barometer.
Daily Mean
Temp’ture.
Daily Mean
Humidity.
Prevailing
Direction
ofWind.
Daily
Rain-fall.
1
30.30
65.0
82.7
East.
2
30.25
65 7
87.3
East.
.13
3
30.25
67.7
83.7
East.
4
30.27
69.0
81.7
S. E.
5
30.24
69.5
72.3
S. E.
6
30.24
69.7
81.0
South
7
30.24
68.0
84.0
S. E.
8
30.09
68.0
82.0
West
03
9
30.06
68.2
78.7
South
....
10
30.10
67.7
78.0
S. E.
11
30.14
68.5
76.7
S. E.
....
12
30.23
67.5
84.3
S. E.
.44
13
30.32
54.5
58.0
North
14
30.19
59.7
74 0
East.
15
30.18
62.7
83.3
North
16
30.14
63.0
80.0
East.
17
30.11
65.7
77.7
East.
18
30.20
62.0
59.0
North
19
30.14
64.2
68.7
S. E.
20
30.04
65-5
76.0
S. W-
21
29.82
66-2
84.0
South
.25
22
29.87
60-5
62-0
North
.17
23
30.04
53-2
48.7
N. E.
24
30 08
51-5
43.7
N. E.
25
29.97
49-5
47.0
N. E.
26
29.83
55-2
54.3
N. W.
27
29.97
58-5
52 0
West
28
30.12
60-2
67.7
S. W.
29
30.11
63-0
65.3
S. E.
30
30.14
66-2
83.0
s- E.
31
30.17
64-5
83.3
North
Sums
Means
30.126
63.2
72.6
S. E.
1.02
General Items.
Highest Barometer, 30.40:1, on 13th.
Lowest Barometer, 29.774, on 22d.
Monthly Range of Barometer, 0.629
Highest Temperature, 76° on 5, 6, 11.
Lowest Temperature, 42° on 24th.
Monthly Range of Temperature, 33°.
Greatest Daily Rauge of Temperature,
18° on 29 th.
Least Daily Range of Temp., 6° on 12,
21, 26th.
Mean of Maximum Temperatures, 69.1°
Mean of Minimum Temperatures, 57.0°
Mean Daily Range of Temp., 12.1°.
Prevailing Direction of Wind, S. E.
Total Movement of Wind, 4,954 miles.
Highest Velocity of Wind and Direc¬
tion, 21 miles, S. E. on 3d.
Number of Clear Days, 10.
Number of Fair Days, 14.
Number of Cloudy days on which no
Rain fell, 4.
Number of Cloudy Days on which
Rain fell, 2. Total number of days
on which rain fell, 5.
Dates of Luna Halos, 21, 23, 26, 27th.
COMPARATIVE TEMPERATURE.
1871 .
1876 .
.60.3°
1872 .
1877...
.53.7°
1873 . 49.5°
1878. .
1874 . 56.00
1879..
.53.1°
1875 . 54.2°
1880 - .
.63.2°
COMPARATIVE
PRECIPITATION
1871 . inches.
1 1876.'
4.43 inches
1872 . “ .
1 1877 :
5.30
tt
1873... 5 06 “
j 1878;
5.36
it
1874. .1.68 “
1879;
2.34
tt
1875.. 8.44 “
| 1880:
1.02
tt
Mortality in New Orleans from January* 18th, 1880, to
February loth, inclusive.
Week Ending.
Yellow
Fever.
Malarial
Fever.
Consump¬
tion.
Small¬
pox.
Pneu¬
monia.
Total
Mortality.
January
25
0
0
5
0
4
76
Febiuary
1
0
2
14
0
6
93
February
8
0
1
23
0
10
122
February
15
0
3
19
0
7
102
Total .
...
0
6
61
0
27
413
NEW ORLEANS
Medical jind SupcjiL Journal
APRIL, 1 880.
PAGINAL poyViyVIUNICATIONS,
A Few Cases of Leprosy,
By J. H. BEMISS, M. D.,
(Lahaina, Maui, H. I.)
“ Leprosy in the Hawaiian Islands ” has been the title of
several papers published from time to time in the United
States. That of my friend and associate in practice, Dr. F. H.
Enders, deals with the most interesting questions, and will be
of value to those who may be able to read it in the Trans¬
actions of the International Medical Congress of 187G. My
purpose is to present a few cases whose histories were either
taken by myself, or obtained from Dr. Enders, or elsewhere,
calling attention to some points w hich may serve to add inter¬
est to this paper.
Statistics as to the time and manner of introduction of lep¬
rosy into these Islands, are wanting. The period between
1825 and 1830 is supposed to approximate to the correct time
of importation, though the evidence to that effect is very
indefinite. Eev. W. P. Alexander who came here in 1833,
says, the first case he met with personally was that of a native
Hawaiian in about 1838, living in a very isolated locality on
this island (Maui), but he had heard several years before that
a chiefess in Lahaina — also on Maui — was affected with the
924 Original Communications. [April
disease. The first case on the islands was said to have been
that of a chinaman on Oahu, the island upon which Honolulu
is situated.
Of course the manner of introduction is just as uncertain as
the time. The means for importing it, however, have been
unlimited. During the height of the whale hunting business,
that is, during the first half of the present century, these
islands were the great resort for the whaling fleets of the
Pacific, as many as a hundred sail often being in the harbors
of Honolulu, Oahu; or Laliaina, Maui; at one time. These ves¬
sels in addition to bringing sailors from all parts of the world,
frequently shipped native crews, who in their cruises were
brought into contact with all nations aloug the Pacific, and
afterwards returned here to spread such diseases as they might
have contracted. But before whalers ever touched at these
islands, the natives are said to have occasionally gone from
island to island in the Pacific exchanging their diseases, as
well as their commodities, which latter, however, were proba¬
bly very limited. It may be then that the disease was present
here in a dormant state long before it became generally known
— at least to foreigners. The old disease, u mai alii — chief’s dis¬
ease ” — is generally supposed to have been Elephantiasis Ara-
bum, or else the result of the high living, in which the chiefs
indulged. Some, however, have thought it not too much to
suppose some of the cases to have been leprosy.
The natives call leprosy ‘‘mai pake,” “Chinese disease,” the
tradition among them being that the “ heathen Chinee” brought
it with them. But the first lot of Chinamen did not come here
until quite a number of years after leprosy became known, and
this charge seems the more unwarrantable wheu we consider
that of the whole population at the leper asylum there are
not over six Chinamen.
After its introduction it seems to have spread quite slowly
until the latter part of the ten years, 1850-1860. It then
became so plentiful that the government took alarm and began
to institute measures looking toward the prevention of its
spread ; one of its acts being the establishment of the Leper
Asylum on Molokai, and the forcible transfer of prououuced
1880] Bemiss — A Few Gases of Leprosy. 925
cases to that place. The census of 1878 (December 21st),
showed the number of lepers at the Asylum Kalawao, at that
date to have been 806 ; since then quite a number have been
added, though there are still many at large. There have been
admitted to Kalawao certainly not less than 2000 persons from
1866 to date; of which number upwards of 750 are still alive.
The total native population, excluding all foreigners and those
born of foreign parents, is 44,088 (census of 1878), quite a
small number to furnish so much leprosy. The large majority
of these are full blood natives or half breeds, there being
two whites, — one American, the other English, and less
than a half dozen Chinamen.
There are present here, the two forms, tubercular and
anaesthetic. This division is based upon the predominance of
one or the other of the two most important symptoms. In
actual observation the disease does not always admit of such
strict classification, but generally shows the two forms combined
in greater or less pathologic preponderance. It may start as
purely tubercular or purely anaesthetic, but does not often
preserve a single type throughout its course ; in the one case
anaesthesia, in the other tubercles making their appearance in
due time. As to a third variety, macular, my observation does
not warrant my stating any such class. True, maculae of one
sort or another are common enough, but these cases already
present one or the other of the two forms generally recognized.
I have seen but one case in which I was not easily able to
observe tubercles or anaesthesia well marked.
This man had several large, light and slightly raised
maculae upon his body, as the only main symptom of the disease,
but these were anaesthetic, and there was a slight enlargement
of the alae nasi due to infiltration, one of the phenomena of
incipient tubercular leprosy.*
The tubercular variety is characterized by infiltration and
* After having prepared this for the mail, I was upon Molokai on professional business,
and there saw a ease more purely macular than the above. The child, a girl ten years
old, presented upon her face especially, but also elsewhere upon her body, large black
maculae, slightly raised above the surface and producing a very disastrous effect upon her
appearance. She was so yonng, that it may he she did not understand my questions ; at all
events, neither by questions nor close examination could I obtain any evidence of
anaesthesia. Scattered from her left eye brow to her hand were not less than six small
tubercles, on her right hand there were about half as many.
926
Original Communications.
[April
subsequent hypertrophy of the skin, especially where there is
much loose tissue, such as the lobes of the ears, alse nasi and
face generally. Later on there is deposited in the skin of the
face, hands, arms, &c., cheesy masses of the size of a pea or a
little larger. These tubercles are prone to break down and
leave deep indolent sores, which heal, however, after a time,
but with strongly marked cicatrices. Mucous membranes, just
as the external skin, are liable to the above morbid changes.
They may become infiltrated and hypertrophied, or tubercles
may appear in their substance and undergo ulceration. When
such changes occur in the larynx an alteration of the voice is
the result. In breaking down, they produce a most offensive
fetor of the breath. The same changes occurring in the
mucous membrane of the intestines are in a certain proportion
of cases the cause of the diarrhoea which is so common, and so
often fatal. But in many instances diarrhoea is only one of the
many intercurrent affections due to a vitiated state of the
system. In cases primarily anaesthetic, I have on several
occasions first observed tubercles upon the mucous membrane
of the posterior part of the tongue and pharynx, as the only
localities where they may be seen at that stage.
The anaesthetic form is marked by all those phenomena
which are the result of degenerative cnauges in the uerves.
These are anaesthesia, paralysis, contractions and distortion,
especially extreme flexion or extension of the fiugers and
toes, also ectropion, loss of smell and taste, wasting of muscles,
vesicles, sloughing of fingers and toes, &c. The ulnar and
facial nerves are especially frequently affected, but all are
liable.
It is with difficulty that any history of a prodromic stage can
be obtained from a native. They are by no means observant
of such matters, but occasionally one may be found who will
complain of a general indisposition extending over a period of
several months or even longer.
When anaesthesia plays an important part from the first, the
patients very frequently speak of formications, over the entire
body sometimes, but especially over the nerves which after¬
wards become anaesthetic.
1880J
Bemiss — A Few Cases of Leprosy.
927
The following case was among the first that came to the
office after my arrival. It is quite a typical case and as will be
noticed combines the two forms :
Case I. Lahela, female, aged 30, pure-blooded native ;
residence, Waihee, Maui. Laliela admits no history of any
syphilitic cachexia. Can say nothing as to the health of her
parents or what caused their deaths. She has a child 6 years
old now affected with leprosy. (It was examined by us.) The
child was quite sickly when a baby, but seems to be healthy,
generally , now. L. first uoticed the disease in herself two years
ago, when she suffered much from chills and fever and general
ill health ; “ she enjoys better health now.”
Skin of face and lobes of her ears infiltrated and more
or less hypertrophied : that of hands, arms and feet tubercu-
lated and shows scars in abundance. Skin of left forearm and
left hand anaesthetic, also little and ring fingers of the right
hand, and uluar side of right hand and forearm. The fingers
of left hand are considerably distorted, the two terminal pha¬
langes fixe 1, which first are slightly extended. Those of the
right hand are also affected slightly in same way. Voice
coarse, tubercles on posterior part of tongue and pharynx.
Smell affected. She was vaccinated when young by a foreigner.
She was put upon one-tenth of a grain (gr. 1-10) of nitrate
of silver three times daily, salt being interdicted. An addi¬
tional note taken one month after first apfiearance reads:
Anaesthesia apparently less, but pruritus of skin where eruption
existed much greater than before — eruption desquamating;
says she is “ oluolu loa ” much' better ; appetite improved and
says she longs for salt food, which I am inclined to think she
uses freely though positively prohibited.
Salt was positively prohibited, because in additiou to the
danger of neutralizing the effects of the nitrate of silver, it is
thought to have a deleterious effect in itself upon the disease.
The food of the native consists principally of “ poi” (a thick
paste made from the baked or powdered root of the tarum
esculentum) and fish, either salt or fresh, and much salt meat.
Some foreigners, not physicians I am careful to add, have a
928 Original Communications. [April
prejudice against fish and much salt food, on the gronnd that
leprosy is caused by such articles.
We were firmly convinced that great improvement had re¬
sulted from the treatment adopted iu L.’s case. Unfortuna'ely
we lost sight of her, she being afraid we would inform the au¬
thorities and have her arrested and removed to Molokai. I
heard afterwards she had been removed.
Case II. Poupouka, female, aged 14, full-blooded native,
residence, Waihee, Maui, came to the office August 27th, 1878.
She gives no history of any syphilitic taint. Her mother has
been affected as P. for the last three years. The man who
brought P. is the father by P.’s mother of a now healthy boy
two years old ; the man himself gives no indication of the
disease,
P. is rather deficient in intellect and can give no history of
her case. Examination shows the skin of hands, arms, legs
and feet tuberculated and infiltrated. Skin of face hyper¬
trophied aud shows two immense irregular black macula} on
each cheek ; right hand and entire right forearm anaesthetic ;
little and index fingers and thumb of left hand anaesthetic :
also back ulnar side of left forearm. She had been vaccinated
six years ago.
The treatment instituted was similar to that in L.’s case,
with the addition that she was to wash the diseased surfaces
daily with carbolic tar soap and anoint the same with solution
of iodide of sulphur in glyceriue.
The points of note in this case are, 1st. The combination of
the two forms; 2d. the partial or irregular affection of the
nerves; 3d. P.’s mother, though a leper, was not sterile, leprosy
according to some, causing sterility ; this, however, is further
contradicted by the fact that children have been born to lep¬
rous pareuts at the asylum itself; 4th. the macula} are also of
interest, but they occur associated with the disease otherwise
well marked.
We were unable to take any notes upon the result of the
treatment, for both Poupouka and Laliela were removed to
1880J Bemlss — A Feic Cases of Leprosy. 929
Molokai, about the middle of September. I might also add
that P. and L. lived in the same house at Wailiee.
Case III. Kealii, male, aged 40 ; residence, Wailuku,
Maui. He gives a history of buboes on two occasions, or as he
expressed it “ syphilis twice.” Can’t speak as to venereal or
other diseases in his parents. Brother died with u sores on his
body and lumps iu his skiu similar to patieut’s.” Says he has
been unwell about four years, but he first noticed these tubercles
about half a year ago. His general appearance is that of a
strong, healthy man. The skin of his face and lobes of his
ears greatly infiltrated and hypertrophied. That of bauds,
forearms and legs hypertrophied, and excessively tuberculated,
the same are covered with numerous scars — the seats of former
tubercles that have ulcerated. Mucous membrane of mouth
and pharynx thickened and tuberculated ; voice coarse. Was
vaccinated six years ago by a physician.
We note here the absence of anaesthesia ; he gave no indica.
tion or evidence whatsoever of it. He remembers having had
chancroids, but as is often the case everywhere, can’t recall
anything like chaucre.
Case IY. Kalepua, male, age 30, full-blooded native, came
to the office with the left side of face swollen, painful and pre¬
senting all the characteristics of phlegmonous erysipelas, for
which he was treated. It proved very obstinate, gradually
becoming chronic with diminution of pain but not of the
swollen condition. It finally improved somewhat under iodide
of mercury internally and external applications of opium and
acetate of lead; but he had been taking at different times
tincture of the chloride of iron, iodide of potassium, etc., for
upwards of a month. So unusual was the case that leprosy
was not suspected. Prolonged observation however led to. a
belief that it existed, and subsequent phenomena one by one
confirmed the diagnosis.
When a child he had an eruption upon his body which was
probably secondary syphilis ; since grown has had buboes ; his
mother died in child-birth ; father still living but complains of
“ heaviness and weight ” in his legs and feet.
930 Original Communications. . [April
The skin of the left side of the face and forehead was anesthe¬
tic and expressionless, still thickened, evidently hypertrophied,
there being no pain, heat, or redness. Muscles of left side of
face paralysed, causing drawing of corners of mouth and face
generally to right side, exactly as in hemiplegia. Paralysis
of left orbicularis muscle causing dropping of lower eyelid
(ectropion) and inability to move but slightly the upper lid.
Tubercles upon pharynx and posterior part of tongue. Slight
anaesthesia of two fingers (little and ring) of right hand. Was
vaccinated 9 years ago by a foreigner, not a physician.
After leprosy was suspected he was put upon nitrate of silver,
resulting in marked improvement in all his symptoms, especially
the anaesthesia, that of his hand disappearing entirely.
This case was unique in its commencement, looking so like
erysipelas and resisting every variety of treatment for over a
month, then gradually settling into a chronic form, finally
leprosy suspected. The diagnosis was gradually confirmed and
improvement occurred under nitrate of silver.
The preceding four cases are from those collected by Dr.
Enders and myself and probably illustrated the most perma¬
nent symptoms. They are, however, the histories of patients
rather in the incipient stages, and the photographs which we
had taken of the two first, would probably not show sufficient
of the disease to warrant their publication.
Those which follow are the histories of lepers already at the
asylum, and whose photographs were taken under the direc¬
tion of the Legislative Sanitary Committee appointed by the
last legislature to go to Kalawao and examine into the needs of
the lepers.
The statements accompauying the photographs were not
taken by us, but at Dr. Ender’s request by Father Damien,
resident catholic priest at Kalawao. Though not possessed of
medical authority they will aid materially in explaining the
photographs.
The following letter from the father is especially interesting :
Kalawao, Sept. 2, 1879.
Dr. F. H. Enders :
Dear Sir. — Your honorable note of the 25th July has been
lately received. I have taken the statements desired concern-
Case V.
(Photograph 1.)
1880]
Bemiss — A Few Gases of Leprosy.
931
mg the lepers who were photographed in 1878. Two of them
are gone, eight still live ; each one’s history shown iu the
blanks the best I could. A very few children arejborn here of
leprous parents and most of those have died ; there are a few
now from four to six years old, and nearly the half of them already
have signs of leprosy. May last, I received from Hong Kong,
China, a new medicine for the amelioration of leprosy — u Hoang
Kan Those who take it and can abstain themselves from fish
and pork feel a general amelioration. It is a beautiful tonic
and shouldbe introduced in this archipelago to keep down the
spread of this disease.
My own health continues to be the same as before ; perhaps
I have the germs of leprosy in my system, I am not sure.
Very respectfully yours,
J. DAMIEN,
Catholic Priest.
Case V. (Photograph 1.) Opu, female, age 38 years, native
of Kauai. Parents dead, not certain of what disease. Opu,
before she was married was paralyzed. In 1870 disease made its
first appearance, was afterwards put in hospital in Honolulu, and
from there sent to Kalawao. Her appetite is good but she is
unable to move around much. Her face, hands and feet, covered
with scars. Skin covered with dark dry cracking spots. Was
vaccinated by a physician on Kauai, result a good scar ; two
years afterwards taken with a paralytic stroke in the legs.
Since she was photographed the disease has made fearful
progress.
The report of the Legislative Committee says :
Opu, woman, 49 years of age, and three years at the settle¬
ments, did not show much indication of leprosy on first arrival,
but the symptoms of the disease developed very rapidly after
her arrival at Kalawao. Neither of her parents nor any of her
relatives had contracted the disease.
The photograph illustrates very finely the hypertrophied and
infiltrated condition of the skin of face and lobes of ears. It
is well to note also the absence of disease in her family, and
2
932 Original Communications. [April
tbe fact that she became affected at least with a nervous
disorder of an uncertain character, subsequent to having been
vaccinated.
Case VI. (Photograph 2.) Pilaui, female, age 41, na¬
tive of Kauai. Father still alive, mother died in child-bed .
both very healthy. Married in 1851 ; had three children. She
says she caught the leprosy from another native in 1872 by living
in same house. In 1874 had first appearance of leprosy with red
spots upon the body. In the same year was sent to Molokai
Does not remember having had syphilis. Legs affected as
hands and face. Skin of body dry and cracking. Eats well
and is able to be about. Was vaccinated by two foreigners, oue
a physician, both times with good result.
Extract from legislative report.
Pilani, a woman, 33 years of age, and three and -a half .\ears
at the settlement, says that her person showed very slight
indications of leprosy when she came here, but since her stay,
the disease has developed rapidly. She has a child, a boy, five
years of age, now living'at Waimea, Kauai, not a leper and in
the enjoyment of good health.
The photograph shows the tubercles scattered in the hyper¬
trophied skin of the .face. The ugly looking ulcers on her
hands are well shown.
Case VII. (Photograph 3.) Kahuna, male, 45 years old,
of Honolulu, four years at Molokai ; being deaf, can not find
out his history $ he had syphilis when young 5 is deaf, has sore
eyes, and asthma.
The committee report says :
Kahuna, 40 years of age, two and-a-balf years at Kalawao
His body indicating peculiar leprous blotches and marks, and
notable swellings in the groins was photographed as No. 3, but
owing to a defect in the focus the blotches do not appear.
Case VIII. (Photograph 4.) Kaluhi, age 15, male, of
South Koua, Hawaii.
His mother is an old leper ; never saw his father. Was
Case VI. (Photograph 2.)
.
i
■I
Case VII.
(Photograph 3 )
/
Case VIII. (Photograph 4.)
Case IX. (Photograph 5.)
I
1
/
\
Case X. (Photograph 7.)
1880J Bemiss — A Few Gases of Leprosy. 938
brought up by a guardian. Leprosy appeared in him at the
age of 5 or 6 years — he is now four years at the settlements.
Is strong and has good appetite. General appearance same as
in photograph. Bespiration as an asthmatic. Vaccinated
twice when very young. Apparently a case of inherited
leprosy, and in this connection, I copy from the legislative
report the following :
It is stated by Dr. Hoffman, who for some time had charge
of the leper patients in Honolulu, that in no instance had
he seen any symptoms of leprosy manifested earlier than
five years of age. Thus it may be that leprosy, like syphilis
requires a certain degree of growth before it begins to make
manifest its ravages upon the system. It makes it thus a sad
reflection, that perhaps the twenty-eight healthy looking
children of the leper settlement at Kalawao are, after all, only
doomed lepers.
Case IX. (Photograph 5 and 6.) Kalamau, female, 60
years old. Mother died of leprosy — father died of nervous
shakes. Kalamau enjoyed good health after marriage. She
had two children. She was infected with syphilis in 1845, by
her husband. She used native medicine which dried up the
sores. In 1852 leprosy broke out in red spots all over her body.
In 1856 commenced to lose fingers and toes. Still able to get
about. Now both feet half gone, hands have no fingers, almost
blind, mouth on one side, eyes always open, flesh wasted away,
skin dry. Was vaccinated after contracting leprosy.
The report says :
Kalamau, a woman, 50 years of age, from Honolulu, and at
Kalawao five years j a poor, helpless creature, whose palsied
and fingerless hands had to be held to enable the photographer
to take an impression— No. 6. The feet of this case without
toes — all destroyed by the erosions of leprosy.
Case X. (Photograph 7.) No history by Father Damien,
Nuluaai being dead. Committee report says : Nuluaai, male,
66 years old ; at Kalawao five years.
934 Original Communications. [April
Case XI. (Photographs 8 and 9.) David Ostrom, a white
man, age 60 years. Father and mother Americans, both
healthy. He contracted this disease on the Island of Maui ;
had had syphilis in 1850 in New York. In 1871, first felt
tenderness in bottom of feet. In 1872 first noticed yellow spots
on breast ; made their appearance after the use of cold water.
Body covered with salmon-covered spots; hands and feet
insensible to feeling ; skin dry and shrivelled. Good appetite
and able to be about. Vaccinated without effect in the States.
Committee report says :
Tom Ostrom, a native of the State of New York, American,
55 years of age, 3 years and six months at the settle¬
ment. No symptoms of the disease until about six months
before coming here. Went himself to be examined by
Dr. Enders and, when satisfied he had the disease, volun¬
tarily came to the settlement. He feels satisfied his case
is incurable. Would be willing to surrender his body to
be vivisected, if necessary for the benefit of medical science.
Wauts to die. His feelings are terrible. Voluntarily offered
his person to be photographed. His case is a marked illustra¬
tion of leprosy. Large swellings in groins, which often
suppurate. According to outside information, he was an
assistant for some years in the hospital at Lahaina. He took
some leper patients to live with him, in order to treat them for
cure, and the disease appeared after this association. Photo¬
graph 8 represents a front view of Ostrom ; photograph 9, a
back view.
Case XII. (Photograph 10.) No history by Father
Damien, Kaapu being dead.]
Committee report says :
Kaapu, a man from Waimaualo, the witness who testified
to the digging of the graves. That testimony is — Kaapu, 32
years of age, and nine years at the settlement, says that he
has been obliged to dig graves ever since he has come here.
His hands are in a very bad condition. Has lost several
joints of his fingers, and all are in an excoriated and suppura-
Case XT. (Photograph 8.)
Case XI. (Photograph 9.)
Case XII. (Photograph 10.)
Case XIV. (Photograph 12.)
'
Case XIII,
(Photograph 1L)
1880] Bemiss — A Few Gases of Leprosy. 935
ting condition. He is one of seven children and neither of his
parents, nor any of his brothers or sisters have contracted the
disease.
Case XIII. (Photograph 11.) Eph. Kanoe, male, aged
30, native of Hawaii. His father is now seventy years old, and
strong ; his mother, 46 years of age; she is supposed to have
had syphilis; she had nine children, Eph. being the oldest.
When young he had sores upon his body. At 1C or 18 he had
syphilis (buboes are meant probably). In 1871 he had for
several months discharge of bloody excrement — (dysentery),
and had a red spot on his right arm which was anaesthetic.
In 1873 all the arm was red. In 1874 this was cold and hot by
turns. Soon covered with bad sores. Iu 1876 redness
appeared on his face ; at the end of same year all his body was
black colored, and in 1877 he was sent to Kalawao. His present
condition is the same as when photographed, a little weaker,
but he continues to .move about. Whole skin leper-colored,
but clean. Vaccinated in 1853 by a physician.
Committee report contains following :
“ Kanoe Eparaima, a man, 30 years of age, and about two
years at Kalawao. A case to illustrate the loss of the eyebrows
as one of the effects of leprosy. ”
Case XIV. (Photograph 12). Wm. Crouningberg, aged
46, male, nativity Lahaina ; mother Hawaiian, father Ameri¬
can, both were healthy. C. healthy from youth up. In 1869
had an anaesthetic spot on right foot. In 1873 one appeared
upon face. Went to Honolulu for examination. In 1874 sent to
Kalawao. He is covered with salmon-colored spots. Hands
affected, fingers off’ one hand. Skin dry, shrivelled, crack¬
ing. Vaccinated a very long time before leprosy appeared.
During 4 months used Hoang Nan pills with wonderful effect
for amelioration. Looks somewhat different from his appearance
when his photograph was taken ; now covered with scales,
longest finger of right hand gone, both hands sore.
The above cases I hope will prove of interest to such of the pro¬
fession as are giving some attention to this rapidly increasing
936 Original Communications. [April
disease. They are necessarily more meagre than I could wish
to have them, but even those whose histories were taken by a
non -professional gentleman, illustrate many of the most interest
ing symptoms of leprosy, and every little helps to swell
the total amount of knowledge possessed of a disease.
It will be noted that syphilis or any syphilitic cachexiae
were in every case diligently sought for, for there are some on
these islands, as well as in India and elsewhere, who hold to
an intimate connection between syphilis and leprosy. If there
is any such relation as they claim, then is it unnecessary to
speculate as to the manner of introduction of leprosy into this
kingdom, for though my experience in foreign lands is confined
to these Islands, I am not prepared to read of a country where
syphilis is so prevalent, so grounded into the whole native
population as here. The problem, then, would be, how long the
disease — syphilis — left to itself, would require to become elab¬
orated into leprosy. But I am not willing yet to adopt such
an hypothesis, for then should leprosy be more general in the
families of those affected, as well as more common in other
countries, where there is a certain proportion of families
thoroughly imbued with syphilis, and from which they have
not been exempt for several generations. Again, anti-syphilitic
treatment should give some good results, which is not the case,
save when syphilis is added to the disease. Moreover, the
symptoms of the two diseases do not coincide in a way to
warrant such an opinion.
Vaccination was also inquired into. Alarmed by an invasion
of small-pox in 1853, a general vaccination of the whole popu¬
lation was ordered, and physicians being at that time very few
on the islands, non-professionals aided in the work. It is
charged by some that, as a natural result of the labors of the
heterogeneous force so appointed, uot only syphilis but also
leprosy was greatly increased. In my last circuit trip in my
district, I found very few adults who had never been vac¬
cinated.
This involves the question of inoculability, in my opinion
the main, if not the only means of propagation, other than in¬
heritance. That is, like syphilis it depends for its propagation
937
1880] Bemiss — A Few Gases of Leprosy.
upon the direct introduction of its virus into the blood. The
general immunity of those coming in constant contact with
lepers points to the absence of any direct contagions quality.
These statements are illustrated in the cases given above, and
it is not necessary to lengthen this paper by explaining them.
I will only quote the following from the committee report, as
one of many instances of similar nature coming under my
knowledge :
“ The committee observed in a hut a leprous woman, named
Makahiki, who presented all the appearances of a badly dis.
eased incurable case, and yet had her fine, healthy child, living
with her, a bright looking little boy, about 2 years of age. Her
husband, Kioni Kahiapo, a healthy, intelligent looking man,
with no appearance of any taint of leprosy about his person.”
“ Had been with her in settlement about five years, and would
remain with her as long as she had breath.”
The duration of life is on an average within a decade of the
undoubted establishment of the disease. With more strict
hygienic measures than seem possible at Kalawao, this might
be increased materially. The disease in itself would probably
be long in producing death, but it causes a vitiated condition
of the system favorable to pulmonary, hepatic and intestiual
troubles which prove rapidly fatal.
Treatment has been directed to only two points : 1, preven¬
tion of spread, and 2, palliative treatment, including the relief
of intercurrent troubles. In fulfillment of the first indication,
the government lias set apart a very favored quarter on
Molokai. It is open to the trade winds on one side, and on the
others is shut off' from the rest of the island by almost impreg¬
nable mountains. To this place the lepers are carried and sup¬
ported by legislative appropriations ; and here also is a hospi¬
tal where the helpless are provided for. Under the second in¬
dication, such as was possible has been done at the settlement
itself.
As directed against the disease itself, I hope nitrate of silver
will be more thoroughly tried. It certainly gave some good
results in several cases under Dr. Enders’ supervision, so far
as the affection of the nerves was concerned— a result intelligi-
938
Original Communications.
[April
ble in the light of its alterative affects upon the nerves. Un¬
fortunately it is impossible to keep a patient under observation
sufficiently long to carry out a line of treatment thoroughly.
Charelmoogra oil has been used in India with good results, so
it is claimed. We lately received from a prominent druggist
in New York a sample, but have not yet been able to report
any cases under its use.
Lahaina, Maui, Hawaian Islands,
December 15, 1879.
The Caesarean Record of Louisiana — A Correction.
By ROBERT P. HARRIS,
Of Philadelphia.
In no State of the Union has the operation of gastro-
hysterotomy been so often performed, and with such good
proportionate results as in Louisiana ; and in no state have so
many claims been made in addition, which after a long and
tiresome investigation have proved worthless. After my
statment of “ twenty operations ,” I discovered that one of
them was in doubt, and wrote to postpone the publica¬
tion; but the article was issued, and I must now correct a
portion of it, and thereby reduce the number to nineteen.
In looking back over my ten years’ research, I find that the
caesarean claims have in all amounted to 27 ; and that eight of
these have been rejected. The remaining nineteen I have
every reason to record with full credit, having been received
in a way to establish their genuineness. Two cases required
me to seek information in France before their final rejection,
and one operation had three claimants, as will presently appear
The following is a tabular record of the cases :
1880] Harris — The Ccesarean Record of Louisiana.
939
RESULT
RESULT
REFERENCE
NO.
DATE.
OPERATOR.
LOCALITY.
TO
TO
OR
WOMAN.
CHILD.
AUTHORITY.
1
Not known.
Francois Prevost.
Donaldsonville.
Recov’d
Saved.
Dr. Tho’s Cottman, N.V.
2
Not known.
Francois Prevost.
Donaldsonville.
Recov d
Saved.
Dr. Tho’s Cottman, N.Y.
3
About 1825.
Francois Prevost.
Donaldsonville.
Died.
Saved.
Dr. Tho’sCottman.N.Y.
4
In 1831.
Francois Prevost.
Donaldsonville.
Recov’d
Saved.
Dr. Tho’s Cottman.N.Y.
5
In 1831.
Cbas. A. Luzenberg
New Orleans.
Died.
Dead.
Drs. J. P. Davidson, and
Ernest S. Lewis, 1879.
6
In 1832.
Thomas Cottman.
Ascension Parish.
Recov’d
Dead.
The Operator, in 1878.
7
In 1838.
ADrnnken Midwife
North of N. O.
Recov’d
Saved.
N. O. Med. and Snrg.
Joirr. Yol. XI, p. 13.
8
In 1846.
J. A. Sondday.
Thibodeaux Parish.
Recov’d
Alive.
N. 0. M. and S. j. 1850-51
Yol. YI. p. 355.
9
May 17, 1849.
J. A. Scudday.
Thibodeaux Parish.
Recov’d
Saved.
N. 0. M. andS J. 1850-51
Vol. VI, p. 355.
10
July, 1849.
Thomas Cottman.
St. James Parish.
Recov’d
Dead.
N. 0. M. and S. J. 1851.
Vol. VII, p, 337.
11
Jan. 30, 1850.
Vincent Boaqui.
Near Opelousas.
Recov’d
Dead.
The Operator, April 15,
1871.
12
May 10, 1851.
Daniel B. Gorham.
Bayou Sara.
Recov’d
Saved.
N. 0. M. and S. J. Yol.
VII, p. 194.
13
1857.
A. T. C. Langen-
]New Orleans.
Died.
Saved.
N. 0. M. News & Hosp.
becker.
Gaz. 1857, p. 555.
14
Ang. 25, 1860.
J. C. Egan.
Bienville Parish.
Recov’d
Dead.
N. O. M. & S. J. July,
1877, p. 35.
15
Jan. 1860.
Beauville Claverie.
Donaldsonville.
Died,
Dead.
Dr. John JEv Duffel,
^ldsonville.
16
July, 1866.
Moody.
Athens, Claiborne
Parish.
Recov’d
Dead.
N. ai. and S. J. July,
187,.
17
Dec. 21, 1867.
H. C. D’Aquin and
D. Warren Brickell
New Orleans.
Recov'd
Dead.
N. 0. M. and S. J., 1868.
Vol. XXI, p. 454.
18
1873.
Trndeau and Felix
Formento.
New Orleans.
Died.
Dead.
Dr. Ernest S. Lewis,
March 5th, 1879.
19
Aug., 1873.
Chas. and Gaston
Near N apoleonviile,
Recov’d
Dead.
Drs. Thos. B. Pugh, Ber-
Bordis.
Assumption Parish,
tie, La., Ang. 21, 1879.
It will be seen that nine cases were published, and ten not.
The twentieth operation, which I have rejected, was claimed
with every appearance of truth, as a caesarean case, by one of
the parties present at operation 11, which he also asserted in
numerous letters to have been his own. So strong, in fact, was
the testimony brought by Dr. Pilate to establish his claim to
case 11, and so weak the opposition, that he was at one time
credited with having performed two caesarian sections, as he
insisted he had done, on the same woman. The late Dr. Fred¬
erick Acher, also present, wrote out two accounts of opera¬
tions performed by him on this same woman, the first caesarian
and the second a laparotomy, for the removal of a utero-ab-
dominal pregnancy of a very unique character, the placenta
being in the uterus ; the cyst and its contents in the abdom¬
inal cavity, with the cord and membranes passing through the
ununited incision made in the uterus by the knife in the cae¬
sarian section. Dr. Acher sent this record of his to his native
city Lyons, and, it appeared in the Gazette Medicate de Lyon ,
after having been presented before a medical society by Prof.
3
040
Original Communications.
[April
Bouchacourt, in 1860. I have had the original of this commu¬
nication sent to me to read, by Dr. Bouchacourt, and have now
a copy of it.
Dr. Boaqui was unfortunately a poor witness for himself
against these two claimants, but finally obtained justice, by the
fortunate discovery of two leaves of an old ledger among some
waste papers, in which were the entries made at the time of
his two operations in 1850 aud 1851. The second operation
was a laparotomy after rupture of the uterus, and performed
on July 30, 1851, and from this the woman also recovered. On
May 4, 1853, she ruptured her uterus a second time, and Dr.
Boaqui operated upon her post mortem, as she was dead when
he arrived. He attributed her death to hcemorrhage, and
thought that the placenta was seated in the line of rupture.
1 was thirteen months in getting at the truth of this case.
There were four physicians present at operation 11, and only
one made no claim to it. Thinking to find an impartial and
truthful witness in him, I sent a letter to him at the south of
France, in which I gave the three claims as seut to me from
Louisiana, Ohio and Lyons, aud asked him to send me the
“exact truth,” which in his answer he claimed to have done,
making both cases caesarian, and giving the first to Acher, aud
the second to Pilate. This writer, Dr. Dabrin, also confirmed
all that Dr. Pilate had written to me about the second opera¬
tion. I was satisfied, from the habits of Acher, that he had not
operated, aud the finding of the old leaves settled the claim
against Dr. Pilate, who ceased his communications after I seut
the papers to show him by a medical friend. He expressed no
desire to see the evidence against him. The combined, cun¬
ningly claimed indifference, and yet pertinacious adherence
of this man of seventy-five, with the wouderful evidence he
presented from the vicinity of the operation, were calculated
to deceive any one, as they did deceive Dr. Reeve of Daytou,
several of my medical associates and myself. I am, therefore,
all the more ready to do justice to Dr. Boaqui, in re-establish¬
ing for him the claim that I gave him in the American Jour¬
nal of Medical Sciences in 1878. I hope there are not many
Pilates, Achers aud Dabrius in the medical fraternity of Louisi-
1880J Love — Hypodermic Administration of Ergot. 941
ana at the present day. They give a statistical worker, who
desires to write correctly, a world of trouble.
General Summary. — Operations, 19 5 recovered, 14; died, 5.
Children alive at delivery, 9; dead, 10; soon died, 1. Women
operated upon twice, 2 — all four children alive; one died in a
few minutes. Parishes of Ascension and St. James, 7 opera¬
tions ; New Orleans and vicinity, 5. Unpublished cases with¬
held respectively, 53, 48, 46, 21 years, etc.
713 LocustIStreet, Phila.,
February 13th, 1880.
The Hypodermic Administration of Ergot.
By A. C. LOVE, M. D., Donaldsonville, La.
It is probable that no single drug mentioned in the materia
medica presents such a checkered history as ergot. Employed
for its parturifacient property, it was long known as the
mutterkorn of the German midwife, and in the latter part of
the seventeenth century, Carmerarius and Bantzmanni lauded
its virtues. In France, in 1774, because of its reputed violent
action, its administration was prohibited by legislative enact¬
ment. In 1807, Dr. Stearns, of New York, recalled the atten¬
tion of the profession to it, but for years, among the best
authorities, there existed great difference of opinion concerning
its efficacy as a parturifacient. Many declared it wholly in¬
efficacious, while Mde. La Chappelle dealt it the ironical
thrust : “ Its innocence is its great virtue.”
But by reason of that property which ergot possesses, of
exciting contraction of involuntary or unstriped muscular
fibre, which has been satisfactorily demonstrated by uumerous
experiments,, it has become one among the most effective
remedial agents of modern therapeutics. Though, until late
years, the favorite field for its operations was the gravid
uterus, yet, acting as it is supposed to do, through the nervous
centres and exciting the contractility of the middle coat of the
942
Original Communications.
[April
arteries and tlie elastic membrane of the capillaries, it exerts
an influence over the whole circulatory system. Besides, the
field of its action embraces the trachea and the bronchial
tubes, the ducts of various glands and the iris, part of the oesoph¬
agus and the stomach, the intestinal canal and the bladder,
and last, but not least, that great and involuntary muscle, the
heart.
Though ergotiue, or Boujean’s purified extract, has been re¬
commended as the preferable preparation for subcutaneous
injection, and marked benefit has resulted from its use in cases
of haemoptysis (Dr. Bitchie, Ed. Med. Jour., February, 1872),
lneinatemesis (Ed. Med. Jour., Dec. 1871), varicose veins ( New
Rem., Oct., 1872), and aneurism (Langenbeck, Am. Jour. Med.
Sci ., July, 1869) ; yet the administration of Squibb’s fluid ex¬
tract hypodermically in a case of black vomit is reported as
having proved happily efficacious (Dr. S. S. Herrick, N. 0.
Med. and Surg. Jour., Oct. 1878).
It is, however, the object of this paper only to notice recorded
cases of its hypodermic use in the lying-in chamber, and to
make brief mention of two such cases in the writer’s practice.
In cases of labor, where there was much irritability of the
stomach, Yilleueuve preferred an infusion of ergot given by
enema ( Waring’s Ther ., p.253). In a case of post-partum haem¬
orrhage, Dr. Fred. D. Lente injected twenty-five drops of
Squibb’s fluid extract under the skin of the thigh ; and, though
various other measures had signally failed, this readily checked
the flow of blood (Med. Rec., Bov. 15, 1869).
Case I.
February 6th, 1879 — M. R.,aged 16 years, and arrived at the
full term of pregnancy, fell from a doorway the distance of five
feet, her forehead striking ou a brick pavement. She was
found in an insensible condition and carried to her bed ; appli¬
cations of cold water were made to her head, and during the
night labor pains set in, accompanied by convulsions. At 11
o’clock the followingmorning she was seen by me. Over the site
of the right frontal prominence there was an cedematous enlarge¬
ment ; but, so far as could be ascertained from careful manipu-
1880J Love — Hypodermic Administration of Ergot. 943
latiou, no fracture of auy one of the cranial bones. The os
uteri was iu a flaccid condition, periodical contractions imper¬
ceptible, the pulse full and rapid, and convulsions recurring at
intervals of fifteen minutes. An attempt was made to admiu-
ter hydrate of chloral per orem , but signally failed on account
of the unconscious condition of thepacient. Resort was made to
the lancet, several ounces of blood, were taken from the left arm
and the convulsions ceased. There still being no evidence of
returning uterine contractions, fifteen drops of the fluid extract
of ergot (U, S. P.), diluted with warm water, were injected
subcutaneously over the deltoid muscle of the left arm. Within
ten minutes uterine contractions were excited, and their regu •
larity and increasing vigor gave encouragement for a repetition
of the dose after the lapse of twenty minntes, and the labor
was conducted to a successful termination.
Case II.
May 22d, 1879 — Was called to see C. G-., aged 32 years, the
mother of two children and now in the sixth month of gestation,
threatened with miscarriage. For months she had been in deli¬
cate health and troubled for several days with a sanguineous
discharge from the vagina. On the day previous to my visit,
she had experienced labor pains which attained their maximum
iu a few hours, and gradually subsided without relieving the
uterus of its contents. The os uteri was found in a relaxed
condition that admitted the introduction of two fingers, the
membranes already ruptured and the amniotic fluid escaped.
A partially detached placenta afforded a constant flow of blood
from the os uteri, and the offensive odor emitted justified the
surmise, soon verified, that the foetus was undergoing decompo¬
sition. Fifteen drops of the fluid extract of ergot were given
hypodermically, the uterus aroused from its dormant state and
periodical contractions excited. As the loss of blood continued,
the forceps were applied to the head of the foetus as soon as it
cleared the os uteri, and by gradual traction during the periods
of contractions, the delivery was hastened. The injection of
ergot was repeated, the partially detached placenta peeled
from the wall of the uterus with the finger, the uterine nozzle
944
Original Communications.
[April
of a Davidson’s syringe introduced and the cavity of the womb
cleansed with a copious injection of warm water. The uterus
contracted firmly and the patient recovered without experien¬
cing any septicaemic troubles.
In cases of confinement, where from any cause speedy deliv¬
ery is desirable, or where life is endangered by post partum
haemorrhage, so far as my limited experience justifies me in
urging it, the subcutaneous administration of ergot should be
regarded as the preferable measure for adoption.
Reflex Sciatica and Lumbago Cured by Removal of Cause,
Stricture of Urethra.
By T. S. DABNEY, M. D., New Orleans, La.
On February 16th, Mr. C., aet. fifty, of powerful frame and
vigorous constitution naturally, came from the country to put
himself under the treatment of Dr. Sara’l Logan and myself.
Twenty years ago Mr. C. had a severe attack of gonorrhoea,
which persisted for many months, in spite of due treatment.
He suffered no ill effects from this persistent gonorrhoea, until
five (5) years ago, when he was compelled to quit work on
account of a severe attack of lumbago and an incessant desire
to micturate.
At times micturition was extremely painful and could
only be accomplished whilst taking a hot hip bath. Attacks
of sciatica, lumbago and other neuralgic affections of more or
less gravity, have occasioned him much trouble since his
first attack, five years ago. He spent several months at Hot
Springs; he has been under the treatment of physicians in
Nashville and New Orleans — not to mention several most ex¬
cellent country physicians, and yet not one of his medical
attendants ever suspected the cause of his neuralgias, and
consequently they all adopted the palliative plan of treatment.
About three months ago his sciatica and lumbago forced
him to keep his bed, where he was kept under the influence
1880J Dabney — Reflex Sciatica and Lumbago. 945
of morphine most of the time. His sufferings are represented
as having been extremely great. As soon as he could hobble
around on crutches, with much pain and difficulty, he took the
cars and came to my office. At one o’clock, on the 16th ult.,
I took him to Dr. Logan’s office. We first carefully examined
the urine with chemical reagents and under the microscope;
but failed to get any clue to his disease. We next carefully
explored his bladder for stone, but found none. Then with an
olive pointed bougie we examined his urethra for stricture.
We found two — one just behind the meatus, the other in front
of the bulbous portion of the urethra.
The patient was at once put on full doses of quinine and
opium and was sent to his room to rest until next day. The
passage of instruments in our examination entirely relieved all
neuralgic symptoms for several hours. Next day, 17th, we
found it necessary to cut with a bistoury the first stricture ;
the other, we determined to dilate. From the moment the
front stricture was cut, all pain vanished to return no
more. In ten days we were able to pass a Ho. 14 steel bougie
through the bladder. On the fourth day we put our patient
ou the following prescription, as he needed a tonic badly.
IJ; Quiniae Sulpliat.
Ferri Redacti, ^ 3j;
Ext. Belladonnse, gr. v;
Ext. Rhei, 3j. M.
Make into pills xxx S. One three times daily.
We passed a bougie every second or third day. In three
days from the time of his arrival he was ab'e to walk without
pain or stick. His general health rapidly improved. On the
16th he came to Hew Orleans on crutches; on the 22d he
walked three miles for recreation. We taught him how to use
the bougie, and having advised him to continue taking the
prescription we gave him, discharged him ou the 27th of Feb¬
ruary — cured.
He was in town to-day, 17th March, and said he was as well
as ever he was in his life. He commenced work again on the
first day of March, and has been working hard ever since.
946
Correspondence.
[Apri
ORRESPONDENCE.
Clinton, La., Feb. 1st, 1880.
Editors New Orleans Medical and Surgical Journal :
Gentlemen — It may be presumption on my part, being only
a country doctor, to differ in opinion with “ A Fellow of the
Academy of Sciences of New Orleans,” nevertheless, I make
bold to do so, and feel it a duty to make public my opinion,
when I can give, as I think, good reasons for the same
What I refer to, is the lecture of U. K. Milner, M. D., before
the Academy, November 16 and December 18, 1879.
Gen’l G. W. Munday, one of our representatives in the
Legislature, sent me a copy of the lecture. It is very interest¬
ing and very instructive, and I shall only take issue with him
on one position. He says yellow fever is not contagious. I
say yellow fever is contagious. I shall not undertake to dissect
his lecture, or dispute any of his statements, or give any
opinion in reference to the character of the disease, except as
to the contagiousness of the same.
A. T. Semmes, M. D., of Canton, Miss., in a very edifying
article published in the December number, 1879, of your
journal, on page 594, makes the following remark :
“ With regard to contagion, our epidemic of 1878 has
completely confounded my opinion.” I take the privilege of
reiterating the same, with the exception of one word. Instead
of confounded , I would say changed. I did not believe, previous
to 1878, that the fever was contagious, although the epidemics
of 1853 and 1867, and also sporadic cases in 1854 and 1855 in this
parish presented many points that were stumbling blocks in
the way of believing in the wow-contagious character of the
fever.
I give, as the reason of my belief, stubborn facts that can
be proven. Of what I write now, I made a report in November,
1878, to the Yellow-fever Commission, through Prof. Bemiss.
The report was very imperfect, as likewise is this communica-
1880 1
Correspondence.
947
tion, owing to tlie difficulty, situated as I was, of taking notes
of the cases under my care.
In 1878 our parish was visited by the scourge, and 9G cases
came under my observation. The cases were all in the country,
and, in order to give them proper attention and not neglect
other duties, I was compelled to ride from 30 to 40 miles every
24 hours.
They were confined to four plantations, and 95 of the cases
could be traced to actual contact with individuals sick with
the fever. By contact, I mean in the room with a yellow-fever
patient long enough, had it been small small-pox, to have
contracted the disease, had the individual been liable to it.
Of those directly exposed, and liable to be taken if in a yelloic
fever atmosphere , only one escaped, and he was a nurse, in good
health and very particular to keep himself so. I speak here¬
after of three children iu one family not getting sick, but they
were not directly exposed.
Previous to the first case, September 7, Clinton and the
country around for ten miles were unusually healthy. During
the prevalence of yellow fever there was but little sickness out'
side of those four plantations. What there was, was of a char¬
acter likely to occur at any season of the year, as bowel com¬
plaint, mild intermittents, etc. The first case was the landlord
of a plantation five miles from Clinton, who at the time was not
known to have been out of the parish for some time. This of
course surprised us all. The thought of yellow fever did not
at first enter any mind. As his case progressed, I felt that, if it
were possible for the yellow fever to break out suddenly in a
healthy section of country, this man must have it. He
died, and even then I could not feel convinced that it was
really yellow fever, until others took it who had nursed him.
It was thought that he might have caught it from opening
blank books for registration that he had received from New
Orleans, he being clerk of the registration board. It was as¬
certained, however, some time after the fever was over, I be¬
lieve in December, that he had visited Baton Rouge and
New Orleans. From that place it spread, not in an epidemic
4
Correspondence.
948
[April
over the country, but only from those visiting as friends and
nurses. The people here were, as all over our land that year,
panic stricken, fear preventing the usual visiting; and it was,
therefore, confined to the before-named four plantations. One
exposed to it, and not resident of the house where it was,
would, on feeling sick, go to his or her home ; then the whole
family did, one after another, and sometimes more rapidly
take it. Whites and blacks on other plantations would not visit
the sick, and therefore did not get sick. So far as cleanliness
was concerned, the houses of the sick were as clean before the
fever as the houses of the well.
Not an individual had an attack who was not exposed to it.
One gentleman who lived two miles west of Clinton, and
seven miles northwest of the house where the first case oc¬
curred, after assisting in nursing and burying an old friend
about five miles further off, went home, and in a few days was
taken down. His family was composed of himself, wife and
four children. He sent for me immediately. 1 found him up¬
stairs, his wife and oldest child, a daughter, about 12 years
old, in the room ; the three younger children out in the yard
playing. Having by that time been converted to the contagion
theory, I insisted on those children not going up stairs, and not
even being with their mother or sister, except after they had
been out in the air or otherwise freed from the fever germ.
These three children escaped ; the other child (12 years old)
had a severe attack; the mother, a healthy lady and very
prudent, took small doses of quinine every day and escaped
with a light attack.
Now if the disease is not contagious, why was it so limited ?
Why did nearly all who never had an attack catch it after
being exposed to it "?
Why did not people living less than one-eighth of a mile from
where it was, who did not come in contact with individuals
sick with it, escape ?
There was scarcely an individual iu that section of the
country who had ever had it.
That it was yellow fever, I know. My first experience was
iu 1853. 1 was one of the many cases in Clinton that year. It
1880J
Current Medical Literature.
949
was the first year of my practice in this place. I saw then at
least 300 cases. After that, previous to the war, I saw a num¬
ber of cases. In 1867 we suffered from as severe an epidemic
as in 1853, and during nearly all the time the whole burden of
medical attention fell upon me. I agree with Dr. Milner, in the
necessity of local sanitary measures, not solely to prevent yel¬
low fever, but as far as possible to prevent all sickness, and
reach as near as possible that condition so beautifully described
by Dr. Richardson, of London, Eng., as “ Salutland.” I have
written this from strong convictions of duty, u pro bono publico ”
Yours truly,
O. P. Langworthy, M. D.
URRENT /VlEDICAL
TRANSFUSION OF BLOOD THROUGH THE PERITONEUM.
From the Indipendente of Turin, February 25th, 1880.
(Translated by Dr: JNO. DEL’ORTO.)
We have to register another triumph of modern experimental
investigation. Professor Ponfick of Breslau performed last
year the operation of transfusion of blood through the peri¬
toneum in three patients, with very satisfactory results.
The experiments, that he had previously made on dogs, had
convinced him that all the blood injected in the abdominal
cavity is immediately absorbed, and brought into the current
of circulation, as no trace of blood was found in this cavity in
the autopsy, nor any haemoglobinuria appeared in the excretions
of the animals.
Later the same experiments were pursued on rabbits by
Professors Bizzozero and Golgi of Italy, who obtained the
same results, that is, twenty minutes after the injection, a
remarkable increase in the quantity of the circulating blood
corpuscles is noted by the chromocitometer (an instrument
invented by Bizzozero, through which the quantity of hcvmo-
globine existing in the blood is measured with a perfect
exactitude). On the 29th of January of this year Doctor
Golgi had occasion to try the experiment on a sick man.
It was in the insane asylum of Pavia — a gentleman affected
with lipomania , reduced to a state of extreme anaemia. The
950
Current Medical Literature.
| April
therapeutic agents administered having proved useless, the
doctor thought of the transfusion of blood through the peri¬
toneum. The relief was immediately felt by the patient.
The instrument for the injection, as well as the mechanism
of the operation, is very simple and easy: a metallic canula
with a spout communicating with a gum elastic tube, at the
end of which a glass funnel is applied. After having closed
the spout, defibrinated blood is thrown through the funnel in
this apparatus; the canula is pushed into the abdomen at
about 2 inches under the navel in the linea alba, the spout is
then opened, and the blood goes spontaneously and smoothly
into the peritoneum. The spout is closed again, the canula
withdrawn, and the wound dressed with simple sticking plaster,
lu this case the' quantity of blood injected was 300 cc — the
operation lasted 12 minutes.
The pain and the consecutive fever were very slight.
The following are the measures of the haemoglobine as takeu
by the chromocitometer.
Before the operation — hmmoglobine —
18 hours after the operation — hamioglobine.
30
it
it
it
40
u
it
it
2 days
it
it
3
it
it
it
4
it
it
ti
5
tt
it
it
0
It
it
it
9
u
it
it
11
it
it
ii
14
it
it
it
ti
ti
ii
ii
it
ii
ii
it
it
it
ii
ii
it
ii
ii
ii
ti
ii
ii
ii
35.8.
41.1.
48.0.
51.1.
52.3.
53.9.
54.4.
50.1.
52.3.
55.5.
55.0.
57.9.
It is evident, that the increase of the hamioglobine in the
last days is directly due to the improvement in the geueral
constitution. The patient had now a good appetite.
It would be rather premature now to speak of the advantages
that may be obtained from this method of transfusing blood
into the human system. It seems, however, certain that in
many respects it ought to be preferable to the other method
through the veins — 1st, for its simplicity ; 2d, for the greater
amount of blood that may be injected through the peri¬
toneum, and finally, for the less risk in causing shock or
embolism, that always makes direct transfusion a very
dangerous operation.
RELATION OF EPILEPSY TO INSANITY.
By J. L. Cleveland, M. D., Cincinnati.
There are some points in reference to the influence of epilepsy
upon the mind that are generally conceded. That, as a rule,
repeated attacks of epilepsy have a tendency to weaken the
Current Medical Literature.
951
1880]
mind of the individual, and may eventually produce dementia,
or even positive insanity. Trousseau, in the following para¬
graph, graphically pictures the epileptic constitution : “ The
functions of organic life are impaired and become languishing.
Epileptics are subject to cardialgia, flatulence and spontaneous
lassitude and trembling ; they have a tendency to venery and
onanism ; they do not, as a rule, live to an advanced age.
The cerebral function, the intellectual faculties become more
and more degraded.”
Exceptions to these well known conditions are recorded and
some of them are historical, where the intellectual faculties
were not impaired in the least, but on the contrary, the neuro¬
sis seemed to have heightened the intellectual power (Caesar,
Mahomet, Napoleon and Swedenborg are said to have been
epileptics). But we are all witnesses to the general truth of the
proposition, that repeated attacks of epilepsy have a deterior¬
ating effect both upon the .mind and body, that it degrades the
body, the mind and the moral nature. The above is generally
admitted. It is the medico-legal aspect of the question that we
wish especially to dwell upon ; as to the criminality of possible
deeds of violence committed by epileptics, and as to the influ¬
ence of epilepsy in predisposing to crime.
Is there Anything in the epileptic neurosis that predisposes
to crime ? Ir may be remarked here that the condition usually
expressed by epilepsy does not cover the ground fully that
properly belongs to this question. By epilepsy we mean that
peculiar state in which there is a sudden and complete loss of
consciousness, associated with convulsions. In addition to this,
we should include those kindred conditions, masked epilepsy,
epileptic vertigo, absence, ecstacy, catalepsy, and possibly som¬
nambulism and hysteria. These may all be classed together as
the epileptic neuroses. This classification will be granted,
when it is considered bow nearly related all of the above men¬
tioned conditions are to epilepsy and how frequently they pre¬
cede it, pointing to its approach or even occuring in conjunction
with it. It is estimated in Reynold’s System of Medicine
that in epileptics (properly so-called) ^ of the cases have per¬
fect average mentality, that is, their minds are not perceptibly
atfected by the attack. This would leave § of the class whose
miuds are more or less affected by the disease. The same
author informs us that of epileptics about .10 are insane.
This much can be stated as positive, that some epileptics
may pass through life, attend to business and not be visibly
affected mentally or physically by the infirmity, but in most
cases the mind suffers in memory or reason, or both, producing
in some cases harmless dementia ; while in another class
mania is developed either preceding, coincident with or follow¬
ing the attack.
The medico-legal aspect of this subject is most important,
whether considered in reference to the testamentary capacity
952 Current Medical Literature. [April
of the epileptic or to his responsibility in case of crime. We
wish to consider only the latter at present.
In order to introduce the subject, let us suppose that a mur¬
der has been committed, and it turns out that the murderer is
an epileptic, what bearing should this fact have before a court
of justice? Does the fact that he is an epileptic free him from
the consequences of his crime ? It does not, for some epilep¬
tics are as responsible by virtue of their mental and moral in¬
tegrity as any other class of men. But it does raise a very im¬
portant doubt in favor of the murderer. The disease may have
rendered the criminal weak-minded, so that his will-power was
insufficient to govern his passions under provocation, or maybe
his epilepsy may have been attended with insanity, and the
man was insane when he committed the crime. If it can be
proved that the crime was objectless, entirely without motive,
this would settle the question of responsibility. But perhaps
this epileptic has always been considered of sound mind and
good average capacity. But he is an epileptic, and may not the
influence of passionate anger developed in him a condition of
epileptic insanity ? Ho one can doubt but that such a thing
would be possible, but it would be impossible to affirm posi¬
tively that such was the case. Suppose the criminal should
affirm that he was unconscious at the time, and did not know
that he had committed the deed until he was informed of it
afterwards. If this could be proved, it would only be iu ac¬
cordance with the epileptic neurosis. But it turns out there is
method and evident deliberation in the murder. Is there any¬
thing per se in the epileptic constitution that would cause the
individual to nourish rensentmeut and plan revenge ? In that
respect he would stand on the same ground as other people.
He loves, he hates, he cherishes revenge. But there is this dif¬
ference, his infirmity has made its impress on him. The epi¬
leptic is an unknown and uncertain quantity, because his
attacks are possible at any time. Frequently before and after
the attack his disposition changes ; he is moody, suspicious,
melancholic, apprehensive; often quarrelsome; easily of¬
fended ; and clinical history tells us he may even plan and
execute revenge, though fortunately he is usually kind and
inoffensive. Sometimes he is subject to ungovernable out¬
breaks of passion. His will-power is deteriorated and shat¬
tered, and for the time he may be like the savage entirely
under the influence of his passions.
Maudsley and Trousseau dwell upon the furious character of
epileptic mania. The disposition to destroy something animate
or inanimate seems to be irresistable. Of course, if it can be
proved that the epileptic was insane at the time lie committed
the murder, the question of responsibility is decided.
The murderer may have what is called masked epilepsy,
that is, there may be no convulsions.
11 Instead of the morbid action affecting the motor centres,
1880J Current Medical Literature. 953
the mind centres are seized upon, resulting in a paroxysm of
mania, producing what Maudsley speaks of as an epilepsy of
mind. These are described as coming on suddenly, the same
as epileptic attacks, and disappearing rapidly in a similar
manner, and during th eattack the sufferer is said to be un¬
conscious of his actions.
Epileptic insanity manifesting itself chiefly by irritability,
suspicion, moroseness and perversion of character, with
periodical exacerbations of excitement, in which visions and
criminal acts are committed, showing itself in fact in a profound
moral and affective derangement, may occur periodically from
time to time, for months or even years before distinct epileptic
fits declare themselves, these at last making their appearance
and supplying the interpretation of the previously obscure
attacks of recurrent mental derangement. Morel has poiuted
out that some cases of suicidal and homicidal mania are really
cases of this kind, in which an epileptiform neurosis has
existed for a long time in an undeveloped or marked form.”
A case is mentioned where a man had had epilepsy in his
youth, none having been noticed for forty years. There was
nothing especially noticeable in him except an inclination for
good living and a condition of exaltation in the spring. One
day he suddenly stabbed his aged mother in the throat several
times, and when she fell down sat upon the body and stabbed
her repeatedly. When he was seized, he exclaimed, “ She is
a villain who has done me all the injury possible; I ought to
have killed her long ago.” There was no discoverable motive
for the crime, but it was discovered that for several years, during
the periods of exaltation in the spring, he had reviled his
mother and threatened to kill her, and the date of the murder
corresponded to the period of exaltation. Another interesting
case is narrated where an epileptic had ceased to have convul¬
sions, but in place of these was developed an irresistable
impulse to commit murder. The sufferer was conscious of his
terrible condition. When the impulse seized him, he said he
felt as though he must kill something, if it were only a babe.
To his mother and father, whom he loved dearly, he would cry
in a’ loud voice, “ Save yourselves, or I must strangle you.”
When it was over, he cried, “Unloose tne, alas! I have suffered
greatly, but I am well out of it, since I have killed no one.”
I quote further from the same author illustrating the epileptic
neurosis: “The form of mental disorder which corresponds
to the petit mat , or epileptic vertigo, may be described as a
great confusion of ideas, accompanied often by instantaneous
impulses to violence. Those afflicted by it become sad and
morose without any cause in external circumstances, are
profoundly distressed, and exhibit much irritation against
those who are about them, suffer from loss of memory and
dullness of intelligence, so they cannot collect and fix their
thoughts, feel sadly that they are no longer themselves, that
they are impelled to strange or violent acts by a power they
954
Current Medical Literature.
[April
cannot resist ; oppressed by a strange anxiety or dread, they
leave their homes and wander about the street or country ; all
the painful ideas which they have conceived of at different
periods of their lives come back and fasten upon their minds ;
they are overwhelmed with a vague anxiety and terror. In
this state of confusion and distress they accuse their friends of
hostility and imagine persecutions which have no existence out
of their morbid fancies, and they do unlawful deeds, such as
theft, incendiarism, suicide or homicide; some relieving them¬
selves by destroying inanimate objects, others killing them¬
selves in order to get rid of their anxieties and fears, and
others attacking in a blind and desperate manner persons
whom they chance to meet when their terror and distress
render their impulses uncontrollable.
The deed of violence done, either there is immediate relief,
the indefinable anxiety and confusion of ideas disappearing,
and they recognize what they have done, or they continue in a
state of excitement, unconscious or very imperfectly conscious
of the gravity of their acts. When they come to themselves,
their memory is uncertain and confused, like that of a person
awaking from a terrible nightmare ; they may remember the
acts in a fragmentary way when they are recalled to their
minds or may deny them altogether. Let him who would
realize, so far as it can be done by a sane mind, the mental
state of those afflicted beings, try to recollect the most painful
dream he ever had ; let him reflect upon its grotesque incon¬
sistencies, the blest relief which he experienced when he awoke
and found it was a dream ; the fragmentary remembrance
which he retained of it and the little desire which he had to
live it over again in memory ; let him then suppose it to be no
dream, but conceive himself to be overwhelmed by the horrible
nightmare day by day, and to be as he surely would be,
incapable even of the hope of relief; what cry would then
suffice to express his agony and despair, save the cry of
supreme agony, u My God ! My God ! Why hast thou for¬
saken mef? What act, save an act of suicide. We should not
apologize for crime, but we should have as clear an under¬
standing as possible of the organic weakness of the human
body. Nearly related to epilepsy are somnambulism, catalepsy
and hysteria, these conditions constituing a well defined
neurosis ; and in case of the commission of crime, the fact that
this neurosis exists, will very properly open up the question of
possible alienation at the time of the commission of the crime.
Cases are on record where somnambulists have committed
murder. The fact that vicious criminals may and do similate
these conditions should only stimulate us to investigate this
subject, further and see if it be true that epilepsy and kindred
neuroses, when they are found to exist in a criminal, are
a sufficient reason to question his responsibility. That it opens
the question of responsibility there can be no doubt, and that
Current Medical Literature.
955
1880]
this plea has more than once cheated the gallows of its own is
beyond perad venture, nor can there be any reasonable doubt
but that, from ignorance of this subject, mauy a luckless
unfortunate has been hung while innocent of the crime imputed
to him. — Cincinnati Lancet and Clinic , Jan. 17.
THE JOHNS HOPKINS UNIVERSITY AND HIGHER EDUCATION,
WITH A GLANCE AT THE HOSPITAL BUILDINGS.
By George Halsted Botland, A. M., M. D.
Hippocrates complained of affairs, educational and profes¬
sional, at Athens. A few centuries later, in the Augustan era,
distinguished alike for its science, art, and literature, it was
the custom to praise the past at the expense of the present.
In the nineteenth century civilization and culture have attained
such a high standard that the reverse is the case, and the
present is praised at the expense of the past; at least, it is so
with the authors of certain pamphlets and articles that within
the past year or two have made their appearance in our cur¬
rent literature. * These productions, whilst deploring the low
status of the medical profession iu particular, and the misman¬
agement of American universities, medical colleges, and insti¬
tutions of learning in general, impress strenuously upon the
public mind the glaring necessity for a more elevated esprit de
corps , with greater scientific attainments among practicing
physicians and professors, together with the urgent need of a
higher standard of education in every department. These
depredators hold, in some instances, diplomas of the very insti¬
tutions they cry down, and are among the first, when perplexed,
to call in consultation the more aged and experienced members
of a profession whose status at other times only merits their
contumely.. The strifes and jealousies of rival schools are
brought to light and dwelt upon.
And now, amidst all this educational anarchy, appears the
Johns Hopkins University, with its brilliant array of talented
professors and tutors (embracing some foreigners), to rescue
our institutions, both general and special, from the total
wreck that threatens their systems. Just as the Renaissance
* In the following article the author has made free use of the programmes of the Johns
Hopkins University and of the Fourth Annual Report, edited by President Gilman, in[order
to show from them directly the relation ofthenew university to other institution sof learn¬
ing, especially to the medical schools and the medical profession of Baltimore. The dis.
cus8ion on this point is just now going on with considerable vigor. The most striking
article that has yet appeared is a pamphlet by John S. Lynch, M. D. This gentleman, for
years a practitioner and professor of medicine in one of our leading colleges, ably handles his
subject, and depicts the true condition of educational and professional affairs in our city.
He has '• seen none of the evils " denounced and deplored, but has noted many improve¬
ments and advances ; among them are the establishment of seveial hospitals for the treat¬
ment of special diseases, the establishment of an out-door clinic at which more than
thirty thousand patients are treated annually, courses with the use of the laryngoscope
and microscope, etc. The increased number of professors in our medical schools, the high
standard of the profession and their many and valuable contributions to literature, as well
as their thriving societies, will give the gist of Dr. Lynch’s article, which is heartily in¬
dorsed by all with whom the writer has spoken.
5
1)56 Current Medical Literature. | April
of arts and letters was commenced by the savants aud artists
of Byzantium, who, alter the capture of Constantinople by
Mahomet II, emigrated to France and Italy, and really did for
them then what was later ascribed to the munificence of the
De Medicis aud Francois Premier. Such is the picture drawn
of affairs, professional and educational, in their relation to the
Johns Hopkins University, a production varying in ability
according to the talent of the artist, but not true to nature, as
will presently be demonstrated. Ten years ago the standard
of educational requirements had made great advances as com¬
pared with the preceding decade, and from then up to the time
of founding the Johns Hopkins University it had been raised
higher and higher, until the utmost was required of students,
until examinations became more frequeut and more stringent,
and until admission examinations were instituted in our medi¬
cal schools. In a word, during the last twenty years the rise
and progress in medical, scientific, aud academical education
has been so gradual, yet so steady and so sure, that our present
fault-finders, not perceiving it, have alone remained behind,
ignoring the fact that we had, when the Johns Hopkins Univer¬
sity was founded, a system of trainiugiu our universities, schools,
colleges, and academies comparing iavorably with those in any
part of the world. This university of the future begins, then,
where the others end, aud comes to us as the natural outgrowth
of advanced civilization and education, as the child of the elder
ones, not inventing any new or patent method of intellectual
schooling, but taking what is best from this oue and that one,
and what is deemed best adapted to the requirements of higher
education.
The medical department, though not yet fully organized,
will, it is understood, be represented to some extent by physi¬
cians aud surgeons Irom our own city, and Baltimore can pride
herself on having the varied talent, the many distinguished
men, as well as the learned and ethical general profession be¬
longing to a great medical centre, iu which original research
is encouraged, and the science and art of medicine are im¬
proved.
It was ascertained that much of the regular four year’s col¬
lege course could be omitted, especially by those intending to
follow scientific or medical pursuits; consequently seven very
concise courses of three years each are open to students as
regular collegiate courses, which thus allow them to enter upon
the university course, whether it he law, medicine, or theology,
oue year soouer. These seven courses are varied to meet the
wants of all , a nd such branches are taught in them as bear directly
upon the student’s course in the future. Much stress is laid
upon modern languages throughout, also upon philosophy and
chemistry during these three years, whilst the introduction of
biology into the preparatory medical course is an entirely new
feature. It is well known that this is almost the last branch
1880]
Current Medical Literature.
957
taught in foreign universities, but a study that requires such
particularization may be useful as a disciplinary agent at first,
not forgeting that au acquaintance with morphology should
form an important part of a course preparatory to the final
study of medicine ; moreover, the mind of the student will have
been sufficiently trained by his schooling in chemistry and
physics during the first year to grapple with a subject that
hitherto has erroneously been thought worthy of introduction
only near the end of a five or seven years’ university course.
At the close of the third and last year of this preparatory
course, which includes also German, English literature, history,
and psychology, it is proposed to confer upon the successful
candidate the degree of M. B., aud thus give to this diploma
a value in America. Although the recipient will not rank as
does the English “ medical man ” who may practice upon it,
yet it will be an advance in our educational gradations, and
the American interpretation of the initials M. B. will probably
be the more correct of the two. The biological course, which
eaunot be overestimated, will be one of wide scope, embracing
the laws of life in general, whether exhibited in animals or
plants ; it is designed at the same time to give students at
least a didactic knowledge of human anatomy and physiology;
comparative anatomy and botany will not be required, as their
general principles and more important facts are taught in the
course of general biology. It will thus be seen that the student
after such a course will be well advanced in his professional
studies, and that the science of medicine proper will present to
him fewer difficulties. It is of course understood that work in
the physical and chemical laboratories forms a prominent fea¬
ture in the schedule.
With respect to medical instruction in connection with the
Johns Hopkins Hospital, the plan has not yet been definitely
agreed upon by the trustees, but we may be sure that whatever
system is determined upon will not be in imitation of any one
routine, but will comprise what is best from the best. That
this has been a ruling principle in the university organization
throughout, the following lines from the Fourth Annual Report
of the Johns Hopkins University, by the president, will attest.
After referring to the extension of its influence beyond provin¬
cial limits, he says : u Having these aims, the next question to
be considered was the interior organization of the university :
should it follow an American, an English, a French, or a Ger¬
man model ; or should it gather from many sources educational
methods to be adapted to the wants of this country, aud
brought into harmony with our conditions, political, ecclesias¬
tical, and social! There was no hesitation on this poiut. The
new foundation was to base its operations upon the experience
of many and diverse institutions, ascertained by inquiries at
home and abroad, among the most enlightened teachers aud
administrators.”
958
Current Medical Literature.
[April
Little lias been said of scientific apparatus in this connec¬
tion, but when we state that $27,761 have been expended in
that direction, it will be readily understood that such appli¬
ances have been purchased of the best European and American
makers, with especial reference to researches in regard to elec¬
tricity, magnetism, and heat.
Another advance in higher education is the system of fellow¬
ships for the purpose of affording to young men of talent, from
any place, an opportunity to continue their studies in the Johns
Hopkins University, while looking forward to positions as pro¬
fessors, teachers, and investigators, or to other literary and sci¬
entific vocations. These Fellows are appointed by the trustees,
and submit to examination ; a small stipend is granted to
them.
The new university has been favorably received by the medi¬
cal profession of Baltimore, many of whom countenance the
lectures and patronize the scientific courses.
Almost any day practitioners may be seen in the laboratories,
and the library has become a sort of Pierian Spring (new books
are kept on a stand and sold at a reduced price after three
months), but no more so than the rest of the university, from
which those who do not intend to “ drink deep ” are expected to
withdraw. The Johns Hopkins University, recognizing the great
benefit to be derived from a literature such as exists in other
institutions of the kind, has given out the first volume of the
American Journal of Mathematics, four numbers being promised
annually; also the American Journal of Chemistry , six numbers
annually. The writings from the biological department have
been communicated to the Journal of Physiology , published in
London and Cambridge. The influence of the university will
doubtless be extended to a certain degree by the Fellows, some
of whom have been and others of whom will be called to differ¬
ent posts in this country, and by the scientific publications
sent abroad. Nevertheless, it is more than likely that its use¬
fulness and reputation will be principally local. Significant is
the note that, of the ninety-one collegiate students enrolled
during the past three years, almost all come from Baltimore
and vicinity. All legitimate means will be employed to gain
renown.
But fellowships are not altogether new ; neither are univer¬
sity organs. This fact is mentioned in sustaining our claim
that the higher standard attained is one that has been raised
by the older universities, colleges, academies, and institutions
of learning in general, not forgetting the much-abused medical
schools, which certainly have contributed their full share in the
onward march. The Johns Hopkins University, then, so far
from being a deliverer from educational ruin, merely borrows
what is best from all our institutions, merely comes under the
standard already unfurled by them.
Before closing, let us leave the university proper, and take a
1880J
Current Medical Literature.
959
casual survey of the hospital buildings, situated on an ele¬
vated piece of land something more than a mile distant. Seen
from a distance, this collection of buildings forms an imposing
memorial pile, more to the purpose than a sarcophagus of por¬
phyry. For a description of the plan of these buildings the
reader is referred to an article on this subject by the writer,
and published in the Journal , November 7, 1878. It is his in¬
tention at present so make a brief survey of the buildings
themselves as they are now. The lot on which they are being-
built is fourteen and a half acres square, and when completed
they will be twenty-five in number and in the form of a paral¬
lelogram. The main building, being the front, is on Broadway,
but only the foundation, which is of brown stone, is laid. The
height will be two hundred feet from the marble flooring to the
lantern. On the right and left, and distant some sixty feet
from it, are the male and female paying wards, each forming a
separate building. These wards are arranged in such a man¬
ner that all the rooms open on corridors leading to the centre
of the building, where is a skylight considerably over one hun¬
dred feet high. There are several floors of rooms. The next
building in order, going to the left, is the kitchen, the first
floor being divided into butcher’s-rooms, store-rooms, pastry-
rooms, etc.; but the kitchen proper is on the second floor, and
is thirty feet by seventy. From this building all the meals
will be furnished by means of a car, with hot-water chamber
and on india-rubber wheels, pushed from building to building
in the long and lofty connecting corridor. This corridor will
be of artistic design, and will have a walk on top. Next in
order comes the octagon building, so called from its shape. In
the middle of this ward is the octagonal shaft to conduct off
foul air. The beds will be arranged around this, feet to the
shaft, the walls of which will be neatly finished and orna¬
mented with works of art. It is thought that this will rest the
weary eye of the patient, as well as break the view in such a
manner that the sufferings of other patients will be in a great
measure hidden, and their cries and groans during bedside
operations more or less deadened. This ward is to be some¬
thing of an experiment, and the idea has already been carried
out in the Massachusetts General Hospital, the only difference
being that the square is used there instead of the octagon. At
the other end of this ward are small rooms for various purposes,
such as sitting-rooms and the like. Then come, at a distance
of sixty feet, and at the same distance from each other, three
charity wards ; the only difference between them and the octa¬
gon ward is that they are parallelograms iu form. Crossing
the lot, the nurses’ home is reached, a large, square building —
from the basement to the top seven stories high. The lower
floors are devoted to dining-rooms, parlors, library, lecture-
room, etc., and the upper ones to bed-rooms. There are, then,
eleven buildings in process of construction — eight actually
960
Current Medical Literature.
[April
under roof. It goes almost without saying that they are built
iu the best and strongest manner, with modern improvements,
double ventilators, etc. Inside, the staircases are supported
by iron pillars, and all the beams and girders are of the same
material. The flooring and partitions are of lime, an imported
French product, to which sand and cinders are added here. It
is put up in large blocks, and the partitions in their present un¬
finished state resemble stone walls. The tiles, of the same ma¬
terial, for the ceiling and flooring are made so as to fit together
between the iron beams and form an arch iu themselves, leav¬
ing the ceiling and floor perfectly level. The buildings are all
of brick, with black pointings, slate roofs, pinnacles, cupolas,
and towers. The style selected is the so-called Queen Anne
style, and the plan chosen seems to be a mixture of those of the
Imperial Hospital of Leipzig, and St. Thomas’ Hospital of
London. It is hardly necessary to draw attention to the fact
that, for the exterior arrangements also, the Johns Hopkins
University is indebted to architectural designs already ex¬
isting, both at home and abroad.
The surgical wards, waiting-rooms, and clinic will form a
separate department, and it is suggested to form eventually a
school of surgery. The graduates would then receive some
such degree as Bachelor of Surgery, Master of Surgery, or
Licentiate. If such a diploma should not confer the right to
practice, that right could easily be obtained from the Medical
and Chirurgical Faculty of Maryland. The domain of gynae¬
cology will probably be included in that of medicine.
As to the length of the medical and surgical courses, the
American system of three years is for our country and our
needs decidedly the best, and is the one most likely to be
adopted by the Johns Hopkins University. That graduates
who have studied but three years have a less variety of scien¬
tific knowledge than those who have studied five years at a
Herman university, or seven at a French one, other things be¬
ing equal, is self-evident. But after graduation, in either case,
a decade will, as a rule, elapse before the graduate gets into
regular practice. During this period, by occasional cases, by
reading, and by hospital study, the American will learn much.
And it is fair to assume that the Frenchman or German, with
his brain more or less overloaded, as he comes fresh from his
laureate, will in these ten years have forgotten much in the
way of botany, mineralogy, comparative anatomy, zoology,
and even physics (which branches, except the last named,
Huxley says ought to be rigorously excluded) ; so that time,
the great leveler, will put them all on even footing when the
hour arrives to enter into the active duties of brisk practice.
Without doubt, the critic will say, there is a certain similar¬
ity between the Johns Hopkins University and other existing
institutions, just as in writing we sometimes speak uncon¬
sciously the thoughts of others. How could it be otherwise 1
Current Medical Literature.
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1880]
True, but enough has been adduced to prove conclusively the
conditions under which the new university comes into being.
That it may be grand and great cannot perhaps be denied ;
that it is original cannot be pretended; that it will be a suc¬
cess as a flourishing university, with crowded lecture-rooms,
the future alone will show. In its struggles for existence it
will be armed with wealth and intellect sufficient to place it
on a par with, but not above, other American universities aud
medical schools. The Johns Hopkins University will owe its
existence and status directly to an immense fortune that has
been in possession of the trustees since the testator’s death.
But from the realm of departed spirits come back to-day the
weird strains of the lyre. Listen : the immortal bard no longer
sings alone his “Exegi monumentum aere perennius.” It will*
owe its intellectual standard to those very American universi¬
ties, colleges, medical schools, aud institutions of learning gen¬
erally which from personal aud selfish motives, too apparent
to need further mention, have been ridiculed, as well as to the
scientific attainments of the learned professions, especially
that of medicine, which has been most unjustly sneered at by
a minority so small as to be barely of sufficient consequence to
remind that they owe everything to the very men they have
sought to undervalue. Let the older institutions of education,
then, welcome the Johns Hopkins University ; let them take
by the hand the child of their adoption, and invite her to march
with them in the way of civilization and culture, to walk with
them in the paths of knowledge, and to unite with them in the
search for truth.
“ That which hath been is now ; and that which is to be hath
already been, and God requireth that which is past.” — Boston
Med. and Burg. Journal , Jan. 29.
INSANITY IN ITS RELATION TO THE GENERAL PRACTITIONER
OF MEDICINE.
Read at the meeting of the Licking County Medical Society, December 2, 1879,
By W. C. DAVIES, M. D., Granville, O.
In the following paper a general discussion of insanity, in
any of its manifold respects, is not proposed. Auy one of these
respects presents too broad a field for a single essay, and most,
*The future tense is used, because it will be three or four years yet before the hospital
can be utilized lor the reception of patients, and then a beginning wiil be made witn
only fifteen buildings. It is designed to receive four hundred patients. The space in
the middle of the lot will be devoted to grass-pb'ts, flower-beds, walks, benches for conva¬
lescents, etc., after the manner of many of our hospitals. We have already several large
and well-appointed ones here, and with the new one the supply might perhaps exceed the
demand. The floral display is evidently .ntended to be very fine, as in addition to the
plots already mentioned, there will be a green-house one hundred and fifty feet long on
the hospital grounds. What the precise object of this is I am unable at the present time
to state ; being left in the dark as to whether the flowers will adorn the beds of sickness
exclusively, or whether anything in the way of renown or pecuniary gain is also ox-
pected from a source which, though it may be aesthetic, can hardly be considered very
lucrative.
962
Current Medical Literature.
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if not all of them are fully considered in medical literature
accesssible to every physician. Not even will a definition of
insanity be attempted, though one perfectly satisfactory would
bring lasting honor to its framer, and peace of mind to every
one who has stood the fire of cross-examination as an expert
in cases involving the question of sanity. Without wasting
any words on the question whether a man really knows anything
which he cannot formulate in words, it will suffice to say that
the term insanity conveys to each one of us a tolerably clear
idea, though cases might be presented concerning whose mental
condition we could not agree. Keeping clear of the “ border
land” which separates sanity from insanity, it is my sole
purpose to offer a few suggestions in regard to our duty in such
cases of undoubted insanity as present themselves to us in the
routine of practice. The rapid advancement m recent times
in all departments of human knowledge has introduced into
all the professions, not even excepting theology, the principle
of the “ division of labor,” and has developed “ specialists.”
In fact every man who aims at the highest success is compelled
to become, to a greater or less extent, a specialist. This tendency
undoubtedly works harm in many ways, and too often secures
only an uusymmetrical development. Sometimes, even, the
thoroughness of the specialists degenerates into the narrowest
and most intolerant bigotry. Still the tendency is irresistible
and year by year becomes more fixed. Physicians in the
country and in small towns lend their influence to the perpet¬
uation of this state of affairs, for, whenever a case Having
novel and difficult features presents itself, it is a great deal
easier to send it to some noted specialist than to perform the
study necessary to a thorough understanding and treatment of
it. This teaching of the profession is not lost upon the laity,
who, in this respect, at least, are “ very apt pupils.” Unless
we who live in the country qualify ourselves to meet the
exigencies of our profession, we have no right to complain if
those who should be our patients run off' to the nearest city for
the treatment of little ailments and the performance of little
operations that really require no more skill than is possessed
by any bright boy, and little more knowledge.
In no department of medicine has there been a more general
disposition to rely wholly on specialists than in the one now
under consideration. In so doing, it seems to us that physicians
have surrendered their rights aud, not to speak too harshly of
one’s professional brethren, shirked the responsibility legiti¬
mately attaching to them.
In the Arcadian days of the world’s youth and innocence,
the insane were supposed to be under the special protection
and inspiration of the gods. The nations of antiquity not
being weighted with the cares aud vices of modern civilization,
insanity was not so common among them as among us, and
the supposed possession of prophetic powers insured to the
Current Medical Literature.
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1880J
insane great regard and the kindest treatment. The proverb
ially narrow line which separates genius from insanity should
teach us to exhibit the kindness if we cannot feel the reverence
of the ancients. In all the civilized nations of the ancient
world, insanity seems to have been reasonably well understood,
and its treatment was mainly conducted on correct principles.
The medical literature of ancient Greece has certainly not
been surpassed, so far as it pertains to this subject, till very
recent times. The inhuman treatment of the. insane which
was in vogue less than a ceutury ago had its birth in the
ignorance and brutality of the “ Dark Ages.” Chained down
in cells and dungeons, and wallowing in dirt and filth, a collec¬
tion of the insane was looked upon much as an assemblage of
wild beasts, and subjected to more barbarous treatment. Out
of all this grew a horror of insanity and a repugnance to those
who unfortunately are afflicted with it, that continues in the
popular mind even now. They are regarded as a peculiar
class, destitute of human qualities and feelings, not appre¬
ciating injustice and cruelty and not susceptible to kindness.
Even physicians are too prone to be influenced by popular
opinion, and forget that these uufortunates are meu of the same
feelings and passions, influenced by the same desires and
motives as others, though not always in the same degree.
As soon as a case of insanity comes under the care of the
ordinary physician, influenced by this feeling, he gives “ neither
sleep to his eyes nor slumber to his eyelids” till his patient is
safely housed in some public asylum. We are led to ask why
this haste ? Is i he lunatic possessed of a devil, and is the
asylum the only place where it can be cast out? Plainly
stated, the only plan of treatment which receives general
recognition from the profession, is to send the insane to insane
asylums. If this statement is doubted, proof of it is to be
found in the statistics of insanity. In this country nearly one-
half of all cases of insanity reported are in asylums, in Great
Britain two-thirds and in France more than three-fifths. Now
if we remember that most of the asylums in this country
retain only acute cases, while incurables are returned to their
friends or sent to special asylums or county infirmaries, and
also remember that many insane persous are so quiet that they
receive no medical attendance, we can not well doubt that the
only medical treatment of insanity that deserves mention is
carried on in asylums.
This tacit refusal on the part of general practitioners to treatin-
sanity is the legitimate result not only ofpublic opinion, but also
of medical education. Many young men receive their license
to practice the healing art, who have never read a page, heartj. a
lecture or been asked a question in regard to the causes,
symptoms or treatment of insanity.
The general neglect of this branch of medicine being
6 - . - •
964
Current Medical Literature.
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admitted, we are brought to the consideration of whether it
ought to be so neglected, whether the asylum plan of treat¬
ment is the best that can be devised in the present state of
medical knowledge; in fine, whether we do our duty in turning
over to specialists every patient bereft of reason.
To consider this question intelligently, we must go back
a little and refresh our memories as to the nature of insanity.
This term is one of many we received as a heritage from the
ignorance of the past. The word means simply unsoundness,
and on no principle of nosology can its present restricted use
be justified. It could with equal propriety be applied to any
other lesion of the body. If we base our nomenclature of
disease on etiology, we find the causes of insanity to be almost
numberless ; it we base it on semeiolog.v, types of the malady
almost as numerous as the frogs that covered the tair valley
of the Nile, in obedience to the magic wand of Aaron, present
themselves ; and finally, if we take pathological lesions as our
guide in the matter, we cannot properly apply any single term
to the lesions which cause a departure from the normal standard
of mental manifestation. When an expert is called into court
in a case involving testamentary capacity or criminal responsi¬
bility, it is notoriously the custom to enter upon the work of
confusing the witness and impairing the force of his testimony
by innocently asking for a definition of insanity. If, bearing
in mind the features of the case in question, he gives a definition
appropriate to that particular case, he finds that he lias
excluded many cases of undoubted -insanity; if, on the other
hand, he is unwise enough to attempt a definition sufficiently
comprehensive to include all possible cases, he finds to his
horror, that he has numbered among lunatics half the jury,
the opposing lawyer, possibly the judge on the bench aud
almost certainly himself.
The confusion of ideas in the popular mind as to what
constitutes insanity is but the reflection of the want of agree¬
ment among medical writers on the same subject. The truth
is, the term cannot be defined, because it stands for no disease.
Insanity is only a symptom, and a symptom of many different
diseases which primarily or secondarily affect the nervous
system, and thereby cause either organic change or functional
derangement in some part of it. It is doubtful whether, in the
present state of our knowledge of the physiology and pathology
of the nervous system, it is possible or desirable to discard the
term. Very few of the lesions whose prominent symptom is
insanity are sufficiently well understood to receive appropriate
names, and until we can replace old terms with new ones about
which there can be no ambiguity, it is better to retain them.
Still, physicians should remember that to pronounce a man
insane is not to diagnose his condition, and remembering that,
they, at least, would use the term intelligently. Little enough
is really known of the diseases grouped together under the
Current Medical Literature.
965
1880]
term insanity, but even that little is chiefly confined to
the few who have made this subject a special study. The
ordinary history of a case of insanity is, that the person
affected is for some time indisposed, nervous and irritable,
displaying eccentricities of conduct that attract the atten¬
tion of his family and friends. The doctor is consulted
and ascribes the change of manner to excessive devotion to
business, or more often to “biliousness,” assures the patient
aud his family that nothing serious is the matter and dismisses
the case from his mind. The disease runs its course unchecked,
until by its gradual progress or in consequence of some shock,
such a change is produced in the patient’s conduct that no
medical skill is necessary to detect his insanity. The next
step is the removal to an asylum, and, as he is almost sure to
object to the removal, deception must be used or compulsion
resorted to. After treatment for a variable length of time the
patient is dismissed cured, improved, or incurable, with the
chances at least that he will be in the last class.
Now, I have no desire to decry insane asylums, nor is it any
part of my purpose to criticize their management. They are
at once the evidence and fruit of a noble and humane civiliza¬
tion. The efforts made to alleviate the sorrows aud improve
the condition of those who are doomed to eternal night, or
everlasting silence, or who, worse than either, are deprived of
reason, the crown and strength of manhood, are worthy of all
praise. A single hospital or asylum is better proof of true
national greatness than were all the monuments of Egypt or
even the magnificent temple of Jehovah, which was the
embodiment of a nation’s offerings.
Indeed posterity, looking at our immense benevolent institu¬
tions, will have more reason to question our wisdom than our
generosity. The treatment which the inmates of our insane
asylums receive is doubtless, in the main, commendable in the
highest degree. As a rule, it is in accordance with the teach¬
ings of the highest medical learning, so far as circumstances
allow it to be so. But admitting all that can be said in favor
of our public asylums, the question yet remains whether that
plan of treatment is best, whether many a patient may not
be kept out of them by a little preventive treatment from his
regular medical attendant, whether some are not made incurably
insane who otherwise might recover, whether in all or even a
majority of cases of fully developed cases of insanity the asylum
offers most hope. Charged, as we physicians are, with the
duty not only of caring for our individual patients, but also of
looking after the best interests of society, we cannot wholly
disregard these questions. To consider them in all their bear¬
ing would require a volume. A few points only can be men¬
tioned in a short essay.
Insanity is a condition which, with few exceptions, develops
slowly, and in the vast majority of cases long before the mal-
966 Current Medical Literature. [April
ady is generally recognized, it gives evidence of its presence
capable of appreciation by any one who has given the subject
careful study. All authorities agree in stating, and the truth
of the statement is almost self-evident, that the earlier a case
of insanity is placed under treatment, the greater the prospect
of complete recovery. In fact, the length of time a case has
lasted is a more important element in prognosis than the extent
of the deviation from the normal standard of mental manifesta¬
tion. In a recent report of one of the best and most successful
asylums in this country, the small proportion of recoveries is
attributed by the superintendent to the fact that very many
are not brought under treatment till the curable stage of their
diseases is passed. What was at first merely a functional
derangement in time becomes an organic change. At first the
evil spirit can easily be exorcised, but at last he defies all the
arts of the charmer, u charm he never so wisely.” This one
tact alone ought to lead every practitioner of medicine, espe¬
cially if he lives remote from a city where the services of experts
can be obtained, to fully qualify himself to detect the first
symptoms of insanity and to adopt appropriate measures for
its recovery.
The next point for consideration is whether the asylum is
the best place for the treatment of fully developed insanity ?
In cases marked by a suicidal or homicidal mania, unless the
patient is possessed of sufficient wealth to procure constant
attendance, thereby insuring the safety of himself and those
around him, the physician has no choice, but must send him to
a place of absolute safety. In many cases, apparenty quiet
and perfectly harmless, the possibility of the patient being sud¬
denly seized with an impulse of this kind exists and must be
guarded against most carefully. But aside from these cases
the physiciau, before sending an insane patient to an asylum,
may well ask himself whether it is not in his power to manage
the case with better prospects of recovery. It is now pretty
generally believed by alienists that all insanity has a patholo¬
gical basis, though the change in nerve tissue eludes the scal¬
pel and microscope. II insanity is simply a symptom of lesion
of the brain, it follows that the treatment ought to be directed
to that lesion ; but our materia medica contains few remedies
that directly affect nerve tissue, and the list of drugs that can
advantageously be used in insanity is a short one. Without
stopping to argue whether mind has an existence separate from
brain, or whether insanity is even caused solely by mental
shocks, we all know how much mental states influence bodily
conditions, and how powerful “ moral measures ” are in the
treatment of insanity. This is admitted in practice by the most
avowed materialists and has a wide application in asylums in
controlling their iu mates. As every sick person is greatly
influenced by his surroundings, and the insane especially, it
seems almost self-evident that, to collect large numbers of such
1880] Current Medical Literature. 967 ,
patients in one building, is open to serious objection and must
result in great injury to many patients. The first requisite in
the psychological treatment of the iusane is that they be sur¬
rounded only by those who are perfectly sound in intellect and
emotion. In an asylum the only sane persons the inmate can
have any association with are the medical and other attend¬
ants. True, visitors daily walk through the corridors of the
building, inspecting the unfortunates there in much the same
spirit as they inspect the animals in a zoological garden. The
association with the physicians and attendants is necessarily
very limited, and the constant association is with the other
inmates. I know common opinion puts all crazy people in the
same class and imagines them to be all alike, and all alike
incapable of appreciating their surrouudiugs ; no greater mis¬
take could be made. True a few are so wrapped up in their
own delusions and hallucinations that they are oblivious of all
else. These and cases of dementia might be exhibited without
suffering harm, but then the exhibition would lack interest and
the show receive little patronage. The types of mental alien¬
ation are exceedingly numerous, and the ordinary lunatic is as
keen to detect the mental failings of his associates as any sane
man can be. Poor fellows! they recoguize all delusions but
their own. One will ridicule another for claiming to have dis¬
covered perpetual motiou, and in the next breath will claim to
be Julius Ctesar, Napoleon Bonaparte or Jesus Christ, or all
three at once.
It is a commou remark that residence in an asylum as an in¬
mate would, in a short time, render a sane man fit to be one,
and the remark certainly has a strong basis of truth. If the
.effect of such a residence would be so great on one in full pos¬
session of all his mental powers, what must it be in the
case of those whose faculties are already weakened by disease?
The repugnance most insane persons exhibit to a residence in
an asylum and tne impossibility of keeping a large number oc¬
cupied, which is important, as a remedial measure, are, perhaps,
minor considerations, but they are too important to be omitted.
These points, which I have briefly and imperfectly presented,
should lead physiciaus to examine carefully the circumstances
of every case of insanity which they are called to manage, and,
if the patient is sent to a public asylum, it ought to be for some
good, assignable reason, not as a matter of blind and reckless
routine. Already in Europe are large asylums closing, and the
insane are placed in families whose cares and labors, recrea¬
tions and duties they share, and the result of the experiment
proves its wisdom. Many of the leaders of medical thought in
this country are proclaiming our asylums as the last resort in
insanity, denominating them necessary evils, but none the less
evil because necessary. The cruelties which are publicly charg¬
ed upon the managers of asylums in a sister state, and the
scandals that are connected with those nearer home, in the
968
Current Medical Literature.
[April
public prints, only show the abuse which is a possible result
of arbitrary power. These undoubtedly are the only blots on
the fair record of our asylums, but the possibility of such dis¬
grace should be borne in mind.
It may be objected to this that, so few cases of insanity pre¬
sent themselves to the ordinary physician, that it will not pay
him to prepare himself to treat them. If dollars and cents are
the only things of value in the practice of medicine, the objec¬
tion is a valid one. If only remunerative knowledge is desir¬
able, the success of ignorant charlatans proves that a very little
knowledge can be made to go a great way. Ho true physician
measures his responsibilities by the golden yard stick.
Insanity is a subject worthy of the gravest consideration and
profoundest study, and its importance is increasing every day.
Statistics show that, as a nation increases iu civilization, wealth
and refinement, insanity increases. Fortunately families with
the taint of insanity have a tendency towards extinction, na¬
ture in this, as other things, being conservative. Insanity
very probably is hereditary in a greater number of cases than
tables indicate, the predisposition to it often beiug inherited
from ancestors in whom it never fully developed. By wise and
careful management it may be kept iu check, and it is the duty
of the medical profession to study this subject in all its mani¬
fold aspects, and by their knowledge to instruct the communi¬
ties in which they live. One of the leading objects of medical
science should be to develop a sturdy race possessing sound
minds in sound bodies. — Cin. Lancet & Clinic , June 17.
FOOT-BINDING IN CHINA.
A very interesting paper upon this subject, read by Dr*
Bobert P. Harris at a recent meeting of the College of Physi¬
cians of this city, affords an opportunity of drawing attention
to the peculiar deformity of the feet brought about by the pro¬
cess of foot-binding practiced in China, and the manner iu
which the tender structures of the infantiue foot are carefully
mis-trained and distorted into grotesque uselessness.
It appears, according to Dr. Harris’s statement, that, among
the wealthy and those who can afford to have it done, the first
binding takes place at the age of from five to seven. Earlier than
this it cannot be done, contrary to the statements of some
travellers, because the child must first learn to walk and do
certain acts or kiuds of work in which walking is essential, or
it will not be able to learn. Circumstances sometimes cause
the postponement of the dwarfing process until the age of
twelve, fourteen, or even twenty ; but the suffering then caused
is extreme, and the result less satisfactory.
The first step iu the process is the bending of the four small¬
er toes under the sole of the foot, and the narrowing of the
parts supported by the metatarsal bones. The second step
Current Medical Literature.
969
1880]
consists in a forcing together of the plantar portions of these
bones, whereby they are subjected to a continuous pressure,
and in an opening, or an attempt at opening, of the articular
crevices of the instep, keeping their ligaments constantly tense
at the same time. The third step is the last to be accomplished,
and can be completed only in the young subject. The os cal-
cis, with the astragalus, is forced downward until the heel is
vertical, and its bone on a line with the bones of the leg. The
calcis is rounded in form, losing its processes, which are so
marked in the normal bone ; and its anterior articulating face
is brought up near to the high, instep-like arch just in front of
the ankle-joint, while at the same time the point of attachment
of the tendo Achillis is made the base upon which the girl
stands when erect and steps in walking.
The operation is begun by placing the end of a long, narrow
bandage on the inside of the instep, carrying it around over
the four smaller toes and taking them under the foot. After
several turns with this object, the bandage is turned so as to
compress the foot longitudinally. The bandaging completed,
the child is left to eudure the torture for a month. At the end
of this time the foot is opened, when the skin is often found
ulcerated, or gangrenous from pressure, and one or more toes
are not infrequently lost.
The shaping of the foot by the bandage requires two or three
years, during which period there is more or less pain. This is
most severe in the first year, and gradually diminishes after
the bending of all the joints and articulations is completed.
During this perioil, and in fact throughout life, the feet are un¬
bound but once a month.
The suffering at first is very severe, and is located chiefly in
the toes, joints, ankle-bones, and instep: it is compared by
those who have endured it to that produced by the thrusting of
sharp needles into the flesh. At night the girl lies across her
bed, putting her legs over the edge of the bedstead, so as to
make a pressure under the knees, and thus benumb the parts
below them. In this position on her back, swinging her legs
backward and forward, she passes many a weary nigbt. Fe¬
brile disturbance is said to be an accoinpanimeut of this tor¬
turing process.
If the feet are firmly bound, and the girl ^oung, they will
cease to ache generally in about two years, the parts being then
denominated “ dead” By this time the calf of the leg, for
want of use, has disappeared, the skin is shrivelled, and the
whole extremity below the knee presents an atrophied and
shrunken appearance, being. little more than skin and bone.
The bom s eventually become attenuated, and the ankle meas¬
urement of a dwarf-footed woman is about the same as that of
her wrist. In adult life the leg frequently becomes rounded
and enlarged by adipose deposit, and the muscles regain their
form in a measure ; but the ankle always remains small.
970
Current Medical Literature.
[April
The binding process is said to exercise a markedly depress
ing influence upon the emotional character of its subjects,
which lasts throughout life and is very characteristic. Dr%
Harris calls attention to a practical point in orthopaedics in
connection with this procedute of foot-binding. He suggests
that, in splay-foot and similar deformities, the converse of
the Chinese deformity, a similar sort of binding, thoroughly
carried out, would prove highly advantageous. — Philadelphia
Medical Times , June 31.
TAMPONING THE VAGINA FOR CYSTITIS.
By WILLIS P. KING, M. D., Sedalia, Mo,
In the May number of the Courier — current year — I read an
article from the pen of E. C. Gehrung, M. D., of St. Louis, on
“ A new Method, of Treatment of Acute Cystitis in Women” etc.,
which method consists in tamponing the vagina with cotton,
so as to support the posterior wall of the bladder, give rest to
that organ and prevent an accumulation of urine in the sagging
wall. Dr. G. deserves the thanks of the profession for his most
excellent paper ; and the article was most satisfactory to me.
because it explained upon scientific grounds some things that
I had not understood.
I have been in the habit for years, of tamponing the vagina
in cystitis, because, I reasoned,, in most cases (and especially in
married and child-bearing women), the bladder must be inter¬
fered with by a displacement of the uterus — anteverted or ante-
flexed — pressing upon the fundus of the bladder; or by a
prolapsus dragging upon and displacing the bladder and thereby
disturbing its functions. I therefore tamponed the vagina to
elevate the uterus and prevent its disturbing the bladder. But
I did not in all cases make out either a flexion, version or pro¬
lapsus, and yet the relief afforded by tamponing was so uni¬
formly satisfactory (always giving almost instantaneous relief)
that I practiced it without being entirely satisfied in my own
mind as to the whys and wherefores. So marked was the relief
in all cases in fact, that 1 fell into the liabir, when called to see
a woman suffering with frequent micturition, burning and scald¬
ing pains at the neck of the bladder— of at once setting about
the preparation of a tampon.
I could give many cases illustrative of the benefit to be de¬
rived from this practice, but will give but one ; and since Dr.
Gehrung regretted that this method of treatment excluded vir¬
gins, I will give a case occurring in an unmarried womau — a
virgin.
I was called on the 6th day of July to see an unmarried
woman, twenty-two years old, who had stood on her feet during
almost the entire day of the 4th, and had walked to the Fair
Grounds (where the celebration was held), and back home —
a distance of more thau one mile — three times. On the 5th she
1880]
Current Medical Literature .
971
had a feeling of weight and uneasiness about the bladder, with
frequent micturition, which grew gradually worse and culmi¬
nated in a chill, with increase of the bladder trouble, on the
night of the oth. I found her suffering with intense vesical
teuesmus, some fever, rapid pulse, and a constant desire to
micturate. Gave potass, acetas and extr. belladonnse, with flax¬
seed tea, and applied hot fomentations over the region of the
bladder. Was called on the morning of the 7th, and found her
no better. I then determined to tampon the vagina. Turning
her across the bed with hips near the edge, I introduced the
index finger of the left hand, palm upwards, into the vagina.
Then having the mother prepare bits of cotton— one-third the
size of the rhumb — into firm wads, I introduced them one by one
with uterine dressing forceps, making the greatest pressure
uijoii the palmar surface of the finger in the vagina, and with
that finger packed the wads of cotton around the cervix until
I filled the vagina. She was asleep in less than twenty minutes.
1 did this once a day for three days, and afterwards had no
trouble in controlling the difficulty.
The objection to using this method in the treatment of vir¬
gins, is the fear of rupturing that insignificant little membrane
that everybody seems so sensitive about— the hymen. I did
not rupture the hymen in this case ; but, suppose that it had
been necessary i Must a woman’s future health and happiness
be sacrificed to save a thin delicate membrane that no one, needs
and nobodv uses ? — St. Louis Courier of Medicine , December,
1879.
CZERNY’S OPERATION FOR THE RADICAL CURE OF HERNIA.
At the last meeting of the West Chicago Medical Society,
Monday, January 12, a paper was read by Dr. B. W. Lee on
Radical Operation for Hernia, — neither strangulated nor in¬
flamed, — by Czerny’s new method. The paper was illustrated
by a successful case. This is the first operation by the new
method performed and published iu the United States. In a
later number we shall give a detailed description of the opera¬
tion, but shall now only point out the main differences between
this and the older operations. It was the antiseptic method
that gave Czerny the courage to attempt the radical operation
in a more effectual manner than was possible by previous op¬
erations. An incision is made along the entire length of the
hernia. The contents of the sac, if intestinal and reducible,
are reduced, if intestinal and irreducible, are dissected loose
and reduced; and the sac is ligatured at the neck and cut off.
If the contents he omental, they are included in the ligature
with the sac. The fibrous columns of external ring are drawn
together by an uninterrupted suture of strong carbolized cat¬
gut, ami thus the internal ring is closed, save at the point of
exit of the spermatic cord. A drainage tube is inserted, the
7
972
Current Medical Literature.
[April
wound closed with sutures and dressed antiseptieally. This
method, as compared with the older ones, is a very remarkable
advance toward perfection. The most recent of the older
metho ;s, — that of Wood, of London, — could only be applied to
reducible hernia, and the results of his operation are always
uncertain, because the fibrous columns are drawn together by
sutures applied more or less subcutaneously, lest suppuration
should supervene. Thus the columns or pillars are not laid
bare, and the exact application of sutures and narrowing of
the ring are rendered impossible. Czerny’s operation has
been performed in nine cases of inguinal hernia, and in no
case did peritonitis follow. The patient presented was oper¬
ated upon in July last for an irreducible omental hernia, that
rendered impossible the continuation of his daily occupation,
since he could not wear a truss. In the discussion which fol¬
lowed aliusion was made to a case of reducible scrotal hernia
in a child. The surgeon, having heard something of Czerny’s
operation from one of the gentlemen present, undertook to op¬
erate similarly. The child did well and the operation was suc¬
cessful. The surgeon, who expressly stated that he had not
availed himself ot the spray, carbolized sutures, drainage and
antiseptic diessing, was singularly fortunate in not losing his
patient from peritonitis (vide history of the older methods of
radical operation for hernia in any of the larger text books on
operative surgery). We must prououme the omission of the
antiseptic system in Czerny’s operation as unwarrantable rash¬
ness bordering on the very confines of crime. Any surgeon
who undertakes to operate for hernia, — not strangulated by
this or by any other similar method, — should be informed in ad¬
vance, from the original literature or tiom minute reliable re-
couls, of the details and history of the operation, especially of
an operation which only the most scrupulous antiseptic pre¬
cautions (Czerny and Socin) render permissible. — Chicago Med.
Gazette, Jan. 20.
THE RAPID TREATMENT OF CLUB-FOOT.
Mr. H. A. Reeves, Surgeon to the East London Hospital for
Children, describes (Med. Times and Gaz., Oct. 25, 1879) his
method of treating club-foot, which is applicable to th * large
majority of congenital or acquired deformities of the feet ; but
the iniider cases — those in which slight pressure will bring t he
foot into the normal position, and in which the rebound on re¬
laxing the grasp is very slight — can, with patience, be cured
without operation.
The pati< nt being held by a nurse or assistant, and the foot
being in the right position, the tendons of the tibialis posticus
and fiexor’longus digitorufm are first divided, and a pad and
strip of adhesive plaster applied. Then the tendon of the
tibialis anticus is divided and a pad put on. Immediately after
the tenotomies, the foot is forcibly but steadily brought into
Current Medical Literature.
973
1880]
its right position, and kept there by au assistant while a flannel
bandage is put on. Over this is put a ] )1 as ter-of- Paris bandage,
then a thin layer of plaster paste, and finally another bandage
and more paste. Sometimes a third plaster bandage is necessary,
but in infants and children it may be dispensed with. Of coarse,
the bandages must not be too tightly applied, and it is well to
protect the bony prominences with a little cotton wool. The
foot is held in position until the plaster has set ; and instruc¬
tions are given to the parents to bring the child at once to be
seen, or they are told how to loosen or remove the bandage,
shoul 1 the toes become cold and purple.
If the inner part of the plasetar fascia be tense and interfere
with the straightening of the foot, Mr. Reeves divides it first,
forcibly stretches it, and at once thereafter divide the tibialis
and flexor longus digitorum. He adopts this plan, which
differs from that usually recommended, so that the uncut ten¬
dons may resist him, and thus enable the anterior part of the
foot to be more successfully abducted. In most instances he
leaves the foot in the plaster case for a week; but iu the more
severe cases ten days to a fortnight are necessary. At the ex¬
piration of this time the bandage is removed, and the foot will
be seen to have assumed its proper position. It is then well
worked (i. e. abducted), afterwards the tendo Achillis is
divided, and the heel gently but firmly brought down. The
pad and bandages are put on while the foot is held in the cor¬
rected position, the toes being left free, but the heel covered.
Another week or ten days usually suffices by this method to
bring the deformed foot into its normal position, and then the
bandage is removed by cutting it in the mid-line along the an¬
terior- aspect of the foot and leg. The foot is then well worked
in the desired directions and the leg-muscles shampooed. The
mother sees how this is done, so that she or her husband may
occasionally do it at home, and the child is brought once a
week to be seen by the surgeon.
If the child be old enough to walk, it is measured for a
proper boot and support at the commencement of the treat¬
ment, and in most cases in three weeks after the first operation
it is allowed to walk. The foot is well worked night and morn¬
ing, and the second plaster bandage is put on at bedtime and
retained in position by an ordinary roller. This is ordered to
be continued for several weeks, in order to prevent a relapse.
Except in very severe cases an anaesthetic is unnecessary, but
in private practice, should it be desired to prevent the child
crying, it may be given.
Mr. Reeves has now had considerable experience iu this, as
well as in the ordinary modes of treating club-feet, and so far
has never had a relapse, if the instructions have been properly
carried ‘out. He can therefore confidently recommeud it to sur¬
geons interested in such matters.
The advantages of the method proposed are briefly the follow-
974
Current Medical Literature.
[April
ing: — 1. The results are rapid and satisfactory. 2. Expensive
apparatus is unnecessary. 3. The muscles, joints, etc., are
worked and exercised, and not allowed to atrophy or become
temporarily fixed, as in the German method ; and, 4. The pa¬
tient in ordinary cases may be allowed to use the foot or to
walk in three weeks after the first tenotomy. — Med. News and
Abstr ., January.
THE HOT SPRINGS—
Famous for the hot water into which the patients get soon
after their arrival in that city, are well known to the profes¬
sion, but the hot water into which they get before reaching the
city limits has not received due attention. The following from
a late number of the Hospital Gazette appears to be a fair rep¬
resentation of the way in which the doctors of that city con¬
duct their business. Unfortunately such practices are not
confined to the Hot Springs: “ The Hot Springs attract the
wealthy who are suffering from certain diseases, the suffering
wealthy have attracted the doctor, the doctors look after the
wealthy and their wealth, the merchants look after the doctor’s
wealth, and so on ad infinitum, eventually developing a circle
full of business, of healing and a striving for wealth. The great
business of the place is doctoring, and everybody in business
is dependent upon the doctors’ success in secur ing custom aud
consequent pay. Doctoring being the chief business, and
everybody being dependent upon its rewards, everybody at¬
tends to busiuess according to business laws. Solicitors solicit,
agents represent, and attendants assist the doctors ; the boats
and cars leading to the city, bringing sufferers who hope to be
relieved, are met by doctors’ representatives, who extol their
respective principals and denounce rivals. Business begins
before the victim gets within the city limits, and continues un¬
ceasingly until he dies, generally, or by some chance is restored
to health, occasionally.” — Chicago Med. Gazette , Jan. 20.
TREATMENT OF CHRONIC ULCER OF THE LEG BY MARTIN’S RUB¬
BER BANDAGE.
By A. W. Perky, M. D.
Chronic ulcer of the leg is one of the most aunoyiug affec¬
tions that the physician or surgeon is called upon to treat.
Found, as it generally is, among the laboring classes, it is,
owing to their circumstances, very difficult to cure and exceed¬
ingly liable to return. Many plans of treatment have been
proposed, and they all succeed when conjoined with rest iu
the horizontal posture. When the ulcerations are small or just
beginning, a timely rest would cure them up ; but in this con¬
dition they are considered too slight to justify the admission
of the subjects to a hospital, and usually they cannot afford to
remain long enough at home to ensure a cure, so they work
Current Medical Literature.
975
1880]
until the ulcer becomes so large and inflamed that they are
admitted to the hospital, where they are cured by rest; leave
the hospital and repeat the same history in a year or two. How
familiar is this picture to every physician. The cause of
chronic ulcer of the leg being deficient venous circulation, the
most successful methods of treatment have been rest or obliter¬
ation of the varicose veins invariably present. It has always,
of course, beeu considered a desideratum to afford support to
the leg by means of bandages, but they all have some objections
for continual wear. The cotton roller easily slips off in per¬
sons who exercise; the elastic stocking is troublesome to put
on, and in a short time stretches so much as to be useless, and
is quite expensive; the laced stocking is troublesome to apply
and does not lie smoothly. The .Martin bandage (a roller ban¬
dage) cut from thin rubber cloth of nearly pure gum, has very
few of the disadvantages above mentioned, and its use will
open a new future to these cases of chronic ulcers. They need
no longer encumber the surgical wards of hospitals or lose their
time at home. This bandage will cure, as Dr. Martin- says,
chronic ulcers of the leg without the necessity of an hour’s rest
or change of posture. Dr. Martin treated over six hundred
cases of this kind, curing all without exception. We can bear
the strongest testimony to the efficacy of this treatment with¬
out rest, and will give the history of the latest case treated by
us in this way.
J. M., about 35 years old, common laborer, was sent to me,
October 11th, 1879, with a chronic ulcer at the lower part of
the leg, with hard bluish edges, a yellow bottom, and discharg¬
ing a thin sanious pus. This was beginning to inflame, and he
had left off work for about a week. He had already been sev¬
eral times in a hospital for previous outbreaks of this ulcer.
I applied a rubber batidage, five inches wide and three yards
long, costing $2 00, to the leg from the instep to just below
the knee, using no reverses in applying the bandage. He then
went to work as usual ; no application was made to the ulcer.
October 14th the ulcer was well, and he has worked all the
time.
The bandage should be taken off at night, washed, and hung
to dry, and should be applied in the morning before the patient
gets out of bed. It never slips off, aud if applied a little too
tight or too loose it adjusts itself to the proper tension. We do
not know of a greater benefit to the large class of sufferers from
chronic ulcers of the legs than this invention of Dr. Martin.
— San Francisco Western Lancet, IS ov., 1879.
GARSON ON INEQUALITY IN LENGTH OF THE LOWER LIMBS.
The asymmetry of the lower limbs in living persons has been
very fully aud satisfactorily proven by Dr. Wight, of Brooklyn,
and his results have beeu con firmed by Dr. Cox, of New York,
976 Current Medical Literature , | April
who curiously enough investigated the subject independently
and almost simultaneously ; but whose paper appeared after
that of Dr. Wight. It had not, however, been shown whether
the asymmetry was due to unequal development of the bones
or of the soft parts. To ascertain this point, Dr. Gar son made
an extensive series of measurements of the bones of the lower
extremities of skeletons in the museum of the Royal College of
Surgeons of England. The results of his measurements show
that the combined lengths of the feunv and tibia on one side
of the body are seldom the same as the combined lengths of
those bones ou the other side. He found that in 10 per cent,
only are the right and left limbs equal. This corresponds very
nearly with the results obtained by Dr. Wight from his meas¬
urements of the limbs of living persons. In the majority of the
cases where the limbs were equal they were so by compensation,
that is, by the tibia being shorter when the femur was longer,
aud vice versa. In 35.8 per cent., the right limb was found to
be longer than the left, the average preponderance of the
former over the latter being 3.3 millimetres. In 54 per cent,
the left limb was longer than the right, and its average pre¬
ponderance over the right was 4.8 millimetres. The left leg,
therefore, is not only more frequently longer than the right,
but the difference between the lengths of the limbs is greater,
generally, when the left is the louger. Regarding the lengths
of the individual bones, the author finds that the left femur is
in 58.5 per cent, longer than the right, it average preponder¬
ance being 3.3 millimetres; in 28.8 per cent, the right is longer
than the left, its average preponderance beiug 2.9 millimetres ;
and in 12.9 per cent, the bones are equal. Again in 34.2 per
cent, the left tibia is longer than the i ight, the average prepon¬
derance being 3. millimetres ; in 41.4 per ceut. the right is
longer than the left, the average preponderance being 2.6 mil¬
limetres ; in 24.2 per cent, the bones are equal. While the left
femur is, therefore, the longer, the left tibia is usually the
shorter. In this way there is, in some cases, a certain amount
of compensation, although it is often found that where the
femur of one side is longer than that of the other, the tibia of
the side on which the femur is the longer is often also the
longer. The inequalities of the limbs do not seem to be con¬
fined to any particular age, sex, or race. Altogether the re¬
sults obtained by the American surgeons are entirely confirmed
by Dr. Garson’s observations on the bones. — London Med. Bee.,
Hov. 15.
TETANUS.
Dr. Krucht, of Walheim, Saxony, has collected 389 cases ol
tetanus, which he reports in the June number of Schmidt’s
Med. Jahrbucher. The following resume will show the compara¬
tive success of the various modes of treatment which were had
recourse to in those 389 cases :
1880J Current Medical Literature. 977
No. Cases
2 reatment
Recovered.
Died.
Mortality.
58
Surgical,
30
28
48 per cent-
51
Curare,
26
25
49 per cent-
60
Calabar,
33
27
45 per cent.
134
Chloral,
79
55
41 per cent.
63
Various,
32
31
49 per cent.
To the 134 cases treated with chloral may yet be added twenty-
three other cases in which this remedy was used in conjunction
with other agents. Of these twenty-three cases, nineteen
recovered and four died — the mortality of the entire number
treated with chloral being thus lowered to thirty-seven per
Cent.
The surgical treatment instituted in the fifty-eight cases con¬
sisted in amputations, stretching of nerves, etc. The editor
closes the article with the remark, “that this collection of cases
again verifies his opinion, that chloral affords better results in
the treatment of tetanus than any- other agent known.”
F. W. Koehler.
TETANUS.
The results at which Prof. D. W. Yandell arrives,
from a careful analysis of three hundred and eighty five
cases published and thirty unpublished cases of tetanus, are
as follows :
1. Traumatic tetanus is most fatal during the first decade
of life.
2. It usually supervenes between four and nine days after
the injury.
3. The largest number of recoveries are found in cases
in which the disease occurred after the lapse of nine days from
the injury.
4. When tetanus continues fourteen days, recovery is the
rule, death the exception, apparently independent of the treat¬
ment.
5. Tetanus arising during the puerperal state is the most
fatal form of the disease.
G. Chloroform has, up to this time, yielded the largest per¬
centage of cures iu acute tetanus.
7. The true test of a remedy for tetanus is its influence on
the history of the disease : (a) Dot-s it cure cases in which the
disease occurred prior to the ninth day alter the injury1? (b)
Does it fi.il in cases whose duration exceeds fourteen days?
8. Tried by these tests, no agent has yet established its
claims as a true remedy for tetanus. — Birmingham Review, J uly ,
1879.
CREMATION IN ITS MEDICO-LEGAL ASPECTS.
This subject has received the attention of the Societe de
Medecine legale de France, a full and interesting discussion
978
Current Medical Literature.
[April
having ensued on the presentation of an essay on the topic by
M. Ladreit de Lacharriere.* The sanitary relations of the
theme received ample consideration also, but with these we
are not now concerned.
M. Lacharriere took the ground that, from a medico-legal
point of view, cremation is open to the gravest objections.
Before any dead body is submitted to incineration, there
should be, he says, certainty upon two points: the fact of the
death itself and the cause of the death. Verification of the
death is not difficult, especially in cities which can adopt the
Parisian system. But accuracy as to the cause of the death
is not an easy matter to manage; medical certificates do not
solve the question, nor is the ordinary autopsy, performed, as
it is, without any presumption or suspicion such as forms the
basis of a medico-legal examination, a sufficient safeguard
against crime. Therefore it would be unsafe to proceed, upon
such inadequate means of detecting in the body the true cause
of death, to destroy the body by cremation, and thus throw
away the opportunity for reinvestigation. Finally, M. Lachar¬
riere supposes two instances, either one of which is likely to
occur: A person dies, presumably of heart disease, but really
by a poisonous dose of digitalis administered with criminal
intent. The autopsy establishes the presence of heart disease,
and the crematory furnace is allowed to do its work, whereby
the real evidence of the crime is destroyed, and the criminal
escapes. Or, in the second case supposed, no crime has been
committed, but popular gossip accuses unjustly one of the
relatives of the deceased. What proof will the accused be able
to furnish, after cremation of the body, that he is really in¬
nocent ?
Thus, by enabling the traces of a crime to disappear, crema¬
tion leaves society defenseless ; it can likewise make it impos¬
sible for an innocent man to answer baseless calumny.
In the discussion which followed the reading of this paper,
M. Napias expressed the opinion ihat cremation offei< d no real
obstacle to the detection of crime in cases of death by violence,
and that burial had no special advantages in this regard. If
a death has been the result of mechanical violence, the case
presents no difficulty, since the injuries could hardly escape
observation. In cases of poisoning, however, there would be
more difficuliy. In this connection, M. Napias would divide
poisons into two classes : those which could not. be recovered
from the ashes of a cremated body, such as organic substances,
mercury (because of its volatility) and phosphorus (normally
present in the body) ; and, secondly, those which can be traced
after incineration, such as arsenic, antimony, and copper.
Poisons of the first class disappear in case of burial as well as
in that of ciemation; poisons of the second class are found
'Annalos d’Hygieue publique et de Medeoine legale, June and July, 1879.
Current Medical Literature.
979
1880]
just as readily in ashes as in the remains of buried bodies.
Moreover, as a matter of fact, the majority of exhumations are
made to determine the nature of mechanical injuries, not of
toxic agents.
In cases of death occurring without an attending physician,
M. Napias would not permit cremation, except after a complete
autopsy ; and if the slightest suspicion were entertained as to
the manner of the death, an inquest also should precede the
final disposition of the body.
M. Gallard argued that the autopsy was an ample safe-guard
against any medico-legal misadventures of cremation. This
will almost always reveal the cause of death, and should in¬
variably be applied. In the exceptional cases where the cause
of death is not thus determined, there should be in addition a
chemical analysis, and possibly an inquest also. M. Gallard
stated that he would subject to cremation all dead bodies not
claimed by friends, such as those of executed criminals, of
persons dying in hospitals or prisons, and those carried to the
mogue and not identified.
M. Riant believed that cremation would expose society to
the most serious dangers from a medico -legal point of view,
because a crime frequently escapes suspicion till long after
the death of the victim, and cremation renders impossible the
demonstration of the crime and the punishment of the criminal.
He did not think that the ordinary medical certificate of the
cause of death, liable as it is to many errors, afforded much
protection against the dark deeds of criminals. Cremation,
after such a certificate, will have rendered a mistake irremedi¬
able and a crime unpunishable ; burial, on the contrary, pre¬
serves for us the corpus delicti , and permits the condemnation
of the guilty.
He pointed out the impracticability of M. Gallard’s proposal
to have an autopsy in every case before cremation ; in Paris
alone nine hundred autopsies would be required each week.
The difficulties in the way of chemical analysis as a prerequi¬
site of cremation would be even greater. In cases of poisoning,
in which chemistry lends its aid under present methods, the
chemist has clews and presumptions, if not proofs, which lie
simply verifies ; and even with these advantages much time
and great care and delicacy are needed in the processes em¬
ployed. The chemical search which M. Gallard would impose
would be simply a search in the dark, without guide or hint as
to the result; such an investigation could not be seriously
undertaken.
To the suggestion of M. Napias that the organic and volatile
poisons are the only ones liable to loss through cremation, M.
Riant replied that these were in fact the poisons most com
mouly used by criminals, and for obvious reasons. Moreover,
granting that the ashes resulting from cremation may be found
to retain mineral poisons, it is easy to see how readily these
ashes might be scattered or destroyed by the criminal, or other
8
980
Editorial.
April
ashes, innocent of poison, substituted. M. Riant also re¬
minded M. Napias that, while gross mechanical lesions would
undoubtedly be seen and investigated, there were means and
agents not unknown to criminals that would leave slight traces
of their fatal work ; there are wicked mothers who know that
a needle or a pin is useful in infanticide, and that it leaves but
a scanty evidence of its use.
An inquest before cremation M. Riant deemed of little prac¬
tical value, since the interval of thirty-six or forty eight hours
available in such a case, betweeu the death and the furnace, is
generally much too short for the manifestation of suspicious
or pointed rumors, upon which alone an inquest would be well
founded or the machinery for the detection of the criminal set
in motion.
M. Riant would reserve cremation for use in seasons of fatal
epidemics and for the disposal of the bodies of soldiers after
great battles. — Boston Med. and Burg. Jour ., Jan. 29.
PARISH MEDICAL SOCIETIES.
Elsewhere will be found the proceedings of two parish asso¬
ciations; the Attakapas Medical Society and the Iberville
Medical Society. There is throughout the State a number of
parish organizations, but our information in regard to their loca¬
tion and membership is very meagre. What they are doing we
have not heard for some time, but trust that good work is being
accomplished and that the secretaries of each will favor us
with a synopsis of proceedings and forward for publication the
interesting papers read by the members. The obliging secre¬
tary of the Attakapas Medical Society has forwarded manu¬
scripts of a valuable article read at the meeting held March
4th. We regret that its late arrival will compel us to defer
publication until the next issue.
Nothing has a greater tendency to unite the profession than
these parish organizations. The fact of membership at once
establishes the status of the practitioner. Ostracized by his
profession, the physician of any place feels alone and in the
country especially it is so gratifying to find practitioners resid¬
ing a few miles apart meeting at stated intervals to confer with
each other on current events in the medical world and special
diseases of their community. Sociability and the cultivation of
kindly feeling are in themselves sufficient incentives.
Editorial.
981
1880]
When the State Association formed it was hoped that dele¬
gates from parish medical societies, with proper credentials,
would compose that body ; lack of organization throughout
the State has precluded this possibility, and the very existence
of the State organization is really dependent upon physicians
who do not belong to parish societies. Fortunately for the
State Medical Association, a large number of physicians, even
though they failed to interest their colleagues in forming local
societies, willingly spend three days in the year in pushing the
interests of the profession at the sessions of the State society.
Still, what we wish, is to have the whole State represented by
special delegates from every district. These reporting on
special features of disease in their respective districts and
topography of each parish, will afford valuable matter for the
future statistician, for the time will come, and we hope is not
far off, when each ward of every parish wiil have its vital
statistics registered by proper officers. Then again, there will
be this gratification to the profession of the State, that the
cause of medical education and practical studies of hygiene
and preventive medicine will, through the thorough organiza¬
tion of the rank and file, lead to such victories as those attained
by our sister States, Alabama and Mississippi.
UNIVERSITY OF LOUISIANA— M EDIC A L DE¬
PARTMENT.
The Commencement Exercises of the Forty sixth Annual
Session of the Medical Department of the University of Louis¬
iana, were held at the Grand Opera House, New Orleans, March
19th, beginning at 12, M.
The pleasant weather, combined with the attractions on this
occasion, filled the house with an appreciative audience, and
the exercises throughout exceeded in interest and taste, any'
similar one witnessed by us.
The exercises were opened with a pleasing musical introduc¬
tory by the Thirteenth Infantry Band.
Dr. B. M. Palmer offered a prayer.
The degeees were conferred by Hon. Randall Hunt, Presi¬
dent of the University, who made a few appropriate remarks.
The Annual Address was delivered by Hon. James B. Eustis,
on the timely topic : The Commercial Intercourse between
Communities and States during Epidemics.
982
Editorial.
[April
Frequent applause demonstrated that the views of the orator
were in harmony with his audieuce.
At the conclusion of the exercises Dr. T. G. Eichardson, the
Dean of the Faculty, introduced Dr. Samuel D. Gross, of
Philadelphia, who addressed the graduates with words of en¬
couragement and advice, and paid a high tribute to the late
Prof. Warren Stone, M. D.
The names of the graduates are as follows :
DEGREE OF DOCTOR OF MEDICINE.
Ash, John W . Alabama
Barham, J. H., M. D., . Texas
Barrow, David . Louisiana
Berry, James R . Mississippi
Bolton, William S . Texas
Bourgeois, Clement A. . . .Louisiana
Brickell, Frank H . Louisiana
Bridges, Robert R . Mississippi
Buckner, W. E . Mississippi
Campbell, Wilfred W.. ..Louisiana
Cook, Thomas L. H . Mississippi
Cooke, William O . Georgia
Courdgd, Simon.. . Louisiana
Donald, Robert B . Mississippi
Dugas, Elphcge T . Louisiana
Dumas, Wm. P., M. D . Texas
Ellis, George E . Mississippi
Fairbanks, Charles M. . . .Tennessee
Fleetwood, John N . Louisiana
Flowers, William M.... Mississippi
Ford, Francis C., M. D . Texas
Freeliug, John W . Tennessee
Greer, Rufus A . Texas
Hanson, John D . Louisiana
Hdbert, Thomas . Louisiana
Helm, William B . Louisiana
Hirnel, Numa . Louisiana
Hiriart, Emil . Louisiana
Jones, John T . Louisiana
Keitz, Gustav . Louisiana
Kennedy, Sterling D . Louisiana
Lewenthal, Abraham .... Louisiana
Lynch, John P . Louisiana
Matas, Rodolfo . Mexico
McGehee, William A . Texas
Mizell, George D . Mississippi
Moody, Thomas . Texas
Nixon, James W . Texas
Owen, W. Glendower . .. Louisiana
Ridley, Francis M . Georgia
Silvestre, Felix A . Louisiana
Smith, Ernest H . Louisiana
Snow, William H . Texas
Sturdevant, James K .. Louisiana
Tarleton, Leo C . Louisiana
Vandergrift, Wash. F . Alabama
Washington, Chas. D . Texas
Whatley, John S . Texas
Young, James A . Mississippi
DEGREE OF MASTER OF PHARMACY.
Albers, David P . Louisiana
Berger, Otto . Louisiana
Bradburu, Wm. P . Louisiana
Caillier, Joseph A . Louisiana
Despovte, Charles . Louisiana
Duffel, Lewis E . Louisiana
Fairbanks, Chas, M . Tennessee
Gessner, Heury C . Louisiana
May, Eugene . Louisiana
Metreaud, Frank M . Louisiana
Pariuelee, James M . Louisiana
Puech, Nevil A . Louisiana
Sayus, Lewis A. de . Louisiana
Schuman, Philip . Louisiana
Tilford, Robert H . Louisiana
Wunderlich, William - Louisiana
PROF. SAM’L D. GROSS, M.D., D.C.L., OXON.
The arrival of Prof. Sara’l D. Gross in New Orleans on the
18th of March was an incident that compares with but one other
event in its medical history. We allude to the visit of the
celebrated Marshall Hall. The reception of this venerable
father has been so general and profound that we feel sure his
stay in the Crescent City will add another to the many delightful
memories which cling to the heart of this good old man. He
was present at the Commencement Exercises of the Medical
Editorial.
983
1880]
Department of the University of Louisiana, and the few words of
welcome and advice to the graduates were impressive and
highly appreciated.
He- was the guest of Prof. T. G. Richardson, his former
pupil, and the reception given him by that gentleman at his
beautiful residence on the 20th inst., was an enjoyable affair.
The host proved himself a master in the art of entertainment,
and fully one hundred and fifty physicians availed themselves
of the invitation to be introduced to one, who although
personally a stranger was yet well-known to all.
On the 24th inst., a complimentary reception was tendered
Prof. Gross by the members of the medical profession in New
Orleans.
The reception was given at Spanish Fort, Lake Ponchartrain.
The day was delightful and at 1 o’clock a special train con¬
veyed the party to its destination. A joint committee,
composed of six members each from the Orleans Parish
Medical Society and New Orleans Medical and Surgical Asso¬
ciation had charge of all arrangements.
The party, numbering about one hundred, atter walking
over the grounds and viewing the many objects of interest, at
half-past two, P. M., seated themselves at the table. The
chairman of the joint committee, Dr. J. P. Davidson, introduced
the guest as follows :
Gentlemen — As the chairman of the joint committee of the
Orleans Parish Medical Society and the New Orleans
Medical and Surgical Association, I have the honor of intro¬
ducing to you our distinguished guest, Prof. Sam’l D. Gross^
of Philadelphia, whose fame both as a teacher aud author is
co-extensive with the civilized world.
To most of those present he may be personally uuknown —
but he comes not to us of the medical profession as a stranger
— rather indeed as an old and familiar acquaintance; for it
may be said that we have all sat at his feet as another Gamaliel.
Therefore, in greeting him to-day with the esteem aud
respect due to his exalted virtues as a man, and his extended
and eminent services in the noble science of medicine aud
surgery, we do honor to the profession aud to ourselves.
In the name of the physicians of New Orleans, honored sir,
984 Editorial. [April
I bid you welcome to our city, and hope that your sojourn in
our midst may be in all respects a pleasant one to you.
The menu was all that could be desired, and amid the rivalry
of such occasions toasts were drank to “ our guest ” the
United States, the Medical Profession, the Press, etc.
An autograph album, containing the names of those present
was presented to Prof. Gross who made a feeling response.
Addresses were made by Prof. S. E. Chaill6, Rev. W. H.
Watkins, Drs. Hale, Sternberg, Turpin, Salomon, Crawcour,
Loeber, Schuppert, Milner and Joseph Holt, after which the
professor and party returned to the city.
PHOTOGRAPH OF PROF. S. D. GROSS.
We have received from the courteous and artistic photo¬
grapher, W. W. Washburn, 109 Canal street, a striking likeness
of Prof. S. D. Gross. We feel sure that members of the
profession in New Orleans will be glad to avail themselves of
the opportunity to obtain a copy as a memento of this illus¬
trious surgeon.
IBERVILLE MEDICAL ASSOCIATION.
The second annual meeting of the Iberville Medical Associa¬
tion took place on February 25, at the residence of its president,
Dr. J. P. R. Stone.
Dr. Edward Duffell, of Ascension, was present by invitation.
The present officers were re-elected for the ensuing year.
J. P. R. Stone, M. D., President.
A. B. Snell, M. D., Secretary.
Bayou Goula, La., March 21st.
NECROLOGY.
Died— At Washington, St. Landry Parish, March 13th, 1880, Dr. Thomas
A. Cooke, aged 70 years, a native of Glaucester County, Va., and a resident
of this State for forty years.
Died — On Wednesday, March 31st, 1880, Dr. Samuel W. Rawlins, aged
22 years and 11 months, a native of New Orleans, La.
1880]
Reviews and Book Notices.
Reviews and Book Notices.
985
A Biographical Dictionary of Contemporary American Physicians.
Edited by Wm. B. Atkinson, M.D., Permanent Secretary
of the American Medical Association and of the Medical
Society of the State of Pennsylvania, etc. Second edition,
enlarged and revised. Philadelphia: D. G. Brinton.
New Orleans : J. C. Eyrich.
The sad thought that we must all die is greatly mollified by
the recollection that we have been our own biographers, and
have left nothing to laborious Dr. Toner or medical journals,
but to complete our records by winding up with the date of
death.
We have seen books entitled “ Every Man His Own Lawyer,”
“ Every Man His Own Book-keeper,” but this work should be
called “ Every Doctor his Own Boswell.”
The first edition of this work, embellished by portraits of
the handsomest, if not the most prominent members of the
medical fraternity, created quite a buz in professional circles,
and complimentary notices went the round of the medical
journals. Pardonable vanity was excused, and the industry
and skill of the editor deserved warmest praise. The work
paid no doubt, and all except those left out were happy.
The second edition is not entitled to the praise bestowed
before. The lack of care evident in getting it up will warrant
some candid remarks. It is, with the exception of a few pages
added at the back part of the work, a mere reprint of the
former edition. The same electrotype plates were used, and it
is minus the portraits. The same typographical errors are at
hand. The dead are along with the living, and if these have
been left in from motives of economy an appendix should have
been added, especially since such men as Woodworth, Peaslee
and Atlee have passed away.
When the first edition of this work appeared we were
gratified, indeed amazed to find that we were living iu the
land where so much genius abounded. We did not expect
to see another edition appear, but confidently thought that
some self- sacrificing doctor would collect for the benefit of the
rising generation, the various articles emanating from these
986
Reviews and Book Notices.
[April
distinguished men and publish them in book form, thus doing
away with the old style text books ; afford a field where the
student could gambol and collect and store away for future
brain nourishment the “ serials.” We know the labor will be
arduous. But oh ! you medical philanthropist, look to it that
this is done before the anchor death has twanged the bow¬
string and let fly the fatal shaft. Think of the important
knowledge lost to medical science should “ The Nature and
Cure of Heterologous Tumors,” “ Marriages of Cousanguinity,”
“ The Function of the Ciliary Processes of the choroid Coat
of the Eye,” “ The Yis Medicatrix as a “ Blood Letter,”
Haematemesic Paludal Fever,” “Tetanoid Fever,” “Elkoplastry,”
“ Inflammation of the Umbilicus,” “ Sickness Tax,” “ Hallux
Valgus,” “ Grace Culture,” “ Albinism in Negro Race,”
“Essay on Quinine,” etc., etc,, be consigned to medical
journals or “ Transactions ” of Associations.
I ' _
A Practical Treatise on Nervous Exhaustion (Neurasthenia),
its Symptoms, Nature, Sequences , Treatment. By George
M. Beard, A.M., M.D., etc. 8 vo. pp. XX and 198. New
York: Wm. Wood & Co. 1880, [For sale by Armand
Hawkins, medical bookseller, 1961 Canal street, New
Orleans.]
The above-named disease is stated by the author to be the
most common of the nervous disorders prevailing in this
country, and to be specially common in the Northern and
Eastern sections, while comparatively rare in the South,
especially along the gulf coast. He adds that this complaint
belongs particularly to the present century, that its true nature
has only recently been recognized fully, having been classed
by physicians and the laity as “ general debility,” “nervous
prostration,” “ nervous debility,” “ spinal weakness,” “ spinal
irritation,” “nervous dyspepsia,” “oxaluria,” cerebral and
spinal ana&mia and hyperaemia. As a consequence very con¬
fused ideas of its nature have been entertained, and it has
been greatly neglected.
Though more common in the North-eastern portion of the
United States than elsewhere, it is known in Europe, where it
has its favorite territory, comprising England, Northern France
and Germany. It is evidently an outgrowth of modern civili¬
zation, and dependent on the excessive strain and friction of
Reviews and Boole Notices.
987
1880 1
the present artificial and highly specialized occupations and
modes of life.
The book is divided into five chapters, of which the first is
brief and introductory. The second, occupying 74 pages,
treats minutely of the numerous symptoms of nervous exhaus¬
tion, of which more than 70 are enumerated and explained.
Among these are classed a variety of morbid fears, for which
the author uses new terms, some of his own invention. Thus
)
we find astrophobia, or fear of lightning ; agoraphobia , or fear
of open places ; claustrophobia , or fear of close places ; anthro-
pophobia , or fear of society ? monophobia , or fear of solitude ;
phobophobia, or fear of fears ; mysophobia , or fear of contami¬
nation ; pantaphobia , or fear of everything.
lu the third chapter he treats of the nature and diagnosis of
nervous exhaustiou. Among the most important distinctions
to be observed are diagnosis between this malady and hypo¬
chondriasis, anaemia and hysteria. In this chapter he gives
the differential diagnosis between cerebrasthenia (brain exhaus¬
tion), and myelasthenia (spinal exhaustion), both of which are
included in the scope of his work.
Chapter fourth treats of the Prognosis and* Sequences of
Nervous Exhaustion, and the fifth of Treatment and Hygiene
of the disease. Among the recognized remedies he includes
metalloscopy and metal therapeutics. While admitting that
magnets and the like operate powerfully through the imagina¬
tion and the faculty of expectancy, he still holds that they
have an essential property, as tested upon persons kept in
ignorance of the real nature of the substances applied. Dr.
Beard is a careful observer, and his reputation as an expert is
such that his statements and opinions are entitled to serious
consideration. We must not, therefore, reject his conclusions,
though we may still require further evidence for full admission.
On the whole, we regard this little work as a valuable
contribution to a rather obscure brauch of medical practice.
It is sure to interest the medical reader, and is well worthy
the attentive perusal of the general practitioner, as well as
those specially devoted to nervous maladies.
S. S. H.
9
988
Reviews and Book Notices.
[April
The Therapeutics of Gynecology and Obstetrics , comprising the
medical , dietetic and hygienic treatment of Diseases of Women,
as set forth by distinguished contemporary specialists. Edited
by Wm. B. Atkinson, A.M., M.D., Author of “ Hints in
Obstetric Practice,” Lecturer on Diseases of Children at
the Jefferson Medical College, etc. 8 vo. pp. 365. Phila¬
delphia : D. G. Briuton. 1880.
This work is a companion to two similar ones brought out
by the late Dr. Geo. H. Naplieys, entitled “ Modern Medical
Therapeutics” and “Modern Surgical Therapeutics.” Its
preparation had been commenced by Dr. N., and was completed
on the original plan by Dr. Atkinson.
The former volumes of the series have already passed through
several editions, and the seventh and sixth issues respectively
lately received favorable notice at our hands. The medical
public are satisfied with these compilations, inasmuch as they
reflect the actual state of medical and surgical knowledge, as
exhibited by their leadiug representatives, and we believe that
the same approval awaits this volume.
Brain Work and Overwork. By Dr. H. C. Wood, Clin. Prof.
Nervous Diseases, Univ. Pa., etc. 24 mo., pp. 126. Phila¬
delphia : Presley Blakistou. 1880.
This is the tenth number of the series of American Health
Primers, edited by Dr. W. W. Keen. The seven chapters are
devoted to the following subjects : I. Are Nervous Diseases
Increasing? II. General Causes of Nervous Trouble. III. Work.
IY. Rest in L ibor. Y. Rest in Recreation. YI. Rest in
Sleep. YII. Conclusion.
The subjects are of practical interest to the laity; the
language is free of technicalities, adapted to the understanding
of general readers; the views of the writer are sound and
appropriate. While we find much to commend in the design
and execution of the work, we canuot forbear noticing some
faults in language, which ought to have been avoided by a
writer as practiced in authorship as is Dr. Wood. Examples
of false syntax occur at the bottom of p. 114 and top of p. 115,
and in the fourth line of p. 121. Provincialisms here and there
betray the associations of his childhood. The native Southern
reader would be puzzled by the word “ skimp,” and Webster
and Worcester would afford him no hint of its meaning. We
1880]
Reviews and Boole Notices.
980
suggest that he might fittingly have closed with the exculpatory
petition of the letter writer, u Excuse haste and a bar! pen.”
The Student’s Guide to Diseases of the Bye. By Edward
Nettleship, F.R.C.S. Ophthalmic Surgeon to St. Thomas’
Hospital. With 89 illustrations. 12 mo. pp. 3G9. Philadel¬
phia: Henry C. Lea. 1880. [Sold by Armand Hawkins,
1964 Canal street, New Orleans.]
The twenty-two chapters of this book are grouped into three
parts, or general heads, devoted to, I. Means of Diagnosis
(three chapters) ; II. Clinical Division (eighteen chapters) ;
III. Diseases of the Eye in relation to Geueral Diseases
(one chapter). The work was prepared for the use of students
of medicine during their hospital course, and will be found well
adapted to the needs of the general practitioner. It contains
much more matter than will be found in systematic treatises
on medicine and surgery upon this special class of complaints,
and is more convenient for reference, being a small and handy
volume.
The Practitioner : An Independent Monthly Journal devoted to
Medical ,• Surgical , Obstetrical and Dental Science. Edited
by Harvey L. Byrd, A.M., M.D , and Basil M. Wilkerson,
D.D. S., M.D. Volume I, No. I, January, 1880. Baltimore,
Md. Subscription, $2 00 per annum.
The Indiana Medical Reporter : A Monthly Journal of Medicine
and Surgery. Editors and proprietors, A. M. Owen, M.D.,
J. E. Harper, M.D., Benj. F. McCoy, M.D. Volume I,
No. I, January, 1880. Evansville, lad. Subscription,
$2 00 per annum.
Galveston Medical Journal. Greensville Dowell, M.D., Editor
and proprietor. J. F. S. Paine, M.D., and T. J. Heard,
M.D., associate editors. Volume I, No. I. January, 1880.
Terms, $3 00 x>er annum.
The first two above-named publications are entirely new
candidates for the favor of the medical public, containing
respectively 52 and 48 pages of reading matter. The first is
about equally divided between medicine and dentistry, and
contains several articles of iuterest and value. The second,
among other articles, contains one on Syphilis from a Sanitary
990
Reviews and Book Notices.
[April
Point of View, by Prof. G. B. Walker, M.D., of Evansville.
The author takes the ground that prostitution can not be
suppressed by outlawry nor by moral suasion. Therefore,
recognizing the social evil as inevitable, he prefers to regard
it as a sanitary problem, to be put under wholesome regula¬
tions. In this we quite agree with him. The clergy and the
moralists have had trial for many centuries, resulting in
conspicuous failure. Neglecting totally the sanitary side of
the question, they have battled solely against the vice ; mean¬
while venereal diseases have constantly violated the sanctity
of domestic life. It is certainly time for change of base in the
warfare. Protect society from these maladies by supervision
of those most liable to disseminate them, and by putting those
infected under restraint. If judicious sanitation can meas¬
urably prevent venereal diseases, we need not beat the air
in vain attempts to suppress the social evil ; and the senti¬
mental nonsence of encouraging vice will subside like the
pious opposition to the use of chloroform in midwifery as a
wicked interference with the curse of maternity.
The Galveston Medical Journal re- appears, after a sus¬
pension of eight years, under the management of the same
senior editor. Having now the assistance of two able coadjutors,
we trust that the new era of material prosperity will give
better auspices to the enterprise and place it upon a permanent
footing. S. S. H.
Transactions of the Twenty-ninth Anniversary Meeting of the
Illinois State Medical Society , held at Lincoln , May 20 and 21,
1879. 8 vo. pp. 302.
As is usual, the president’s address occupies a prominent
part. It was pronounced by Dr. E. P. Cook, of Mendota, and
touches upon a variety of topics of interest. The work of the
State Board of Health is mentioned with commendation and
congratulation, particularly in its energetic enforcement of the
Medical Act, which has created an exodus of more than a
thousand unqualified practitioners of medicine from the State.
Dr. Cook also takes a prospective view of this work, as
expressed in his own words :
Reviews and Book Notices.
991
1880]
“ Seriously we regard the work thus far done by the State
Board of Health, as having accomplished more in the direction
of medical education in our State than could have been done
by any other means in the same or much longer time.” But he
is not willing to let the reform in medicine rest here. The
pharmacists, he thinks, should also be subjected to similar
conditions, and he is undoubtedly right, provided the law can
be enforced. We should like very much to see how that Board
of Health will succeed in its grand reforms, and, if it continues
as it has begun, we may indulge the hope that, in the future
(more or less remote), the people of Louisiana may enjoy sound
medical advice and safe physic.
We are gratified to find the trite subject of medical educa¬
tion come in for a share of attention, because its agitation is
sure to bring results. Dr. Cook advises an extension of the
course from three to five years, devoting the first to preliminary
studies and the last year to clinical application. That is a
consummation devoutly to be wished ; but we suspect I hat the
public of Illinois get already about as good medical advice as
they pay for, and that they would not agree to pay for much
better, at present. (As regards the Louisiana public, it is not
a suspicion but a conviction).
The same question of medical education was made a subject
of report by a committee of three, and the following table is
presented to show the relative number of medical men in this
and the other principal civilized countries :
Number of Annual Graduates. Ratio to Population.
United States .
. 3,000 .
. 1
to 600
Great Britain .
. 1
to 1,700
France . .
. 750 .
. 1
to 1,800
German Empire . .
. 000 .
. 1
to 3,000
Austrian Empire . .
. 600 .
. 1
to 2,500
Italy .
. 200 .
. 1
to 2,500
The complaint is made that our excessive number of physi¬
cians reduces the individual incomes in like ratio, but this is
clearly an error. In this country wealth is more evenly
distributed than in Europe, and our common people are able to
992
Reviews and Book Notices.
[April
pay larger medical fees. Besides, our 40,000,000 sovereigns will
not submit to such control in the practice of medicine as the
subjects of paternal governments are obliged to. They claim
and exercise the privilege of risking their lives in a variety of
ways, apart from the perils of the healing art.
We have space to notice here only one other paper — that of
Dr. E. Boyer on Compensation of Medical Witnesses. After
relating a number of instances, illustrating the defects of
American laws touching the recognition of the claims of
experts to some compensation beyond that allowed to ordinary
witnesses in matters of fact, he makes the following conclusion,
which is certainly equitable and we hope may be sustained
generally by courts :
“ That we have a legal right to demand compensation, when
called upon by coroners to make post-mortem examinations,
and without an agreement to compensate, to refuse to make
such post mortem ; also that we have a legal right to refuse to
sit and hear testimony in courts of justice, for the purpose of
giving medical-expert testimony, without compensation.”
This is a bound volume, and presents a creditable appearance,
both externally and internally. S. S H.
Transactions of the Tenth Annual Session of the Medical Society
of Virginia , held at Alexandria, Ocohter 21, 22 and 23, 1879.
8 vo., pp. 152.
The address of the President, Dr. L. S. Joynes, treats of
several points of interest. The discrimination between the
legal and medical professions made by the law is justly com¬
plained of: “ For evidence of qualification and character is
required for admission to the bar, and the lawyer cannot be
compelled to divulge the confidential communications of his
client.” Probably if the medical profession were as largely
represented in our legislatures as is the legal, such partiality
would not prevail. He also enters a plea in favor of the too
much depreciated country practitioner by making honorable
commemoration of Edward Jenner ; of Ephraim McDowell, the
author of ovariotomy ; of Crawford W. Long, of Georgia, lately
proved to have first used ether as an anaesthetic in surgery ; of
1880]
Reviews and Booh Notices.
993
Dr. Stearns, of Saratoga County, N. Y., who re-establishedergot
as a therapeutic agent ; of John Tennent, Thos. J. Gordon, Wm.
Baynham and John P. Mettauer, all country practitioners in
Virginia.
With reference to the uncertainties of medicine and the
ditferences of doctors, he makes a comparison with the profes¬
sions of theology and law. It is unnecessary here to allude to
the antagonistic doctriues, all derived from the same book,
which have resulted in the bloodiest deeds that staiu the pages
of history, for nobody expects the clergy to agree. But Dr
Joynes has applied the numerical method to the examination
of law decisions, with very interesting results. Thus, taking
five volumes of reports of the Appellate Court of Virginia,
embracing 215 decisions, he found the judgment of the lower
court affirmed 90 times and reversed 102 times. Moreover, in
34 of these cases the Appellate Court itself was divided.
English court practice gives about the same results, for out of
41 appealed cases decided by Lord Justice Gifford in the first
half of 1870, the previous judgment was affirmed 17 times,
reversed 19 times and varied five times. In a remarkable case
touching the validity of marriage (whether the usual forms
and ceremonies are indispensable, or the mere consent of the
main parties are sufficient), the court of first resort declared
the marriage valid without the usual ceremonies, the higher
court (four judges) was equally divided, and the chief justice
then joined the two who were of an opposite opinion to his own,
in order to take an appeal to the House of Lords ; there the
six law-peers rendered separate opinions at length, and they
were equally divided. The famous decision of our Electoral
Commission, three years ago, familiarly known as the “Eight
to Seven,” is fully an offset to any difference of doctors extant.
A Report of Advances in Hygiene and Public Health was
made by Dr. Samuel K. Jackson, of Norfolk. The germ theory
of disease is accepted and pursued to its utmost limit by Dr.
Jackson, and he declares his belief that “ All zymotic diseases
will, ere long, be classed according to the biological relations
of the organisms producing them.” The following resume of
this able paper will give an idea of his views :
994 Reviews and Book Notices. [April
“We have urged that the ultimate causes of fever lie, for the
most part, outside of the body, and that all sanitary questions
hinge upon discovering them ; that a materies morbi, a pyro¬
genic virus, is introduced into the system and produces in the
blood or other fluids of the body processes similar to, or iden¬
tical with, those of fermentation and putrefaction ; that agents
capable of arresting these processes outside of the body, are
capable of preventing them in the system, and might be so
used if they are not poisonous or incompatible with the health of
the body; that these virulent particles, either themselves or
the secondary particles developed as another stage or phase of
life, enter the vascular system, find in the blood a pabulum or
plasma favorable to their growth and development, and by this
development setting up the processes of decomposition alluded
to, and thus become a pyrogenic cause — that is, cause an elevation
of temperature and all the disturbances which occur in the
state we call fever. That these pyrogens existing outside of
the body can be destroyed before they enter the body ; that
while we have at our command many means calculated to
destroy them, among the most efficient are the cheapest and
most accessible, viz : sulphur, sulphate of iron, sulphate of
zinc, common salt, carbolic acid and refrigeration.”
A very interesting clinical paper is contributed by Dr. J. Marion
Sims, of New York, on Diagnosis of Abscess of the Liver by
Symptoms of Cerebral Hyperaemia ; with some remarks on Treat¬
ment of Hepatic Abscess by Aspiration. The cases used by way
of illustration occurred in the practice of Dr. W. A. Hammond,
of New York, who has learned “to associate abscess of the
liver with byperamiia of the' brain, depression of spirits,
hypochondria, insomnia, and unpleasant dreams, with occa¬
sional gastric derangement.” The most remarkable case le-
lated, both in its clinical and its personal aspect, was that of
Dr. E. S. Gfaillard, formerly of Richmond, and lately of Louis¬
ville.
The following propositions have been formulated by Dr.
Hammond, in an article published in the June number of the
St. Louis Clinical Record, for 1878:
“ 1st. That hepatic abscesses are probably much more com¬
mon with us than is generally supposed.
2d. That they may exist without any local symptoms, or
such general disturbance of the system as is commonly regard¬
ed as indicating their presence.
Reviews and Boole Notices.
995
1880]
3d. That they may be associated with hypochondria and
other evidences of cerebral disturbance.
4th. That they should be opened at the earliest possible
moment, and without waiting for adhesions to form between
the liver and the abdominal wall.
5th. That the proper place for performing the operation of
aspiration is in one of the incercostal spaces. This point is
strongly insisted upou by Dr. Davis in his memoir.
(5th. That the operation by aspiration is free from danger.
Dr. Davis never saw any ill consequences from it, and Dr.
Jimiuey, of Mexico, states, that of the hundreds of times he has
punctured the liver through the intercostal spaces for abscess,
he has never once seen the operation followed by peritonitis.
In a very admirable paper, Dr. Lanszky, of New York, ex¬
presses like opinion.
7th. That in all cases of hypochondria or melancholia, the
region of the liver should be carefully explored ; and that even
if no fluctuation be detected, or any other sign of abscesses
be discovered, aspiratiou — being a harmless operation — should
be performed.
8th. That if the pus be evacuated, the operation may be ex¬
pected to be followed by a cure of the mental disorder as well
as by the preservation of the life of the patient from the prob¬
ably fatal consequences of hepatic abscess.
9th. That if no abscess be found, the patient will, at least,
be no worse off than he was before.”
Several other papers, of less interest, occur in this volume,
which we have not space to notice here. S. S. H.
Transactions of the Medical Society of the State of Pennsylvania ,
at its Thirtieth Annual Session , held at Chester , May , 1879.
Yol. XII. Part II., 8 vo. Pp. 490. Published by the
Society.
In so bulky a volume, containing such a number of articles
on various subjects, it is obviously impracticable to give a crit¬
ical notice of the whole contents. Attention will, therefore, be
restricted to a few of the most important papers.
The address of the President, Dr. Jas. L. Stewart, consists of
a brief biographical memoir of several of the most distin¬
guished medical men of Pennsylvania, such as Samuel Jack-
son, Wilmer Worthington, William M. Wallace aud Washing¬
ton L. Atlee.
Dr. Chas. T. Hunter made the “ Address in Surgery,” on
the Treatment of Wounds. The subject of ligatures is promi-
10
996
Reviews and Boole Notices.
[April
nently presented, and decided preference given to the carbolized
catgut. He also takes occasion to commend the treatment of
divided nerves and tendons by suture of the pared euds. The
immobilization of injured parts is particularly insisted on, as
an essential to rapid union. Free ventilation and perfect clean¬
liness are regarded of more importance than the “ antiseptic
method” of Lister.
Dr. Win, Goodell contributes an interesting paper on the
Extirpation of the Ovaries for some of the Disorders of Men¬
strual Life. He is strongly disposed to regard the operation
as legitimate, though he would first give trial to less heroic
proceedings. He adds his testimony to that of Battey, Wells,
Atlee and Peaslee, that the removal of these sexual organs is
not usually followed by loss of feminine traits of character —
not even loss of sexual desire — though ovulation necessarily
ceases, and with it commonly menstruation. It amounts, in
fact, only to a premature supervention of the menopause.
In an instructive paper on Juvenile Insanity, Dr. Isaac £T.
Kerlin shows that its occurrence is more common than has
been generally supposed. It is highly probable that many
cases regarded as incorrigible viciousness in young children
are in reality the outcropping of hereditary mental disease.
Dr. Kerlin’s experience shows that most of these cases are
amenable to treatment by the usual methods pursued with
older subjects — that is to say, removal from home and manage¬
ment in a suitable asylum ; but the permanent cure of such
subjects must not be expected in the great majority of cases.
The Address in Medicine, by Dr. Andrew Fleming, was
upon the subject of Emotional Fever. This term he uses to
include those cases rather vaguely called nervous fever by many
writers, and also the affection known as nostalgia. Emotional
fever has no discoverable organic lesion and no definite dura¬
tion, though it sometimes terminates abruptly by a crisis. He
does not attribute it to any miasmatic influence, though, when
induced by a sudden shock, it is frequently introduced by a
rigor. The seat of the malady is referred to the ganglionic
system of nerves, and, in the absence of any anatomical
changes yet discovered, must be regarded as functional. The
Reviews and Boole Notices.
997
1880]
writer claims no originality of thought in this paper. His ob¬
ject seems to be, to give the malady some distinctive character
by which it may be recognized, with the view of judicious man¬
agement by suitable hygiene and nutrition rather than active
treatment of therapeutic agents.
Dr. Benjamin Lee offers some remarks on Horizontal Exten¬
sion for the purpose of applviug the Porous Felt Jacket for
Curvatures of the Spine. His paper is illustrated by wood-
cuts, to show the mode of applying the extension and also the
effects gained by wearing the jackets.
A distinctive feature of the Pennsylvania Medical Society
Reports is the incorporation of synopses of reports of county
societies. In some instances these are clinical records ; in
others, biographical sketches of worthy deceased members.
For these we have no space. S. S. H.
The Hypodermic Injection of Morphia. Its Advantages and
Dangers. By. H. H. Kane, M. D. New York : Chas. L.
Bermingham & Co., Medical Publishers.
Few works have issued from the press of more absorbing in¬
terest thau this of Dr. Kane. There is probably no physician
who at some time has not resorted to the use of the hypoder¬
mic syringe, and though fortunately, the large majority have
never met with any untoward symptoms, still it is an advan¬
tage to be reminded in a work like the present, that disagree¬
able results are possible. We agree with Dr. Kane in his
preference for glass syringes, for however perfect the metal
ones may be, still the packing will sometimes dry aud it is of
the utmost consequence to be able to see that our syringes con¬
tain the full quantity necessary to be injected. Except by
some few makers, too little attention is paid to the manufac¬
ture of the hypodermic needle. Nearly all are too large, and
all of European make are simply execrable. It should not be
forgotten that freedom from pain and abscess depends much
on the fineness and temper of the needle. Those made by
Messrs. Tiemann, of New York, and called by them Green’s
Needles, are unexceptionable, and are by far the best we have
seen.
We would like to make some observations on the graduation
998
Reviews and Boole Notices.
[April
of tlie syringe. Unfortunately wirh some few exceptions this
is rarely correct. Possessing a large number of hypodermic
syringes, we one day tested the graduation and with the fol¬
lowing results : In the small instrument made by Gemrig, of
Philadelphia, we found the 10 divisions correspond to 20
minims, In his large ones, the line making 25 minims, only
equalled 20. In four of Tieman’s, which we will call A, B, C
and D, in A the 10 line equalled 10 minims, but the 20 line only
equalled 15 minims. In B, the 25 line only contained 20 min¬
ims. In 0, the ten line only equalled 9 minims, the 20 line
only 17 minims, the 15 line was correct. In D, which is the
instrument called Green’s syringe, all the graduations were
correct.
In three syringes made by Hawksley, of London, and in two
by Arnold, of London, all the graduations were correct. We
would draw special attention to the syringe of Leitner, sold by
Otto & Sons, of New York. Unless specially informed this
may lead to grave errors as the divisions are those of the
gramme, each mark, being equal to nearly two minims. We be.
lieve we know of one death resulting from the belief, that each
mark represented one minim. It would be as well for every
practitioner to verify his own syringe before using it.
With regard to the solution for injection, we would draw at¬
tention to the formula of Dr. Kane, at page 17, in which
decomposition is prevented by using a solution of salicylic acid,
although we have found that two drops of chloroform to the
ounce will keep solutions indefinitely. We have solutious of
atropia two years old, still perfectly bright and free from fungi.
We do not agree with the author that death results from inter¬
ference with the renal secretion, and must regard his experi¬
ments on the lower animals as not conclusive. In cases of
recovery from extreme narcotism where antidotes have been
used, recovery occurs long before the renal excretion has been
established We think too much stress has been laid upon
puncturing a vein, such cases must be very rare. We have used
the syringe at least 10,000 times, and have never met with such
an accident, still it is well to be aware such may occur, and to
take every precaution.
1880J
Reviews and Book Notices.
999
With regard to the ligature, the use of which is strongly
recommended by the author, it is only in cases where the injec¬
tion is made into the extremities that it can be of use $ when
the syringe is used ou the trunk, face or neck, it of course,
would be inadmissable.
The author relates several cases of death after the use of the
hypodermic syringe, in which postmortem examinations
revealed the fact that the fatal event was due to an entirely
different cause, and our own opinion is that very few deaths
are absolutely the result of injections of morphine.
We agree with the author that the subcutaneous application
of morphine should always be by the physician, and never by
the patient or nurse. By taking this precaution the self-abuse
of the instrument will be prevented, and there will never be
any difficulty in stopping the employment of the morphia
whenever desired.
We cannot too highly recommend this work of Dr. Kane,
and think it supplies a much needed want of the profession.
Every physician who uses the hypodermic syringe (and who
does not ?) should procure it and read it carefully. It is clearly
and handsomely printed, is well bound, and will be an or¬
nament to any library. J. L. 0.
SMn Diseases , including their Definition , Symptoms, Diagnosis ,
Prognosis , Morbid Anatomy and Treatment. A Manual for
Students and Practitioners. By Malcolm Morris, Lecturer
on Dermatology at St. Mary’s Medical School, etc. Illus¬
trated. Philadelphia : Henry C. Lea. 1880. Kew Or¬
leans ; Armand Hawkins, 196 £ Canal street. Price, $1 75.
Mr. Malcolm Morris is one of the English representatives of
the Vienna school of Dermatologists, which couuts among its
adherents in Great Britain such men as McCall Anderson,
Hilton Fagge and Warren Tay, the two latter the translators
of Hebra’s classical work for the Sydenham society.
It is rarely that the task of the reviewer is so pleasant as in
the case of the work whose title heads this notice. The
author’s task has been well done and he has produced a book
which will be warmly welcomed by students of medicine as
one of the best recent works upon the difficult subject of which
1000
Boolcs and Pamphlets Received.
[April
it treats. It is not intended to convey the impression that it
is at all competent to take the place of the thorough treatises
of Duhring and Neumann. These will still be necessities to
those who desire to study more fully these affections. For
students, however, there is no work published which gives a
better view of the elementary facts and principles of dermatology.
The arrangement of the matter is simple, the definitions and
descriptions clear and accurate, and the treatment suggested
judicious. The differential diagnosis between affections likely
to be confounded with each other is very clearly presented.
The classification is with slight modifications — that of Hebra,
and is the one generally followed by modern dermatologists.
With the exception of a few important typographical errors,
the publisher’s work is well done. Ro.
Books and Pamphlets Received.
The Hypodermic Injection of Morphia. Its History , Advantages
and Dangers. By H. H. Kane, M. D. New York.
The Therapeutics of Gynecology and Obstetrics , comprising the
Medical Dietetic and Hygienic Treatment of Diseases of Women.
By William B. Atkinson, A. M., M. D.
Sanitary Organization of Rations. By Henry I. Bowditch,
M. D. Reprint from the Boston Medical and Surgical Journal.
Posture in the Treatment of Intestinal Colic and Ilius ; with a
consideration of the Pathology of “ Spasmodic Colic.” By Frank
H. Hamilton, M. D.
Boraic Acid. A New Remedy in Eye Diseases. By Samuel
Theobald, M. D., Surgeon to the Baltimore Charity Eye and
Ear Dispensary, etc. Reprint from the Medical Record, Feb.
7, 1880.
Norris on the Discovery of an invisible or Third Corpuscular
Element in the Blood. By Mrs. Ernest Hart. From the London
Medical Record.
1001
1880J Books and Pamphlets Received.
Partial Foncard Dislocation of the Head of the Humerus or
Backward Displacement of the Tendon of the Long Head of the
Biceps Flexor Cubiti — Replaced After the Lapse of One Month.
By David Prince, M. D., of Jacksonville, Ills. Reprint from
St. Louis Medical and Surgical Journal.
The Fallacies of Popular Clinical Medicine. By Jarvis S.
Wright, M. D., Professor of Surgery. An introductory lecture
delivered at the Long Island College Hospital, Brooklyn, N.
Y., February 5, 1880.
Second Annual Report of the Health Commissioner of Mil¬
waukee , January, 1880. «
Richmond as a Manufacturing and Trading Centre ; including
a Historical Sketch of the City. By R. A. Brock, Esq., Corre¬
sponding Secretary Virginia Historical Society.
A System of Medicine. By J. Russell Reynolds, M. D., F. R. S.,
Fellow of the Royal College of Physicians of London, etc., etc.
With numerous additions and illustrations. By Henry Harts-
horne, A. M., M. D. Fellow of the College of Physicians of
Philadelphia, etc., etc.
Clinical Lectures on the Diseases of Women , delivered in St.
Bartholomew ’s Hospital. By J. Matthews Duncan, M. D.,
LL. D., F. R. S. E.
A Manual of Pathological Histology. By V. Conil, Assistant
Professor in the Faculty of Medicine of Paris aud L. Ranvier,
Professor in the College of France. Translated with Notes and
Additions. By E. O. Shakespear, A. M., M, D., Lecturer on
Refraction aud Operative Opthalmic Surgery in the University
of Pennsylvania, etc., etc., aud I. Henry C. Simes, M. D., De¬
monstrator of Pathological Histology aud Lecturer on Histol¬
ogy in the University of Pennsylvania.
A Plea for Cold Climates, in the Treatment of Pulmonary
Consumption. Minnesota as a Health Resort. By Talbot Jones,
M. D., of St. Paul, Minn. Reprint from the New York Medi
cal Journal, 1879.
Twelfth Annual Report of the New York Orthopaedic Dispensary
and Hospital.
1002
Meteorological and Mortality Tables ,
| April
Meteorological Summary — February, 1880.
Station— New Orleans.
Date.
Daily Mean
Barometer
Daily Mean
Temp’ture.
Daily Mean
Humidity.
Prevailing
Direction
ofWind.
Daily
Rain-fall.
1
30.09
51.2
73.0
N. E.
.62
2
29.79
50 5
62.7
West
1.69
3
30.13
50.7
46.0
N. W.
4
30.26
52.7
50.7
North
5
30.35
48.7
68.3
N. E.
.43
6
3U.44
50.5
57 0
N. E.
.02
7
30.47
50.2
48.7
N. E.
8
30.35
56.2
60.3
East.
....
9
30.28
58.2
80.0
N. E.
10
30.26
61.7
79.0
East.
11
30.11
66.0
84.0
S. E.
03
12
29.87
69.2
86.7
South
....
13
29.91
60.2
57.0
S. W.
.16
14
30.11
58. 5; 48. 7
N. W.
15
30.33
56.7152.7
North
16
30.33
59.5'59.7
East.
17
30.26
65.0
68.0
S. E.
....
18
30.21
66.5
84.7
S. E.
1.15
19
30.38
57.5
71.3
North
.31
20
30.29
56.7
62.7
East
.03
21
30.10
61.7
80.7
N. E.
.08
22
30.09
60.5
82.7
North
....
23
30.11
66.5
77.3
"West
...
24
30.08
65.7
77.0
S. E.
....
25
30.01
63.5
78 3
South
26
39.02
70.7
81.0
S. W.
.6i
27
30.07
70.5
72.2
South
28
30.06
72.2
73.7
S. W.
29
30.09
68.0
78.0
N. W.
.09
Suui8
Means
30.168
60.4
69.1
N. E.
4.62
General Items.
Highest Barometer, 30.547, on 7th.
Lowest Barometer, 29.600, on 2d.
Monthly Range of Barometer, .947
Highest Temperature, 77° on 27, 28.
Lowest Temperature, 43° on 2, 3, 4, 6.
Monthly Range of Temperature, 34°.
Greatest Daily Range of Temperature,
19° on 10th.
Least Daily Range of Temp., 8° on 12,
19.
Mean of Maximum Temperatures ,65.9°
Mean of Minimum Temperatures, 53.7°
Mean Daily Range of Temp., 12.2°.
Prevailing Direction of Wind, N. E.
Total Movement of Wind, 5,499 miles.
Highest Velocity of Wind and Direc¬
tion, 32 miles, West on 2d.
Number of Clear Days, 3.
Number of Fair Days, 11.
Number of Cloudy days on which no
Rain fell, 8.
Number of Cloudy Days on which
Rain fell, 7. Total number of days
on which rain fell, 12.
Dates of Luna Halos, 19, 23, 27th.
COMPARATIVE TEMPERATURE.
1871 . i
1876 . . .
58.9C
1872 . |
1877...
55.9°
1873 . 60.5°
1 1878...
55.5°
1874 . 59.1° 1
| 1879...
55.8°
1875 . 55.9° |
1880...
60.4°
comparative
PRECIPITATION
1871 . inches.
1 1876:
8.20
inches
1872 . “
1 1877:
0.98
1873.. 193 “
j 1878;
3.50
it
1874.. 3.68 “
1 1879;
2.13
it
1875.13.85 “ | 18801 4.62 _
GEORGE H. ROHfi,
Sergeant, Signal Corps, U. S. A.
Mortality in New Orleans from February loth, 1880, to
March 21st, inclusive.
Week Ending.
Yellow
Fever.
Malarial
Fever.
Consump¬
tion*
Small¬
pox
Pneu¬
monia.
Total
Mortality.
February
22
0
6
16
0
9
88
February
29
0
4
14
0
12
li 9
March
7
0
1
14
0
8
82
March
14
0
2
8
0
9
78
March
21
0
19
10
85
Total.
...
0
13
70
0
48
442
NEW ORLEANS
Medical jlnd
SopcjiL Journal.
MAY, 1 88 0.
PAGINAL poyViyVIUNICATIONS,
Interpretations of the Structure and Function of the
Kidney.
By ANDREW W. SMYTH, M. D.
The anatomy and physiology of the mammal kidney bare
remained, to this day, as much matters of inference as of
observation. There are some points on which our knowledge
is complete, but the undoubtedly erroneous theories of the
structure and uses of the malpighian bodies, have obstructed
human thought and progress by false notions of the mechanism
of secretion.
To authors and students of surgery the name of Dr. Andrew
W. Smyth has for some years been familiar, especially for his
great case of ligature of the innominate, carotid and vertebral
arteries. His lucid remarks on the collateral circulation in
aneurism, published in 1876, proved him to be as earnest a
physiologist, as he was skilful a surgeon.
For many years past he has persistently objected to the
description by Bowman, of the relation between the malpig¬
hian bodies and the tubuli uriniferi. With special mechaircal
aptitude, Dr. Smyth has devoted much attention to the micro¬
scope, and he has been subjected even to supercilious criticism
1004
Original Com mtmicatiom.
[May
for having had one constructed of silver, oroid, aluminium, and
in part even of gold, that he might possess a perfect, smoothly
working instrument in the New Orleans atmosphere which so
promptly tarnishes other metals.
Having failed, at all times, to trace a connection between
the capsule of the malpighian body and the interior of a urini-
ferous tube ; having likewise observed that the hyaline mem¬
brane, enclosing each glomerule, was unprovided with epithe¬
lium, essential to every secreting structure, Dr. Smyth per¬
ceived that so delicate a sack would rupture, and the plexus
be destroyed, if subjected to hydrostatic pressure, either during
secretion or from accidental regurgitation.
The only conditions under which the transudation of water,
and its collection for onward flow as universally admitted,
could have existed, would have been some mechanism for
filtration from the vessels a contractile reservoir, and a valvular
opening into the uriniferous tube. The soundness of this view
will appear as we proceed.
The kidneys, lodged in the lumbar region, receive a direct
and abuudant flow of blood from the aorta, and are more than
any other glands under the direct influence of cardiac energy.
They have smoothly rounded contours, and, when their
inelastic capsules are pierced, the parenchyma is found granu¬
lar, compact and solid, normally incapable of expansion and
contraction, except as a whole.
At the hilum of the kidney we trace the ureter into the pel¬
vis, into which project the conical ends of the pyramids of
Malpighi. From the infundibula, in the conical apices, the
straight uriniferous tubes radiate outward ; they subdivide, so
that their area, with their epithelial contents, iucrease and
expand, into the pyramidal base of the convoluted tubes,
towards the outer surface of the kidney. The tubes are
individually larger at their orifices than at the pyramidal
basis.
The form and structure of each malpighian pyramid indicate
a necessary and independent purpose in the mechanism of
secretion. For it is evident that a moderate constriction,
throughout the substance of the broad base, will cause a rapid
1880] Smyth — Structure and Function of the Kidney. 1005
and certain flow through the straight tubes and their outlets
in the infundibula.
* The ample, short and stout, renal arteries, subdivide into
straight and important branches, which go directly towards
the cortical portion of each pyramid, and here give off terminal
branches, right and left, which constitute the afferent vessels
of each malpighian body or glomerule.
The artery of each glomerule splits up into coiled loops and
branches, which are traced inward towards the center and join
together to form an efferent vessel. This, on emerging from
the hilum of each malpighian body, subdivides into the abun¬
dant vascular net-work supplying the convoluted uriniferous
tubes.
Having carefully examined the relations of these vessels to
surrounding structures, Dr. Smyth perceived that the capsule,
wrongly supposed to be the origin of each uriniferous tube, had
no intimate structural relation with the ample vessels of the
glomerule. It simply sheathed them. It was in fact a peri-
plexus, and by this name Dr. Smyth proposes it shall be
known. Around this periplexus, are the convoluted tubes,
with that abundant spheroidal and polyhedral epithelium sup¬
plied by blood from the capillary net- work into which the
efferent malpighian vessels are divided.
A feature brought out by many injected specimens is the
apparently constricted aspect of the efferent vessel, compressed
by the more readily injected afferent vessel and its external
coils. This is important, according to Dr. Smyth, in explain¬
ing how the forces which come into play govern the action of
the gland as hereafter to be explained.
In fresh sections of the cortical structure, it frequently hap¬
pens that a glomerule drops out of its periplexus, and this is
seen of extreme tenuity, constituting the boundary of a per¬
fectly empty sac. There is no epithelial lining, and the glome¬
rule when visible fills the cavity entirely, or partially, accord¬
ing to its state of distention. This distention is kept within
bounds by the manner in which the individual loops sustain
each other, and are, en masse , when unduly filled, supported by
the periplexus.
1006
Original Communications.
[May
On the 3d of June, 1879, Dr. Smyth had occasion to extir¬
pate a floating kidney from a woman. For eight years a pain
in the right side had rendered life unendurable, and had
actually impaired the mind. Dr. Greensville Dowell, of Gal¬
veston, Texas, brought her to Dr. Smyth in the preceding
month of April, with request that he should attempt the re¬
moval of what Dr. Dowell believed, at the time, was the fans
et origo inali —the floating kidney. An incision in the right
side of the lumbar region, and forcing the organ into its place
by pressure upon the abdomen, enabled Dr. Smyth to grasp it.
He had anticipated the impression which its strong pulsation
produced on his mind, and he asked Dr. 0. B. White, one of
the attending physicians, to notice this pulsation. Dr. Smyth
observed that as the organ filled, under the direct action of the
heart, confined as it was in an inextensile capsule, a pressure
inward in all directions, from the base to the apex of every
malpighiau pyramid — from the outer surface of the cortical
structure, to the center of the renal pelvis — was inevitable.
This general behavior of the kidney had been his interpreta¬
tion of the purpose of each malpighiau body. This, under the
direct pulsating influence of the heart, distends in all directions.
The cortical structure is studded in regular and nearly equi¬
distant parallel rows with these spherical objects, capable of
equal distension in all directions. Every heart-beat is attended
by turgesceuce of the glomerule. The loops from their posi¬
tion and form must swell outward and inward in all directions,
and, constricting the efferent vessel, momentarily impede the
blood’s exit. At each cardiac diastole, the arterial column
sustaining the blood in its channel, the malpighian loops recoil
and fill the current in the secreting vascular rete. And this is
Dr. Smyth’s view of the special function of the malpighian
bodies. Their alternate turgesceuce constituting a “ rhythmic
vascular impulse,” a uniform, safe and sufficient expelling pres¬
sure is maintained on the coiled tubes, and indeed on the whole
excreting structure of the kidney.
Those acquainted with the laws which govern the flow of
liquids, can readily understand, that the power required to
maintain a circulation, beyond the coils of the glomerule, would
1880] Smyth — Structure and Function of the Kidney . 1007
be destroyed, if a mere physical transudation could occur
through the loops, so well-disposed to briug the very active
pulsation to bear on the maintenance of a circulation. A flow
outward from the vessel would constitute a leak in the tube.
If filtration, as it is termed, had to take place, the blood ves¬
sels would have been so disposed, as, when filled, not to press
on one another, or against a periplexus— vessel to vessel, and
vessels to capsule — in a manner which can only serve to keep
the fluid in its regular current. The incompressibility of water
is often forgotten, and it is evident, that if at each pulsation a
flow had to occur, there would be provision for a relief of pres¬
sure and not for its increase at the moment of outlet. That in¬
crease inevitably occurs j and if space and structure had been
provided for the free and abundant aqueous filtration, is it not
evident that the uriniferous tubes, having — for argument’s
sake — an opening iuto each periplexus, would be subjected to a
strong and intermitting spurt of water, driving before it the
epithelium and tending to expose the delicate tube to the de¬
structive action of the urine f
When the general expansion of the malpighian bodies has
driven on the urine, the efferent vessel being then relieved of
uudue pressure, the blood vessels of the secreting rete, which
have also been subjected to systolic pressure, are left free to
carry on the blood flow.
The unmistakable constriction of the efferent vessel, on the
filling of each glomerule, causes an alternation between clear¬
ance of the tubuli and the flow of blood in the secretiug vascular
rete.
The glomerules are filled during the heart’s systole ; the se¬
creting rete is turgid during the heart’s diastole.
A physiological poiut to which Dr. Smyth directs attention,
is that the commonly received opinion of a portal circulation
in the human kiduey is not justified by the facts. There is an
identity, in so far as a branching of a vein is concerned, if the
efferent vessel can be regarded as a vein ; but, in truth, no
change, or only that due to the slight nutrition of the plexus
itself, occurs in the blood as it passes through the glomerule.
It is evident that in a solid glandular organ, confined within
1008 Original Communications . [May
a non-extensile covering, a fancied filtration into the secret¬
ing tubes, and their consequent distention by systolic pressure,
would oppose and obstruct the circulation iu the adjacent blood
vessels There cannot be filtration by pressure.* On the con¬
trary the compression and emptying of the tubuli with the
systole of the heart, must proportionally increase the circula¬
tion of blood through the organ. This is precisely the effect
produced by the action of the malpighian bodies. The secret¬
ing and vascular structures are not distended simultaneously,
but alternately. The expansion of the tubuli, during the
heart’s diastole, assists the draining into the tubuli from the
secreting vascular rete.
We have reason to believe that a low tension of blood in
glandular organs facilitates secretion. The largest secreting
glandular organ in the body is situated at the point of low¬
est blood tension in the circulation. Pressure must antago¬
nize cell accretion so that relief from pressure during secre¬
tion is important.! It can readily be perceived how ad¬
mirably these conditions are fulfilled in the circulation of the
kidney. The distention of the glomerule with constriction of
the efferent arteries causes an onward movement to the hilum
of the contents of the whole secreting structure. These glorn-
erules are practically reservoirs in a state of fullness ready to
supply instantly a large volume of blood at minimum tension
to the secreting rete. The quick, sharp expulsion, and the
longer intervals of quiescence, with the incident variations of
* Filtration from the glomerule into the malpighian capsule would
be, mechanically identical with filtration from the heart into its pericar¬
dium, utterly impossible, — whether the capsule does or does not com¬
municate with the tubuli.
fin cases of obstructed uterer from impacted calculus, pressure,
arresting the flow of excreted urine, arrests secretion itself. This pres¬
sure in the excreting tubuli, neeessarily equal to the force exerted to
expel the calculus to the bladder, would if the tubuli communicated
with the malpighian capsules, so distended them as to destroy the struc¬
tural integrity of the organ. The laws of hydrostatics demonstrate this
to be inevitable. The expelling force is the systolic action of the heart, in¬
creased by the special action of the malpighian bodies. This is shown
by the continuation of the circulation of blood through the organ during
the time of this critical pressure, which, in many instances, continues
several days.
1009
1880] Smyth — Structure and Function of the Kidney.
tension, constitute the best conditions for functional renal
activity.
In accordance with the views herein expressed and in proof
of the use and function of the malpighiau bodies, a highly satis¬
factory explanation cau be given of the way in which the
functional activity of the gland is adjusted to the varying
necessities and exigencies of the general system.
When, synchronously with the systole of the heart, the cur¬
rent of blood commences to flow, it goes directly forward
through the gland. The condition of the gland at this instant
is favorable to such a flow. As soon as the current has ac¬
quired a certain degree of velocity, a rhythmical constriction,
more or less complete of the efferent artery takes place. The
sudden interruption of the onward current by this constriction,
forcibly distends the glomerule — increasing the glandular
action.* None who are familiar with hydraulics will have any
difficulty in understanding the mechanical effect produced in
this way.
The rhythmical constriction of the efferent artery, following
the systole of the heart, it will be seen governs the action of
the gland in the most varied and effectual manner. It regu¬
lates the circulation for the double purpose of secretion and
* The functional activity of the kidney increases with the circulation
of the blood, and with the diminution of tension during the diastolic
period. This result is aided by the hydraulic-ram action of the mal-
pighian bodies, which more forcibly compresses the structures contained
within a non-extensile covering. It is impossible to conceive of an
increased circulation of blood without a corresponding increase of systolic
pressure ; so that the functional action varies with the alternations of ten¬
sion in the gland during systolic and diastolic periods. The systolic ten¬
sion caused by distending arteries, increased as it is by the consequent
sudden interruption of the circulation, and so arranged as to compress
and force onwards the blood in capillaries and veins as well as the con¬
tents of the secreting tubes, is the most effectual action possible for sub¬
sequent diminution of tension during the diastolic period. The tension
during the diastolic period must diminish with increase of the systolic
tension.
We find in organs of quickly varying functional activity, such as the
brain and the kidney, constricting arterial plexuses which, operating in
conjunction with the heart’s systole, instantly increase the circulation
of the blood, and consequently the functional action by intensifying the
systolic pressure.
1010 Original Communications. [May
expulsion : the obstructed blood is furnished to the secreting
rete, at a low tension, and its mechanical energy is utilized in
facilitating secretion, and expelling the excrement from the
gland.
Thus we have an admirable combination of forces and
influences, operating to ensure the adjusted and continued
action of the glaml. Energy is applied in the most effective
manner, to forcibly and quickly expel the secreted fluid. Its
retention would arrest the glandular action. Secretion could
not go on without expulsion.
So manifest and effective a function is incompatible with the
still credited discharge of the greater part, namely, the abun¬
dant water of the urine, by the glomerule.
In considering the agencies effecting the blood’s circulation,
we must recognize the existence of rhythmical variations of
tension in many favorably located, free and independent, yet
synchronously acting plexiform,. vascular loops ; and as a
result of this, the alternating compression and relaxation of
confined organs incapable of expansion beyond the limits of
inextensile coverings. That the distension of the arterial system
acts as an essential auxiliary in carrying on the circulation
of blood is evident.* It rhythmically compresses capillaries,
veins and in fact all adjacent structures within their res¬
pective enclosures— sacs, sheaths, or similar membranes.
And this pressure, regulated by constriction, must neces¬
sarily be followed everywhere bj7 correlative relaxatiou.t
*It is the pressure from this distension that causes absorption of
solidified aneurisms and inactive arterial trunks, after ligation.
tA continuous, uniform pressure of blood cannot exist in the arter¬
ial system ; for no organized animal structure is capable of withstanding
for any length of time, without remissions, the mean arterial blood pres¬
sure. Aneurisms of considerable size represent nearly the mean tension
of blood in the arterial system, which ol course is considerably less than
the systolic pressure, and we know that all structures, including cartilage
and bone, disappear, — are absorbed or destroyed — even by this tension
continuously applied. Neither nutrition nor secretion can go on against
such a pressure. We are therefore warranted in believing that all
organs having a direct arterial communication, and enclosed within an
inextensile fibrous sac, must have their functional action arrested by
pressure during the period of the heart’s systole. A knowledge of phy-
1880] Smyth — Structure and Function of the Kidney. 1011
Dr. Smyth many years since directed attention to the fact
that the structural circulation of the heart occurred during this
organ’s diastole.* * The cardiac arteries fill when the contrac¬
tions cease, and the analogy in the circulation of the renal
secreting rete beyond the glomerule is obvious. The impor¬
tance of this in the circulation is evident, when we consider
that the heart’s diastole occupies more time than the systole,
in the proportion, according to Valentin, of three-fifths to
two-fifths. It was found by Donders in a large number of
observations, that whilst the duration of a complete cardiac
revolution varied between 0.640 and 0.806, the duration of a
ventricular systole fluctuated within very narrow limits,
namely, between 0.301 and 0.327.1
The special exercise of energy in the propulsion of blood, by
the blood vessels themselves, has long since been regarded as
non-existent. The heart is the engine ; and the modifying or
regulating influences at a distance from the heart, have been
defined without reference to any such special action, as Dr.
Smyth has so happily discovered. Mr. Bowman was literally
correct]; when he described tho circulation in the malpighian
body itself. He said : “ A large artery breaks up in a very
direct manner, into a number of minute branches, each of which
suddenly opens into an assemblage of vessels, of far greater
aggregate capacity than itself, and from which there is but one
narrow exit. Hence must arise a very abrupt retardation in
the velocity of the current of the blood. The vessels, in which
this delay occurs, are uncovered by any structure ; they lie
bare in a cell.”
sics enables us to readily understand that an interrupted or intermittent
action of the brain may, practically, be of continuous effect. The
periods of diastolic laxity are periods of functional action. In fact,- it
may be said that the sum of these periods constitutes the actual time of
animal existence.
*Southern Journal of Medical Sciences, New Orleans, La., Febru¬
ary, 1867.
tHermann’s Physiology, translated and edited by Dr. Arthur
Gamgee, F. R. S., London, 1878.
JPhil. Transactions, 1842.
1012
Original Communications.
[Maj
Bowman simply erred in his interpretation of the use of this
arrangement; for he thought u it would indeed be difficult to
conceive a disposition of parts more calculated to favor the
escape of water from the blood than that of the malpighian
body.” Dr. Smyth has shown, that which is self-evident when
perceived, namely, that a simply retarded flow in a tightly
packed structure, canhot favor transudation, but does favor ex¬
pulsion and the blood’s vis-a-tergo. The fact that the malpighian
bodies of the parrot and the boa are so minute, and that in
these animals the urine is almost solid, was regarded by Bow¬
man as proof of the v atery filtration from the glomerule. But
on the other hand in these animals the urine is scanty, the
uriuiferous tubes are small, and the mechanical work of dis¬
charge lessened.
In those animals in which the malpighian bodies open into
the uriuiferous tubes, the expulsive functioli of the plexuses
still comes into play ; but nature provides a ciliated epithelium
and the structure of the kidney is open and even loose. In
the mammalian kidney a ciliated epithelium could not work,
and the tubes are filled with au abundant spheroidal secreting
lining. .No ciliated epithelium crammed in the contorted
passages, could effect expulsion like the “ pulsating propellers ”
acting by lateral expansion in all directions, all working iu
strict harmony, and with admirably distributed force.
The facts that in the evolution of the kidney in the inverte-
brata, the malpighian capsule is not necessarily a terminal
dilation of the uriuiferous tubes, and that in some the blind
end containing the glomerule, as iu bdellostoma, is actually
constricted off, lend great support to Dr. Smyth’s observations.
That the plexus may operate in the renal circulation in the
same way, whether the periplexus be perforate or imperforate,
is quite clear, and it is also certain that secreting vessels iu all
glands are disposed in the stroma and secretiug membranous
walls and not in the form of plexuses of the nature of a
glomerule.
Whatever accident may have led to an apparent connection
between the delicate fibrous sheath enclosing the coiled vessels,
and the secreting structure with its manifest and indispensable
1880] Smyth — Structure and Function of the Kidney . 1018
epithelium, it is evident from Dr. Smyth’s prolonged investiga¬
tions, that the condition could not be normal. Messrs. Todd
and Bowman thought they proved the continuity in several ways
and especiallv by specimens which had been carefully injected
from the artery. In these, not un frequently, the colored mate¬
rial escapes and extra vasatbs from the vessels of the tuft into
the cavity of the capsule and thence into the tube. But such
post-mortem infiltration is unverified or not paralleled by the
most extensive research in examining normal structures. As
Dr. Lionel S. Beale with his usual caution and clearness has
said, “ In the commou newt or eft (triton or lisso-triton) we
have, so to say, a natural dissection of the* elements of the
gland structure, and we may demonstrate an arrangement, the
existence of which we can only infer , by an examination of
thin sections of the compact kidney of mammalia.”
Not only does the presence of the malpighian bodies in
animals secreting solid urine, refute the idea of a watery filtra¬
tion by them, but so also do Dr. Smyth’s observations on the
absence of that essential element in a secreting structure,
epithelium, as first shown by Mr. Bowman. Dr. Beale also has
said, u The appearance of epithelium upon the surface of the
vessel is caused by the loops of capillaries being shrunken and
collapsed. When distended with transparent injection, no
such appearance is observable ; but here and there a few small
granular cells are observed. Masses of germinal matter or
nuclei are connected with the walls of these vessels, as well as
those in other tissues.”
The secretion of urine is constant and incessant. Its expul¬
sion must be equally continuous. Stagnation of this excretion
would imply disintegration of tissue ; and for this reason, each
malpighian body, and the entire kidney, act alike in forcing
on whatever has to flow. The velocity of the discharge in¬
creases from the time the urine begins to accumulate in the
convoluted tube, to its passage to the straight tubes, which,
enlarging in individual diameter actually contract and activate
the flow, by a reduction of area in their coalescence. Tardy at
first, the ejection into the calices must be rapid and forcible at
every heart beat. Arrest is impossible in so peculiar a gland.
1014 Original Communications. [May
The flow is as incessant and involuntary as the cardiac action
until muscular passages and a muscular bladder are reached.
The wide bearing of the law now promulgated that the me¬
chanism of secretion is intimately related to and partly de¬
pendent on the direct percussing energy of the heart, is another
happy illustration of the complex phenomena resulting from
simple mechanical arrangements. Once this aid or stimulus to
secretion in the kidney suggested itself, the analogy with' the
mechanical excitants of the salivary and mammary glands be¬
came obvious.
Briefly, the facts tending to disprove the correctness of the
theory generally entertained of renal secretion in the mamma¬
lian kidney, may be stated as follows : —
1. It is founded on the assumed existence of a permanently
open communication between the renal tubes and the capsule
of the malpigkian bodies. This communic ition is not stated to
have ever been seen by Beale, while its existence has been
positively denied by Huschke, Reichert, Gerlach, Bidder, and
others. If it existed, there is no reason why it should not as
readily be demonstrable, and as often have been seen, as the
vascular communications.
2. It is based on the belief that water can be separated from
the blood by filtration through blood-vessels without the action
of glands and without even the presence of glandular struc¬
ture 5 and that the filtration takes place against an external
pressure at least equal to if not greater than that within the blood¬
vessel ; thus suggesting an exception to the rule of secretion
into tubes in the direction of least resistance.
3. It requires the capsule of the malpighian body, an unpro¬
tected hyaline membrane, to act as a reservoir connected with
tubes excreting a fluid capable of rapidly destroying its struc¬
ture, as well as that of the glomerule contained within it.
4. In works on the subject the open communication between
the tubes and the capsules is shown, in stereotyped diagrams,
to be many times larger than the vascular communications of
the glomerule.
Every diagram or illustration is on its face a positive demon-
1015
1880 1 Smyth — Structure and Function of the Kidney.
stration that certain destruction by hydrostatic pressure of
both capsule and glomerule must attend an obstructed outlet —
a condition known to occasionally occur.
5. The theory is contrary to well-known physical laws as well
as to recognized physiological facts.
0. It does not show any mechanism for varying the functional
activity in a gland having great variation of functional action.
7. Even if it were demonstrable that there is an actual com¬
munication between the tubuli and the capsule, the facts and
arguments here adduced would still invalidate the generally
accepted theory of renal secretion.
Viewed with clearness and precision the mechanism of renal
secretion explains many pathological conditions which have
hitherto received very unsatisfactory elucidation.
The pallid, sallow, bloated, and enfeebled aspect of a man
with heart disease, is but the counterpart of the sufferer from
chronic inaction of the kidney. Impairment of the first arrests
the functions of the second.
The relation of certain forms of haeinaturia to scanty urine ;
the resulting ausemia, hectic, and even active blood poisoning,
due to a chronic nephritic condition, relieved by astringents,
stimulants and generous support, are readily explained.
Dr. Todd long since stated in his clinical lectures, that in
contracted kidney, the “ coats of the minute arteries, particu¬
larly their longitudinal fibres, are often more or less hypertro¬
phied and these vessels themselves frequently very tortuous
(the canal ot a minute efferent artery being blocked up with
oil, while the malpighiau body to which it leads is wasted and
shrunk up) ; and the malpighian capillaries are generally
thickened and opaque. In some kidneys of this kind, you will
find distinct streaks of a whitish material, following the direc¬
tion of the tubes of the cones ; these you may pick out with the
point of a knife or a needle, and upon examination you will
find them to consist of lithate of soda, which has remained in
the tubes. When this deposit is met with in the kidney, the
same salt will be found deposited, in greater or less quantities
in other parts of the body.”
1016 Original Communications. [May
No case can better illustrate the evils of a defective clearance
of the kidney’s structure by impaired mechanism.
Dr. Todd has likewise shown how obstructions to the circu¬
lation, due to chronic bronchitis and emphysematous disease of
the lungs, with extreme impediment to breathing, may indi¬
rectly produce congestion of the kidneys and rupture of the
malpighian capillaries. The imperfect aeration and secretion
over the respiratory mucous surface, nndulv force on the renal
secretion. The heart laboring to overcome the thoracic impedi¬
ments impels with extra force the systemic and hence the renal
flow to the actual rupture of the terminal arteries of the kid¬
neys and formation of blood clots.
“Let me caution you,” said Dr. Todd, addressing his students,
“ to keep in view the complications which are apt to accompany
these r renal diseases.” * * * “Of these complications
diseased or weakened heart is one of the most frequent, as well
as one of the most serious.”
A highly instructive and common pathological condition of
the kidney, is that attendant on scarlet fever, especially in cold
weather. The malphigian bodies are highly congested; their
impulse being exaggerated, liquor sanguinis actually flows, not
into the periplexus, but into the uriniferous tubes. The urine
becomes albuminous and often bloody. The most dangerous
and deadly, because permanently most obstructive to urinary
secretion, is the so-called glomerulo nephritis or inflammation
directly invading and destructive of the malphigian body.
It is not improbable that these new views relating to the
urinary secretion may shed much light on the nature of yellow
fever symptoms and complications. A rapidly reduced heart
action and typically slow pulse — notwithstanding a continued
high tempertaure, — may explain a mere physical arrest of the
kidney’s function. Suppression of urine is perhaps the most
dreaded of all symptoms; and well may it be, when the restora¬
tive influence of a vigorous heart action is impossible with
blood changes, extravasations and black vomit.
The presence of tube casts so frequent in the urine is explicable
on the theory, that the convoluted tubuli are loops within
which the secreted fluid must flow iu opposite directions from
1880] Sternberg — Havana Yellow Fever Commission. 101 7
sites of actual stasis. At these sites tube casts, and, under
certain conditions, other urinary deposits are allowed to form.*
Brief and scanty as these pathological references are, they
are cited as suggestive ol many more. A just interpretation
of function is essential to a correct interpretation of disease.
It is the faculty for making this iuterpretation, which I have
found conspicuous in Dr. Smyth, that has induced me to
commit to writing views which he has developed in repeated
conversations. The important parts of this paper he has either
written or dictated, and all have received his sanction and
caieful revision.
J * * * £ * # # * #
New Orleans, La., April 8r 1880.
The Microscopical Investigations of the Havana Yellow
Fever Commission.
Address before the Louisiana State Medical Society.
By GEORGE M. STERNBERG, Surgeon. U. S. A.
Mr. President and Gentlemen : — 1 shall endeavor to give you
this evening, some idea of the nature of the investigations
which engaged my attention last summer, while in Havana,
as a member of the Yellow Fever Commission, and of the sup¬
plementary studies which the liberal policy of the National
Board of Health has enabled me to make since, and in the
prosecution of which 1 am now a temporary resident of your
city.
The invitation to address you not having been received until
Tuesday morning, I have had very brief time for preparation,
and this, I trust, will be accepted as some excuse for the ram¬
bling and disconnected form of the impromptu remarks which
I expect to make in explaining to you the points of interest
concerning the photo micrographs taken in Havana and in this
*That the convoluted tubuli are nothing but loops is made clear by
the invariable disruption on attempts being made to inject them, as may
be seen in prepared specimens.
Origin al Commtnica tion s .
1018
[May
city, which will be projected upon the wall for your inspec¬
tion.
The Havana Commission received the following instructions
from the National Board:
‘'First, To ascertain the actual sanitary condition of the
principal ports of Cuba from which shipments are made to the
United States.” * * *
“ Second. To increase existing knowledge as to the pathology
of yellow fever.” * * *
11 Third. To obtain as much inforrpation as possible with
regard to the so-called endemnity of yellow fever in Cuba, and
the conditions which may be supposed to determine this en¬
demnity.” * * *
“ The three points above referred to are believed to be those
which will most certainly yeild results to scientific investi¬
gation ; and which, therefore, should receive the special atten¬
tion of the Commission.”
In the division of labor made by the members of the com¬
mission, the duty of conducting the investigations under the
first and third of the above headings was assigned to the chair
man of the Commission, Dr. S. E. Chaille; and that of conduc¬
ting the investigations under the second heading to Dr. J.
Guiteras; while my attention was chiefly given to investiga¬
tions contemplated in the following additional intructious:
“But, in addition to these, the National Board desires that
the commission shall consider certain problems relating to this
disease; problems which may be entirely insoluble, but which
nevertheless are of such importance that an effort should be
made to decide whether the National Board of Health will be
justified in undertaking the labor and expense which will prob
ably be required to obtain anything like a complete solution of
them, if .such solution is at all possible. These problems relate
to the nature and natural history of the cause of yellow fererP
# * *
This then, gentlemen, was the task set before me. To deter¬
mine the nature of the yellow fever poison ; to answer the
question which is uppermost in our minds whenever this disease
1880] Sternberg — Havana Yellow Fever Commission. 1019
is mentioned, and which has heretofore baffled all research. Is
it an emanation from the human body ? Is it a gas generated
external to the body ? Is it a bioplast ? Is it a germ ?
I might well have hesitated before undertaking this unprom¬
ising investigation, if the language of our instructions had
implied that the National Board considered this an easy task,
and one which they expected would be accomplished during
our brief stay in Havana. But you will observe that no such
result was anticipated, that the difficulty of the undertaking
was fully appreciated ; and that the work of the Havana
Commission in this direction was looked upon as pioneer work,
“ to decide whether the National Board will bo justified in
undertaking the labor and expense which will probably be
required to obtain anything like a complete solution of them,
if such solution is at all possible. ”
Now, I have great faith that science will eventually solve these
problems, but had little expectation that my feeble effoits for
three months, in Havana, would do more than to clear away
some of the difficulties and make the solution easier for future
investigators. I therefore had no hesitation in undertaking to
do my best to fulfil the expectations of tffe National Board,
without troubling myself as to whether a failure to find
the germ would be considered a serious neglect of duty by the
expectant public, or would be seized upon as a proof that there
is no germ, by the wise men who haviug, without any investiga¬
tion at all, pronounced positively against its existence, are
naturally anxious to have a chance to say, u I told you so.’?
The truth is that we are yet a long way from settling this ques¬
tion. But 1 think I may safely say as the result of my investi¬
gations in Havana, that there is no gross and conspicuous germ
or organism , (such as I saw in the Mardi Gras procession for
instance,) either in the blood of yellow fever patients or in the air of
infected localities , which by its peculiar appear auce or abundant
presence might arrest the attention of a microscopist and
cause suspicion that it is the veritable germ of yellow fever.
By gross and conspicuous germ I mean an organism, the
morphological peculiarities of which are readily made out with
a first class modern objective, such as the Zeiss 1-18, which I
3
1020
Original Communications.
[May
used in Havana. The Bacillus anthracis of splenic fever ; the
Spirillum Obermeieri of relapsing fever ; and the bacillus of pig
typhoid, or infectious pneumo-enteritis, all come under this
head. Yellow fever, so far as the germ theory is concerned,
may therefore be classed with cholera, typhoid fever and the
malarial fevers, which, by a process of reasoning similar to
that commonly used for yellow fever, are very generally
believed to be germ diseases.
It is true that the recent investigations of Klebs and Thoma¬
son in the vicinity of Rome, have resulted in the discovery of
what they believe to be the veritable germ of malarial fever ;
but these observations require verification, and I may say here
that lam instructed by the National Board of Health to repeat
their experiments, and to seek their Bacillus malarice in the
swampy grounds in this vicinity.
But little attention has been given in this country to such
investigations as I am engaged in, but in Europe numerous
microscopists and men of science have devoted more or less
time to them.
Ehrenberg first studied “dust” in 1830, and sought for the
cholera germ in f848. In 1849, Swayne, Britton and Budd
claimed that numerous annular cells found in the dejections of
cholera patients and in the dust of wards where cholera patients
were treated bore a causal relation to the disease. This was
disproved by Robin, by Dundas Thompson, and others. The
experiments and the lectures of Professor Tyndal upon dust
and atmospheric germs are classical ; Pasteur’s demonstration
of the role played by the minute organisms known under the
general name of bacteria, in processes of fermentation and
putrefaction are familiar to all of you ; and his rec nt important
announcement in regard to the cause and prevention of chicken
cholera shows that he is still actively engaged in these import¬
ant investigations, which Lave giveu him world wide fame.
You are probably not so familiar with the work of Cunning¬
ham, in India, and of Miquel, in Paris. #
The first named gentleman, a surgeon in H. M. Indian Medi¬
cal Service, was detailed to study the organisms found in the
atmosphere in the vicinity of Calcutta, in 1872, with reference
1880] Sternberg — Havana Yellotc Fever Commission. 1021
to their relation, if any, to the prevalence of cholera, diarrhoea,
dysentery, etc. The following are his conclusions :
“Distinct infusorial animalculae and their germs or ova, are
almost entirely absent from atmospheric dust.”
“ Distinct bacteria can hardly ever be detected among the
constituents of atmospheric dust, but fine molecules of uncer¬
tain nature are almost always present in abundance. They
frequently appear in specimens of rain water collected with all
precautions to secure purity, and appear in many cases to arise
from mycelium developed from atmospheric spores.”
u Distinct bacteria are frequently found amongst the part|.
cles deposited from the moist air of sewers.”
“ The addition of dry dust, which has been exposed to tropi¬
cal heat, to putrescible fluids, is followed by a rapid develop¬
ment of fungi and bacteria, although recognizable specimens
of the latter are very rarely to be found in it while dry.”
“ Spores and other vegetable cells are constantly present in
atmospheric dust and usually occur in considerable numbers.”
“ No connection can be traced between the numbers of bac¬
teria, spores, etc.., present in the atmosphere, and the occurrence
of diarrhoea, dysentery, cholera, ague or dengue 5 nor between
the presence or abundance of any special form or forms of cells
and the prevalence of any of these diseases.”
u Although these observations may not appear to encourage
the hope of success in discovering the presence of atmospheric
particles connected with the origin of disease, it must be re¬
membered that they refer only to bodies distinguishable from
one another whilst in the air , the possibility remaining that
many of the finer molecules present in it are really of different
natures, and yet may be distinguished from one another by
their actions or developments.”
“ Many interesting questions are suggested in connection
with the fact of the presence of such considerable numbers of
living cells in the air. What becomes of them when they are
drawn into the respiratory cavities of animals ? Is their
vitality destroyed, and if so, how are they got rid of? Are
they ever capable of undergoing any development within the
organism, and do they exert any prejudicial influence on the
1022
Original Communications.
recipient? These and similar questions can only be answered
by means of patient and extended experiment, but even such
imperfect and superficial observations as the present will, I
trust, serve a useful purpose in clearing away a few of the
preliminary obstacles from the path of investigation. ”
These conclusions of Cunningham’s correspond in the main
with my own, drawn from observations made in Havana and
in this city; and his final remarks are entirely in conformity
with my views.
Miquel, the chief of the micrographic service in the observa¬
tory of Montsouri, Paris, has recently published a full account
of his investigations in this direction, which are still being ac¬
tively prosecuted.
He says : “ So long as it is not possible to cultivate in a
state of purity, and to inoculate living beings with these pro¬
ductions so diverse, designated under the general terms bacteria
and vibrios , the questions of public hygiene attached to the
knowledge of the.^e lowest beings will not have made a decisive
step. It is here that the processes of M. Pasteur find their
most rational application. * * Our regular researches upon
the air ot the south of Paris in the interior of the park of
Montsouris are only preliminary to a more extended labor con¬
cerning the hygiene of Paris. It is certain that those who
without previous researches have ventured to study germs
held in suspension in special atmospheres, have failed in the
indispensable elements to a healthy criticism of the localities
submitted to their investigations. They have exposed them¬
selves, as has already happened, to sec in some inoffensive
cells, some morbid ferments, while these same cells abounded
in healthy localities and were found in the nasal and pharyn-
gial mucous of persons in the best of health. Then, before
seeking in confiue'l air the cause of epidemic maladies it is
necessary to know first, perfectly, the microbes which free air
contains in the normal state, and to know in what proportion
these are found in infected localities. Then only will it be
possible to approach these grave questions with some chance
of success.”
This, gentlemen, is the main object of my present visit to
1880] Sternberg — Havana Yellow Fever Commission. 1023
New Orleans. Deeply impressed by my investigations in
Havana, with the importance of special training and familiar¬
ity with the common organisms found every where suspended
in the atmosphere, as a necessary preparation for the study of
an infected atmosphere, I am here for the purpose of studying,
during the absence of any epidemic disease, the organisms
present in the atmosphere of this city.
Listen, if you please, to a brief synopsis of the microbes
found by Miquel in the air of Paris : “ Fibrous and cellular
debris, epidermic pellicles, spiracles of trachem, hairs of plants,
pollen, grains of starch, spores of moulds, spores of lichens and
of mosses, and of all the cryptograms which give l >y dehiscence
microscopic fructifications, the green spored algse of the genera
chloroeoceum, protococcus, palmella. Vibrios are always found
in the air in the state of germs, visible by powerful lenses, when
colored by iodine. * * * But besides these constant ele¬
ments there are others which are either more variable or more
difficult to seize, of which the nature and the properties are un¬
known to us. Some mouths of observation are insufficient to
their general study. * * * If has always seemed to us
that this examination ought to proceed and accompany the
delicate researches upon the microbes infinitely smaller, of
which the redoubtable role ought principally to attract our
attention. * * If the monographs of these inferior b mgs
had been made, if their physiological functions had been
established, perhaps it might be possible to discover, mixed
with the bacteria, des vibrions nocifs. * * The study of the
vibrioniens has scarcely commenced ; it is of importance to
science and to hygiene that it be continued and pushed with
activity.”
The sentence last quoted will, I doubt not, meet your
approval, and that these researches, so important to science
and hygiene, should be pushed with activity by Americans as
well as by Englishmen and Frenchmen, is a proposition which
you will also readily agree to. 1 therefore anticipate your pro¬
fessional and patriotic interest in the work in which I am
engaged under the auspices of the National Board of Health,
1024
Original Communications.
[May
and if necessary, your active support of this central Health
Board, which, controlled by advanced and liberal ideas,
promises to do so much for medical, and especially for sanitary
science.
Nitrate of Silver in Erosion of the Teeth.
By GEO. J. FRIEDRICHS, D. D. 8.
NEW OREEANS.
Every physician ought to be congnizanant of the fact, that
the timely application of this agent in the iucipiency of this
disease, will not only save pain and annoyance to their patients,
but in the end be the means of preserving these organs, for in
many instances, when the teeth are breaking down in Common
with the general system, and this remedy is not applied — before
the patient is perhaps able to call in the services of a dental
surgeon — the disease may have progressed to such an exteut
that they are beyond redemption. This lesion is generally
seen and incidentally developed in connection with an anaemic
and depraved condition of the system, and the remedies
employed to correct this condition, are the accredited agents of
being the cause of the loss of these precious jewels ; for how
often have we not heard the remark : that it is the acid or
iron that I am taking that are causing my teeth to decay.”
Erosion of the teeth has been divided by writers into congeni¬
tal and accidental ; — the former occurring previous to eruption,
the latter at any subsequent period of life. I shall, however,
confine my remarks in this paper to the accidental occurence
of this disease : this being a species of carries, characterized by
gradual decomposition, first of the enamel and afterwards of
the subjacent dentiual tissue of a tooth. Erosion, properly
speaking, confines itself to the enamel, and it generally
attacks a number of teeth at the same time, usually developing
itself on their surfaces near the margin of the gums. The
decomposed part of enamel is white, although I have seen many
cases where the disease in its incipieucy was primarily of a
green color ; this condition, however, is more frequently met with
1880] Friedrichs — Nitrate of Silver in Erosion .of Teeth. 1025
in children than in adults, and as it progresses becomes soft
and of a chalky texture, generally very sensitive to thermal
changes, and to the touch.
The teeth most liable to be affected by this disease are the
superior incisor cuspidati, and bicuspids, and singular to say^
some times those only on one side of the mouth. The next
most liable are the biscuspids and molars of the inferior max¬
illa. Occasionally the process begins at a number of points
and these enlarging finally coalesce to the destruction not
infrequently of all the anterior enamel wall.
CAUSES.
I do n6t propose here to enter into my opinions, or to
theorize on the probable cause or causes of dental erosion. I
will however repeat the promulgated opinions of different
writers, as to the causes to which this disease has beeu attrib¬
uted, to wit : constitutional predisposition to viscidity of the
fluids of the mouth, acrid secretion of the mucous membrane,
utero- gestation, dyspepsia, altered condition of the system
after anaemic and zymotic diseases, electro chemical action.
TREATMENT.
We all know that the vital force is ever on the alert, to
combat the injury done through the destructive influences of
disease. We are also aware that a tooth attacked at a given
point by irritating agencies will, step, by step break down and
give away before the irritant, unless it is counteracted by the
efforts of nature or art — and in the words of Dr. Garretson,*
“Not but what such repair is attempted and indeed often¬
times successively accomplished, as witnessed in tubular
consolidation where power sufficient exists to perfect the
attempt, as seen in the process generally spoken of as vitri¬
fication, or eburnification, a mode of natural cute and resistance
which no mechanical operation however successfully performed
can equal.” Now, from the above premises it is self-evident,
if we can bring assistance to the inherent vital force of a tooth,
this disease erosion of the teeth can be cured. The agent to
*Systein of Oral Surgery by E. Garretson, M.D.. D.D.S.
1026
Original Communications.
[May
accomplish this is nitrate of silver, for when applied to an
eroded part of a too li it puts forth its tiat and says. “ so far
Shalt thou go and no further.” The salt when brought in
contact witli the organic matter of the teeth, is decomposer ;
the oxide of silver is deposited, an insoluble and inert substance,
which protects and relieves tin se portions of the t< eth of their
hypersensitiveness, antagonizes the action of morbific influ- nces
and assists the “vis medicatrix naturae” to eradicate the
disease. The method of using it, is, to chip oft' of a solid
stick of nitrate of silver, a piece about the size of a pin’s head
(or a crystal of about this size) ; applying this to the eroded
part of the tooth, moving it over the surface until dissolved or
decomposed, taking care to keep it from coming in contact with
the gum as much as possible, or the gum can be protected by
a coating of collodion previous to the application of the eschar-
otic. If after a week’s time, the sensitiveness to the touch has
not been allayed, the application must be renewed at intervals
until this is attained. No danger need be apprehended of its
too frequent use, as no injury to the teeth can possibly ensue,
for the escharotic operation of lunar caustic is always super¬
ficial, it is almost impossible to make it act to a great depth.
The salt produces, along with its excitant eftV-ct, couti action of
the tissue, or, in other words acts as an a tringeut, and this
prop rty also constitutes one of its therap utic recommenda¬
tions. You will find that after a few applications the surface of
the eroded par: will be covered by a thin film of the oxide of
silver, which must be allowed to remain until the subjacent
layer of enamel becomes solid, and structural consolidation
has taken place, after which it can be scraped off, and the sur¬
faces polished, leaving the teeth comparatively uninjured.
In conclusion, knowing that the family physician is the only one
that has the opportunity of seeing this disease in its iucipieucy
in ninety-nine cases in a hundred, and- that unless arrested at
this stage, the loss of too'h structure is irreparable, I felt it
a duty incumbenton me to call the attention of the practitioner
of medicine to the facts stated above, and which my personal
observation in the past ten years have confirmed. If, then, it
has become an established rule that a physician will risk his
Gates — < Surgical Notes.
1027
1880]
own life to save that of his patient’s, I know, 1 am not asking
too much, when life is not at stake, that in prescribing the
proper remedies to restore their patients to health, that due
attention will also be given to the preservation of the dental
organs.
Surgical Notes.
By A. S. GATES, M. D., Franklin, La.
Oblique Inguinal Hernia in Female — Gunshot
Wound of Shoulder Joint.
(Read before the Attakapas Medical Association, Maroh 4th, 1880.)
Gentlemen — If I trespass somewhat upon your time and
patience to-day, the interest of the two cases herewith reported
to your honorable body, will I hope, plead some excuse for any
want in polish and elegance of the report itself. The one case
possesses interest from its rarity, the second for its unexpected
favorable result. The first case to which I wish to call your at¬
tention is confessedly a rare condition, few authors at our com¬
mand have made any mention of it, and the few who do notice
it give it very meagre mention. It is a case of “ oblique in¬
guinal hernia in female.” Some authors class it as labial or
pudendal hernia, while others, as Gross, calls labial hernia,
that condition in which the tumor, consisting generally of blad¬
der alone, seldom intestine, descends between lamas of ischium
and the vaginal wall, making its appearance as a tumor in the
labia, of the size variying from a small marble to a pullet’s
I will relate to you the history of the case, and so much of its
preceding history as I have been able to obtain from husband
ahd friends, and patient herself.
Was called on the 3d day of February, 1880, to see Mrs. H.,
whose husband said “ she had a lump in her side ; that it had
been there for years, making its appearance occasionally, but
as a general rule giving no pain or inconvenience. That on the
Sunday previous, 1st of February, she had walked from Cen-
4
1028 Original Communications. [May
treville to Franklin, five miles, over a muddy, slippery road,
that she was carrying on terribly with pain,” etc.
When I saw the patient she was seated in a rocking-chair,
with knees drawn up and feet resting on seat of chair. She
was suffering intense pain, moaning and screaming so as to
have the neighbors alarmed and collected around her. Fetch¬
ing and nausea were the prominent symptoms. There had been
vomiting before my arrival, whether stercoracious or not,
was not able to ascertain. Pulse was quick and thready, tem¬
perature normal, though not taken thernometrically, cold,
clammy perspiration and symptoms of collapse, features pinched
and anxious. After much persuasion, was allowed to make a
manual examination of painful part. Found a hard inelastic,
pear-shaped tumor, about the size of a hen’s egg, distending
labia majora of right side, extending along course of inguinal
canal, with its apex about the internal abdominal ring, ex-
quisitively sensitive, manipulation provoking screams of
pain. Refused chloroform, and insisted on being let alone. I
here had a case of oblique inguiual hernia, with all the charac¬
teristic symptoms of strangulation. After persuasion, pa¬
tient consented to be lifted upon the bed ; placing head low
and knees drawn up to relieve tension of abdominal muscles, I
proceeded carefully to attempt reduction by taxis. After half
an hour steady compression and manipulation, was gratified to
hear that peculiar gurgling sound which is so welcome
to the surgeon’s ear in reduction of strangulated her¬
nias. The knuckle of intestine was gradually returned
into abdominal cavity, and to be certain of my diagnosis in the
case, I pushed the index finger of right hand clear up through
the inguiual canal with little difficulty, and almost into the in¬
ternal abdominal ring as my subject was spare and thin. The
reduction was completed as I here before remarked, in about
half an hour.
A consideration and comparison of the surgical anatomy of
these cases in the male and female, is here apropos. The re¬
lations of the spermatic cord to the canal, and also of the
sound ligaments of uterus, analogues of spermatic cords, are
thus defined by Gray, in his work on Descriptive and Surgical
1029
1880] Gates — Surgical Notes.
Anatomy : u The inguinal or spermatic canal contains the
spermatic cord in the male and the sound ligament in the
female. It is bounded in front by integument, superficial
fascia and by aponeurosis of external oblique throughout its
whole length, and the internal oblique for its outer third, etc.
That form of protrusion in which the intestine follows the
course of the spermatic cord along the spermatic canal, is
called olique inguinal hernia.” In his description of the
cremaster muscles, considered as one of the coverings of this
form of hernia, he says : “ No such muscle exists in the female,
but an analogous structure is developed in those cases where
an obligue inquinal hernia descends beueath the margin of the
internal oblique.” Erichsen’s only mention of oblique inguinal
hernia occurring in a female, is that it sometimes occurs as a
congenital condition in female children, and is then to be
treated in the same way as a corresponding condition in the
male. The works of Ericbsen and Gross, on surgical inter¬
ference is also meagre and unsatisfactory, in fact, they leave
us to inaugurate our own methods of procedure.
Gross under the head of “ Labial Hernia,” says that this is a
rare form of disease, and describes it as a descent of the blad¬
der between vaginal wall and branch of ischium. It rarely
contains intestine, recedes readily under pressure, the tumor
varying iu size, as before remarked, between a small marble
and a pullet’s egg.
The heruia is sometimes double in this form of disease, both
tumors containing bladder ; strangulation or its possibility is
not noticed in either one of these authorities on Surgery. In
the works of Thomas and Seanzoni on Female Diseases, I am
not able to find much information. Thomas asserts that it is
of rare occurrence, but that oblique inguinal hernia does occur
he is positive. He says, “ By some anatomists it is stated that
the round ligaments of the uterus end in the tnons veneris ;
but this view is probably incorrect. A more careful dissection
traces them through the internal abdominal rings, along the
course of the inguinal canals to the labia rnajora, where they
are lost in the dartoid sacs described by Broca, as passing-
through these folds. The labia rnajora are unquestionably the
1030
Original Communications.
[May
analogues of the scrotum, and the sound ligaments correspond
to the spermatic cords. Down one of these canals , by the side of
the sound ligament , a loop of intestine , and sometimes a portion
of the mesentery, an ovary, or even a bladder may pass , as
inguinal hernia occurs in a male. The fact that this disease is
by no means frequent, makes its recognition the more important,
for were the practitioner not aware of the possibility of its
occurrence, the intestine might be wouuded under the supposi¬
tion that the labial enlargement was due to abscess or disten¬
tion of the vulvo vaginal glands. The displacement may be
produced by violent muscular efforts, or blows or falls, as in
the male. Strangulation of the intestine, with its characteristic
signs, may occur, according to Sir Astley Cooper and Scarpa.
The hernia may usually be overcome by taxis.” Scauzoni in his
valuable work on “ Diseases of Females,” says of this disease
or condition : “For the diagnosis of these hernias, we must
pay attention to their form, which is round or oval ; to the
color of the skin, which is normal, when there is no strangula¬
tion ; they are not generally painful, have little consistency ; '
when they contain a large loop of intestine percussion yields a
tympanitic sound.” Finally, he adds : “ It is also important
to know that these tumors are mostly reducible, and that they
may reappear whenever the patient coughs, sneezes, etc. A.
Cooper and Scarpa have observed strangulation of these hernias,
still it always yields to taxis.”
Now, please observe, gentlemen, that of these author’s
accepted as authority in the subject of diseases of females,
neither one asserts positively that there is never need for
operative procedure or surgical interference. Thomas says
they are usually reducible. Scanzoni, that they are mostly
reducible. When describing it and when quoting or giving
Astley Cooper and Scarpa as his authority, he says they are
always reducible by taxis. If unfortunately it should be a
country practitioner’s luck to meet with such a case, where
by reason of adhesive inflammation or any of those accidents
which produce an irreducible hernia in the male, and we must
admit that such might occur in a female, he deemed surgical
inierference imperative for the welfare and life of his patient,
Gates — Surgical Notes.
1031
1880J
what coverings would he seek for as with knife and grooved
director in hand he determined upon operating — first integument,
superficial fascia, intercolumnar fascia, aponeurotic expansion
of internal oblique, analogue of cremaster muscle, transversalis
fascia, subserous celular tissue and peritonium. The round
ligament being analogous to spermatic cord must be found in
its situation by the side of, and a little back and to the inside of
peritoneal sac, investing the intestine. What truss is proper
for such a case after reduction to prevent repetition of descent
and possible strangulation in acts of coughing, sneezing, and
the muscular exertion iucideut to a housewife’s daily routine of
life, is a question naturally presenting itself to us as country
doctors, as of sufficient importance for discussion. Every one
has his preference for this or that form of truss for the same
hernia in the male, and here I would say a word for the
Spilman truss of New Orleans manufacture, which I
have recommended to my patient. It is a truss which instead
of opening in front and being subject to displacement by
motions of the body, opens in the back, a steel spring with
curves to fit any pelvis, the pad movable in front, but capable
of being fixed by a set screw at any point where pressure is
desired. The motion is between the open ends which rest on
sacrum. Not wishing, particularly, to advertise Mr. Spilman’s
trusses, I only call your attention to them as fulfilling the indi¬
cation in this particular case of u Oblique Ingunial Hernia ” in
a female.
The second case which I shall make very brief, merely stating
facts, is that of Paul F., who was shot on Sunday, January 4,
1880, with a Smith & Wesson improved No. 32 pistol, accident¬
ally. I saw the case in consultation with my confrere Dr.
Chas. M. Smith, in the evening of the same, some three or
four hous after the accident. The ball had entered the shoulder
at the anterior edge of the deltoid muscle, — there was very little
haemorrhage. A No. 8 female catheter used as probe passed
readily into the wound and struck denuded bone, evident from
roughness and peculiar feel on probing. Grasping the elbow
firmly and rotating by means of hand and tore arm, cupitus
was distinctly felt and heard, that portion of bone in contact
1032 Original Communications. [May
with probe moving with, but not following motion of lower
fragment of humerus, nor did this fragment remain stationary
when the head of the bone and upper fragment were held fixed
by hands of assistant. Dr. S. and myself concluded from
these facts that we had before us a case of communited frac¬
ture, with at least three fragments, upper and lower ends of
humerous and median fragment struck by probe. The site of
fracture being through that portion of the humerous known
for purposes of description as the surgical neck,
The ball was not found and we decided that it was wedged
between or buried into some of the fragments. We applied
anti-septic dressing as near, according to Lister’s method, as
possible, consisting of layers of gauze saturated with solution
of carbolic acid and water, 1 part to 50. With a competent
nurse to keep the dressing wet with the solution, we left the
case as it was too late to operate that evening, fully convinced
that Vesection of the communited bone would be our ouly
chance, and determined to coine the next morning prepared to
operate.
Together we visited our patient the next morning, with
instruments, etc., all ready, but much to our surprise our
our patient presented little or no local, or constitutional
disturbance — was cheerful and bright ; we therefore concluded
to postpone the operation, which sooner or later we had
decided would be necessary for the salvation of our patient.
The case still progressed favorably on our next visit, no
local or constitutional disturbance yet making its appearance,
and on the Sunday following, just one week from the date of
injury, we applied starch bandage from tips of fingers to the
shoulder, rendering the arm perfectly immovable. Cutting
fenestrum in bandage over seat of wound for the purpose of
inspection and dressing, for which carbolic acid and olive oil
was used, one pi nt“ to 16, instead of acid and water solution.
Two doses of epsom salts were given, but having no effect,
bowels were opened with enemata of soap suds, warm water
and a little common salt. Morphine was left in doses to be
taken pro re nata , but he never found it necessary to take
more than two doses during the night to make him rest. His
1880J
1033
Rohe — Recent Progress in Dermatology.
case bas gone on favorably, and on the li3d of February our
patient called at my office to report himself well, with no
deformity.
This case, gentlemen, we report as a remarkable one of
conservative surgery.
Recent Progress in Dermatology.
By GEORGE H. ROHE, M.D., New Orleans.
Dr. Jas. Nevins Hyde, of Chicago, reports a rare and extremly
interesting case of what he terms Molluscum Verrucosum. The
subject of the affection was a stout, otherwise healthy German,
35 years of age, aud ten years a resident of this country. The
main features of the case are briefly as follows :
Between two and three years ago he began to notice over
the left buttock numerous white spots or points, about as large
as pin heads, which gradually increased in number, extending
first upward over the loin, and then downward upon the inner
and outer faces of the thigh, the corresponding surfaces of the
other side becoming similarly involved. After continuing
about a year, these lesions disappeared leaving a reddish pig¬
mentation of the skin where they had existed. Three months
afterward the affection reappeared in the same localities first
invaded, spreading at first upward, then downward as in
the first instance. When Prof. Hyde first examined the patient,
the eruption occupied the trunk, thighs, arms and legs to the
level of the boot-tups. The head and face, palms of the hands,
the feet, and the legs below the level of the boot-tops were
exempt. A few papules were noticed on the backs of the hands.
The genital organs were not involved. The eruption was tol¬
erably symmetrical. The papules were not numerous on the
gluteal regions
The papules varied in size from a pin-head to a split-pea
with a smooth, globoid surface, neither umbilicated, flattened
or acuminate. Neither scale, scab or other pathological pro¬
duct was discoverable on them. There was no itching, burn¬
ing or pain connected with the eruption ; neither was there
1034
Original Com munications .
[May
any infiltration, oedema or inflammatory congestion. The con¬
tents of the papules, of which a number were opened, was in
each case — so far as discoverable by microscopic examination —
healthy blood. There was no trace of gland outlet, hair-follicle
or other depression on the summit of any of the papules.
This eruption attained its greatest development during the
summer of 1878. By January, 1879, nearly all the lesions had
disappeared, to recur again to a moderate extent in April, the
same year ; but on the 12th of July, when another examination
was undertaken, all of the lesions had vanished with the ex¬
ception of the purplish stains of the surface, which had been
the seat of the eruption in the spring.
The patient received no treatment whatever ; there being no
subjective symptoms calling for medication. The only other
peculiarity of the patient was a marked development of the
perspiratory function.
The diagnosis of this case presented so much difficulty, that
Dr. Hyde — himself one of the foremost dermatologists in the
country — consulted with a number of gentlemen prominent in
this specialty, both in this country and abroad, and finally con¬
cluded to give it the name at the head of this article, which
was suggested by Prof. Kaposi, of Vienna, the associate of
Hebra, in the Vienna University.
This diagnosis is merely a provisional one, and the problem
of the true pathological character of the eruption remains for
further clinical and microscopical investigation. It is to be
hoped that Prof. Hyde will keep this case under notice, and
report upon it further,. if the eruption re appears during the
coming summer.
The following are the cautious conclusions of the author of
this exceedingly interesting paper : — “ 1. The case here de¬
scribed is one exhibiting certain rare and peculiar features,
and cannot, therefore, be made to serve as a basis for generali¬
zation. It is merely a contribution to the literature of the sub¬
ject. 2. Considering it, nevertheless, in connection with cer¬
tain other cases, * * * it would seem to be reasonable to
admit that there is a variety of molluscum whose character¬
istics differ in a marked degree from those first observed by
Rohe — Recent Progress in Dermatology.
1035
1880J
Bateman, and since studied by later investigators. * * *
3. To the objection possibly brought against the conclusion last
stated, that the lesions in question are merely incomplete and
undeveloped forms of molluscum bodies, it may be responded
that in the case here described there were several recurrences
of the disease, none influenced by either internal or external
treatment, each accompanied by an abundant and copious de¬
velopment of the eruption under circumstances particularly
favorable to the growth of typical mollusca. 4. The term,
molluscum verrucosum , proposed by Kaposi, properly desig¬
nates the clinical features of the lesions to which the name has
been limited in this sketch, and, in any view, is useful in dis¬
tinguishing all the wart-like varieties of molluscum sebaceum
from those typical lesions to which the title of contagiosum
was formerly applied. 5. As between those authors who hold
that even the typical or wart-like forms of molluscum originate
in disorders of the sebaceous glands, and the authors who op¬
pose this view, the case here described would point to an origin
from the rete bodies by proliferation, rather than to a disorder
originating primarily in the sebaceous glands.” — Edinburgh
Medical Journal , February, 1880. Reprint.
A Case of Lymphangioma Cutis Multiplex.
Pospelow reports a case of this extremely rare disease of the
skin, — the second on record, — in the last number of the Viertel
Jahresschrift f. Dermatologie u. Syphilis , No. 4, 1879.
The patieut was a peasant woman, unmarried, age 23, suffering
from papillomatous growths on the vulva, of five months’ stand¬
ing, for the relief of which she had applied to the hospital. Aside
from the above mentioned affection and an insignificant gas¬
tric catarrh, the patient was in good health, with the exception
of the pathological condition now to be described.
The integument was of a light yellowish color. Under the
left breast the pigmentation was dark brown, resembling the
ordinary chloasma. The mammae were very slightly developed
Between the left breast and the median line was situated an
oval tumor of the size of a pigeon’s egg. The skin over the
5
1036 Original Communications. [May
swelling was of a light rosy violet color, thin, and could not be
raised in a fold between the fingers. Upon closer examination
it could be seen that the tumor was made up of a number of
smaller nodules, a little larger than a millet seed. The skin
over the tumors was smooth, rosy and the epidermic covering
apparently normal. Similar tumors, of smaller size were
observed on various parts of the patient’s body. They varied
in size from a millet seed to a hazelnut. The smallest were on
the face and neck ; the largest on the abdomen. The palms of
the hands and soles of the feet were free. The distribution of
the growths was un symmetrical.
The shape of the swellings was generally oval. Pressure from
side to side — between the fingers — gave the sensation of a
tolerably compact nodule ; pressure from above, however,
caused the tumors to disappear. When the finger was removed
the swellings returned.
By lateral illumination, the tumors were translucent, and
appeared filled with fluid. Cutting into the tumor revealed a
pearl colored jelly-like mass. A small quantity of a turbid
fluid exuded from the surface of the cut ; but the gelatinous
mass did not flow out. The bleeding from the incision was
very slight.
The tumor on the left breast was said by the patient’s mother
to be congenital ; the remaining tumors aud tubercles had
formed since, but the time of their appearance was not known.
The diagnosis of lymphangioma cutis was based on the
resemblance of the case to the one recorded by Kaposi (Hebra
and Kaposi : Hautkrankh eiten : vol. 2, p. 282, and Hebra ; Atlas,
etc., 1876). Microscopic examinations of excised tumors made
by Kaposi, Neumann and Auspitz, confirmed the diagnosis.
Both cases are females.
The patient remains in the hospital (in Moscow) under obser¬
vation. The number of small tubercles has increased of late.
No treatment has been given. A flue chromo lithograph, and a
wood cut of the microscopic characters, accompany the article.
The use of Water in Skin Diseases.
Among the most practical of recent articles on dermal thera¬
peutics is a paper by Dr. L. D. Bulkley, of New York, on “The
1880] Rohe — Recent Progress in Dermatology. 1037
use of water in the treatment of Diseases of the Skin.” After some
judicious remarks upon the use of baths in health, Dr. Bulkley
goes on to treat of the application of water to the skin iu a
state of disease. Some of his statements are of so much prac¬
tical value as to justify quotation at some length. Thus instead
of advising the indiscriminate employment of baths in skin
affections, he says :
u But ordinary warm water baths cannot always be advised
with impunity in all diseases of the skin ; acute eczema, or even
more sub-acute, exuding forms of this disease will be found to
be aggravated by the contact of simple water. Urticaria will
also be rather irritated, as will indeed most of the inflamma¬
tory affections of the skin. * * * Sea-bathing is of service
in psoriasis, and warm baths of sea-water have been followed,
in my experience, with very beneficial results in this disease.
* * * But sea-bathing is decidedly harmful in most cases of
eczema. * * * I am very cautious about allowing eczema
patients either to bathe in the sea, or to spend much time
at the sea-shore. * * * Sea voyages generally act unfavor¬
ably in acne.”
In regard to the too frequent ablutions iu exudative diseases,
Dr. Bulkley also has some very sensible words. Upon this
point he says : “ It is a most common practice to wash eczema,
and especially do we see the eczema of children washed dili¬
gently, often several times a day, the mothers saying they find
it ‘ impossible to keep it clean.’ Now, in my opinion, an ecze¬
matous surface should be washed very seldom. Nature seeks
to make a protective covering with Jthe exudate ; this is con¬
tinually removed by washing, and the cure most certainly
retarded. * * *”
In eczemas in adults, of course the same is true, and a simi¬
lar caution applicable. In chronic cases, however, where there
is much thickening of the skin, the frequent and prolonged
application of water is indicated, and is often of the greatest
service. Hot water applied to the anus, vulva or scrotum, in
eczema or pruritus of those parts, is often more effective than
any other application. This is also useful in the chronic ecze¬
ma of the palms of the hands which is so difficult of cure. This Dr.
1038
Original Communications.
[May
Bulkley says, “ will sometimes almost seem to melt away under
the daily soaking of the palms on the surface of a basin of
scalding hot water, followed by diachylon or other ointment.
Eczema of the ends of the fingers and of the nails sometimes
yield to this after all other means have failed.”
(As it is doubtful whether the diachylon ointment referred
to by Dr. Bulkley, can be readily obtained here, the following
formula is given as an easily procured substitute :
Take of simple lead plaster and cosmoline (or vaseline) equal
parts, melt together with the aid of gentle heat and stir while
cooling. This makes one of the most elegant preparations that
can be used in skin affections. It is useful in most cases, and
rarely is a case met with, where it proves too irritating.)
In psoriasis and acute general eczema, the wet pack may be
resorted to with advantage. The Russian and Turkish baths
do not command Dr. Bulkley’s commendation to any very great
degree. Water made alkaline by the addition of four ounces
of carbonate of potassa, two of carbonate of soda and one of
borax, with a quarter or half a pound of starch to a thirty-
gallon bath, is recommended in sub-acute eczema and urticaria.
This is soothing to most skins and will frequently give relief
to the intense itching that accompanies these affections. — Chi¬
cago Med. Jour, and Exam., January, 1880. Reprint.
Therapeutic Notes.
Dr. M. Charlouis, of Sumatra, reports ( Viertel Jahresschrift
fuer Dermatologie u. Syphilis , No. 4, 1879) two cases of
syphilitic serpiginious ulceration of the foot, treated after a
method somewhat novel. After failure to produce improve¬
ment with large doses of iodide of potassium internally, and
mercurial ointment locally, with occasional cauterizations with
lunar caustic, the following treatment was adopted : The ulcers
were penciled with tincture of iodine, and directly afterwards
covered with a layer of mercurial ointment. A sensation of
heat in the part followed, lasting however, only a short time.
Within a week the ulcers healed in both cases. The author
thinks the rapid and favorable result due to iodide of mercury
Current Medical Literature.
1880]
1039
forming at the point of application and acting on the tissues in
its nascent state.
How to cover the odor of iodoform so as to make it more
bearable has been a troublesome problem in practice. Neither
tannic acid nor ether succeed well, though both have been re¬
commended for that purpose. Linderman reports that two
parts of Peruvian balsam to one part of iodoform covers the
smell completely. A convenient preparation is :
lodoformi, pt. 1 ,
Balsam, Peruv. pt. 2,
Vaseline, pt. 8. M.
A fluid preparation may be made by mixing 1 pt. iodoform,
3 pts. Peruvian balsam and 12 pts. alcohol or glycerine.
EXCERPTA FROM DR CARL HEINEMANN’S “ CONTRIBUTIONS TO
THE KNOWLEDGE OF YELLOW FEVER (VOMITO OF THE
NATIVES) ON THE EASTERN COAST OF MEXICO.
Translated from the German, by Dr. T. S. Dabney, for the Yellow Fever Commission of
the National Board of Health
Since my last communication on Yellow Fever more than six
years have passed, during which I have had ample opportuni¬
ties for collecting new data, especially concerning the epidemics
of 1875, 1877 and 1878, which were of unheard severity. I
would fain have postponed the publication of this work until
some conclusions had been drawn from microscopic and chemi¬
cal investigations, but the increasing significance of Yellow
Fever to the Western Hemisphere, especially to the United
States ; the growing danger of frequent importation to
European harbors, leads me to believe that ever so small a con¬
tribution as this to the knowledge of this pestilence may be of
some interest.
“ Dr. Heinemann writes from Vera Cruz, where he has been
for 12 years. At what points on the eastern coast of Mexico,
is yellow fever endemic Answering this question necessi¬
tates first, a comparative examination of all the larger and
smaller harbors and districts on the coast ; then whether the
disease be always present at all seasons of the year ; whether
1040 Current Medical Literature. |May
it occurs sporadically or in more or less severe epidemics ; or
whether it only occurs periodically from special causes.
In the first instance foreigners alone will suffer ; in the
second neither foreigners nor natives will be spared. The
immunity of natives, though not entire as we will see, must
henceforth be regarded as one of the best criteria for deter¬
mining whether the pestilence be of endemic or epidemic char¬
acter. Since some places where many foreigners trade without
first having come in contact with yellow fever places, are not
directly on our coast, I state positively that all places on the
eastern coast of Mexico iu which yellow fever prevails in an
endemic form are in constant communication with recognized
hot-beds of the disease. Taking up the places on the east
coast we will commence with Matamoras. The German Con¬
sul gave me some information concerning the three epidemics
here in 1858, 1863, 1867.
Tampico de Tamaulipas, on the left bank of the Panuco, af¬
fords much interest as it is a new town. Before the building
of Tampico, the foreign commerce was all concentrated at
Altamira, a village of 5000 inhabitants, seven miles up stream.
Here the disease occurred for the first time in October, 1821,
after the arrival of a steamer from Havana.
More than 1500 people, foreigners and natives alike, died.
In 1823, Santa Anna ordered the building of Tampico, under
the name of Santa Anna de Tamaulipas. Most of the citizens
of Altamira at once moved to the new town. Yellow fever ap¬
peared in Tampico in 1843 for the first time, twenty years after
its foundation, by means of a body of troops from Vera Cruz.
The epidemics of 1847 and 1848 are due to the same cause. I
can obtain no particulars of the epidemic of 1853. The disease
was crrried in 1863 and 1864 by French troops from Yera Cruz.
Both of these latter epidemics were endemic in character, for
both Fuzier and Eoman de la Torre, state the natives enjoyed
immunity from the disease.
This proves conclusively that yellow fever may assume for
years an epidemic character but can also become endemic, pro¬
vided the essential conditions for naturalization be found.
Dr. Hegewisch in 1877 treated in a military hospital an
entire company of soldiers, born in Tampico, who had lost their
immunity by prolonged absence.
Tuxpan, 6000 inhabitants, has been the theatre of many epi¬
demics. The town remained free from yellow fever from 1838,
up to the last European intervention. Juarez during his term,
ordered the harbor of Vera Cruz to be closed, consequently all
the ships then lying in the roads and on their way, were
ordered to Tuxpan.
Then, in 1863, a frightful epidemic occurred, which extended
far and wide iu the interior. Hone were spared; aboriginees,
natives, resident foreigners and foreign seamen, all shared a
common lot. Muleteers carried germs to many communities
where they carried merchandise.
1880]
Current Medical Literature.
1041
After the harbor of Yera Cruz was re-opened, the disease dis¬
appeared not to return again till the town was occupied by a
French garrison. The fever has occurred here twice since then
in 1875 and 1878, each time due to soldiers from Yera Cruz.
Nautla, small harbor on the Nautla river, has not suffered
from the disease since 1859. Jicaltepec, ten leagues up stream
from Nautla, suffered in 1861 and 1868. In 1861, the disease
was limited exclusively to the right bank of the river.
Papautla, Indian village of 14,000 inhabitants, almost all of
whom are warlike Indians, suffered severely in 1877.
Yera Cruz has been for two hundred years, the chief focus
of the disease on the coast. Here the disease is unquestionably
endemic. It is never absent, but proves its existence by spo¬
radic cases, or by outbreaks of greater or smaller epidemics.
From this town it flows out as from a centre, always following
in the wake of commercial highways to other coast towns or
going to the iuterior. Epidemics generally occur here from
March to October. Alvarado, a harbor near Yera Cruz, is
called the constant home of the disease. The inhabitants eujoy
perfect immunity.
Between Alvarado and Campeche are a number of places,
important on account of their timber trade. At certain seasons
of the year these places are visited by a large number of for¬
eign ships. The principal places are twelve in number, all
situated on mouths of rivers, which at certain seasons are full
of water and at other seasons are stagnant or dry. With the
exception of La Frontera de Tobasco, yellow fever has never
been known to occur in any of these places.
Foreign sailors are busy loadiug timber here under a tropi¬
cal sun from June to January. They escape yellow fever to
fall victims to the murderous endemic swamp fever, All the
ships, especially the Norwegian, Swedish, Danish, Euglish and
North American and a few French and German, come here iu
ballast without having touched at any yellow fever focus.
It is therefore conclusive evidence of the incorrectness of the
commouly received theory that yellow fever occurs endeinically
on the east coast of Mexico and only requires a considerable
number ot unacclimated persons to produce its evolution in
spite of San Jean Bautesta de Tabasco having for a number of
years established regular communication with Vera Gruz and
Frontera by means of steam ships, yellow fever remained un¬
known there until 1877.
Let us turn for a moment to Minatitlan, celebrated for its
export of Mahogany, a village of over 500 regular inhabitants,
but with a large floating population, mainly Indians, seeking
work when vessels are being loaded. At this season of the year
the place is filled with foreigners, sailors and Indians, yet yellow
fever has never occurred ; but the whole coast from Minatitlan
is celebrated for its malignant swamp fevers. No place could
be more suitable for the development of malarial diseases, as it
1042
Current Medical Literature.
[May
is surrounded by vast swamps, at times filled with water and at
other times dried up. Fuzier says the French troops were here
decimated by pernicious swamp fever, but not a man suffered
from yellow fever. For five months last year, 1878, 1 had an
opportunity of studying a fearful epidemic of this fever. Un¬
fortunately the inhabitants are not accustomed to seek the aid
of skilled physicians and on that account I was summoned to
see only ten cases, all in the last stages. All were fatal and
from two patients I was allowed to abstract small quantities of
blood. A microscopical examination was commenced. The
blood was moderately consistent, of a pale reddish yellow, of
strong gloss ; in it were structureless spherical bodies whose
size varied from that of the largest white to the smallest red
blood corpuscle. At this point of the examination the friends
of the patients interfered and cut further examination short.
Laguna is a yellow fever focus. It is on the island of Carmen.
The natives are not liable to the fever, but those on the oppo¬
site shore are, strange as it may appear. Campeche is a focus
of endemic yellow fever. In Merida the fever occurs from time
to time in an epidemic form.
Summing up we find : Endemic yellow fever occurs in five
places only on the east coast of Mexico : Vera Cruz, Alvarado,
Flacotalpam, Laguua and Campeche.
A very important questiou now is: what influence will the
improvement in commerce, due to steamships and railroads,
prove on the spread of yellow fever ? Observation alone can
settle this. Is yellow fever indigenous to Mexican soil or was
it brought there ? In spite of the darkness enshrouding the
origin of this disease, the question can be solved at an early
date by means of analogy, if the closer study of the older his¬
torical traditions do not throw much light on the subject. The
results of historical investigations as we see from Hirsch’s com¬
pendium are very unsatisfactory.
Hirsch, himself, believes yellow fever to be indigenous,
neither to the Antilles nor to Mexico. He maintains that it
most probably made its first appearance after the arrival of
Europeans, and he supports this view mainly on the incorrect¬
ness of the writings handed down to us, in which swamp and
typhoid fevers are described rather than yellow fever.
It will be necessary to touch succinctly on the founding of
Vera Cruz, which city, according to Clavijero, thrice changed
its location ; according to Lerdo de Tejada, four times.
The first Vera Cruz was built where Hernando Cortes lauded
on April 22d, 1519. This site was shortly abandoned for the
sake of finding a better climate and anchoring place. Vera
Cruz No. 2, was founded in a plain at the foot of Mount Qui-
ahuitzla. This place was abandoned1 in 1523 or 1524, and
La Antigua (old) Vera Cruz, was founded on the right bank of
Rio de la Antigua, seven leagues north of the present city of
Vera Cruz.
Current Medical Literature.
1043
1880]
At the close of the sixteenth century, this third settlement
was also abandoned on account of the incessant and malignant
fevers and the difficulty attending the unloading of ships at
that point. In 1599, the Count of Monterey founded the pres¬
ent Yera Cruz, on the original spot which first under Philip III,
received the privileges of a city.
According to Padre Alegre, yellow fever was first introduced
into Yera Cruz in 1699, by an English slaver. Lerdo de
Tejada thinks differently, for he says : u In the first place, yel¬
low fever is not contagious, as we now know, and on that
account it cannot be brought here from another place by per¬
sons suffering with it. Consequently it is a great error to be¬
lieve that yellow fever was brought here from abroad.” Don
Florencio Parez de Comote, M. D,, in Juue, 1803, wrote to the
Consul at Yera Cruz : “ Yera Cruz has not gotten the germ of
the disease from Siam, Africa, the Antilles, Carthagenia, nor
from the United States. The disease was developed in the
ground at that place ; there it always exists, and is developed
whenever certain climatic conditions prevail.”
Padre Algre states his belief, gleaned from various sources,
in the importation of yellow fever from Africa, where, as is
well-known, on certaiu portions of the western coast, north of
the equator, it occurs endemically. Dr. Comote, on the other
hand, emphasizes that it is the morbid material contained
originally in the ground, although a certain chain of conditions
is necessary for its evolution.
If we accept the opinion of those who teach that yellow fever
is indigenous to Mexico, it seems highly improbable, from what
has been written, that it should have been limited, on the arri¬
val of the earlier Spaniards, to the environs of their landing
places.
It is extremely improbable that there should be on a coast
stretching from 18° to 26° north lat., only five foci of the dis¬
ease if it were really indigenous ; therefore our opinion against
this view is considerably strengthened when we reflect that
four of these places have been connected the longest and most
uninterruptedly with Yera Cruz. Regarding Alvarado, Tlaca-
talpam, Laguna and Campeche, as foci of the second class,
which are continually being contaminated by fever material
from the chief focus, Yera Cruz then alone remains. We can¬
not refrain from believing the yellow fever germ to have been
imported here instead of declaring it to be iudigeuous. As far
as Yera Cruz is concerned, we would have to seek the fountain
of the disease beyond the Mexican border, most probably in
HaVana, which, from earliest times, has been in uninterrupted
communication with Yera Cruz and in a more limited manner
with Campeche and Alvarado.
It can be set down as a rule that yellow fever almost in¬
variably occurs first on the coast or on the banks of navigable
6
1044
Current Medical Literature.
[May
streams. 1 must mention the influence that railroads have
already had, and are likely to have to a greater degree, on the
spread of the disease. During the construction of the rail¬
road from Yera Cruz to Paso del Macho, small epidemics re¬
peatedly broke out at all the stations, except La Tejera, the
nearest one to Vera Cruz, where the fever has never occurred.'*
The greatest elevation above the sea level at which yellow
fever in this latitude has occurred as an epidemic is at Las
Animas, 1008.59 metres above the sea level. Cordova, 105.84
Kilometres from Yera Cruz and 827.08 metres above the sea
level, remained from 1804 and 1806, free from the fever until
1876, when a fearful epidemic prevailed there.
The origin of this epidemic is attributed to the son of Dr.
Casas, who returned to Cordova after a short visit to Yera
Cruz, where he contracted the disease which resulted in his
death. The disease spread over the whole city, then to neigh¬
boring towns, haciendas and ranches.
In 1877 and 1878, a few sporadic cases occurred. The Mexi¬
can coast affords numberless proofs of the absolute independ¬
ence of yellow fever and the so-called malarial fevers.
For instance, Tampico is almost yearly the theatre of very
severe swamp fever epidemics of the most pernicious character.
The entire coast, from Tampico to Vera Cruz, has a bad name
on account of the prevalence of swamp fever. On this account
San Juau Bantista has been called the grave of Europeans, yet
yellow fever was unknown there until 1877. Mexico furnishes
many exceptions to the rule that yellow fever is almost invari¬
ably a disease peculiar to cities.
All authors lay particular stress on the predominance of yel¬
low fever in harbors having narrow and dirty streets and
sailors’ drinking saloons.
They say th’at cleanliness of the streets and other conditions
coming within the poll of police ordinances are of great weight
in this question.
Yera Cruz will serve me as an illustration. In the first place
no sailors’ quarters exist here and but few drinking saloons, for
sailors are seldom allowed here, never many at a time, and
those generally under inspection whilst on shore. lu the
second place the excessive cleanliness of the streets leaves
nothing to be desired in that direction. Strangers are always
struck with the cleanliness of Yera Cruz. Filth and bad ven¬
tilation are limited to the so-called Patios de Yeciudad, which
were formerly considered the foci of pests of all kind, except
yellow fever, for the houses were occupied almost exclusively by
natives. In the frightful epidemic of 1875 the disease began in
the best part of the city.
Fuzier in his book expected great results from the introduc¬
tion of the water of the Jarnapa and from the erection of pub¬
lic bath-houses. For twelve (12) years the Jarnapa water flow¬
ing from many pumps has flushed our gutters and has fur-
Current Medical Literature.
1045
1880]
nished the houses with an abundance of water. The baths have
been supplied and are well attended to. Vera Cruz has also
about the best police in the Republic, yet we had fearful epi¬
demics in 1875, 1877 and 1878. It very evidently follows
therefore, that filth per se has nothing to do with the develop¬
ment of yellow fever and that the statements of many authors
in reference to this are exaggerated.
Until very lately a firm belief of the absolute immunity of
natives prevailed at Vera Cruz and other foci of yellow fever.
Most of the physicians shoved this belief to a point little short
of fanaticism. The fearful epidemics of late years have, in
Vera Cruz, caused a change of opinion; for so many deaths
among the natives occurred from yellow fever that the truth
could no longer be denied. Children as well as adults shared
a common fate. These cases, however, were regarded as
exceptions to a general rule.
Foreigners, even, can remain insusceptible to the disease for
a uumber of years, provided they do not leave the yellow fever
country. A few months’ absence suffices to destroy an immu¬
nity thus acquired. It is a well known fact that natives them¬
selves may loose their immunity through a prolonged absence.
Concerning the nature of the yellow fever poison, our know¬
ledge is not very definite, yet we can explain certain character¬
istic peculiarities of it. In the first place it is very difficult to
eradicate it after it has taken root any Avhere. Its continued
existence is possible only within certain degrees of mean tem¬
perature. If, however, it be carried to colder latitudes, it will
live until the mercury falls to 32° F. Even in the tropics
repeated introductions of the poison are necessary to produce
an epidemic.
In spite of the steamship communication which Vera Cruz
has by means of different lines, with Tampico, Tuxpan, Miua-
titlan, San Juau Bantista and Progreso, not a single epidemic
has been produced through this means. Another highly char¬
acteristic feature of yellow fever can be explained only on the
ground of the great difficulty of transporting the poison on
account of its stability. I mean the formation of larger or
smaller foci, observable in every epidemic and especially the
occurrence ot sporadic cases, when no epidemic prevails. It
frequently happens that the nearest surroundings to a fever
stricken place escape. In 1866, the French camped immedi¬
ately in front of Vera Cruz on the plain, and no case occurred
in their cam]), although a fearful epidemic prevailed in Vera
Cruz. All things being considered, we are forced tu regai d the
yellow fever poison as belonging to that lower order of organ¬
ized beings which live as parasites on higher beings. Highly
developed plants require certain conditions of temperature and
soil, and a certain amount of warmth and moisture for their
development. Limited to certain well-defined groups aud
often confined to narrow tracts of country, they reach develop-
1046
Current Medical Literature.
[May
ment with difficulty and become acclimated with still more
difficulty under conditions, to the casual observer, scarcely or
not at all changed.
What is true of the higher forms of plant-life is also true of
the lower forms, such as algae, lichens and fungi, and espec¬
ially the latter, which belong exclusively to the group of para¬
sites in the vegetable kingdom. Many fungi are assigned to
quite peculiar strata. If we consider the lowest fungi as the
bearers of the yellow fever poison, the difficulties of transport¬
ing it is easily explained, and if, as it sometimes happen, it be
transported, the difficulty of its making a permanent abode, is
also explained. The latter can never be effected until the fever
germ accidentally comes in contact with that stratum on which
it grows luxuriantly and from which it cannot be easily eradi¬
cated. On this stratum it can invade the human organism —
that it is not propogated in the human organism, and that it is
not transmitted from one person to another, numerous facts,
in the history of the spreading ot the disease, attest. Many
tacts attest that the human body (organism) is not the bearer
or the propagator of the disease.
How is the fact explained, that ships that have no communi¬
cation with the land remain free from the disease? This is a
well known fact at Yera Cruz, according to Hirsch. Ships
from Yera Cruz are seldom the bearers of disease.
After they have been cleared, they receive all their supplies
through native boatmen ; they get ballast from the reefs. In
unloading or loading a ship, the native boatmen never come in
contact with the ship or crew. Goods are handled entirely by
machinery. Ships ofren lie at Yera Cruz for months with per¬
fect impunity. At Laguna, vessels are loaded with wood by
machinery, and the crew aud natives never come in contact, yet
the wood certainly carries the germ of the disease, for many
sailors contract the disease annually from this cause.
We are forced to conclude that the yellow fever poison is
transported exclusively by means of wares (merchandise) — in
the broadest sense of the term — the numerous epidemics such
as that at Altamira, and the one at Tuxpan attest this. There
can be no doubt of the germs possessing a greater affimity for
certain kinds of wares. In June, 1877, Mr. Bustamente, a
merchant at Pichucalco, ordered an assorted lot of goods from
the infected town of San Juan Bautista. The goods were
brought in skiffs to within one league of Pichucalco, were
there put on mules and carried to Mr. Bustamente’s house. 1
failed to learn from my friend, Don Francisco Arguellus, the fate
of the boatmen $ the muleteers and the occupants of Mr. Busta-
mente’s house all contracted the disease. A wide-spread epi¬
demic then prevailed. In a few days after the arrival of the
goods, they were put on the backs of Indians and sent to Cris¬
tobal. Most of these Indians died. This single epidemic
proves conclusively two things — the transportation of the germs
1880]
Current Medical Literature.
1047
of the disease in goods, and the transmission of the germs from
goods to men. I feel justified in drawing this conclusion —
that, it is impossible for the body of an acclimated person, or
that of a person suffering from the disease, to transport the
germs of tfie disease. The germs have to be brought by some
thing the person brings, either in his clothes or baggage.
The native Campeche troops carried no germs to San Juan
Bautista, although they hailed from the hot bed of yellow fever,
but Gen. Luz Enriquez’ troops who went from Campeche to
San Juan, carried the germs of a frightful epidemic.
This is easily explained !
The native Campeclieans, according to their custom, carry
no baggage and wear but few clothes. The outfit of a Campe-
chean soldier consists of a cotton shirt, a light straw hat, san¬
dals, a musket, a cartridge-box and a machete. Gen. Enriquez’s
troops were equipped in modern European style and they car¬
ried also a large amount of baggage and war material.
In regard to the investigations of the blood with the micros¬
cope, a few words only are necessary. In nine different cases I
failed to find the smallest chauge from the normal state. In
several cases the red blood corpuscles had assumed the well
known gooseberry shape; but this was found out to be due not
to disease, but to artificial serum I used for the dilution of the
blood. The blood of healthy persons diluted with the same
serum gave the same result. With new serum I proved that
the suspected blood was normal. Lower organisms could not
be proved to exist in blood taken from patients in the last
stages of the disease. With two exceptions all my experiments
were made on blood abstracted from the vieus in the hand of
patients in the last stages of the disease. But it is by no
means proved that snch organisms are not present in the
earlier stages of the disease. The negative result of these
investigations is important since it shows how groundless are
the often repeated assertions about the analysis of the blood
iu yellow fever.
THE SANITARY COMMISSIONER OF INDIA ON THE PREVAILING
DOCTRINES AS I’O THE CAUSES OF CHOLERA IN THEIR RE¬
LATION TO SANITARY IMPROVEMENTS.
The Aunual Reports of Dr. J. M. Cuningham, the Imperial
Sauitay Commissioner of India, have for several years main¬
tained a place in the foremost rank in English and Continental
Sanitary literature. As the one just issued — the fourteenth —
summarises to a certain extent the doctrines which have been
advocated in his previous reports, excerpts from some of the
more salient portions of the volume will doubtless be welcome
to our readers, especially as the original volumes are available
to but a very limited number of them. We shall confine our
extracts to sections of the Report dealing with cholera.
1048
Current Medical Literature.
[May
Referring to the prevaliug view that the course taken by the
disease bears a relation to the high roads and railways of the
country, Dr. Cuuingham states that the cholera-history of the
year under review (1877) coincides with previous experience,
namely, that 11 cholera in India in these days of railways and.
steamboats travels no quicker than it did when there were no rail¬
ways and no steamboats and hardly any roads.” The italics are
in the original. In no instance could the Sanitary Commis¬
sioner satisfy himself that an outbreak of the disease occurred
through 11 importation atid with regard to the supposition
that attendants on the sick are proportionately more liable to
be attacked than others living in the same neighborhood, Dr.
Cuningham compares the facts with the theory in this wise : —
“ According to a prevailing theory, a single case of cholera in¬
troduced into a community may communicate the disease to
the neighbors or to those who may have ordinary every day com¬
munication with the house or person of the sick man, and may
thus form a centre of contagion from which an epidemic may arise
destructive to thousands. This is the theory. The fact is,
that during 1876 and 1877, in this presidency, 422 cases of
cholera were treated in 101 hospitals, 1,301 attendants came
into immediate, and many of them into almost constant con¬
tact with them for days, and yet out of these 1,301 persons,
only 18 suffered from any symptoms of cholera. In 85 out of
the 101 hospitals concerned none of them suffered at all. The
only attacks which can in any way be connected with the 1,301
cases of cholera are 18 — 16 of cholera and 2 of severe diarrhoea.
“ Moreover, in none of the 18 instances in which attendants
suffered is there evidence to show that the attack was even
probably due to coutact with the sick. The whole evidence, as
given in the medical officer’s reports, is extracted in Appendix
D. The details necessary for forming an opinion on the point,
it will be seen, are generally wanting, but in several of the
cases, from an examination of dates and other circumstances,
there is good reason to conclude that the attack was in no way
due to attendance ; at Banda, for example, the only three cases
in the 20th Madras Native Infantry occurred in the same hut,
and the second was attacked within five hours of the first. The
mere fact that an attendant is attacked is no evidence that he
was attacked because he was an attendant. In some reports
the two are conjoined in the relation of cause and effect, just
as if there could be no question on the subject, as if the fact of
being in attendance on a cholera' patient ought actually to pro¬
tect a person from the influences producing the disease in
others, and virtually confer on him immunity from attack.
This fallacy was pointed out in the Annual Report lor 1872,
but it is still very frequently repeated.
“ In order to prove that cases of cholera among attendants
are due to contagion, it must be shown that the attendants
suffered in larger proportion than others. In limited out-
1880]
Current Medical Literature.
1049
breaks the materials may not suffice for any general conclu¬
sions, but the facts should be carefully recorded, so that they
may be of use when collected as a whole. In the case of any
attendant attacked it should be stated how long he has been
in attendance; the nature of the attendance ; the date of attack ;
how far this date corresponded with the time when the out¬
break was at its height, for this is an important point in the
evidence, as tending to show whether the disease should be at¬
tributed to causes general to the community, or particular to
the individual ; how far the results ascribed to attendance may
be due to locality, and how far the attendants, as regards local¬
ity, movements, etc., were treated differently from others. The
period of supposed incubation is important. It will be ob¬
served that in one of the instances it was believed to have been
ninety-four hours, and in another twenty-one days.
“As has been pointed out in former reports, the free lorn of
attendants on cholera cases from any special risk is not to be
explained by disinfectants, even if the efficacy of disinfectants
were undoubted. Every one acquainted with the habits of
natives knows how little care they take in their use, and how lit¬
tle value they attach to them. The facts of 1876 aud 1877 merely
repeat in a definite form what has been long observed in this
country. Knowledge of these facts may do much to calm the
minds of people in cholera times. At present, many approach
a case of cholera with the greatest dread, and attend ou it as if
they were undertaking the most dangerous duty. If they were
to realize that it has been proved by experience that there is
absolutely no danger whatever in such attendance, much good
would be done not only in quieting needless fears, but also in
impressing the important truth that the measures which are
best calculated to prevent cholera are not isolation aud disen-
fection of the sick, or the ‘ stamping out’ of the disease, as it is
popularly called, but the removal or remedying of all local in¬
sanitary conditions.”
Following this analysis of the evidence which the material at
his command furnished, as to the influence of contagion in dis¬
seminating cholera. Dr. Cuuiugham proceeds to submit the
water theory of the origin and promulgation of the disease to
trenchant criticism, the nature of which will be best ascertained
by again quoting from the Report : — “ Comparatively few per¬
sons now believe that cholera is propagated by direct contact
with previous cases; but it is still held by many that the dis¬
charges of the sick contain a specific poison, which acts in¬
directly through the water supply. This water theory of chol¬
era, as it is called, is interpreted in different senses. By some
it is regarded merely as the means of explaining the special
violence of certain outbreaks. By others it is held to have a
much wider application, and is believed to account for the epi¬
demic diffusion of the disease. In regard to the former view,
all that need be said is, that no instance has been adduced in
1050
Current Medical Literature.
[May
India to which it seems applicable. Innumerable outbreaks
have been connected with the use of impure water ; but not
only has no specific germ been proved to exist in the water,
but the ideas seems opposed to the facts of the case.
‘‘ This water theory was discussed at some length in the Re¬
port of 1872* It was then pointed out that it seemed irrecon¬
cilable, first, with the geographical distribution of the disease
in this country — with the existence of well marked and exten¬
sive tracts of country which escaped, and the existence of
other well-marked and extensive tracts which suffered severely,
there being no material difference in the water-supply of those
exempted as compared with the epidemic areas; secondly , with
the experience of the same areas in different years, some of which
were marked by almost total absence of cholera, and others by
violent epidemics, there being no material difference in the water
supply of one year as compared with another ; thirdly , with the
history of individual stations, some of which suffer frequently
severely from cholera, while others, where the water is just as
liable to contamination, generally escape, or, if they do suffer,
suffer to a trifling extent ; fourthly , with the experience of
bodies of men moving into camp on account of cholera, and
using an entirely different water from that which had been
in use when the disease attacked them in cantonments, and yet
with the change there was no abatement of the disease, even
when there had been ample time for all effects derived from
the cantonment water to disappear ; fifthly , with the almost
simultaneous appearance of the disease among various bodies
of men in the same place, but drinking water drawn from many
different sources ; sixthly , with the general similarity in the
rise and fall and disappearance of the disease among these
different bodies of men ; seventhly , with the fact that the pollu¬
tion of the water supply is least likely to occur at the commence¬
ment of an outbreak when the cases are fewest, and that the
outbreak begins to decline just when the cases are most numer¬
ous, and the risks of pollution greatest; eighthly , with the gen¬
eral character of different epidemics, some of which are distin¬
guished by great force, not only in the extent of country which
they cover, but also in the severity with which they affect the
individual places attacked ; in one epidemic the different sec¬
tions of the community, such as the various bodies of men in a
cantonment, all suffer much, in another they all suffer compar¬
atively little, the sources of water supply being numerous and
of the same character in both epidemics. It seemed hardly
possible that the virulence of the supposed poison could vary
in different years, or that the quantity could have been so
apportioned to the different sources as to produce such results.
u The experience of the years since 1872 has fully confirmed
these views. The history of the non-epidemic year 1874, as
compared with the epidemic year 1875, is particularly striking.
*Pp. 20 to 25.
Current Medical Literature.
1051
1880]
In O.udh. for example, in 1874, there were only 68 deaths from
cholera, in 1875 there were 23,321 ; in the Punjab 78 in 1874,
6,246 in 1875; in the Central Provinces 14 in i874, and 14,643
in 1875; in Berar 2 in 1874, and 22,465 in 1875; and so on with
other provinces, as may be seen in the table given in the first
paragraph of this section. According to this theory, in 1875
the water was generally polluted with cholera discharges ; in
1874 it was not. In other words, a cholera epidemic over an
area of many thousands of square miles was dependent on a
series of accidents occurring in neighboring districts about the
same time, while in 1874 these accidents were as rare as they
had been frequent in 1875. The enormous differences between
these two years are not to be explained by mere accident. Even
if it had been shown beyond all manner of doubt that cholera
is due to a specific poison, and that this poison resides in the
evacuations, it would require very strong proof before the
accidental pollution of the water supply over enormous areas
could be accepted as an explanation of an epidemic year ; for
even in a non-epidemic year there is no want of cholera cases
amply sufficient to contaminate the water. But as the very
existence of the cholera germ has itself still to be established,
as well as the opinion that it resides in the discharges, not only
is the chain of argument imperfect, but every important link
in it seems to be wanting.
“The question receives, perhaps, even more definite and
striking illustration from the statistics of villages attacked in
1876 and 1877, as given in Appendix B, especially if they be
taken in conjunction with those of 1875. The variation in the
figures for these years is often very remarkable, as may be seen
from the following examples, which might be multiplied so as
to include very many districts : —
8
b*)
JZ
£*J
Number of Villages attacked and Number of
Deaths Registered from Cholera.
District.
£0
'o
0)
pO e
1875.
1876.
1877.
S'"
a
Villages
Deaths
Villages
Deaths Villages
Deaths
Ranchee .
7,464
170
1 472
431
3,885
15
52
ChybasHa .. .
3,179
108
172
62
143
16
33
Allahabad.. . .
3,183
#
1,383
483
19,85
5
253
Unao .. .
1,682
460
1,605
*
1,428
32
4
Hardni _ _ _
1,980
365
2,973
*
A 2
5
Bareilly .
3,082
*
730
304
3,111
10
33
Lahore .
1,710
28
288
130
722
4
5
Rawalpindi . .
1,717
1
l
142
626
1
i
Sangor .
1,873
3
20
213
2,975
65
344
Narsinglipnr .
971
19
93
289
4,192
7
28
Akola .
1,108
708
7,847
38
233
62
394
* No Information.
1052
Current Medical Literature.
[May
“ Villages vary much in size and in means of water supply.
Often there are many wells; in other cases the people depend
on a stream. It is very much understating the case to take
one source of water supply for each ; but even on this most
inadequate basis of calculation it would follow, according to the
water theory, that while in Rancliee, iu 1875, 170 sources of sup¬
ply were polluted by cholera discharges, and 431 in 1876, the
number so polluted in 1877 was only 15 ; that in the neighbor¬
ing district of Ch37bassa similar preponderance of such accidents
took place in these two first years, and that in the third they
were here also simiarly rare. Or, to take Bareilly in 1876,
304 such accidents occurred, but in 1877 there were only 10;
and so on with the others.
“ Setting aside scientific inquiry altogether, the mere doc¬
trine of chances altogether forbids the acceptance of any such
explanation. As regards water drawn from streams, there is
in addition another great fact which seems as fatal to the
water theory as the great fact already stated is fatal to the
theory of human intercourse. Cholera invariably travels , not
down , but up the great drainage channels of the country. There is
no such thing on record as an epidemic commencing iu the
Upper Provinces and working its way, for example, down the
valley of the Ganges or the valley of the Indus. The progress
is always in exactly the contrary direction.
“ The vast importance of pure water can hardly be exagger¬
ated. This has been urged again and again in these Office
Reports during the last ten years. The evil of the water theory
is, not that it insists on this requisite, but that it does not in¬
sist on it on a sufficiently wide and logical basis. As regards
cholera, the only danger iu the water-supply, according to this
theory, is the danger of its containing cholera discharges.
Other impurities may exist in abundance, but without the sup¬
posed germ there can be no outbreak. But this view of the case
is insufficient, especially as it is based on purely theoretical
considerations. The only sound sanitary principle iu regard to
water is, that it must be tree not only from cholera discharges,
but from every form of impurity. Pure water is a most im¬
portant preservative of health, not only against cholera, but
against all diseases. On this point the following remarks from
Dr. Payne’s Annual Health Report of Calcutta for 1877 may be
quoted with advantage :
‘ The doctrine known as the water theory did not hold good, for it de¬
manded a germ from a cholera-stricken person to produce the change ; and
the wholehistory of the season was opposed to such specific origin. It is nec¬
essary also to anticipate objection by pointing out that there were probably
other media besides foul water, wherein the poison might be created, that
disease often appeared where foul water could not be found, and foul water
frequently failed to cause immediate disease. All these precautions were
taken, and they left the main propositions unimpaired, as an argument of
commanding force, for leaving no means untried to get rid of filthy water.
In my first report I alluded to some facts which had occurred in the native
lunatic asylum as strongly suggestive of a close relation between filthy
‘ Current Medical Literature.
1053
1880J
water and fatal dysentery. The experience of the year 187(3, striking as it
was in this respect, did not justify a positive conclusion. It was followed
in 1877 by events which rendered such a conclusion inevitable. The dys¬
entery which had from the earliest times been the great scourge of the
place, and had yielded to no efforts of sanitation, now disappeared. The
fatal cases, which had always been uumerous in former years, were in 1877
represented by a single death. The surreptitious conveyance of filthy
water to the mouth was discovered in the middle of 1876, and prevented.
No other changes took place to explain the disappearance of the disease. ’
Along with abetter water. supply it may be mentioned that
the lunatics were relieved of the overcrowding from which the
asylum had suffered so much in former years.
“ The water theory errs in demanding a remedy for only one
out of many sanitary defects. But cholera is to be dealt with
on the same general principle as all other diseases, and this is,
that every sanitary defect must be sought out, and, as far as
possible, remedied. The cause of cholera— what governs its
distribution, and its relative incidence in different places — is
still as inscrutable as when the disease first appeared ; but it is
well known that when this cause or combination of causes is
present, it is favored by filth, overcrowding, and every other
condition adverse to health. The practical work to be done is
to remedy these conditions.
“ Theories of contagion, whether direct or indirect, form no
safe basis for State interference iu sanitary affairs. The action
they involve is either already as well or more fully provided
for on sound sanitary principles, as has j ust been illustrated in
the case of cholera and water, or it is altogether impracticable,
like quarantine, which has been in former years attended with
great discomfort and oppression to the people, and with no
good result. Even isolation and disinfection, which are pre¬
scribed in hospitals, aud can be productive of no harm in them,
if pressed on the people, can be productive only of mischief,
for such interference worries and annoys them in their domes¬
tic relations, it tends to make all sanitary measures unpopular,
and it diverts their attention from the only real work to be
done — sanitary improvements. Quarantine, isolation, and dis¬
infection have utterly failed to prevent or arrest outbreaks
among European troops in cantonments, even when carried out
under the most careful superintendence. To ask the people
over the enormous area of India to rely on such measures for
protection, is to ask them to rely on what has been tried within
the limited area and population of a station and fouud ineffec¬
tual. Even if isolation and disinfection had been attended with
decided benefit in the case of troops and jails, it would be alto¬
gether a mistake to order their adoption by the people at large,
for the people have often no means of carrying them out. Any
machinery directed to enforce such an order must be most costly,
and, in spite of its costliness, must be most inefficient, produc¬
tive of much social misery, and powerless to effect any good.
The removal from the affected locality has proved of signal ser.
1054
Current Medical Literature.
| May
vice in the case of troops and prisoners, but this measure also,
although founded on the theory of contagion, is one which,
however much it may be recommended, can never be ordered
by the Government. Practically, then, State legislation in
this matter is limited to urging on sanitary improvements apart
from all theories. It may he argued that the stoppage of pil¬
grimages has proved beneficial, and that this can be explained
only on the theory of contagion. But no such explanation is
needed. The stoppage of pilgrimages in time of cholera means
the stoppage of tilth at fairs, of overcrowding, of fatigue, ex¬
posure, and privation — all most insanitary conditions.
“ In the report for 1872 the truth of the general principles
here advocated was illustrated by the marked diminution of
cholera in the Madras jails siuce they had been placed in a bet¬
ter sanitary condition ; a similar illustration may now be given
for Bengal. In his report, as has been already mentioned in
Section IV., Dr. Bryden has tabulated most complete statistics
of the jails of each local government and administration in this
Presidency since 1859. The result is shown in two nine-year
periods, and they are as follows. They have already been
tabulated in the section on jails, but this section, which deals
with cholera, would be incomplete without them :
Province
Bengal Proper _
Oudh . .
N. W. Provinces..
Central Provinces.
Punjab .
Total for Bengal . .
Year.
Cholera
mortality
per 1000.
Total mor¬
tality in
eluding
Cholera.
1859—67
19.40
90.30
1868—76
7.85
51.45
1859—67
7.40
83.50
1868—76
.82
21.68
1859—67
7.59
72.52
1868—76
1.45
36.34
1859-67
11.27
63.78
1868—76
2.73
38.95
1859-67
2.19
46.46
1868—76
.82
32.94
1859—67
10.77
73.45
1868—76
3.28
38.68
“ These figures are very striking. The mortality from chol¬
era has been reduced to a small part of what it was, and this
cannot be explained by measures taken against contagion,
for — and this is perhaps the most gratifying feature in the
case — the marked diminution in cholera has been attended
with a marked reduction in other diseases also. The total mor¬
tality from all causes iu the jails of the Bengal Presidency from
1868 — 76 was little more than one-half what it had been in the
nine years previous. The practical and most important infer¬
ence is, that the general sanitary measures which reduce other
diseases also effect a marked reduction in cholera.”
Currmt Medical Literature.
1055
1880J
The portion of the section of the Report dealing with cholera
is brought to a conclusion with an extract from the recently
promulgated Government of India Regulations, which are to
be enforced in future on the outbreak of cholera in India. The
rules hitherto in force were amended in accordance with the
recommendation of a Special Committee, which had beeu as¬
sembled under the orders of Government towards the end of
1876, to report on the whole question of quarantine as a means
of protecting cantonments from the disease. The amended
rule cited bears the heading — “ Officers iu Command not to es¬
tablish Quarantine,” and it runs thus: —
“ It must be distinctly understood that commanding officers are not
authorized to establish or enforce against the public at large, or any sec¬
tion thereof, any quarantine, or any restrictions in the nature of quaran¬
tine, as against cholera in particular, which are not equally applicable at
all times to the control of vagrant classes of people having no legitimate
ground for claiming admission within cantonment limits. The employ¬
ment of the troops to form cordons round cantonments for such purposes is
strictly prohibited, discipline in this, as in other matters, being enforced
by the ordinary means placed at the commanding officer’s disposal for such
purposes, and it is to be carried out without additional expense to the
State beyond that authorized by these rules.”
FISSURED NIPPLES.
Of all the small things which worry a practitiouer of medecine,
this apparently little ailment has been the bugbear of my pro¬
fessional life. Apparently so insignificant, and yet so painful,
so persistent and intractable, that I have often felt that I would
give a good, round sum for what I could really call a remedy,
and have always wished that I may never see another case of it.
Do what we will, the child must suck (children do not u nurse” in
Sedalia, they suck) or the milk must be drawn with a breast
pump, and, in either case the fissure is torn open and bleeds
and our case is as bad as ever. I have tried everything — tr.
benzoin, argent, nitras, collodion, and have seen my work
go down to naught at the hands (or mouth rather) of an infaut,
only oue week old. I found myself with a case of this kind on
my hands in the month of August of this year. Two or three
times the case was reported to me as cured, and as often an
“ adverse report ” had been sent in the next day. On one of
these occasions I walked into my private office, trying to think
of something, when my eyes fell on a bottle of “ Prof. Callen’s
Brazilian Gum.” It came to me like a revelation. I had bought
the stuff to ineud a Politzer’s bag. It is pure gum in solution
(iu naphtha, I think), and is of about the consistency of thick
mucilage. When exposed to the air the solvent evaporates and
leaves the elastic rubber adhering to whatever it has been ap¬
plied. I knew it would do. I went at once to the patient and
applied it with a camel’s hair pencil all over the nipple (except
the milk ducts) aud over the areola around the nipple. It re¬
mained on three days, and came oft' leaving the parts entirely
1056 Current Medical Literature. [May
healed. There were one or two slight fissures afterwards, but
the patient applied the remedy without sending for me and had
no further trouble. I have tried it in one other case with equal
success. I also applied it to a largely abraded surface on a
man’s face, who had been thrown from a buggy and scraped the
side of his face on the ground. The remedy adhered beautifully,
excluding the air, and when it came off, rubber, scab and all
came together, leaving a perfectly healed surface behind. This
preparation is usually kept by dealers in leather supplies.
Mr. Editor : All the above ar e successful cases. “ Let the dead
bury the dead.”
[Cobblers, for mending shoes with what they call the “ seam¬
less patch,” use a kind of cement, made by dissolving gutta-per¬
cha in benzine or bisulphide or carbon. It is found in the
“leather and findings” stores, put up in two-oz. bottles, retail¬
ing at 15 cents. The odor is disagreeable, but if bisulphide of
carbon is the solvent used, it may be deodorized by tinct. iod.,
£ part, or it may be scented with mint or bergamot. Chloro¬
form is also a solvent for gutta-percha. This solution has been
used to retain the edges of incised wounds in apposition ; also
to protect abraded skin against mechanical injury or the absorp¬
tion of poisons.
The dematologists have of late been very largely using rub¬
ber bandages in the treatment of eczema and other skin dis¬
eases, and it occurred to us that this solution of gum would be
an excellent substitute, and much more convenient. On inves¬
tigation, we find it has been recommended in the treatment of
lepra, psoriasis, small pox and erysipelas We believe Dr. King
is the first to recommend it for sore nipples. — Ed.] — St Louis
Courier of Med., December, 1879.
RECENT DECISIONS.
The following are notes of decisions by the courts concerning
matters of medico-legal interest :
(1.) In the trial of a man indicted for rape,* the complain¬
ant testified that the defendant and some others seized her on
the street at night and carried her into an alley- way, where he
and the others ravished her. There was a verdict of guilty,
and the defendant moved for a new trial. The defendant re¬
quested the court to charge the jury that, to constitute the
crime of rape, it was necessary that the prosecutrix should have
manifested the utmost reluctance, and should have made the
utmost resistance. The court did not comply with this request,
and the refusal to do so was made the ground for asking anew
trial. The importance of resistance was held by the supreme
court of appeals, before which the motion came, to show two
elements in the crime: carnal knowledge by force by one of the
*State | of Connecticut] vs. Shields. The Reporter, 1879, vol. vii. page 140.
Current Medical Literature.
1057
1880]
parties and non-consent thereto by the other; and the jury
must be satisfied of the existence of these two elements in every
case, by the resistance of the complainant if she had the use of
her faculties and physical powers at the time, and was not pre¬
vented by terror or the exhibition of brutal force. So far,
resistance by the complainant is important and necessary; but
to make the crime hinge on the uttermost exertion the woman
were capable of making would be a reproach to the law as well
as to common sense. Such a test it would be exceedingly
difficult, if not impossible, to apply in a given case. If the fail¬
ure to make extreme resistance was intentional, in order that
the assailant might accomplish his purpose, it would show con¬
sent ; but without such intent it shows nothiug important
whatever. A new trial was not grauted.
(2.) A man murdered a woman by shooting her ; his defence
was that he was intoxicated, and thus irresponsible.* The
case came before the Nebraska supreme court on exceptions
filed by the defendant. The court reaffirmed the principle,
now tolerably well established, that “settled insanity, pro¬
duced by intoxication, affects the responsibility in the same
way as insanity produced by any other cause ; but insanity im¬
mediately produced by intoxication does not destroy responsi¬
bility when the patient when sane and responsible made
himself voluntarily iutoxicatedd7
In the same case, it was held that the fact that the prisoner
was in a drunken state when he committed the homicide does
not in itself render the act of shootiug the deceased any the
less criminal, nor is it available as an excuse.
(3.) A midwife volunteered to cure an attack of ophthalmia
in the infant at whose birth she assisted, and whom she was
nursing.t She advised the parents that it was unnecessary to
call in a physician, as she had successfully treated similar
cases. The sight of the child was destroyed. The mother of
the child brought an action to recover damages. At the trial
there was medical evidence that, if other and more active rem¬
edies had been used, loss of sight would not have resulted.
The midwife did not pretend to know of these remedies.
The case was carried from the superior to the supreme court
ou exceptions, the lower tribunal having dismissed the suit
with a verdict for the midwife, without giving the case to the
jury. The supreme court confirmed this disposition of the
action, ou the ground that a person who without special quali¬
fications volunteers to attend the sick can at the most be
required to exercise the skill and diligence usually bestowed
by persons of like qualifications under like, circumstances. Un¬
der the rule requiring ordiniary care, as applied to this case,
*State [of Nebraska] vs. Schlencher, The Keparter, vol. vii. page 207.
t Higgins vs. McCabe. Supreme J udicial Court of Massachusetts. 125th Massachusetts
Reports.
1058
Current Medical Literature.
[May
the court saw no evidence of neglect in any degree. [That is
to say, the midwife showed no greater skill than she pretended
to possess, — a safe harbor for incompetency.]
(4.) The liability of hospitals for the consequences of the acts
of their visiting physicians and surgeons on duty has recently
been tested anew in a case in New York,* and the principle is
reaffirmed that, if such institutions have exercised due diligence
in securing skillful and careful medical men to treat their pa¬
tients, they cannot be held accountable for alleged malpractice
on the part of those medical officers.
One of the surgeons of the Manhattan Eye and Ear Hospital,
after consultation with both his colleagues, advised and per
formed an operation for chronic glaucoma. The necessity of
an operation was agreed to by the three consultants, and there
was no accident during its progress. Two weeks later the
patient left the hospital with vision exactly the same as when
she entered. In a few days after her discharge, inflammation
developed, and she returned to the hospital for treatment.
Another operation was advised, and the patient consented to
its partial performance. The operation had no permanent
beneficial effect, and the woman became blind. She brought a
suit against the hospital for fifty thousand dollars for the loss
of her sight. The trial took place before the New York su¬
preme court, Judge Lawrence presiding. After a full hearing
of the testimony, in which, on the part of the hospital, it was
shown among other things that no complaint was made at the
time of the alleged injury to the surgeons or to any of the hos¬
pital authorities concerning the surgical treatment ; that the
surgeons were men of preeminent skill in their profession, and
had pursued the usual methods of diagnosticating and treating
chronic glaucoma, — a disease which almost inevitably ends in
blindness, — the judge dismissed the complaint, without giving
the case to the jury. This decision in favor of the hospital
rested on and reaffirmed the principles set forth in a jndgment
rendered by the supreme court of Massachusetts in a similar
case,t the essential points being that the Manhattan Eye and
Ear Hospital was a chairitable institution which, having exer¬
cised due care in the selection of its agents, was not liable for
any injuries to a patient caused by their negligence; that, in
the present instance, there was no proof that there had been
any negligence whatever on the part of the surgeons, who were
shown to be men of superior skill, and to have exercised their
skill with proper caution. — Boston Med. and Surg. Jour., June 27.
ANTIDOTE FOR CARBOLIC ACID.
Husemann recommended several years ago sccoharated lime
(a solution of caustic lime in sugar- water) for neutralizing the
*The Medical Record, June ‘21, 1879, page 600.
‘McDonald vs. Mass. Geu. Hospital, 120th Mass. Rep., page 423.
Current Medical Literature.
1059
1880J
poisonous effect of carbolic acid, while Sanftleben claims to
have found an antidote in sulphuric acid, which, according to
his statement, enters into a not poisonous combination with
carbolic acid. He prescribes the following :
11 Dilute sulphuric acid - 10 grams.
Muc. of gum arabic, - 200
Simple syrup, - - 300
Mix, and give a tablespoouful every hour.
— Ztschr. d. Allg. Oest. Apoth. Ver,, Jau. 10, 1880, p. 10, from
Pharm. Ztschr. f. Bussl. — American Journal of Pharmacy.
SYPHILIS — A CHILD INFECTED THROUGH THE UTERO-PLACEN-
TAL CIRCULATION.
Mr. - , a merchant, married, aged twenty-five years, ap¬
plied for treatment for what he supposed was gonorrhea. I
found a well-defined single indurated chancre situated on the
glans about three lines from the corona, on the right side near
the frenum. The patient stated chat some three weeks before
the sore appeared he had connection with a courtesan in the
city. He declared that this was his first illicit indulgence during
two years, and I place confidence in his statement. He declared
that his sore could have been contracted only at the time re¬
ferred to. On making inquiry concerning his wife, I was told
that he had had regular connection with her since his return
from the city. She herself had discovered nothing wrong up to
this time ; but on the following day I was allowed to make an
examination, and found a newly-developed sore presenting all
the characteristics of a regular chancre, which in due time was
followed by constitutional syphilis. When she contracted the
disease she was between the third and fourth month of preg¬
nancy. Constitutional developments became well marked some
time prior to birth, and when born the child was intensely syph¬
ilitic. It was thickly covered from head to foot with syphilitic
patches. Nodes were apparent on most of the long bones. The
child lived but about two weeks. — N. 8. Hudson , M. D. Ameri¬
can Practitioner.
RECTAL FEEDING IN DISEASE.
CONCLUSIONS.
The principles which this paper seeks to enforce may be for¬
mulated as follows :
I. — That rectal alimentation is a valuable agent, nay, even an
indispensable factor, oftentimes, in the management of all cases
of disability of the upper portions of the digestive tract when,
from any cause, stomachal ingestion becomes harmful or impos¬
sible.
8
1060
Current Medical Literature.
| May
II. — That stomachal rest, in so far as the entire prohibition
of buccal ingestion cau make it so, is a condition precedent to
success in all the severer maladies for which rectal feeding be¬
comes necessary. There cannot be the slightest doubt in re¬
gard to the adequacy of nutritive injections, to sustain life and
maintain the nourishment of the body, wholly unassisted by
the ordinary methods of ingestion, for a considerable period
(from three months to five years), as attested by well-authenti¬
cated cases of record.
III. — u That rectal nutrition requires rather an explanation
of its rationale than a demonstration of its truth.”*
IV. — That in a more enlightened understanding of its value
and certainty of action on the part of the profession, rectal
alimentation and medication will obtain a wider range of thera¬
peutical usefulness than it lias heretofore occupied. Limited
in the past, speaking generally, to the severer forms of chronic
diseases of the stomach and oesophagus, I cannot doubt that
they will, in the near future, become of vast service in the
management of acute disease when, from any cause, the stom¬
ach becomes intractable and rebellious.
Example. — In October last I was treating a case of typhoid
fever which, by the twenty -first day, became so critical that all
hopes of recovery were abandoned by thefrieuds of the patient.
The case was rendered particularly desperate by the fact that
the stomach now declined to further retain anything — water,
food, or medicine. At this juncture, while collapse was threat¬
ened, I suspended all attempts at ingestion by the stomach,
and gave injections of beef-essence, milk, brandy, ammonia,
quinine, etc. ‘This plan was steadily maintained for five days,
when buccal ingestion was gradually and cautiously resumed,
from which time everything progressed favorably ; convales¬
cence was promptly established, aud the patient is now quite
strong and well. There cannot be the slightest doubt, not only
in my own mind, but also in the mind of others who saw the
case, that success was due to the timely abandonment of the
stomach, and the employment of rectal alimentation and medi¬
cation.
Y. — That the rationale of rectal nutrition is not satisfactorily
explained in the absorption of the aliments by the rectum or
colon alone ; nor by means of the artificial digestion of the food
previous to its injection, after the method of Leube ; nor by the
vicarious secretion of the digestion juices, according to Flint ;
nor by the attraction downward of the digestive fluids of the
stomach and small intestine, until the alimentary mass is met
aud rectal digestion is accomplished, also an ingenious propo¬
sition of Flint. But I am persuaded that the adequacy of
rectal feeding, in supplying nutrition and support to the body,
can be fully accounted for in the recognition of the retrostaltic
^Campbell, loc. cit.
Current Medical Literature.
1061
1880]
action of the intestinal tube — the “ intestinal inhaustion ” of
Campbell — whereby the pabulum ascends to the small intes¬
tine, meeting there those digestive principles so necessary for
its assimilatiou and chylification, preparatory to its admixture
with the blood. Here, also, are found in abundance the lacteal
vessels for the absorption of the chylous emulsion, ready to
perform their part in the vital constructive process, whereby
blood is made for the repair of the wasted and worn -out tissues
and for the buildiug of such new ones as are demanded by the
economy. Furthermore, that in this manner digestion is as
certainly accomplished as though the food came by way of the
mouth instead of the rectum.
VI. — That a timely and systematic employment of rectum
alimentation and stomachal rest, in cases where the stomach is
so disabled as to render the ordinary methods of ingestion
harmful or impossible, is demanded alike by reasons scientific
and humanitarian ; and no person, except the most ignorant or
malicious, could for a moment call it starvation. But, on the
other hand, rectal alimentation, medication and stimulation
can be carried up to the point of affording the greatest amount
of nutrition and support, and that wholly unassisted by any
other means of ingestion.
VII. — That in many forms of disease, stomachal ingestion is
positively harmful, even though all food may not be immedi¬
ately rejected. Such as is retained oftentimes undergoes de¬
composition, producing thereby fermentation, irritation, and
distress, rendering it unfit for the purpose of nutrition ; and,
finally, the stomach expels the offending contents undigested.
In such .cases digestion is so disturbed as to render stomachal
alimentation positively harmful — nay, even impossible ; and its
entire prohibition becomes at once a therapeutical factor of the
greatest import.
VIII. — And, finally, that food sent upward through a healthy
avenue, in good and sufficient quantities, will contribute with
vastly greater certainty to the nutrition and support of the
body, than when it reaches the absorbents through a diseased
and disordered digestive tract, with its juices chemically at
fault, and all its functions rendered morbid by pre-existing
reflex or organic maladies. — Wm. Warren Potter , in the Medical
Record.
SPEEDY CURE OF NASAL POLYPI.
By S. Cako, M. D., 17 West Ninth Street, New York.
Dear Sir : — The painless method of removing nasal polypi,
never before made public by the originator, is an apology for
taking a small space of your valuable journal.
Mr. Gr. M - , iet. 60, ten years ago applied to me for relief
from a soft polypus in the left nostril. I proposed evulsion ;
but not liking the proposition, he left, and I never heard of him
until last May, when he returned with another polypus in the
1002
Current Medical TAterature.
[May
same nostril. I advised evulsion once more; he declined again
and desired me to cure him the same way as did Dr. (1. Ceccar-
ini the first time, (ten years ago). On inquiry, Dr. C. kindly
answered: u The medicine which 1 use for removing nasal
polypi is four or five drops of pure acetic acid injected with an
hypodermic syringe within the body of the polypus once only,
very seldom twice ; the polypus generally drops off within
three or five days without discomfort or pain. Disinfecting
lotion will correct the offensive odor.” With this information,
on the 12th of August, in presence of my friend Dr. J. L. Lit¬
tle, I injected the polypus with six drops of chemically pure
acetic acid, and instantly we saw the discoloration of it from
red to white. Business preventing him from returning, I could
not observe the daily progress ; but when he called on Septem¬
ber 2nd. he had only a small portion of it yet adhering to the
middle turbinated bone, the other having dropped off the
fourth day after the injection ; this remaining portion was
injected with four drops of the same acid, and on the third day
dropped off, leaving his nose clear, without sore or a vestige of
it. Neither of the two operations were followed by any
unpleasant symptoms, save slight smarting from the pricking
by the needle when the acid was injected. The offensive odor
arising from the decaying mass was corrected by a weak car-
bolized wash. The long interval from the destruction of the
first, and the appearance of the second — ten years between —
precludes the possibility of this last being a portion of the first,
but a new one. — Med. Record — Journal of Materia Medica.
SUDDEN DEATH FROM INTRA-UTERINE INJECTION OF WATER.
Dr. Gleason relates a case in which sudden death appeared
to have been produced by intra uterine injection of warm water,
used in order to induce criminal abortion. The woman, Mrs.
EL, was a negress, a domestic servant. At about 11, a. m., on
June 8, 1878, being in apparently perfect health, she had gone
up to her bedroom, accompanied by a Dr. Gilson, of Boston,
she carrying up with her a basin of warm water. In from
twenty to thirty minutes he came down hurriedly for brandy.
This the servants procured for him, and accompanying him up¬
stairs, found Mrs. H. upon the floor, dead. A tub containing a
small quantity of bloody water was seen near. This the doc¬
tor directed one of the servants to throw away. Another of
the servants had, at a previous visit of the doctor, lent him a
common rubber syringe. This was discovered concealed in a
bureau near the bed, and wheu found, was still wet. To the
discharge pipe of the syringe a strange nozzle was affixed,
which bore evidences of having been filed off, though some¬
what roughly, and which was found a few days later to fit
quite well a female catheter which the jailer at Plymouth dis-
Current Medical Literature.
1063
1880]
covered as it dropped from its concealment upon the person of
the prisoner at the time of his commitment, June 12th.
The author made an autopsy the same evening. The only
external evidence of violence was fresh blood-staining of the
underclothing about the genital organs. The cervix was suffi¬
ciently dilated to admit easily the index finger and the unrup¬
tured membranes could be felt through it. The uterus was of
the size usual in the seventh month of pregnancy. The blood
following an incision over the thorax was frothy. The heart
was empty and healthy throughout; the. vessels connected with
it were also normal. The lungs were hyperemic, vessels dis¬
tended, the air-cells filled throughout with bloody serum. On
the right side of the uterus, front and back, the membranes
were found dissected up from the uterine wall to the extent of
some two-thirds to three-fourths of their whole connection with
the interior of the uterus. The lining of the uterus, from which
the membranes had been detached, was reddened, and scat¬
tered over its surface was seen a number of bright, red loose
clots of the size of a pea or bean. The placenta was involved
in this separation, its right edge, to the depth of two and a
half to two and three-fourths cm. around one-third to one-half
of its circumference, being detached opening sinuses. No blood
was effused as a layer. The foetus, a female, was 39 cm. in
length, and weighed fully kilograms, having a fresh healthy
appearance. Experiments with the syringe found showed that
air could enter both by a defect in the bulb of the syringe, and
between the nozzle and the catheter, when the latter was at¬
tached, so that numerous fine bubbles were discharged, when
the orifice was placed under water at each compression of the
bulb.
The author, with other medical men, concluded that the
separation of the membranes and placenta was due to the
intra-uterine injection of water; and that sudden death
arose from the entrance into the veins of air which had
been injected with the water. The story of the prisoner was
that he had been treating the woman for suppression of
menses and for a uterine leucorrhea, but that he had failed
to detect the pregnancy. He stated that on the day of
her death he gave her an intra- uterine douche with the cath¬
eter and syringe, and at length gave up to Mrs. H. the instru¬
ment, which she herself applied, as he walked away from her
bed toward the window. While using it, she fell back, and in¬
stantly expired. The prisoner was found guilty, and sentenced
to six years’ imprisonment. — Medical and Surgical Journal —
The Obstetric Gazette.
ON THE TREATMENT OF CHOREA WITH HYPODERMIC INJEC¬
TIONS OF ARSENIC.
For the last ten years I have, in obstinate cases of chorea,
employed hypodermic injections of Fowler’s solution with
1064
Current Medical Literature.
[May
marked success. In recent or slight cases they do not appear
to be necessary, these yielding readily to the use of arsenic by
the stomach or very often getting well of themselves, but in in¬
stances of long standing, which are generally classed as incu¬
rables, I am quite sure that we have in the means referred to a
valuable therapeutic measure which ought not to be disregarded.
In administering arsenic by this method, a few points of
manipulation are to be considered, for there is a decided ten¬
dency to the causation of cellulitis and consequent abscess, and
also of painful cutaneous inflammation.
A point tor the injection should be chosen in some part of
the body where the skin is loosely attached to the subjacent
tissues. The skin near the insertion of the deltoid is not a
suitable place for the hypodermic injection of arsenic, however
well adapted for injections of other substances. I very soon
found out that when inserted there, erythema, or abscess, or
both, were the invariable sequences. Moreover, the mere act
of injecting arsenic in those situations where the skin is tight
and the tissues dense is accompanied with very considerable
pain.
The best point is on the front of the forearm about midway
between the wrist and the bend of the elbow. Here the skin
is loose and can be easily lifted up by the thumb and finger
from the tissues below. In the next place the arsenic should
be deposited just under the skin in the cellular tissues, and not
in the substance of the skin or muscles. Neglect of this point
will almost invariably lead to the formation of abscess. The
point of the syringe should therefore be just carried through
the skin and then for about half an inch parallel to the face of
the arm. The injection should then be made slowly, and it is
well to lift up the skin over the place where the injection has
been made, so as further to facilitate its absorption.
And, lastly, it will not do to inject the undiluted Fowler’s
solution, for if this provision be not followed, cellulitis, eryth¬
ema and intense pain will certainly be produced. The dose
which it is deemed proper to inject should be diluted with at t
least an equal quantity of water, or preferably, of glycerine.
The latter substance seems to be more readily absorbed aud to
produce less irritation than water. All these precautions are
for the purpose of preventing local troubles. There is certainly
a strong disposition on the part of arsenic to produce them. If,
however, attention be paid to the rules I have laid down, there
will rarely if ever be any local disturbance.
The dose of arsenic administered by hypodermic injection
may be very considerably larger than that which the stomach
will ordinarily tolerate, and it is just here that the superior ad¬
vantages of the method are most clearly shown. It is in
chronic cases of chorea and certain choreiform affections that
large doses of arsenic are especially required, and the effect of
such doses in curing the disease is not only generally prompt,
1880]
Current Medical Literature.
1065
but is un associated with any toxic phenomena. I have fre¬
quently given as high as thirty-five drops of Fowler’s solution
by hypodermic injectiou, as an initial dose. It is very certain
that the stomach would not tolerate this quantity. Again, 1
have often carried the amount taken by the stomach to the ut¬
most bounds of prudence — till the eyes were puffed and vom-
ittiug was almost incessant, and then have continued the
arsenic in larger doses by hypodermic injectiou with the result
of the cessation of all gastric symptoms and the rapid cure of
the disorder.
With these introductory remarks I pass to the description of
two or three cases in which the beneficial effects of the arsenic
administered hypodermically were unquestionable.
In cases of acute chorea a large number of which I have
treated with hypodermic injections of arsenic, smaller doses
may be given than when administered by the stomach, and
they do not require to be so frequently repeated. Thus it often
suffices, for the speedy cure of the disease, to give four drops
of Fowler’s solution hypodermically every alternate day for a
week or ten days, and then to increase the dose to five drops
for a like period. I have compared the duration of acute
chorea as treated by the gastric and hypodermical administra¬
tion of arsenic, and have ascertained that the period is short¬
ened one-half by the latter method. While admitting that the
tendency in such cases is, with hygienic measuies, towards a
cure, the beneficial effects of the arsenic are uoue the less evi¬
dent. I have repeatedly seen the most marked improvement
result from a siugle injectiou. — !St. Louis Clinical Record.
MISUSE OF THE IRON PREPARATIONS— THEIR EFFECT ON THE
DIGESTIVE PROCESS.
In cases of debility, prostration, or loss of appetite, prepara¬
tions of iron, alone or variously combined with bitter tonics,
are seemingly indicated clearly, and are very generally used.
But in many cases they do harm, either from their being admin¬
istered at a wrong time or because they are not tolerated under
any form or circumstance. The greatest abuse of iron is where
it is given for loss of appetite or difficult digestion, and when it
is given within half an hour before eating or within three hours
after. We have found entirely to our own satisfaction, both
by clinical observation and by experiment, that iron prepara¬
tions introduced into the stomach while digestion is going on
either hinder or arrest the process. Our attention was first
called to this by clinical observation. We treated a patient
some time since, who had been treated by another physician
for slight cystitis with considerable depression of spirits and
loss of appetite. The man was, however, quite strong, and not
emaciated. He also had a slight feeling of weight after eating.
For this he was given 6 gr. doses of cit. ferri. et quiniae a half
1066
Current Medical Literature.
[May
hour before eating. This made the feeling of weight worse.
The physician increased the dose to 10 grs., and it was still
worse, and the appetite also remained very small, with consid¬
erable depression of spirits. Upon taking charge of the case,
and finding out what he had been taking, I stopped all tonics
and used only slightly anoydine suppositories for the irritable
bladder. His appetite immediately improved, and the weight
at the epigastrium disappeared. This is only one of many
cases where we have found the use of ir on preparations to pro¬
duce indigestion, feeling of fullness at the epigastrium, and
even vomiting when given at the wrong time. To find reason
for this we tried the effects of iron preparations upon artificial
digestion of animal substances.
We took two test tubes, and put in each the same quantity
of artificial gastric juice, i. e., a 2 per cent, mixture of hydro¬
chloric acid with pepsin, and then placed in each a few pieces
of coagulated albumen. Into one was also placed 31 of elixir
of iron and qui ilia. Both test-tubes were kept at blood heat
for ten hours, In four hours the albumen was rapidly disin¬
tegrating in the gastric juice alone. At the same time the
albumen in the tube containing gastric juice and iron was ap¬
parently intact.
In ten hours the albumen in the gastric juice alone was en¬
tirely dissolved, while in the other tube it was still intact.
In a number of experiments the same results were arrived
at. We may then consider it established that some iron pre¬
parations, if not all, when taken into the stomach during diges¬
tion, hinder that act, and therefore they should not be given
so that they will then be present in the stomach. Whether
the secretion of gastric juice is affected by iron preparations or
other tonics it will remaiu for further observation to determine,
and thus contribute valuable addition to therapeutics. There
are many medicines the effects of which, whether good, bad or
nil, depend entirely on the time of administration.
The tendency both on the part of prescribers and the large
drug manufacturers is to combine iron with other tonics, so that
the markets are flooded with elixirs, syrups, and wines of iron
and quinine, iron and strychnia, iron, strychnia and pepsin,
and so on ad infinitum. The combinations with pepsin are a
shameful waste of this valuable medicine, and well calculated
to bring it into disrepute. None of the others above mentioned
should be used for or in any gastric derangement, except with
due regard to time of administration. The most suitable time
to give iron is one hour before meals or four hours atterwards.
— A If. W. Perry , M. I)., in Western Lancet.
TRANSMISSION OF HYDROPHOBIA FROM MAN TO RABBITS.
♦
* M. Raynaud inoculated a number of rabbits with the saliva
and blood of a hydrophobic patient on the day before death.
1880]
Editorial.
1067
The inoculations of blood gave negative results ; the inocula¬
tions of saliva, however, were followed by rabies in a relatively
short space of time, at most a few days. M. Raynaud also ex¬
tirpated the submaxillary glands of two rabid rabbits and inoc¬
ulated them on two healthy rabbits ; the results were equally
positive, that is to say, the inoculations were followed in a
short time by the symptoms of rabies. No reliable case of the
transmission of rabies from man to man has yet been recorded,
but M. Raynaud thinks that, after his demonstrations of the
possibility of its transmission from man to rabbits, it is fair to
conclude that the results would be identical in the case of
man if accidentally inoculated. — Le Progres Medicale, Nov. 15,
1879. — The Medical Record.
NT
LOUISIANA STATE MEDICAL ASSOCIATION..
The Third Annual Session of this organization was held in
this city on March 31st, April 1st and 2d. The meeting was
harmonious and instructive, and the delegation from the coun¬
try quite large, considering the difficulties attending transpor¬
tation. A number of valuable papers were read, and the
annual oration by the Rev. Hugh Miller Thompson, D. D,, was
a masterly effort. The courteous Recording Secretary, Dr. L.
F. Salomon, has furnished us with a transcript of the proceed¬
ings, which appear in the Journal. When we consider the
failure of former State medical organizations in Louisiana’
there is reason for congratulation now, as the earnest efforts ot
the members precludes any possibility of its dissolution. The
Fourth Annual Session will be held in New Orleans, on the
last Wednesday in March, 1881.
LOUISIANA STATE BOARD OF HEALTH.
The combined action of the Governor of the State and the
City Council, has reorganized this body, with the following
result : President, Dr. Joseph Jones ; Secretary, Dr. S. S. Her¬
rick ; Drs. F. Loeber, F. Formento, E. T. Shepard and J. C.
Beard, and Messrs. I. N. Marks, Robt. Brewster and E. Her¬
nandez, members. Great activity and singleness of purpose is
being displayed, and it is probable that greater efforts toward
9
1068
Editorial.
[May
sanitation will be made this year than ever before. He w Or¬
leans will be cleansed and disinfected. The Hew Orleans Aux¬
iliary Sanitary Association which last year did such important
service by employing a force to forward sanitation, has already
commenced laying pipes, for the purpose of flushing the street-
gutters, and we are glad to state, that this Association and the
Board of Health are in harmony, and will work together to
keep Hew Orleans free from disease. The shipping will be
carefully watched, and the cleansing of all vessels arriving at
this port demanded.
THE YELLOW FEVER CANARD.
That officious person, whose individuality is cloaked, but
whose power is felt, known as “ Associated Press Reporter,”
has made Hew Orleans the victim of as vile a piece of malig¬
nity as was ever perpetrated on a much-abused city, by tele¬
graphing that eleven deaths had occurred here from malignant
yellow fever. Indeed, it appeared in the dispatch that the
Hational Board of Health had been “ officially” notified of
this fact. The excitement over this falsehood was intense, and
but for the immediate refutation by the President of the State
Board of Health and Dr. Bemiss, member of the Hational Board
of Health, there would have been quite an exodus and the
probable establishment of local quarantines. Hew Orleans has
been especially free from malignant disease this spring. Scar¬
let fever and diphtheria have prevailed to a limited extent, but
the cases have usally been very mild, and not a case of yellow
fever has made its appearance.
AN OMISSION.
In our report of the commencement exercises of the Univer¬
sity of La., we neglected to state that the valedictory was de¬
livered by Dr. Thos. Hebert, of La. The address, eminently
suited for the occasion, was finely delivered and met with fre¬
quent applause.
A CORRECTION.
We have had our attention called to an egregious error
occuring in the Journal , June, 1879, wherein on page 995 we
quote from the Medical Tribune, the statement that : “ The
half dime token, nickel, weighs a gramme, and is a metre (39.369
Editorial
1069
1880]
inches) in diameter.” In fact the nickel has a diameter equal
to two centimetres and weighs five grammes.
HYDRATE OF CHLORAL.
Dr. H. H. Kane, of New York city, specially requests mem¬
bers of the profession with auy experience whatever in the use
of the hydrate of chloral to answer the following questions,
and give any information they may possess with reference to
the literature of the subject :
1. What is your usual commencing dose ?
2. What is the largest amouut you have administered at
one dose, and the largest amount in twenty-four hours ?
3. In what diseases have you used it (by the mouth, rec¬
tum, or hypodermatically), and with what results ?
4. Have yon known it to effect the sight ?
5. Have you ever seen cutaneous eruptions produced by it ?
6. Have you known it to effect the sexual organs ? If so,
how ?
7. Do you know of any instance where death resulted from
or was attributed to its use ? If so, please give full particulars
as to disease for which given ; condition of pulse, pupils,
respiration and temperature ; manner of death ; condition of
heart, lungs and kidneys ; general condition, age, temperament,
employment, etc., etc., etc. If an autopsy was held, please
state the condition there found.
8. Have you seen any peculiar manifestations from chloral —
as tetanus, convulsions, or delirium?
9. Do you know any cases of the chloral-habit ? If so, please
state the amount used, the disease for which the drug was
originally administered, the person’s temperament, and the
present condition of the patient, with reference to the state of
body and mind in general, and the various organs and systems
in particular ?
Physicians are earnestly requested to answer the above
questions fully, especially 7 and 9, in order that the resulting-
statistics may be as valuable as possible.
All communications will be considered strictly confidential,
the writer’s name not being used when a request to that effect
1070 Louisiana State Medical Society. [May
is made. Address all letters to Dr. H. H. Kane, 191 West
10th Street, New York city.
Erratum. — In the April number of this Journal, page 940,
fourth line from bottom, read Boagui instead of Boaqui.
LOUISIANA STATE MEDICAL SOCIETY.
THIRD ANNUAL MEETING.
First Day. — Wednesday, March 31st, 1880.
The Society met in the building of the Medical Department
of the University of La., at 12, M., the President, Dr. J. W.
Dupree, in the chair.
The meeting was opened with prayer by the Eev. H. M.
Thompson, D. D.
The report of the Committee of Arrangements was read and
adopted.
The minutes of the last meeting were read and approved.
The President stated that owing to the absence of Dr. Thos.
Layton, he had appointed Dr. L. F. Salomon Secretary.
On motion of Dr. W. H. Watkins, the appointment of the
Committee on Credentials was postponed.
The report of the^Committee on Publication was read, and on
motion duly seconded, action thereon was postponed until the
report of the Treasurer be heard.
The reading of the reports of the Treasurer and Correspond¬
ing Secretary was postponed until the noon session of Thurs¬
day.
A communication from the members of the Society of the
Parish of Caddo, expressing their inability to attend the ses¬
sion, was read and received.
Dr. J. B. Wilkinson stated that the Parish Society of Pla¬
quemines was desirous of applying for admission to this body,
as an affiliating society.
On motion of Dr. S. E. Chaille said society was admitted.
A motion to reconsider the motion postponing the report of
the Corresponding Secretary was adopted. The report was
was read and received.
Under a supension of the rules the following gentlemen were
elected members by acclamation :
Louisiana State Medical Society.
1071
1880 1
Dr. A. Maguire . of St. Mary.
“ T. G. Wolf. . of Iberia.
u L. G. Blanchett . of “
“ A. S. Gates . of St. Mary.
“ R. O. Matas . of Orleans.
“ D. C. Holliday . of Orleans.
“ Y. R. Lemonier . of Orleans.
“ T. B. Pugh . . of Assumption.
“ G. M. Brumby . of Richland.
“ C. T. Hines . of Livingston.
A communication from the Attakapas Medical Association,
containing a memorial to the legislature, favoring the passage
of laws for the prevention of unqualified persons practicing
medicine in the State, was read aud referred to the Committee
on State Medicine.
A communication from the Louisiana Ice Manufacturing
Company, inviting the members to visit their works, was read.
The invitation was accepted, and Friday, at 9, A. M., was the
time fixed for the visit.
There being no further business, the meeting adjourned un¬
til 7£ o’clock, P. M.
EVENING SESSION.
The meeting was called to order at 8 o’clock, P. M., Yice
President Dr. J. P. Davidson in the chair.
A communication from Dr, Samuel Choppin, First Vice- '
President of the American Public Health Association, asking
for the appointment of a committee to confer with committees
from other organizations, for rhe purpose of making arrange¬
ments for the coming meeting of aforesaid body, was read. A
motion that the communication be received and a committee be
appointed was adopted.
The President, Dr. J. W. Dupree, delivered his annual ad¬
dress.
On motion of Dr. T. G. Richardson, the thanks of the Society
were tendered Dr. Dupree, for his able address, and it was
ordered published.
Dr. G. M. Sternberg, U. S. Army, and Dr. Reilly, Inspector,
National Board of Health, were introduced and received as
members by invitation.
Dr. Sternberg read an interesting paper on Microscopy, and en¬
tertained the Society with photo-micrographic views, showiug
the result of his investigations in Havana.
1072 Louisiana State Medical Society. [May
On motion of Dr. Chaille, the thanks of the Society were
tendered Dr. Sternberg, for his very instructive lecture.
The meeting then adjourned until Thursday, April 1st, at
12 M.
Second Day— Thursday, April 1st — Noon Session.
The meeting was called to order at 12 o’clock, M., the Pres¬
ident, Dr. J. W. Dupree, in the chair.
The minutes of the first day’s proceedings were read and
adopted.
The election of members being in order under a suspen¬
sion of the rules, the following were elected by acclamation :
Dr. Peter Randolph . of Point Coupee.
“ N. M. Hebert . of Plaquemines.
“ T. Y. Aby . of Ouachita.
“ U. R. Milner . of Orleans.
“ Wm. Kelly . . . of Madison.
“ J. B. Henderson . . of Orleans.
u N. L. Sigur . . of St. Mary.
Dr. W. H. Watkins, chairman of the committee of arrange¬
ments, read his report of programme of proceedings for the
day. Report received.
Dr. G. K. Pratt, Treasurer, read his report, which was accepted.
On motion the report of the Publishing Committee was
ordered read.
The report was read, whereupon Dr. C. P. Wilkinson moved,
that, in view of the fact that excessive expense had been incur¬
red contrary to the authorization of the publishing committee,
a committee of three be appointed to adjudicate the bill ren¬
dered by the printer. The motion was seconded and carried.
The chair appointed on the committee, Drs. C. P. Wilkinson,
Posthelland Lewis.
Dr. J. P. Davidson, chairman of the Auxiliary Committee
on State Medicine, read his report which was accepted.
Dr. S. E. Chaill6 offered the following resolution :
Resolved, That the Louisiana State Medical Society heartily
concurs with the Attakapas Medical Society, in respect to the
petition to the General Assembly for the enactment of a law
regulating the practice of medicine ; it urges greater consider¬
ation by, and greater union of the profession as to the tenor of
such law as would accomplish the important object in view.
The resolution was adopted.
1880]
Louisiana State Medical Society.
1073
The reports of Drs. Biekham and Herrick of the Committee
on State Medicine, were read and referred to the Publishing
Committee.
Dr. G. B. Fox read a paper on the Medical History of the
Parish of Plaquemines.
The paper was referred to the Publishing Committee.
Dr. T. G. Bichard son read a paper on “ Hydrophobia in
Louisiana.”
Beferred to the Publishing Committee.
Dr. G. K. Pratt moved a reconsideration of the communica¬
tion of Dr. Choppin, read at a previous meeting. Carried.
Dr. S. E. Chaille moved that the Secretary be instructed to
notify Dr. Choppin that this society will take no action in the
matter, as it rests entirely with local organizations.
The motion was seconded and carried.
On motion, the order of business was suspended for the elec¬
tion of officers, and, under a suspension of the rules, the follow¬
ing were elected by acclamation :
Dr. C. M.* Smith, of St. Mary, President.
Vice-Presidents :
Dr. D. B. Fox, First Congressional District ;
Dr. J. P. Davidson, Second Congressional District ;
Dr. P. S. Posted, Third Congressional District ;
Dr. A. A. Lyon, Fourth Congressional District;
Dr. G. M. Brumby, Filth Congressional District;
Dr. O. P. Langworthy, Seventh Congressional District.
Dr. L. F. Salomon was « lected Becording Secretary.
Dr. G. K. Pratt offered his resignation as Treasurer.
On motion, the resignation of Dr. Pratt was not accepted.
On motion, the meeting adjourned until 7£, P. M.
Evening Session.
Meeting was called to order at 8, P. M., Dr. J. W. Dupree
in the chair.
The President introduced the annual orator, Bev. H. M.
Thompson, D. D., who delivered an eloquent address upon the
“Curative Value of High Character in the Physician.”
On motion of Dr. Chaille, the thanks of the Society were ten¬
dered to Dr. Thompson, for his able, eloquent and instructive
address. The meeting then adjourned until Friday, April 2d,
at 10J, A. M.
1074 Louisiana State Medical Society. [May
Third Day — April 2d, 1880— Day Session.
The meeting was called to order at 11, A. M., the President,
Dr. J. W. Dupree, in the chair.
Dr. W. H. Watkins, chairman of the Committee of Arrange¬
ments, reported the order of proceedings for the day. Report
accepted.
Dr. C. P. Wilkinson, chairman of the committee appointed
to adjudicate the bill of the printer for last year’s proceedings,
made his report recommending that the bill be paid. The re¬
port was accepted.
Dr. L. F. Salomon reported ten additional cases of leprosy,
since last report. Report accepted and referred to Publishing
Committee.
Dr. M. Sehuppert read a paper entitled “ Morbus Coxarius
at the International Medical Congress at Philadelphia, in 1876.”
The paper was referred to the Publishing Committee.
On motion of Dr. W. G-. Austin, the following gentlemen
were appointed a committee to make arrangements for the re¬
ception of the American Public Health Association at their
annual meeting : Drs. W. G. Austin, C. M. Smith, J. P. Wilk¬
inson, R. C. White, C.- J. Bickham, D. R. Fox.
Dr. H. R. Day read a paper on u Incised Wound of the
Stomach.” The paper was referred to the Publishing Com¬
mittee.
Dr. U. R. Milner read, for the information of the Society,
resolutions adopted by the Georgia State Medical Society, op¬
posing the bill now before Congress, conferring certaiu powers
upon the National Board of Health.
Dr. A. W. DeRoaldes read a paper entitled “ Contributions
to Medical Hydrology.” The paper was referred to the Pub¬
lishing Committee.
Under a suspension of the rules, the place of meeting for next
year was fixed at New Orleans, on the last Wednesday in
March. Hon. Thos. J. Semmes was elected an honorary mem¬
ber and annual orator for 1881.
The following were elected delegates to the American Med¬
ical Association : Drs. Joseph Jones, A. B. Miles, J. P. David¬
son, J. D. Hammonds, G. A. B. Hayes, T. J. Woolf, S. M.
Bemiss.
1880 J Louisiana State Medical Society. 1075
A motion by S. L. Henry, providing for the collection of vital
statistics, was lost.
On motion, the meeting adjourned until 7J o’clock, P. M.
Evening Session.
The meeting was called to order at 8, P. M., the President,
Dr. J. W. Dupree, in the chair.
Dr. A. B. Snell read a paper on the Conservative Influence of
Disease. The paper was referred to the Publishing Committee,
Dr. Jones read a paper on Fatty Degeneration of the Heart in
Fevers. Referred to Publishing Committe.
The report of Dr. C. J. Bickham, on Medical Education, was
read and accepted.
The report of Dr. S. S. Herrick, on Public Hygiene, was read
and accepted.
Dr. Sampson of Madison, and R. C. McCullogh of Tensas,
were elected members.
On motion of Dr. J. P. Davidsou, the thanks of this associa¬
tion were conveyed to Hon. T. J. Semmes and Hon. Jas.
McConnell of Orleans, Hon. R. L. Luckett of Rapides, and
Hou. N. C. Blanchard of Caddo, for their eiforts in behalf of
State Medicine iu the Constitutional Convention of 1879.
The Chair announced the following as the committees on
State Medicine :
Dr. S. E. Chailld, Chairman.
Public Hygiene — Drs. Davidson and Herrick.
Medical Education — Dr. Bickham.
Medical Jurisprudence — Drs. Dabney and McCutchon.
Public Institutions — Drs. Miles, Matas, Vance.
The thanks of the Association were voted to the President, Dr.
Dupree, and the other officers, for their services to the society
during the meeting.
Dr. Dupree, in retiring, introduced its newly elected Presi¬
dent, Dr. C. M. Smith, who took his seat.
There being no further business, the Society adjourned to
meet in New Orleans on the last Wednesday in March, 1881.
L. F. SALOMON, M. D.
Recording Secretary.
10
1076 Proceedings of the Attakapas Medical Association. [May
PROCEEDINGS OF THE ATTAKAPAS MEDICAL
ASSOCIATION.
THIRD MEETING.
New Iberia, March 4, 1880.
The Attakapas Medical Association was called to order at
1 o’clock, P. M. Vice-president Dr. George Y. Colgin, in the
chair, and a quorum present.
The minutes of the last meeting were read and approved.
Dr. Gates of Franklin and Dr. Minvielle of Jenerette, pre.
sented their diplomas, to be referred to the committee on
credentials. Dr. Gates presented also the diploma of Dr.
C. M. Smith of Franklin, which was, likewise, referred to the
committee.
On a motion of Dr. Richardson, duly made, seconded and
carried —
The committee on “ the petition to the Legislature ” had
more members added to it, and was requested to report imme¬
diately.
The committee on “ a schedule of regular and uniform prices
for the practice of medicine ” was not ready to report.
The committee on credentials reported favorably on the
verification of the diplomas of Dr. Gates, Dr. C. M. Smith and
Dr. Minvielle. These members came forward and signed the
Constitution and By-Laws. Dr. Gates with a proxy signed for
Dr. C. M. Smith.
On a motion duly made, seconded and unanimously carried —
The articles 4 and 8 of the constitution were amended. The
time for holding the election of the officers of the society was
changed, and fixed for the first Tuesday of May. The time of
the regular meeting was also changed and fixed for twice a
year — the first Tuesday of May and December.
The committee on the petition to the Legislature presented
its report, which was approved.
On motion of Dr. Gates, duly made, seconded and carried,
it was —
Resolved, That a copy of the petition be sent to our honorable
1880] Proceedings of the AttaTcapas Medical Association. 1077
senators, M. J. Foster and R. Perry, and also to our represen¬
tatives, C. Young and A. Voorhies.
On motion of Dr. Gates, duly made, it was —
Resolved , That delegates be appointed to represent this
society, at the next meetiug of the Louisiana Stato Medical
Association, on the 31st inst.
Motion adopted.
Dr. 0. M. Smith and Dr. Maguire were appointed from St.
Mary, Dr. Woolf and Dr. Blanchet from Iberia, and Dr. Thomas
from St. Martin.
On motion of Dr. Gates, duly seconded, it was —
Resolved , That a copy of the petition to the Legislature be
sent to Dr. 0. M. Smith to be presented, also to the Louisiana
State Association, with the request to co-operate.
Motion carried.
Dr. Thomas offered the following resolution —
Whereas , by the amendments just made to the constitution,
the election for the officers of the association is now fixed for
the first Tuesday in May ; and whereas, the offices of our
present officers becoming vacant on the first Tuesday of April,
and no meeting being fixed this year for the month of May,
therefore be it —
Resolved, That we proceed at once to the election of our
officers for the coming year, to take charge of their respective
offices on the first Tuesday of May next.
The resolution was seconded and carried.
Dr. C. M. Smith and Dr. A.M Maguire were nominated for
president. Dr. Maguire was elected.
Dr. Geo. J. Colgin and Dr. Blanchet were nominated for and
elected vice president and secretary.
Dr. Woolf was elected treasurer.
On motion of Dr. Thomas, the president elect was requested
to prepare an address for the next meetiug in December.
On motion of Dr. Gates, it was
Resolved , That it is the desire of “ The Attakapas Medical
Society” to follow the good example of the “New Orleans
Medical and Surgical Society,” the “ Orleans Parish Society,”
1078
Reviews and BooJc Notices.
[May
and similar associations, that have intelligently considered the
deficiencies of our organization in this State; that it is our
purpose to become useful in this grand reform, and our united
energies shall be devoted to the accomplishment of that object;
that our personal experience in the several branches of medi¬
cine shall ever be submitted to the inquiring minds ot medical
men ; that it is derogatory to the dignity and interests of the
profession for a member of a recognized medical society to en¬
gage in any trade or calling, the duties of which are inconsistent
with the legitimate pursuit of his profession ; that it is unpro¬
fessional to do cheap contracts for societies, plantations, etc.
Motion seconded and carried.
Dr. Gates offered and read the report of one of the rare cases
of oblique inginual hernia in a female, and also reported a re¬
markable case of gun-shot wound of the shoulder joint.
Dr. Meslayer presented a subject with cancer, and Dr.
Deblanc a case of muscular atrophy.
On motion of Dr. Thomas, duly made and seconded, the
meeting adjourned to meet in the parish of St. Mary, at Frank¬
lin, on the 7th of December, 1880.
L. G. Blanchet, M. D., Secretary.
Reviews and Book Notices.
Headaches, their Nature, Causes and Treatment. By William
Henry Day, M. D., Mem. Boy. Col. Phys. (London) ; Phys.
to Samaritan Hosp. for women and children. Third edi¬
tion, with illustrations, 12 mo. Pp. 322. Philadelphia :
Lindsay & Blakiston, 1880. [Sold by Armaud Hawkins,
196£ Canal street, New Orleans. Price $ 2 00.]
The appearance of a third edition of this work, within three
years of its first publication, affords abundant proof of its
appreciation, so that scarcely more is now needed than to
announce its reappearance,
The present custom of bringing out monographs on the prin¬
cipal subjects of practical medicine and surgery has its advan-
Reviews and Book Notices.
1079
1880]
tages in affording ample material on a given subject in a vol¬
ume of convenient bulk; but, on the other hand, there is a
tendency to diffuseness, hard to be resisted by one who writes
upon his favorite topic. In the present work we think Dr.
Day would have rendered his teaching more available, and
consequently more advantageous, if he had compressed it into
one-half the number of pages. Life is too short and the world
too full of books to allow time for one person to keep up with
the progress of medicine in all its branches ; consequently the
general practitioner will prefer monographs in concise and sys¬
tematic style, rather than the diffuse and dropsical language
which specialists are apt to assume.
After these abstract remarks, we are ready to say that the
general practitioner, for whose use this volume is intended, will
find its chapters much more satisfactory than the paragraphs
devoted to the same topics in systematic works on medicine.
Headaches are chargeable with a large share of human suffer¬
ing, which are generally endured with patience and silence,
from the indifferent success achieved by practitioners in their
relief. This is not creditable to the medical fraternity, and
we are sure that the attentive study of this little book would
go far to remove this reproach. S. S. H.
The Theory and Practice of Medicine. By Frederick T. Roberts,
M. D., B. Sc., F. R. 0. P., Prof, of Mat. Med. and Thera¬
peutics at University College^ With illustrations. Third
American, from the fourth London edition. Philadelphia :
Lindsay & Blakiston, 1880. New Orleans : Armand Haw¬
kins, 196£ Canal street. Price, $5 00.
When a work on the Practice of Medicine passes through
four editions within as many years, it is pretty good evidence
that it fills a want. Hence, in noticing the appearance of a
new edition of Roberts’ practice, it is only necessary to call
attention to the improvements which have been made in it in
order to render it a trustworthy exponent of demonstrated facts
and accepted theories in modern medicine. In the chapter on
the diseases of the absorbent system, the latest researches have
been availed of as shown by the references to Mr. Messenger
Bradley’s work on the diseases of the lymphatic system, and
1080
Reviews and Book Notices,
[May
Dr. Curnow’s excellent Gulstonian lectures on the same subject,
both published in 1879. The exposition of this unsatisfactory
class of diseases is clear and explicit.
The diseases of the uervous system are very fully treated.
Here also the most recent work done in this field by Ferrier,
Hitzig and Fritsch, Gowers, Charcot, Hughlings Jackson and
others has been drawn upon to make the book representative
of contemporary medical science and art.
In the chapter on contagion and epidemics the germ-theory
is discussed as fully as the limits of the work allow, and while
the author is non-committal, he evidently believes at heart in
the theory of contagium vivum.
Altogether, a somewhat lengthy examination of this edition
confirms our previously formed opinion, that as a safe guide to
the student, Roberts’ practice has no superior among medical
text-books, in the English language. The publishers’ work, as
is usual with this firm, is well done. Ro.
Photographic Illustration of Skin Diseases. By George Henry
Fox, A. M., M. D., Clin. Prof, of Dermatology, Starling
Med. Col., Columbus, O., etc. 4to. New York : E. B.
Treat. 1879. [Sold by K D. McDonald & Co., 116 Caron -
delet6street, New Orleans.]
In the January number we gave a favorable notice of the
four first parts of this splendid work. Four more are now
before us. Part Y. illustrates Eczema infantile, E. papulo-
sum, E. iehorosum, E. pustulosum and E. squamosum ; part YI.
Eczema barbae, E. inanum, E. venis varicosis, Ulcus varicosum
and Psoriasis annulata ; part Y1I. Lupus vulgaris, L. erythema¬
tosus, Epithelioma superficiale aud E. rodens (two plates) ; part
YIII. Trichophytosis capitis, T. corporis, Lichen planus (two
plates), and L. Ruber.
The superiority of these illustrations of skin affections to all
others yet 'published is well sustained in these parts. It is
proposed to publish only four more, but we are sure that the
list of illustrations, from which these are selected, would fur¬
nish materials quite sufficient to extend the work considerably
further, and we hope the publisher will find encouragement to
enlarge its original scope. S. S. H.
1880]
Books and Pamphlets Received.
1081
Books and Pamphlets Received.
The Principles and Practice of Gynaecology. By Thomas Addis
Emmet, M. D., Surgeon to the Women’s Hospital of the State
of New York, etc., etc.
Clinical Notes upon the use of The Galvano- Cautery . By Wil¬
liam A. Byrd, M. A., etc., Quincy, Illinois. Reprint from The
Practitioner , January, 1880.
A State Board of Health. A Communication to a Member of
the Legislature on Sanitary Organization and Administration in
the State of New York. By Stephen Smith, M. D., of New
York.
Gleanings from the History of Medicine. An address delivered
in Evansville , Indiana , November 4, 1879. By J. A. Ireland,
M. D., of Louisville, Kentucky, President of the Tri-State Med¬
ical Society. Reprint from the St. Louis Medical and Surgical
Journal , January 5, 1880.
On the use of Water in the treatment of Diseases of the Skin.
By L. Duncan Bulkley, A. M., M. D., etc., 13 pages. Reprint
from Chicago' Medical Journal and Examiner , January, 1880.
A New Method of Permanently Removing Superfluous Hairs.
By L. Duncan Bulkley, A. M., M. D., 7 pages. Reprint from
Archives of Dermatology, October, 1878.
On the Nomenclature and Classification of the Diseases of the
Skin. By L. Duncan Bulkley, A. M., M. D., etc., 15 pages.
Reprint from Archives of Dermatology , April, 1879.
Annual Announcement of the Medical College of the Pacific ,
Session 0/I88O. San Francisco, Cal.
On a case of Molluscum Verrucosum , presenting certain unusual
features. By James Nevins Hyde, A. M., M. D., Professor of
Dermatology, Rush Medical College, Chicago.
Vicarious Menstruation. By H. G. Landis, A. M., M. D.
Reprint from The Cincinnati Lancet and Clinic , February 28th,
1880.
1082
[May
Meteorological and Mortality Tables.
Meteorological Summary — March.
Station — New Orleans.
Date.
! Daily Mean
j Barometer.
Daily Mean
Temp’ture.
Daily Mean
Humidity.
Prevailing
Direction
ofWind.
Daily
Rain-fall.
General Items.
1
30.18
64.7 76.3
East.
Mean Barometer,
30.069.
2
30.22
65.7 81.7
East.
....
Highest Barometer, 30.311, on 21st.
3
30.09
70.7,78.7
South
.01
Lowest Barometer, 29.811, on 15th.
4
30.01
71.7 82.0
S. W.
Monthly Range of Barometer, 500.
5
30.04
74.5
76 7
S. W.
• - - -
Highest Temperature, 81° on 5th. 6th.
6
30.06
74.2 77.7
South
Lowest Temperature, 42° on 17th.
7
30.02
74.0 78.7
69.084.0
64.7 72.0
South
Monthly Range of Temperature, 39°.
8
9
29.91
30.01
N. e.
North
2.8i
55
Greatest Daily Range of Temperature,
24° on 18th.
10
29.97
66 0 86.3
East.
.03
Least Daily Range of Temp., 5° on 14,
11
29.89
72.5 87.3
South
....
Mean of Maximum Temperatures, 72°0.
12
29.98
72.2 84.7
South
.54
Mean of Minimum Temperatures, 59° 0.
13
30.06
66.0 84.3
North
.30
Mean Daily Range of Temp., 13° 0.
14
30.06
65.2 91-3
North
.24
Prevailing Direction ofWind, North.
15
29.87
69.2 82 7
S. E.
.62
Total Movement of Wind, 6,222 miles.
16
30.11
51-2 68.0
N. W.
.06
Highest Velocity of Wind and Direc¬
tion, 24 miles, Southwest on 15th'
17
30.18
51.7
b4.3
N. E.
....
18
29.88
67.2
86.7
N. E.
.02
Number of Clear Days, 7.
19
30.05
62.0
73.3
North
.13
Number of Fair Days, 11.
20
21
30.22
30.25
61.5
53.5
58.3
79.3
N. E.
N. E.
.13
.38
Number of Cloudy days on which no
Rain fell, 2.
22
30.18
59.2
89.7
East.
.84
Number of Cloudy Days on which
23
30.17
63.0
64.7
N. E.
Rain fell, 11. Total number of days
24
30.17
65.0
54.3
North
on which rain fell, 15.
25
30.16
64.5
59.7
S. E.
Dates of Luua Halos, 25th.
26
30.01
69.2
69.3
S. E.
COMPARATIVE
TEMPERATURE.
27
29.95
68.5
64.7
N. W.
1871 .
1876 . 59.9°
28
30.02
66.2
32.7
N. W.
1872 .
1877 . 60.7°
29
30.10
63.5
47.0
North
1873 . 60.4°
1878 . 66.4°
30
30.17
60 0
51.7
East.
1874 . 66.2°
1879 . 64.7°
31
Sums
30.12
64.5
61.3
S. E.
—
1875 . 63.5°
COMPARATIVE
1871 . inches.
1880 . 65.7°
PRECIPITATION
1876: 11.22 inches
Means
30.069
65.7
70.9
North
6.66
1872 . “
1873 -.5 10 “
1874.. 7.57 “
1875.10.84 “
1877 : 4.94 “
1878; 4.63
1879; 1.36 “
1880: 6.66 “
GEORGE H. ROHE,
Sergeant , Signal Corps, U. S. A.
Mortality in New Orleans from March 21st, 1880, to
April 17th, inclusive.
Week Ending.
Yellow
Fever.
Malarial
Fever.
Consump¬
tion'
Small¬
pox
Pneu¬
monia.
Total
Mortality.
March
28
0
9
19
0
8
109
April
3
0
5
27
0
6
112
April
10
0
2
17
0
5
100
April
17
0
3
16
0
6
114
Total .
—
0
19
79
0
25
435
NEW ORLEANS
Medical and Surgical Journal.
JUNE, 1 88 0.
ORIGINAL, PoyViyvlUNICATIONS.
Differential Diagnosis of Tumours in the Scrotum.
By S. LOGAN, M. D.
(Read before the New Orleans Medical and Surgical Association, March 27, 1880.)
In the ever-recurring combats waged by the medical man in
active practice with the multitudinous diseases and accidents
incident to human life, his first move not unfrequentlv decides
the issue. To make that more efficiently he must be as well
acquainted with the battle-field as circumstances permit. He
must, if practicable, thoroughly diagnose his case ; for unless
he knows the dispositions of the enemy his plans of attack or
of defence must necessarily be indefinite and therefore less
effective.
As the science of medicine becomes more exact, and conse
quently the art of medicine as exemplified in practice becomes
more accurate and defined, the subject of differential diagnosis
attracts more and more attention. The profession owes much
to the great intellects who have, in modern times especially,
labored successfully in this field. They have gleaned a rich
harvest whose beneficient effects, have entered into all the
details of practical medicine. To such men as Laennee and
Velpeau, in France ; Latham and Williams, in Great Britain ;
G-uttmann, in Germany, and Da Costa and the Flints, in
America, we shall always acknowledge ourselves as greatly
indebted for their researches and their systematized productions
in this line.
1084 Original Communications. [June
The first thing to be done by the practitioner of medicine or
surgery, when he assumes charge of a case is to find out k< what
is the matter ” — to make his diagnosis. To do this he has to
rely much more on himself than when next he comes to apply
the therapeutics. To assist him in the latter, he has the
recorded experience of the profession at large to guide him ;
while to make his diagnosis he has to rely on his own resources,
aided, of course, by his previous study.
Once he has made his diagnosis, it is only a matter of mem¬
ory or of reference — should time permit — to apply the appro¬
priate therapeutics. It follows, therefore, that few lessons are
more beneficial thau those by which diseases or injuries bear¬
ing a gross likeness are grouped together and then differenti¬
ated from each other.
These are the reasons which have influenced me in inviting
your attention this evening to the “ Differential Diagnosis of
Tumours in the Scrotum.”
In this group we have many affections more or less similar in
many respects, and yet widely differing in Etiology, Pathology
and Prognosis ; a careful differential diagnosis becoming,
therefore, of the greatest importance.
So numerous are the affections which may cause a swelling
in the scrotum, that a general classification with divisions and
subdivisions becomes essential to their proper consideration.
Whenever I am confronted with such a case, I am in the
habit of first asking myself the following question : Does the
swelling originate here or has it been produced by causes origin¬
ating elsewhere ? I think you will find this a useful primary
division of the subject. The first requisite in making a diag¬
nosis of any local disease or accident, is to know to what dis¬
eases or accidents the given part is liable. Well ; this part
is liable to some swellings which may originate elsewhere, and
some commence in the part itself. Let us go over the tumours
which may be found uuder each of these great divisions ; and
as we ennuinerate them, let us consider their special diagnosis.
First : Tumours of the Scrotum originating elsewhere.
We find them under the following heads: (a) Urinary infil¬
tration; (b) Hernia. This division does not include many
1880] Logan — Diagnosis of Tumours in the Scrotum. 1085
varieties ; but it is of the highest importance to distinguish
them from other conditions with which they may be confounded.
Nor is this always so easy a matter as may be supposed at
first glance.
(a) Urinary infiltration, must be distinguished from (1) simple
oedema; from (2) erysipelas; from (3) strangulated hernia
and from (4) scrotal neoplasms.
(1) From simple oedema it may be recognized by the his
tory of urinary troubles ; by the more active inflammatory
symptoms ; and by instrumental exploration of the urethra.
As a rule there will be no difficulty here — but we must bear in
mind, that in oedema itself we sometimes see quite au active,
even rapidly destructive grade of inflammation. The presence,
however, of the symptoms and the history of urinary trouble
will settle the question.
(2) Uriuary iutiltration may be distinguished from subcu¬
taneous erysipelas of the scrotum, by its history ; by the
X>resence of a stricture, as proven by instrumental exploration ;
and by the escape of urine on practicing the incisions demanded
by both conditions : while the cutaneous form of erysipelas
will be recognized by the absence of the above mentioned symp¬
toms, and the evideutly superficial character of the iufl unma-
tion.
(3) From strangulated hernia, urinary iutiltration will
hardly be difficult to recognize when we bear in mind — first,
the history, — in the one case to pointing to an anterior and
inguinal origin, in the other to a posterior, — in the one case
to bowel trouble, iu the other to urethral and vesical distress.
Again, the strangulation in hernia, to have produced so much
inflammatory action as to simulate that caused by uriuary
infiltration, must have reached an almost fatal degree; and the
prolonged intestinal obstruction, the collapse, the tympanitis
and the evident localization of the chief suffering in the neck of
the hernia and abdominal cavity will establish the diagnosis.
(4) At first glance it might be inferred that no difficulty
need be expected in effecting a differential diagnosis between
urinary infiltration and scrotal neoplasms. My experience,
1086 Original Communication a. [June
however, proves the contrary, as the below mentioned case
will show.
In order to explain the possibility of making a mistake in
this regard, it must be borne in mind, that urinary infiltrations
do not always present the acute phenomena usually found.
We may say that there are two classes met with — i. e., those
characterized by acute and those presenting chronic symptoms.
The former variety is familiar to all, being by far the most
common ; while the latter is well known to those who see rnanv
cases of genito-urinary disease — though comparatively rare.
In the chronic cases the urine escapes in such small quantities
at a time, that, instead of rapidly streaming through the
areolar spaces and producing a correspondingly extended area
of inflammatory action, it remains near the point of escape from
the urethra ; there excites a localized inflammation, and the
result is a distinct tumour, hard and circumscribed, the fluid
becoming walled in by organized plasma. Further escape of
urine, little by little, causes a more or less rapid increase in the
size of the tumour till at last suppuration results and a fistu¬
lous opening is formed through the hardened mass. These
tumours thus formed vary in size, from that of a chestnut to
that of an orange. Before the fistulous opening finally divulges
the true nature of the swelling, it may readily be mistaken by
even practitioners of judgment and general experience, for a
neoplasm. The following is a case in point .
Case I. B - , colored ; laborer, aged about 35, was sent
to my office by a medical friend of large practice and proved
ability, about eight years ago, with a hard tumour occupying
mainly the middle line of the scrotum just iu front of the peri¬
neum. The patient brought a note from my friend to the effect
that he had diagnosed a cancer and wished to know whether
iu my opinion it would not be best to remove it at once. The
swelling was round, hard, about the size of a small orange and
had been about six weeks in attaining those dimensions. It
was the seat of severe pain and the patient stated that it was
hard from the beginning. Its peculiar central position and the
manner in which it appeared as if attached to the walls of the
urethra attracted my attention and upon making the necessary
1087
1880] Logan — Diagnosis of Tumours in the Scrotum.
inquires I found that he had long suffered from difficulty in
micturating, and urethral exploration demonstrated the exist¬
ence of a narrow indurated stricture. Coincident with the
relief of the stricture, the swelling gradually disappeared
entirely, without even the formation of a urinary fistula.
1 have had many other cases where a like mistake might
easily have been made. To be forewarned iu this regard is to
be forearmed. A careful inquiry as to the previous history with
urethal exploration suffices to lead us to the proper diagnosis.
Let us now consider the other form of scrotal swelling belong¬
ing to the first division, or those originating elsewhere, i. e. :
(b) Hernia. When strangulated or irreducible, it is to be dis¬
tinguished from (1) urinary infiltration ; (2) orchitis, especially
gonorrhoeal or epididymitis, with or without orchitis ; (3) inflam¬
ed hydrocele or haematoceli, and when not strangulated form (4)
varicocele; (5) hydrocele, especially when of the cord or congen¬
ital, and haeinatocele ; (G) neoplasms.
(1.) Hernia when strangulated or irreducible from urinary infil¬
tration.
What has been already said when speaking of the differ¬
ential diagnosis of urinary iufiltration will cover all that is to
be said under this bead.
(2) Hernia when strangulated, or irreducible from orchitis and
epididymitis , or the two combined , especially as a complication of
a gonorrhoea. Both hernia and orchitis are so common that we
need not be surprised at their coincidence, and that the one
should be occasionally mistaken for the other, Perhaps orchi¬
tis, with or without epididymitis, is more frequently taken for
strangulated hernia than vice versa. I have known of one
case iu which surgical assistants were called on and instru¬
ments prepared, when the appearance of a discharge from the
meatus excited attention, and led to such a more cautious in¬
vestigation as to result in the correct diagnosis. When we
bear in mind the fact that the cord as well as the epididymis is
frequently quite large and exquisitely tender iu the gonorrhoeal
cases, we need not be surprised that a hasty examination might
lead to such a serious error, especially if the patient be the sub¬
ject of hernia. The history of the case — on the one hand point-
1088 Original Communications. [June
ing towards hernia, on the other towards inflammatory local
troubles will materially assist in the diagnosis — bearing in
mind, however, that the two conditions may coincide — that
indeed even strangulated hernia and orchitis may exist together.
The prolonged absence of alvine evacuations, with increasing
abdominal symptoms; the rapidly increasing evidences of a
desperate malady ; the thready pulse ; the impending collapse;
the clammy skin ; the stercoraceous vomiting ; the facies hip-
pocratica, will soon point out the fatal tendencies of a strangu¬
lated hernia ; while the comparative mildness of the general
symptoms ; the fact that the pain, fever, etc., are not pro¬
gressively worse and worse, but often soon reaching a climax
and then declining, or at least remaining stationary for a day
or two, will indicate the less serious condition. The merely
irreducible hernia is easily distinguished by the absence ot any
local inflammatory trouble, and by its soft doughy character ;
and even a strangulated hernia, while frequently quite tense,
has not the solidly hard feeling of the inflamed tesitcle.
(3) Hernia, iclien strangulated, from inflamed hydrocele or
hcematocele.
Here again the history of the case; the ingravescent
feature of all the symptoms, and the other above mentioned
characteristics of strangulated hernia, will usually suffice for a
positive diagnosis. But here too a hasty conclusion may lead to
error. It must be borne in mind that almost any scrotal swelliug
may be called li a rupture,” and the physician is not uu frequently
led astray by the positive assertion of the party, that he has a
rupture. We often meet cases who have worn trusses for
months, and even years, and who have never been the subjects of
hernia. I have known cases of hydrocele and other swellings,
in which the truss has even been fitted by the attending phy¬
sician. It behooves the practitioner of medecine to be cautious
in such cases, for his own sake, as well as the good of his
patient.
Case II. Some years ago, a patient was sent into the
Charity Hospital, by a physician who had diagnosed u a badly
strangulated hernia,” and who sent word that the case required
immediate operative relief, as taxis, etc., fairly tried had utterly
1880] Logan — Diagnosis of Tumours in the Scrotum. 1089
failed. The man was suffering severe pain— or at least so
stated, — had considerable fever with some vjmitiug, of no
fcecal character however, — aud au immense tumour the size of
a small watermelon, occupying the left side of the scrotum.
It was hot, purplish red, highly sensitive and tense. But it
evidently came to au abrupt rounded termination against but
outside of the external inguinal ring. There was no tympanitis
or other abdominal symptom ; he had taken opiates and that
accounted for the vomiting, constipation, and perhaps some of
the delirium also present in the case.
An active cathartic was given, which purged him freely in a
few hours, and the next day a free incision was made into
the cavity of au inflamed hrematocele, and an immense quan¬
tity of bloody serum, mixed with flakey pus was evacuated ; a
large fold of the hypertrophied tunica vaginalis was removed ;
the cavity was washed ; a drainage tube inserted, and in a few
days the patient was fairly convalescent. The patient inform¬
ed the writer that he had been wearing a truss for years, and
exhibited one considerably the worse for wear, to substantiate
his assertion.
In this particular case, the best marked local diagnostic
feature, was the rounded and abrupt termination of the tumour,
evidently external to the inguinal ring.
(4) Hernia ( not strangulated) from varicocele ,
Here both tumours are, ordinarily, reducible. But the hernia
slips back altogether, as it were, and usually with a gurgling
sound, while the enlarged veins are but slowly emptied of their
contents by steady and continuous pressure even to the last drops.
Then the hernia receives a more decided impulse when the pati¬
ent is made to cough ; though in a large varicocele where the
veins are enlarged even in the inguinal canal this may be also
perceived, in a measure, in some cases. The earth-worm feeling
present in varicocele, if marked, is quite characteristic ; but
where the veins are very large they may feel like intestines.
The test proposed by Sir Astley Cooper must not be forgotten
in a doubtful case. You will remember that it consists
in reducing the swelling, and then placing the thumb well
applied agninst the external ring, or the internal if the swell-
1090 Original Communications. [Juno
ing can be traced that far, while the patient stands up. If it
be a case of hernia the intestine is held back, or if it escapes
past the finger it produces a characteristic sensation ; while if
the case be one of varicocele the swelling is gradually repro¬
duced as the blood slowly fills the veins again. If the hernia
be irreducible this test cannot of course be applied.
(5.) Hernia ( not strangulated ) from hydrocele or hcematocele.
Ordinarily the distinction can readily be made. The hernia is
soft or doughy and often palpation elicits a characteristic
gurgling; the hydrocele or hematocele is yielding but teuse
and elastic. The hernia may be traced up and into the ring ;
the hydrocele comes to a rounded limit outside the ring, gener¬
ally not even reaching the cord. Gather up the hernial mass
in the palm of the hand and gently press it upward ; tell the
patient to cough, and an impulse will be transmitted through the
contents of the tumour to the palm of the surgeon’s hand. Do
the same to a hydrocele, and, while the whole mass may be
shaken, that internal transmittal of visceral impulse will be
wanting.
If the patient be capable of giving a reliable history, he will
tell you, should it be a hernia, that it came down from above,
and generally, he is in the habit of putting it up, or it goes up
when he goes to bed ; if it be a hydrocele he will tell you that
it began “iu the bag,” aud generally at the bottom of it.
It is true that a hydrocele of the cord, or an encysted hydro¬
cele may lie well up against the external ring, but its teuse
elastic feeling, and its irreducibility will usually suffice to dis¬
tinguish it. Then again, a congenital hydrocele is reducible ;
bnt not with the sudden slipping and, it may be, gurgling of
hernia, but it slowly ami gradually empties its contents into
the abdominal cavity. The hernia pops back with promptness,
especially if the patient coughs ; the hydrocele refills gradually,
and is not much influenced by abdominal succussion.
I attach but little importance to the light test. A hydrocele
is often opaque from accidental haemorrhage, aud an hemato¬
cele (practically identical with hydrocele) is of course always
so. This test may be of some use in cases where we suspect a
coincidence of hernia with hydrocele ; and even then the possi*
1880J Logan — Diagnosis of Tumours in the Scrotum. 1091
bility of the fluid being opaque with blood, to a great extent
nullifies the result of such an examination.
(6) Hernia from neoplasms in the scrotum.
The above memtioned symptoms of hernia will ordinarily
suffice to distinguish it from any of the numerous varieties of
new growths. The history, if reliable ; the feelingunder man -
ipulation ; the prolongation of the hernia into the abdominal
cavity; the transmitted visceral impulse, &c., will ordinarily
suffice to designate its nature. When, however, we pass in re¬
view the differential diagnosis of each variety of scrotal neo¬
plasm it may in some instances be requisite to mention other
special points of distinction as applicable to the special form
of tumour under consideration.
II. We have next to consider the tumours originating in the
scrotum. These are so numerous that a systematic classifica¬
tion is very desirable. I think that this classification — espe¬
cially with a view to a differential diagnosis — is best made on
an anatomical basis as follows : (a) affections of the skin :
(b) of the underlying connective tissue and dartos : (c) of the
blood-vessels of the cord, especially the veins : (d) dropsy of
the tunica vaginalis: (e) diseases of the testes, epididymis and
cord.
Then, under each of the.se heads we must further differen-
ciate various special diseases.
(a) Local affections of the skin, may be grouped under the
following heads: (1) cutaneous erysipelas ; (2) elephantiasis ;
(3) epithelioma.
In regard to the first, there will hardly be any trouble in the
diagnosis. The swelling is seldom so extensive as to similate
a scrotal tumor, and the same symptoms which characterize
this form of diffuse inflammation elsewhere, will suffice to
identify it when occurring in this locality.
(2) j Eliphantiasis of the scrotum.
This may be distinguished from other tumours, by the ab¬
normal feeling of the skin. It is nodulated, hard, stiff and evi¬
dently hypertrophied ; while other tumours lie under, and do
not generally involve the skin itself, which may usually be
2
1092 Original Communications. [June
lifted up from tlie diseased tissues beneath. The exceptions to
this are found in the later stages of malignant disease, aud in
the suppurative aud ulcerated stages of scrofulous degenera¬
tions. Under both of these circumstances, the skin is drawn
into and involved with the originally deep-seated pathological
processes.
These exceptions can be recognized by the distinctly local¬
ized phenomena, aud the absence of the general hypertrophy
of elephantiasis, which at the same time seldom ulcerates;
while ulceration and suppuration are necessarily present in the
two other conditions.
Elephantiasis, it must be remembered, is not unfrequently
complicated with hernia ; which may be reducible or irreduci¬
ble. If reducible, this fact alone will generally suffice to indi
cate its existence. If, however, the hernia be irreducible, then
the diagnosis is more difficult owing to the fact that the indu¬
rated and thickened condition of the skin renders it impossible
to derive any satisfactory information concerning the facts
beneath by means of digital palpation. In a very large casein
which I assisted in the removal of the tumour, it was impossi¬
ble to form a positive opinion as to this complication before
operating, but bearing in mind the danger, the operator was
on the lookout, and sure enough an irreducible hernia was pres¬
ent. The removal was effected safely and the patient finally
recovered.
(3) Epithelioma— soot wart , or chimney sweepers cancer.
Here too there is hardness and thickening of the skin ; but it
is more localized than eliphantiasis ; tends towards ulceration
long before it attains anything like the proportions of that dis¬
ease, aud is more painful. Indeed there is but little suffering
in elephantiasis. It is possible, however, that epithelioma here as
elsewhere may be confounded with various chronic sores. The
indurated, lumpy edges; the fact that the ulceration was pre¬
ceded by a wart or local induration ; that pricking pains dart
through it at times, and that the neighboring little vessels soon
begin to enlarge; will serve to indicate the nature of the
disease.
(b) Local affections of the subcutaneous tissues of the scrotum , —
1093
1880] Logan — Diagnosis of Tumours in the Scrotum.
may be classified as follows: (1) Simple oedema. (2) Subcu¬
taneous or phlegmonous erysipelas.
(1) Simple oedema is easily recognized by the phenomenon
of pitting; by its boggy feeling; by the absence of active
symptoms of inflammatory action; and by the presence of car¬
diac, renal or other disease of such a character as to develop
other coincident dropsical syintoms,
(2) Phlegmonous erysipelas ; must be distinguished from the
violent grade of inflammatory action often caused by urinary
infiltration. A careless diagnostician may readily confound
the two. Indeed the phenomena are almost identical, and it is
only by enquiring into the history, — directing the questions
chiefly to the condition — preceding, as well as present— of the
urinary apparatus, and by exploring the urinary canal that
the diagnosis can be positively made out. Then all is clear and
the indications for action are positively defined.
(c) Affections of the blood-vessels of the cord.
Varicocele is the only affection which need be considered under
this head. It is to be distinguished from hernia by means al¬
ready considered under that head. From other swellings in
this region it can be readily diagnosed by its soft flabby feeling,
and by recognizing the worm-like shape of the distended veins.
By the absence of great tenderness under manipulation it dif¬
fers from all the inflammatory swellings.
(d) Dropsy of the Tunica vaginalis, shows itself under the two
forms of hydrocele and luematocele. Not unfrequently the
latter follows the former — especially after tapping or acci¬
dental injury. Indeed these two conditions are practically
identical, except in those cases of rapidly forming lnematocele
from traumatic causes.
In either variety we have a tense elastic tumor ; of rather
indefinite duration and equally indefinite size ; forming first, as
a rule, low down in the scrotum and in front of the testicle ;
assuming generally the shape of a pear with the upper ex¬
tremity or neck of the pear rounded off abruptly and evidently
not penetrating the abdominal walls.
In speaking of strangulated hernia I have already alluded
to the possibility of mistaking a hydrocele or haematocele which
1094 Original Communications. [Juno
lias taken on inflammatory action for that serious trouble ; and
a case in point was given. I need not do more in this connec-
tiou than merely refer to that portion of this paper.
The differential diagnosis from non-strangulated reducible
hernia is easily made by simply reducing the hernia — except
in the congenital form of hydrocele. Here it must be borne in
mind that reduction of the tumour may be effected by steady
continuous pressure. But the sudden slipping in of the hernia
is very different from the very gradual emptying of the sac in
congenital hydrocele.
To distinguish hydrocele from irreducible hernia may be a
little more difficult. Here, however, the tense feeling and
rounded abrupt upper extremity of the hydrocele usually suffi¬
ces to identity it, as contra-distinguished from the relaxed, often
gurgling, soft mass of intestine or omentum.
But perhaps, the most important point in the study of the
differential diagnosis of hydrocele has yet to be considered. It
is not unfrequently -confounded with encephaloid of the testicle.
When we come to consider the diagnosis of that affection we
will discuss thfs matter more fully. Suffice it to say that in
case of the least doubt it is always best to explore with the hy¬
podermic syringe or aspirator before committing oneself in the
premises. This expedient may also be resorted to in case the
diagnosis is doubtful from strangulated hernia. In resorting
to it here, however, it must be borne in mind, that a reddish
or even a straw-colored fluid may be found in the sac of the
hernia. If all the fluid, however, be evacuated, it will be found
that in cases of hernia the quantity will be comparatively little
and the tumour will usually be but little diminished ; while in
case of hydrocele the quantity is very considerable and when
all the fluid has beeu withdrawn the tumour has almost, if not
quite disappeared. This latter statement, however, must be
qualified in this respect, i. e., if the case be one ot encysted hy¬
drocele in which there is more than one sac, each sac has to be
punctured separately before the tumour disappears. In a case
of hernia from the sac of which au unusual amount of reddish
serum has been obtained, the general symptoms of strangulation
are, as a rule, so apparent that there can be no doubt in re-
1095
1880] Logan — Diagnosis of Tumours in the Scrotum.
gard to the condition, especially when it is found that, not¬
withstanding a large quantity of fluid has been removed, and a
corresponding diminution of the tumour has been thereby ef¬
fected, the inguinal canal or external ring — as the case may be-
is still packed with the remains of the swelling, pushing itself
into the abdominal cavity. No such condition of affairs will
be found in a case of hydrocele or hsematocele.
(e) Affections of the testicles , epididymis and cord.
These may be considered under the following heads : (1) Or¬
chitis and epididymis , acute and chronic. (2) Scrofulous or tu¬
berculous disease. (3) Syphilitic disease. (4) Malignant disease.
(5) Other tumours — as fibromata; cysto-sarcomata ; cy stomata ;
and euchondromata.
(1) Acute and chronic orchitis, complicated or not with epi¬
didymitis, are chiefly recognized by greater or less active evi¬
dences of inflammatory action as contra distinguishing them
from the other more slowly developing swellings or neoplasms.
The distinction between acute orchitis, especially when accom¬
panied by epididymis and inflammation and swelling of the
cord, on the one haud, and strangulated hernia on the other
hand has been already sufficiently considered under the latter
head.
Chronic orchitis must be differentiated from scrofulous dis¬
eases, syphilitic disease, and neoplasms in general. It will
sometimes be quite difficult to do so : indeed in the two former
cases we have really in many instances a certain grade of
chronic inflammatory action.
As a rule, however, in simple chronic orchitis, we have tbe
following points to aid us. In the first place we fail to make
out, as a rule, either a tubercular or a syphilitic history. In
the second place, the organ is much more tender under mani¬
pulation, than in either of these affections or any of the neo¬
plasms. In the third place, the swelling while hard is at the
same time smooth on the surface, a condition seldom or ever
seen in the two conditions most apt to be confounded with it :
i. e., scrofulous and syphilitic disease. These affections almost
always present one or more nodules corresponding to the
location of the tubercular or syphilitic infiltration. In the
1096 Original Communications. [June
fourth place, the swelling is of more rapid production than in
either of the above diseases. In the fifth place, it is to be dis¬
tinguished from the malignant neoplasms, by its greater ten¬
derness and yet as a rule less spontaneous pain. It is also a
more solid tumour than the usual form of carcinoma found
here : i. e., the encephaloid. Indeed so rare are the harder
forms of cancer here, that some have even denied their exist*
ence.
The features by which it can be distinguished from other
neoplasms, will be mentioned when we come to consider the
latter in detail.
(2) The tubercular or scrofulous testicle , may be mistaken for
the syphilitic testicle ; for malignant disease ; for hydrocele , or
or for a neoplasm.
Sometimes it may happen that the two conditions of syphil¬
itic and tubercular disease co-exist, as I am quite confident I
have observed in more than one case, and as one of our author¬
ities also affirms.
We can see no reason why this coincidence may not be
found.
The history of the patient’s previous health, or that of his
ancestry may aid materially in the diagnosis. But here we
must not forget that some cases of the so-called tuberculous or
scrofulous testicle, present no family or personal history point¬
ing to that diathesis. What is called the scrofulous testicle,
however, may be usually recognized by the torpid increase of
the swelling ; which begius as little hard lumps or nodules in
the substance of the gland. The organ seldom attaius a size
larger than a duck egg, this feature soon aiding in distinguishing
it from malignant disease. It also tends to early suppuration,
and fistulous openings soon form, as in scrofulous inflammations
elsewhere. Succeeding the melting down of tubercular mate¬
rial, we may have the phenomenon of a hernia testis; which
may possibly be mistaken for either the fungus haeiuatodes of
true cancer, or the ulceration of epithelioma. But I have never
seen a cancer reach the stage of fungus haematodes before the
malignant growth had reached such dimensions as to preclude
the supposition of tubercular disease; while to distinguish a
1880] Logan — Diagnosis of Tumours in the Scrotum . 1097
hernia testis from ulcerated epithelioma we must remember
the different phenomena characterizing the previous history of
the respective diseases. The epithelioma starts on the skin :
the scrofulous tumour begins as one or more nodules in the
substance of the testicle. The affectiou is apt to attack one
organ after the other, and this aids in diagnosing it from other
tumours. Again the fungus of the scrofulous testicle never
bleeds with the profuseness aud readiness of a true fungus
hsematodes. In case of doubt, subject a small piece of the
hernia testis to observation under the microscope and the
anatomical elements of the testicle are readily detected, not so
of course if it be a case of malignant fungus hsematodes.
(3) Syphilitic disease of the testicle , possesses many of the
features of the scrofulous affection ; but it attains a greater
size, and does not show by any means so marked a tendency to
suppurative action. It is more apt to infiltrate a larger por¬
tion of the organ with its peculiar material aud thus enlarges
more generally, though still beginning like the other by one or
more small nodules deposited in the substance of the organ.
The same features which, differentiate the scrofulous testicle,
from the various other swellings in this locality, will apply
equally well to the syphilitic affectiou. It is here necessary
then only to specify in more detail the differences between
these two. The syphilitic disease may be further distinguished
from the tubercular affection, by the nocturual pains sometimes
found in the former ; by the favorable results attained by
specific treatment ;.and by the fact that, as a rule, the syphilitic
diseasels not so apt to attack both organs in succession as is the
scrofulous, perhaps because it is more amenable to treatment.
I have, however, seen both organs attacked either simulta¬
neously or in succession, as in the following case :
Case III. P. G., aged about 56, —robust, history perfectly free
from suspicion of scrofula or other cachexie, personal or by inher¬
itance, except that of tertiary syphilis, of which there were
marked indications, — applied to me in 1877 for relief from two
enormous hydroceles — one in each tunica vaginalis — which had
been developing for about eight or ten months. It was impos¬
sible to diagnose the condition of the testicles before operating
1098 Original Communications. [June
for the hydroceles. 1 cut out an eliptical portion of each sac —
the operation I almost always uow resort to — and when the
fluid was evacuated both testicles were found as large as duck
eggs, and evidently the subjects of syphilitic infiltration. Spe¬
cific treatment was instituted, and with such marked results as
to fully confirm the diagnosis as to the nature of the disease of
the testicles.
Whether in this case the syphilitic infiltration of the two
organs was simultaneous, or consecutive, I had no means of
ascertaining.
(4) Malignant disease.
The form of carcinoma almost . invariably found in the testes
is encephaloid. For practical purposes we may diseard all the
other varieties. If this fact be borne in mind the differential
diagnosis will be much simplified. Encephaloid of the testicle
has then to be distinguished from the following diseases : (a)
hydrocele and hsematocele ; (b) other neoplasms.
(a) Encephaloid from hydrocele and heematocele considered
together.
This is perhaps the most important of all the diagnostic
studies we have yet engaged in. Perhaps the best method of
proceeding in its elucidation will be to enumerate the symptoms
of encephaloid, and contrast them with those of hydrocele or
heematocele.
First. The previous history and inheritance. From this
not much information of diagnostic value is to be derived.
While a history of ancestral cancer may tend to awaken suspi¬
cion it can do but little more, for very many cases present no
such history.
Secondly, liate of development. Here again we find, but
little, on which to found a differential diagnosis. Nothing is
more indefinite than the rate of progress in the tumours under
consideration. I have seen a pure encephaloid take four years
to attain the dimensions of a small head; and I have had cases
of hydrocele to take about the same time to assume such pro¬
portions. (See case further on.)
Thirdly. Shape. At first an encephaloid is rounded ; a hy-
1880J Logan — Diagnosis of Tumours in the Scrotum. 1099
clrocele usually pear-shaped ; but an luematocele is often
rounded like encephaloid. Usually, however, the haematocele
which assumes this shape is one formed very rapidly. — prompt¬
ly after some injury — too rapidly to be an encephaloid — say
within a few hours or a few days. Tuis promptness of develop¬
ment together with a history of tramatism will usually suffice
to indicate the nature of such a swelling.
As the encephaloid increases steadily in dimensions it almost
invariably assumes a bossellated shape. The disease, no longer
confined within the tunica-albuginea, sprouts in parts through
this tough envelope, involves the superincumbent tissues and
there develops a kind of tuberous off-shoot from the main
growth, producing the change of shape alluded to. It matters
not how large or how old be the hydrocele, no such change oc¬
curs. But it is a pity if the diagnosis has been so long delayed,
either by ignorant neglect on the part of the patient to apply
to the proper person, or by the fault of the medical adviser.
Here, if anywhere, an early diagnosis is urgently demanded.
So that these symptons, which require such delay for their de¬
velopment, while of prime importance when the case is seen
late, are generally too late to inure to the benefit of the patient,
as compared with such symptons as assist us in an early diag¬
nosis! Delay in such cases is terribly dangerous. I cannot
too urgently insist on a prompt diagnosis in all cases of scrotal
tumours, and to do this we must consider more especially the
symptoms which are appreciable at an early stage of the
disease.
Fourthly. The feeling of the tumour. The disease first con¬
fined within the tunica-albuginea stretches and distends that
membrane; and, the morbid substance being soft — somewhat
softer in many cases than brain — a feeling of fluctuation is
soon developed to such an extent as to simulate that produced
by a hydrocele or haematocele — especially if, by rough usage or
other cause, the tunica-vaginales in the hydrocele or lnemato-
cele has become thickened. In such cases an early diagnosis is
sometimes extremely difficult. Under such circumstances take
a hypodermic syringe, the aspirator or a fine trocar and canular,
3
1100
Original Communications.
[June
and explore the centre of the tumour. I prefer the latter in¬
strument as a rule; because by using it we have the means at
hand of emptying the sac of the tunica- vaginalis in a few min¬
utes, provided hydrocele be present ; thus giving us the
opportunity of examining the testicles, after the fluid is re¬
moved ; while at the same time we give the patient the benefit
of a temporary — possibly a permanent — relief from the fluid ac¬
cumulation. If it be a cancer, the fine delicate instrument I
use — such as is employed in infantile hydrocele — does no man¬
ner of harm.
Under the head of the feeling of the tumor we must not for¬
get that even in the earliest stages in cancer, we tail to discover
any distinction between the tumor and the testes; while in
hydrocele and hsemotocele this distinction can often be made
perceptible to the patient, as well as to the surgeon. For when
the healthy testicle is pinched, a peculiar sickening pain is pro¬
duced. This I have not found to be the case when a testicle
infiltrated and destroyed by carcinoma is subjected to a similar
test.
Fifthly. The appearance of the tumour on the surface, in
encephaloid, soon begins to indicate its nature. The skin
becomes traversed with enlarged blood vessels ; while no such
change occurs in hydrocele or haematocele, as a rule, at least
to any marked degree.
Sixthly. The nature of the pain in encephaloid is character¬
istically different from that of hydrocele. In the former case
it is lancinating; often coming on without the least provocation —
even when the part is supported and the patient in bed ; while
in the latter it is of a dragging kind ; often referred to the
back ; generally relieved by supporting the tumour so as to
avoid traction on the cord ; seldom or ever occurring while the
patient is recumbent, and not unfrequehtly of such a slight
character that the patient makes no complaint of it. It must
be stated, however, that in a few cases encephaloid of the testi¬
cle gives little or no pain. Such has been my observation in
several cases. We must not, therefore, attach undue impor¬
tance to its absence, though when present, and when its pre¬
sence is ascertained by carefully interrogating the patient so
1101
1880] Logan — Diagnosis of Tumours in the Scrotum.
as to elicit his own description of its character, without giving
him what the lawyers call leading questions — it becomes a
symptom of great value in making out the differential diagno¬
sis, — not only from hydrocele and hsematocele, but from all
other tnmours occurring in these parts.
Seventh. Involvement of surrounding parts. It matters not
how large the hydrocele or hsematocele, neither the skin, the
cord, nor the neighboring lymphatics show any sign of disease;
whereas I need hardly say that they all, sooner or later, become
involved in cases of encephaloid. This is another distinguish¬
ing feature which, while characteristic, is unfortunately too
tardy in its development to prove of much value in the attain¬
ment of that great desideratum — au early diagnosis. In the
case already alluded to, which came under my care four years
after the testicle first- began to show signs of disease, uo such
involvement had occurred, notwithstanding the immense size to
which the tumour had grown.
Eighth. Constitutional cachexy. This is another symptom
whose value is much lessened by its late appearance. By the
time it shows iiself, the other symptoms have pretty generally
settled the diagnosis. In doubtful cases, however, it may prove
of some value. That there are any special phenomena charac¬
terizing the debility induced by cauccr in its later stages is
itself rather questionable. The earthy hue, the emaciation,
the prostration, etc., etc., differ in no recognizable degree from
what we see as the results of other exhausting diseases.
(b) Diagnosis of encephaloid from other neoplasms.
In a general way many of the symptoms already enumerated
as serving to effect a differential diagnosis between encephaloid
and hydrocele and hsematocele, will also serve the same pur.
pose iu regard to other neoplasms occasionally found here. But
as we enumerate these latter their individual points of differ¬
ence from cancer will be mentioned.
The chief points of distinction will be found in the rapid
growth ; the large size; the characteristic lancinatingpainand the
increasing vascularity around and over the cancerous growth ;
while the comparatively early involvement of surrounding parts
1102 Original Communications. [ Jun<-
and the lymphatics, with the gradual debility, earthy hue and
emaciation still later on may confirm the diagnosis, in the
absence of other causes for such evidences of vital exhaustion.
(5) Other neoplasms.
The testicles are occasionally found to be the seat of the fol¬
lowing non-malignaut tumours :
(a) Cysto-sarcoma ; (6) cystoma ; (c) enchondroma.
(a) Cysto- sarcomatous tumours of the testicle, formerly called
fibro-cystic, are very rare. They may attain a great size, but
are of slower growth ; are less vascular ; less painful — except
from their dragging weight; — do not involve the neighboring
lymphatics and do not produce the cachexia of malignaut
growth.
They may be distinguished from hydrocele accompanying
chronic orchitis or the scrofulous or syphilitic testicle — a compli¬
cation which iu my experience is quite common, by the facts
that the cysts— if perceptible by palpatation — seem buried in
the growth, not lying separate from it; and that when said
cysts are evacuated their contents are quite limited, while the
withdrawal of the fluid hardly lessens in any marked degree
the size of the swelling, the rigid walls of the cysts — consti¬
tuted as they are of the sarcous growth — failing to collapse as
does the tunica vaginalis after a hydrocele has been emptied of
its contents.
Neither the syphilitic nor the scrofulous testicle ever attains
the size of a, cysto-sarcoma ; nor does the latter tend to sup¬
purate as does the scrofulous disease.
(b) Cystomata. These are occasionally found containing vari¬
ous substances— as cuticle, hairs, teeth, etc. — and their diagno¬
sis is mostly effected after exploration and evacuation of their
fluid contents. This evacuation not disposing satisfactorily of
the tumour, exploratory incisions should follow; and, after due
examination of the exposed parts an immediate diagnosis is
effected, and all disease removed at once.
Presenting none of the cardinal symptoms already enumer¬
ated as belonging to malignant disease their differentiation from
the same should present no special difficulty.
(c) Enchondroma.— Sometimes — but very rarely — this form
1880J Logan — Diagnosis of Tumours in the Scrotum. 1013
of neoplasm presents itself. Here as elsewhere it assumes,
clinically, two forms, the rapidly growing and the slow grow¬
ing. The former may be mistaken on account of its rapidity
of growth for scirrhus cancer itself — even a still more rare
tumour in the testicle. The absence of the other cardinal symp¬
toms of cancerous disease should prevent such a mistake
Practically, however, this is of little moment, for removal is
demanded in either case, and the examination of the tumour
afterwards will reveal its true nature, and indicate the appro¬
priate prognosis.
I have thus, geutlemen, enumerated the affections of these
parts which may produce a tumour or swelling, and endeav*
oreu to present to you what in my experience have proven the
most useful features for effecting the proper diagnosis in each
case. These affections are many and of most diverse charac¬
ter ; and the necessarily prolix detail has I fear tried your
patience sorely. As my apology I have to plead the intrinsic
importance of my subject, and the correspondingly earnest de¬
sire I feel to so present the facts as to inure to the best practi¬
cal good. The surgeon in active life instinctively reaches out
for a correct diagnosis, not merely with the intellectual appe¬
tite of the pure scientist ; but for the higher and nobler pur¬
pose of benefiting his patient in the case before him. His
mental query — earnestly put — “ what is this ?” derives its chief
significance from the reflection that it is to be immediately fol¬
lowed by the query, “what am I to do about it ? ” The vast
array of symptomatology embodied in this paper, and anatic-
ally examined, has been to the best of my ability arranged
with the object of so generalizing and grouping the items as to
afford, I trust, some aid in answering the latter query.
In dealing with scrotal swellings our therapeutical indica¬
tions may be divided into three classes. In some cases we
must resort to medicatiou ; in some cases to minor operative
measures and in some to total ablation. The choice is deter¬
mined by the diagnosis. If I have in the least aided any of
my confreres in making hereafter a judicious selection in so
serious a matter my object will have been accomplished.
Please accept my thanks for you patient attention.
1104
Original Communications.
| J uue
The Physiological Action of Atropia as Demonstrated by
Experiment.
By JOHN T. JONES, New Orleans La.
1st EXPERIMENT.
To a young kitten, about three weeks old, and weighing
about £ lbs., I gave a subcutaneous iujection of gr. £ atropia
sulpli.
Symptoms: first quarter minute, slight dilatation of pupil ;
After 1 minute, absolute dilitation ;
After 7 “ subsultus tendinum ;
After 15 u convulsions and tracheal respiration.
Judging from the manifested effects that the amount of the
poison injected, was sufficient to produce fatal results, I gave
a second subcutaneous injection of gttj acid hydrocyanici dil.
and almost immediately an abatement of the previous alarm¬
ing symptoms took place, and the little animal recovered com¬
pletely.
2nd EXPERIMENT.
To a young kitten, twin sister to the former, I gave a
subcutaneous injection of gr. | sulphate atropia.
Symptoms : in 2 minutes the pupil was perfectly dilated, the
breathing very much accelerated, and the temperature rose 1£°.
There were no convulsions, but the animal seemed to be unable
to walk, and often fell down, in the attempt to move, especially
its hind legs were dragged along in its creeping course. When
pricked with a piu, the kitten gave only slight evidence of
feeling pain, its ears seeming to be the most sensitive part. In
25 minutes after the injection, the kitten seemed to be in a
perfect state of stupor, lying motionless on its belly, and enjoy¬
ing apparently a death-like sleep. Breathing was also grad¬
ually diminished in frequency, until, after an hour’s time, it
had almost entirely ceased, I then gave another subcutaneous
injection of morph, sulph. grs. iii. Whereupon the breathing
was immediately restored, the animal rallied and soon recov¬
ered completely.
1880J Jones— Physiological Action of Atropia. 1105
3rd EXPERIMENT.
Into another twin sister of the two previous kitteus, I in¬
jected gr. iii atropia sulph., partly subcutaueously and partly
into its jugular vein. All the symptoms of the two first kittens
mentioned, became immediately visible, but in a more aggra¬
vated form. I apprehended speedy death, and therefore
drowned it. I then dissected out one of its eyes, and dropt its
humours on the eyes of two other cats. But no dilatation took
place in either of them.
4th EXPERIMENT.
Dog, medium size, weighing 24 lbs., previous to its receiving
the hypodermic injection, its temperature was 99.4°, pulse 92.
I gave it a subcutaneous injection of gr. i atropia sulph.
SYMPTOMS.
The dog became extremely restless, so that I found it impos¬
sible to ascertain its temperature and pulse-rate. It walked
confusedly, knocking its head frequently. Copious and fre¬
quent urination followed. Its breathing became so accelerated,
that it was impossible to record it with any degree of accuracy.
It shortly became overwhelmed, so that the slightest touch
caused it to fall, and when pressed on its back, it fell on its
abdomen with its forelegs extended. Insensibility to pain
supervened to a marked degree, and profound stupidity fol¬
lowed. After the lapse of 20 minutes, I gave it an injection of
morph, sulph. gr. iv. The animal almost immediately became
quiet, its temperature stood then at 101°, the breathing
became more easy, and gradually returned to its normal fre¬
quency. The pupil, which previous to the injection of morphia
was very much dilated, now became less so and iu 20 minutes
time almost normal. It finally recovered.
5th EXPERIMENT.
On a kitten 4 weeks old I cut down through the abdominal
wall in the inguinal region, to where the iliac artery, nerve and
vein lie in the one sheath. I then separated the vein and
nerve, and ligated it in two places. The artery below the
lower ligature soon became white, showing plainly a depriva-
1106 Original Communications. [June
tion of blood, and the vein collapsed. I then injected subcu¬
taneously grs. ii g of atropia sulph. in five different doses, viz :
1st gr. i, after 50 minutes gr. £, — 15 minutes later gr. £, iu 35
minutes later gr. £, — in 25 minutes after gr.
The following table will show the variations in the number of
respirations and temperature, at different intervals after each
injection :
5 minutes before 1st injection, No. Respir. 67 Tern. 99°
5
u
after
u
u
44
44
58,
44
not taken.
15
a
«
C4
u
44
44
54,
4(
4c
44
30
u
u
u
u
44
44
60,
44
91.5.
45
u
u
u
u
44
44
66,
44
not taken.
5
a
u
2nd
u
44
44
45,
44
44
44
14
u
a
44
u
44
44
56,
44
44
41
10
u
a
3rd
u
44
44
61,
. 44
44
44
15
u
u
u
■ <4
44
44
47,
44
44
44
5
u
u
4th
(4
44
44
30,
44
44
44
10
u
u
5th
44
44
4<
27,
44
44
44
15
44
u
u
44
44
44
18,
44
44
4i
The pupils became dilated after the first injection, the urine
flowed away while 1 was opening the animal’s abdomen, and
the same occurred immediately after the first injection, but was
not again repeated after any of the other injections. The ani¬
mal at first became very much excited, this became constantly
more aggravated, subsultus tendinum frequently taking place
and finally convulsions followed in rapid succession and con¬
tinued till the animal’s death, which occurred in five minutes
after the last observation was taken. In this case the leg
whose iliac artery I ligated became paralyzed, while the other
leg with its circulation unobstructed, escaped this injurious
effect, and was capable of vigorous movements. This result
is in accordance with a physiological law, which H. 0. Wood,
in his therapeutics (page 236) seems entirely to ignore, viz :
that “ if the artery supplying a muscle or set of muscles, be
tied, their contractile power is destroyed.”
The temperature of the leg whose artery I ligated fell in a
perceptible degree and continued so till life ended. The pre¬
cise temperature of the animal’s body I cannot state, since the
18801 Jones — Physiological Action of Atropia. 1107
lowest marking of my thermometer, is 95° and at no time after
the first injection, did its temperature reach that height, 1
could therefore only state it to be below 95°. As to the pulse,
it was so feeble, both before and after the injection, that I
could not record it accurately.
6th EXPERIMENT.
On an old female cat, weighing 7 lbs., I cut down through
the skin and fascia of the upper part of the thigh, until 1
reached the femoral artery, and having separated it from the
vein and nerve between which it lies, I ligated it in two places.
I then dissected off the skin of the neck, on each side of the
trachea to the length of three inches, carefully avoiding to do
any injury to the numerous vessels and nerves to be met with
in this region. 1 separated the pneumogastric nerves from
their accompanying carotid arteries, on both sides of the neck,
and completely divided them with the knife. The respirations
of the animal, which before the division of the vagi nerves
were 56 per minute, immediately fell to thirty. Directly after
dividing the vagi, I gave a hypodermic injection of sulphate
atropia, gr. i. In the course of three more minutes the respi¬
ration rose to 37 per minute, at which rate it continued for two
minutes longer, when the animal taking one long inspiration,
ceased breathing and died.
My intention of studying the effect of the injected atropia
on the respiration of the animal, after division of the vagi, and
more especially in what manner the leg, with its circulation
free, would be differently affected from the leg with its supply
of blood completely cut off', could not, to my great regret, be
realized on accouut of the death which so speedily followed the
operation, and also on account of the fact that the paralysis of
the limb, naturally resulting from the complete loss of its blood
supply, would more or less obscure the action of the medicine.
7th EXPERIMENT.
On another large female cat, which weighed 6.J lbs., I ligated
the femoral artery which I found to be extremely small, so that
its pulsation was scarcely perceptible. I then injected gr. £
4
1108
Original Communications.
[June
into itsjugular vein, and grs. iii subcutaneously of atropia sul¬
phate, with the following results, in regard to the respira¬
tion and temperature; , the pulse, on account of its extreme
feebleness, not being countable.
2 minutes before injection, No. respirations 78^. temp,101.8°
5
a
after
a
a
a
92,
a
101.20
15
a
a
a
a
a
76,
ti
not taken
20
ti
u
a
a
80,
a
ti
25
It
It
a
a
ti
76,
ti
44
40
•4
a
i
a
n
a
60,
ti
44
55
u
a
a
a
a
67,
ti
44
GO
u
u
a
a
ti
not taken
a
99.80
65
a
a
a
a
a
56,
,i
not taken
102
a
a
a
a
a
60,
a
(4
145
a
u
Li
a
a
70,
t.
il
165
u
a
a
a
a
114,
a
li
185
.<
u
it
a
a
not taken
■ l
96.80
195
a
it
a
it
ti
86,
tt
not taken
205
a
a
a
a
a
84,
it
In fifty minutes after the injection, the animal had a violent
tetanic convulsion, subsultus tendinum was also developed at
the same time. These convulsions occurred at variable inter¬
vals in the course of the next few hours ; any sharp, sudden
noise being sufficient to bring them on. [In the case of
this animal, I noticed that the leg, with its circulation free, was
moved more slowly and feebly than the leg with its circulation
obstructed by ligation of its principal artery.] Before admin¬
istering the injection of the poison, I examined the interior of
the animal’s mouth and found it moist as usual. I again
examined it sometime after the injection and found it un¬
usually dry, without the slightest trace of any kind of moist¬
ure. Notwithstanding the large amount of the alkaloid in¬
jected, the animal recovered, without the employment of any
antidote.
8th EXPERIMENT.
A small dog, weighing 12 lbs., received a hypodermic injec¬
tion of atropia sulph., grs. v. with the following results :
1880J Jones — Physiological Action of Atropia. 1109
2 miuutes before inject, respir. 134 £ temp. 101° pulse 88. pfn.
10
u
after
u
tt
too fast to count
a
101. 4°
u too fast
40
a
Is
it
a
ll it t t it
it
101. 6°
it it a
60
it
ll
It
tt
tl ll tl ll
it
not taken “ 150
80
u
tt
tl
a
80
it
it tt
“ 120
135
ll
It
it
it
168 .
it
101°
“ 90
180
ll
u
It
tt
not taken
it
99°
not taken
About 10 minutes after the injection, the dog vomited up
the contents of its stomach, and became paralyzed, lying on its
side with its head drawn back, apparently avoiding the light.
It sometimes endeavoured to rise up, but each time fell down
again when half risen.
When at 250 minutes after the injection its breathiug was
reduced to 15 respirations per minute, I gave it a hypodermic
injection of morph, sulph. grs. v. Its breathiug was then imme¬
diately restored, and soon became as fast as before. But at
the end of two hours after the injection of the morphia sul¬
phate, the dog’s breathing again began to fail, and was restored
by a second injection of the morphia salt. Begular breathing
continued only for a short time, when it again began to fail,
making another injection of the salt necessary. This fluctua¬
tion in the breathing occurred very frequently, and was only
counteracted each time, by the employment of the morphia
sulphate. The aggregate of morphia injected, in this manner,
amounted to grs. xv. The dog finally recovered; the only
noticeable effect, left by the poison in 12 hours after, being
slight paralysis of the hind legs, which however disappeared
in the course of 24 hours more.
The proportion of the morphia salt to that of the atropia
used in this experiment, was as three to one, while that recom¬
mended by all experimenters is five to one. But perhaps the
fact that such a small amount of the antidote sufficed in
this case, may be accounted for by the economical manner of
using it, it not having been given until the breathing had
almost or entirely ceased.
9th EXPERIMENT.
In a large dog, the same upon which I performed the 4th
1110 Original Communications. [June
experiment, I injected atropia sulpli. grs. vii ss in 16 doses, at
intervals, in the space of two hours and a half.
Before 1st inject, pulse was 80. temp 100.8. resp. 92
5
min after 1st
a
it
a
74
ll
not taken
it
42 “
3
n
a
3rd
a
u
too fast to count
u
n
u
ii
96 “
2
it
a
4th
u
ii
u
n
u
u
a
ll
u
ii
106 “
2
u
a
11th
a
u
ii
u
a
u
a
ll
a
ii
130 “
2
it
u
12th
a
u
u
ft
u
u '
u
a
n
u
180 “
5
a
u
<(
it
n
a
n
ii
u
u
u
it
ii
174 “
10
a
■ u
U
ii
u
u
a
u
a
n
not taken
a
174 “
20
a
a
u
a
ii
n
li
ii
u
it
101
a
158 “
5
u
u
13th
a
it
it
ii
ii
il
ii
not taken
it
178 “
10
a
it
14th
it
ii
n
il
ii
i<
n
ii
ll
ii
150 “
5
u
u
15th
ii
u
ii
n
a
n
n
it
ll
ii
124 “
5
a
ll
16th
ii
u
u
a
(c
n
u
100.6,
ii
84 “
15
a
i*
a
u
ii
u
u
u
ii
u
not taken,
a
64 “
20
a
a
a
ii
it
u
ll
it
ll
u
u
a
ii
58 “
25
a
a
a
ii
u
it
u
it
il
ii
ii
u
ii
28 “
30
it
it
a
ii
n
u
it
ti
il
u
100.7,
ti
22 “
40
a
u
it
n
ii
n
n
u
ll
u
not taken,
n
16 “
55
(C
u
u
u
ii
n
it
it
n
ii
(<
ii
12 “
In this experiment it was remarkable that the large amount
of atropia administered, produced less striking effects than
was produced one week before on the same animal by a dose of
gr. j of the sulph. atropia. The respiration and pulse rate in
this ninth experiment seem to have been of ell other functions
affected by the drug. The dog was surely excited, but could
walk, and pressure on its back, though slight, caused it to fall.
It also urinated frequently, and it is hardly necessary to say
that its pupils were so dilated as to produce for the time being
perfect blindness. This manifestation of toxemia lasted only
for a few hours, when the dog had completely recovered with¬
out the benefit of any antidote.
10th EXPERIMENT.
On the same dog on which I performed the eighth experi¬
ment. The interval between the eighth and tenth experiments
was six days.
1880] Jones — Physiological Action of Atropia, 1111
My object in this experiment was to prove* the antidotal
effect of the inorplia as used in experiment eighth, by killing
the dog with the same quantity of the poison employed in that
experiment.
Before injection resp. 36, pulse 90 X. temp. 100°
5 minutes after
it
o'
“ 136,
not taken
15
<<
it
ti
not taken,
not taken,
99.8
5
u
<t
2d
it
154,
not taken,
not taken
15
it
(t
ii
tt
not taken,
174,
not taken
10
u
ii
10th
<t
too fast to couut, 85,
99.8°
30
u
it
it
t<
too fast to count, 114,
not taken
44
<t
it
it
it
144,
138,
not taken
55
u
ii
it
ii
90,
not taken,
99.80
60
it
ii
it
it
54,
120,
not taken
65
it
it
it
it
126,
138,
not taken
75
tt
ii
tt
ti
not taken,
138,
not taken
80
u
ii
it
tt
22,
not taken,
not taken
90
it
it
it
ti
not taken,
150,
not taken
95
it
<1
it
tt
26,
120,
not taken
This animal was, with the exception of its pulse rate and
breathing, very little affected by the poison. Only temporary
blindness was produced, no antidote was given, and yet the
animal recovered completely.
llth EXPERIMENT.
On a toad, I injected subcutaneously the | of a grain of
sulph. atropia, corresponding to the one thousandth part of the
animal’s weight. This injection, having escaped through the
hole in the skiu, left by the needle of the syringe, ou its having
been too hastily withdrawn, dilation of the pupil and accelera¬
tion of breathing were consequently the only effects noticable.
1, therefore, after the lapse of half an hour, gave another hy¬
podermic injection of atropia sulph., gr. £. In the course of an
hour paralysis became developed, which after a lapse of 30
minutes had grown complete, and remained so for fully 12
hours. At the end of this time the animal showed symptoms
of gradual recovery, by dragging its hind legs after it, then
leaping for the space of an inch, till at the end of 24 hours the
1112 Original Communications. [June
animal had recovered completely. At no time before or after
the paralysis was there any convulsive movements perceptible,
nor could I discover after careful and repeated examination
any dryness of the mouth and throat.
12th EXPERIMENT.
I opened a toad’s abdominal and thoracic cavites, and after
taking careful cognizance of the respiration, cardiac pulsations
and persistalic movements of the intestines, I injected subcu¬
taneously a solution of sulph. atropia, corresponding to one
thousandth of the animal’s weight. I could not record the
effect of the alkaloid on the toad’s temperature. But the fol¬
lowing table will show the variation in the cardiac pulsation,
for an hour after the injection :
1 minute before injection, cardiac pulsation 126. per min.
10
a
after
a
a
a
106.
a
15
a
a
a
a
a
72.
a
23
a
a
a
a
a
72.
a
33
a
a
a
it
a
78.
n
42
a
a
a
a
a
68.
a
55
a
a
a
a
a
55.
it
60
a
a
a
a
a
60.
a
The breathing could not be recorded on account its having
become almost imperceptible. Peristaltic movements increased
in frequency to a very striking degree for 5 minutes after the
injection. But then they began to diminish, and in 3 minutes
time ceased to be perceptible. The animal died in seven hours,
death being the consequence of the operation.
13th EXPERIMENT.
On a toad, I opened the abdominal and thoracic cavities, the
same as in the previous experiment. Here the luugs protruded
and the abdominal and thoracic viscera became exposed. But
after 5 minutes the lungs retired within the chest as if drawn
there by suction force. I then gave a hypodermic injection of
the one-thousaudth part of the little animal’s weight. Here,
too, the respirations could not be counted with any degree of
accuracy, at first on account of its great rapidity, and its sud¬
den cessation after some time. Neither could I record the ani
1880] Jones — Physiological Action of Atropia. 1113
mal’s temperature for the same reason, which I inadvertently
omitted to state in the relation of the previous experiment, viz ;
the want of a proper thermometer.
The following table will show the variations in the number of
cardiac pulsations per minute, for 425 minutes after the injec¬
tion :
2
minutes
before
injection, cardiac
pulsations,
118
1
t<
after
tt
it
tt
110
6
tt
<i
tt
tt
108
13
tt
u
tt
tt
tt
98
15
u
tt
tt
tt
t.
82
26
u
tt
tt
tt
.t
96
30
44
tt
it
tt
tt
72
40
44
it
<t
tt
ti
50
55
44
it
tt
tt
tt
56
425
*4
it
tt
tt
<t
42
14th EXPERIMENT.
On a toad, I opened the thoracic cavity and injected a con¬
centrated solution of the sulph. atropia directly on the animal’s
heart.
I regret very much that the notes which I took down in this
experiment were accidently destroyed. But immediately after
the contact of poison with the heart muscle, the number of
cardiac pulsations was diminished more than one-half. They
continued at this rate for seven minutes, when they became
more frequent, and in fifteen minutes after the injection the
number of heart-beats was the one-half of what it had been
previously. After about fifteen more minutes, the heart began
again to beat slowly, and continued doing so till the animal’s
death, which occurred in a few hours afterwards.
RESUME.
Having thus indifferently described these few experiments, I
will uow endeavor to briefly summarize the results and the con¬
clusion arrived at regarding the action of atropia on the sys¬
tem in general, and its special influence on particular organs
and their functions.
^114 Original Communications. [June
GENERAL ACTION.
The most prominent and indisputable effect of atropia, and
which perhaps was the cause of its first introduction into the
materia rnedica, is dilatation of the pupil, and as a consequence
disorder of vision. Next in time and prominence is dryness of
the mouth and throat together with acceleration of the blood-
circulation, as manifested in the increased frequency and rapid¬
ity of the cardiac pulsations and frequent respirations.
Expulsion of urine almost invariably follows with subsequent
retention of this excretion. Many observers assert that erec¬
tion of the penis in the male always occurs as soon as the
poison becomes absorbed by the system ; and I, from my own
observation in experiment 4th can confirm this assertion of
others. A staggering gait is also noticable a short time after
the administration of the alkaloid, provided a large dose has
been given. Many authors also speak of a u peculiar, talkative,
wakeful delirium,” but in no instance of any of my repeated
experiments have I been able to detect the manifestation of
any symptom which would lead me to suppose the animal was
delirious. “ Death is usually preceded by a failure of the
heart’s action and of the respiratory forces ; in most cases it is
brought about by asphyria.” In performing experiment 9th I
was not a little astonished to notice how very slight was the
influence of the atropia on the dog, administered hypodermi¬
cally in the quantity of grs. viss. and this the more, since the
same animal, in my 4th experiment, was almost overwhelmed
by the poisonous power of gr. i. of the drug. The same pecu¬
liarity attracted my attention in my 10th experiment. In this
instance I performed the experiment on the same animal upon
which I had performed the 8th experiment. While in the 8th
experiment the dog under the influence of a hypodermic injec¬
tion of atropia sulph. grs. v. showed all the symptoms of toxemia
in a most aggravated form, indicating a speedily fatal issue ;
so that, in order to prevent the threatened death of the dog, I
was obliged to resort to a hypodermic injection of inorphise
sulphatis. Yet the same animal 6 days later, under the influ¬
ence of the same quantity of the alkaloid, showed such good
humour and fearless stoicism to the drug, that with the excep-
1880] Jones — Physiological Action of Atropia. 1113
tionofthe dilation of the pupils and fluctuation in frequency of
the respiration, and heart- beats, no manifestation of the deadly
nightshade’s power was visible. I am therefore compelled to
deduct from these observations of mine that the first adminis¬
tration of atropia to the dogs habituated them sufficiently to its
action and rendered the animals insusceptible to its subsequent
poisonous influence. Though I own that it must appear proble¬
matic that one dose could produce such an impression on the ani¬
mal’s system, as to render it insusceptible to the action of the
drug after 6-7 days. This would perhaps appear unprecedented,
yet with all the pains taken to And another solution of the
problem, 1 was unable to do so, and am compelled to fall
back for an explanation of this otherwise unaccountable
phenomenon to the deduction alluded to above.
Prof. Bloebaum, the most prominent perhaps of all experi
menters with atropia, also relates a similar observation of his
own, with regard to the greatly diminished action of this alka¬
loid on a dog when administered a second time. This eminent
experimenter went so far as to inject a large dose of the poison
into the jugular vein of a dog, having a few days previously
given the same dog a subcutaneous injection of the drug,
From the large quantity injected and from its having been
thrown into the jugular vein the Professor thought himself jus¬
tified in expecting the speedy death of the animal, yet notwith¬
standing all this the dog not only remained alive, but even
seemed to be scarcely at all affected by the poison. Prof.
Bloebaum then drew the conclusion that dogs are especially
insusceptible to the action of atropia. But can I accept this
conclusion, while my own observations convince me to the con¬
trary, that even a small quantity of the alkaloid is sufficient to
produce alarming symptoms in the dog ! With all due respect
therefore to such an eminent authority, as Prof. Bloebaum cer¬
tainly is, I cannot without doiug violence to my own conviction,
but rufute his theory and maintain my own explanation as
given above, to account for the diminished action of atropia
when employed on the same animal a second time.
Whether this law holds good of other animals and man, I
6
Original Communications.
1116
[June
am at present unable to state, but hope to ascertain at no dis¬
tant day, by further experiments.
THE ACTION OF ATROPIA ON THE NERVOUS SYSTEM.
There can scarcely be a doubt that atropia, when given in
sufficient quantity acts as a paralyzant, first, on the efferent or
motor nerve, and secondly, and to a less extent on the afferent
or sensitive nerves. The experiments 4, 6 and 7, which I
undertook with a special view of testing the action of atropia
on the nervous system, gave but negative results.
The failure in these experiments can be in great part ac¬
counted for by remembering the physiological law, before men¬
tioned, that, “ if the artery supplying a muscle or set of
muscles be tied their contractile power is destroyed.” In the
4th experiment, for the reason above given, the result was
only partial and incomplete, while in the 6th experiment the
animal died before any observation could have been made.
I think it most probable, that, the artery which I ligated in my
7th experiment carried the circulation to the extremity by one
of its branches higher up and this may account for the fact
that the limb was still capable of a certain amount of vigorous
motion after ligation of the artery. Botkin in his experi¬
ments with this alkaloid on the frog, having previously ligated
the artery of one leg, injected subcutaneously a solution
of atropia, and found that though the action of the poison
manifested itself on the leg with its circulation free by paraly¬
zing it, yet the leg whose artery had been tied escaped the
influence of the drug, retaining its full power of motion, and its
capacity of responding to galvanic or other stimuli. He also
found that, although, at first, irritation of the leg with its cir¬
culation unobstructed would cause movements in the opposite
limb with its circulation cut off, yet after some time no response
would be given to the irritation, unless it were directly applied
to the non-poisoned extremity. Results in accordance were
obtained by other able and distinguished experimenters, and
reading over the relation of my experiments, it will be seen
that one of them is corroborative of those of Botkin. They cer¬
tainly indicate that though the primary and most marked effect
1880] Jones — Physiological Action of Atropia. 1117
of the poison is on the motor nerves, yet that after some time
the sensitive nerves are also effected.
Dr. Fraezer, of Edinborough, found in his experiments on
the frog, that hypodermic injection of one part of the drug
to the one thousand of the animal, is sufficient to produce
complete paralysis, lasting for two or four days, succeeded
by tetanus or convulsions. In my own experiments, while
noticing the prompt development of paralysis, I failed to
notice anything like tetanus or convulsions. Yet I must
admit that the negative results, thus obtained, are by no
means sufficient to disprove those obtained by Fraezer and
corroborated by Lemattre. Besides this, although as stated
above, I did not at any time see convulsions iu the toad result¬
ing from the action of the poison, yet I have seen them of the
most violent tetanic character caused by it iu the case of the
cat in experiment 7th.
Dr. Fraezer further asserts, that when the spinal cord is cut
high up in the neck in an animal, under the influence of
atropia, convulsions continue, and that when access of the
poison to the sciatic nerve is prevented by ligating the crural
artery, the leg is in a state of tetanus, while the rest of the
body is paralyzed. It is therefore evident, that atropia acts as
a direct stimulant to the spinal cord.
THE ACTION OF ATROPIA ON THE CIRCULATION.
The first evidence of the action of atropia on the circulation
is a slight diminution in the number of cardiac pulsations, soon
followed by au increase of the same. Injectiug the alkaloid
directly into the carotid artery, there is an u instantaneous fall
in the rate of the heart’s pulsation.” The only reasonable in¬
ference to be drawn from these phenomena, is that by injectiug
the poison subcutaneously, or into the jugular vein, there, it
paralyzes the vagus nerve, while by injecting it into the caro¬
tid artery it is ftrst brought to the cardiac inhibitory centres,
and directly stimulates them. This inference is strenghtened
by the fact, experimentally determined by Bezold, Bloebaum
and others, that section of the vagi nerves in animals fully
under the influence of the drug, is not followed by any in¬
crease in the number of the heart’s pulsations.
1118
Original Communications.
[June
Many authors maintain that paralysis of the vagus nerve is
not the sole cause of the increase of the cardiac pulsations, since
in Lemattre’s experiments the administration of atropia still
caused an increase in the number of the heart’s pul¬
sations after section of the vagi. But looking over the
minute details of a series of experiments by Prof. Bloebaum, I
find that he obtained directly opposite results to those of
Leinattre, and I therefore conclude that the question of its
directly stimulating the cardiac accelator nerves, or nerve
centres must still be considered as subjudice.
Botkin states that when atropia is directly applied to the
heart, “ it causes a great decrease and final arrest of its action.”
This 1 found to be true in my own experiment (14). From this
we may reasonably infer that on the heart itself atropia has a
direct depresant elfect.
Dr. Wharton Jones, of England, found that atropia ap¬
plied locally causes contraction of the capillaries, though
this is asserted by Dr. Hayden, of Dublin, to be a mere reflex
effect, resulting from the irritant action of the atropia ; yet most
experimenters, among whom we find no less authorities than
Bezold, Bloebaum and H. C. Wood, confirm Jones’ experiment,
and his explanation of it. The cause of this action of the drug
is undoubtedly attributable to its influence over the vasa motor
centres, since the contraclion of the capillaries did not take
place by applying atropia to the frog’s web when the vaso
motor nerves were separated from their centres, by division of
the cord high up in the neck. Judging from the evidence of
many experimentors, we may take it for granted that small
doses of atropia produce an increase and large doses a diminu¬
tion of blood pressure within the arteries. The cause of this is
not yet settled.
ACTION OF ATROPIA ON THE PUPIL.
Although the action of atropia in dilating the pupil, has been
the first recognized and is the most indisputable symptom, yet
as to the reason for this action physiologists are by no means
in accord with one another. The most prominent of these the¬
ories are that dilation is produced either, 1st, by paralyzing the
circular fibres of the iris ; 2d, by stimulating the radiating
1880] Jones — Physiological Action of Atropia. 1119
fibres ; 3d, by producing these two antagonistic effects on both
sets of fibres, and 4th, by acting on the nerves which supply
these parts. Though it can not so far be clearly demonstrated
which of these theories is correct, yet it is reasonable to accept
the fourth as most likely correct, since it seems to be incom¬
prehensible how the poison should act on the one set of fibres
and not at all on the other, or act upon the two sets of fibres
in a directly opposite way, while both sets have the same ana¬
tomical composition, viz : unstripped muscular tissue. Dogiell
applied electricity to oculo motor nerves without auy effect on
the pupil being produced ; yet, immediate dilatation followed
each application to the iris. Claude, Bernard and Lemattre
found that mydriasis still occurs after section of the oculo mo¬
tor, and Vierordt and others found that it still occurs after the
removal of the ciliary ganglion. This tends to show that the
poison exerts its influence externally to the ciliary ganglion
and it is most likely to be a paralysis of the peripheral ends
of the oculo-motor.
It is asserted that the aquerous humours taken from an eye
under the influence of atropia, when dropped into another eye
produces dilatation of the pupil, yet in one of my own experi¬
ments this proved not to be the case.
ACTION OF ATROPIA ON THE RESPIRATION.
All experimenters agree that a small dose of the alkaloid pro¬
duces a slowness of the breathing, while large doses cause in¬
crease in its frequency. This is well demonstrated in uearly all
of my experiments before related. It is most likely that this
increase in the frequency of the breathing is due to a direct
stimulation of the respiratory centres in the medulla oblougata,
since it occurs after division ot the pneumogastrics, previous to
administration of atropia. It is also likely that the peripheral
ends of the pneumogastrics are affected, since their division in
the animal, fully under the influence of atropia, is not followed
by any marked change in the respirations.
ACTION ON THE MOUTH AND FAUCES,
The action of atropia in producing dryness of the mouth and
fauces, is the first of its virtues, with which we became ac¬
quainted, which has been demonstrated by all experimenters,
1120 Original Communications. [June
and which I have also seen. The reason for this action is prob¬
ably to be found in supposing that the atropia influences the
nerves leading to these glands in some manner as yet unknown
so as to prevent their secretion.
ACTION ON THE INTESTINAL CANAL.
As to this, different authors differ materially; for while some
report having found the intestines in a state of marked seda¬
tion, as a consequence of the action of atropia, others again
assert that they have seen the intestines undergoing violent
contractions after the administration of the drug. But my own
observations prompt me to reconcile both of these diverging
statements, for in my own experiments, though the intestinal
movements increased at first for a short time, yet they again
began to diminish, and continued diminishing until no peristal¬
tic movement was perceptible. The cause of this phenomenon
I am inclined to think is that the alkaloid, first paralyzing the
splanchnics which are the inhibitory nerves of the intestines,
brings about an increase of the peristaltic movements, and
afterwards acting in the same manner on the muscular fibres
causes a state of perfect sedation.
ACTION ON THE VOLUNTARY MUSCLES.
Though it is undoubtedly a fact that in full therapeutic or ordi¬
nary toxic doses, this alkaloid has but a very slight, if any,
effect on contractility, yet it is proved by many experimenters
that when the muscle is immersed in a concentrated solution of
the drug, it becomes incapable of any contraction, even when
a powerful galvanic stimulus is applied to it. It is therefore
evident that it has some, though a very slight paralyzing
influence on the voluntary muscles.
THERAPEUTICAL APPLICATION.
Never having had any opportunity to study the therapeutical
application of this drug, with the care and diligence that would
be necessary to enable me to speak of it with some degree of
assurance, I prefer to pass over this part, important though it
be, in silence. Only one thing in connection with the thera¬
peutics of atropia do I beg leave to mention here: its autedotal
effect to opium. In many of my experiments related above
1880J Trueheart — Planter-Bandage Sato. 1121
aud especially in experiment 8th, I noticed the strong antago¬
nistic action existing between these two drugs, aud how the
breathing of the animal that was almost extiuct under the
influence of atropia was repeatedly restored by a hypodermic
injection of morphiae sulphatis.
Plaster-Bandage Saw.
By C. W. TRUEHEART, M. D., Galveston.
With this instrument, plaster of Paris bandages of the limbs
or trunk, can be rapidly and smoothly cut through (on opposite
aspects of the bandaged part) and removed without risk to the
patient. If desirable, the parts beneath can be thoroughly
inspected by removing the one-half of the divided bandage at
a time, while the other half is retained in position to prevent
displacement of the fracture, or other abnormity under treat¬
ment. The same bandage, having been coated with impervious
varnish, can then be re-applied and held in situ, without im¬
pairment of its efficiency, by simply splicing the cut-edged
(E. E. fig. I) at several
points with strips of
tin (T) 1 to 2 inches
wide by 3 to 6 inches
long, (according to
strength required) the
tin being roughened
like a nut-meg grater
by numerous small
holes punched from
either side alternately,
the two halves of the
bandage being held
together by a few
turns of starch band¬
age, adhesive plaster
or plaster bandage
thrown around over
the tin strips. By the
1122
Original Communications.
[June
substitution of small strap hinges for the tin strips on one side,
the bandage can be arranged to open like the lids of a book.
Fenestrae can also be cut out by means of the small curve on
the back or with the heel. of the saw.
The blade of the saw is 18 inches long by 4 inches wide. Fig.
II, which is a diagrainatic representation, serves to illustrate
the points of the instrument. The curved contour of the cut¬
ting edge renders it easy to saw ou extended flat surfaces or
even on concave surfaces. The addition of the sharp knife
teeth (K), which are about 2l4 of an in. longer than the inter¬
posed saw teeth, greatly facilitates severance of the roller ban¬
dage stuff combined in the plaster bandage. These knife teeth
(16 in number) are /6 of an inch in length at the base, £ of an
inch in height and set so as to make cuts in the plaster a little
to the outside, to the right and left of the cut made by the saw
teeth. The saw teeth are isosceles shaped, 12 to the inch
(measured from poiut to point).
The backbone (B) lends stiffness to the saw. The transverse
bolt (P) serves as a subsidiary handle for the left hand when
sawing with the small back or end curve of the saw.
The depth to which the saw cuts is regulated by the guage
(Gr), which is fixed by the thumbscrews (S S). The blunt end
of the spatula hook (Et), which is sheathed in the wooded han¬
dle, serves as a sound to determine if the bandage is cut
through at all points. The sharpened concave edge of the
hook is useful to sever any shreds of roller bandage that inter¬
fere with the halves of the bandage.
I have used this instrument for several years and having
found it to answer the purpose better than any other instru¬
ment proposed, I venture to call the attention of the profession
thereto.
/
1880J
Current Medical Literature.
1123
F
URRENT
EDICAL
ITERATURE,
THE BENZOATE OF SODA IN PHTHISIS.
It will be remembered, that the attention of the medical pro¬
fession was aroused in September, last year, by an announce¬
ment that phthisis pul monads in all its different stages could
be cured by the very simple remedy, benzoate of soda, used in
the shape of inhalations. In the first communication fifteen
cases were mentioned, some of them with cavities as large as a
fist, which had been cured in this manner in a remarkably
short time. The curative effect was attributed to the faculty
of the salt in killing the parasitic organisms in the lungs, sup¬
posed to be the origin of the disease. The announcement of
these marvelous cures sounded very incredible but was sus¬
tained by Kokitansky in Innsbruck.
Drasche (Wiener med. Wochenschrift) has tried the use of
benzoate of soda, and publishes his results with it in twenty
cases of phthisis. The ages of the patients were between 19
and 54 years, and they represented all the different stages of
the disease ; four of them were suffering from limited catarrh
in the apex of the lungs, 12 from more or less large solidi-
fications, and in 4, cavities were developed. Amoug the patients
7 had had haemoptysis, 4 had only seen streaks of blood in their
expectorate. At the time when the treatment commenced, 9
were without fever, 11 had fever ranging between 99 and 104°
F. One of the patients continued to use the inhalatious for
50 days, finally using 10 drachms a day, and consumed in all
32 ounces of benzoate of soda ; 6 of the patients used only 2£
drachms a day. The method is rather fatiguing and trouble¬
some and necessitates frequent interruptions ; in 2 patients there
appeared pleuritis ; 10 more had to discontinue the treatment
on account of more or less dangerous symptoms. Very often
the inhalations produced oppression, even symptoms of
suffocation; at the same time the cough increased, and con¬
tinued day and night. Dizziness, fear, headache, vomiting and
hiccup, were quite frequent symptoms. Often the patients
complained of pains in the maxillar joints after the long-last¬
ing seances and as a general thing the process was disagreeable
to them and they were glad to stop the treatment.
Of the 20 patients treated in this way 6 died, 3 were in the
last stage of the disease when this report was written, 5 were
discharged in a somewhat improved condition, while the con¬
dition of the 6 remaining still in the hospital was worse, or
very little changed. From this we may positively conclude
that the treatment possesses no specific curative effect on
phthisis; we shall now show the influence this treatment has
upon the symptoms constituting the phthisical process :
6
1124 Current Medical Literature. [June
In the first place there is nearly always noticed an increase
of the cough and expectoration during the inhalations $ this is
due partially to the deeper inspirations, partially to the free
benzoic acid, which is suspended in the steam ; this acid irri¬
tates the mucous membrane of the bronchi, and renders the
secretion more liquid aud easier to expectorate. Often oppres¬
sion appears, especially in patients with emphysema, compli¬
cating the phthisical process. At times it is also noticed that
the patients cough and spit less after the inhalations, but such
improvement is only of short duration, and may also be noticed
by the inhalation of steam alone.
As the fever is of great importance in the development of
the phthisical process, a remedy, which possesses curative
effect on this disease, must necessarily also show its influence
on the accompanying fever. Of the 9 patients who were with¬
out fever at the beginning of the treatment, 5 got fever with a
temperature as high as 102.9° F. after having used^the inhala¬
tions for several weeks, while on the other hand 2 patients
previously with fever, got rid of the same during the treatment.
In the 9 other patients the fever presented itself during the
treatment in a very different way, being sometimes slight, at
other times strong, in some patients continuous, in others
intermittent, with a temperature as high as 104.3, and the
variations in the intensity of the fever could not be brought in
any relation to the length of time the patients were treated,
nor to the quantity of the consumed benzoate of soda. At any
rate the observations demonstrated clearly that the inhalations
of the salt showed no influence whatsoever on the fever in the
consumptive patients, who were submitted to this treatment.
The weight, which is always influenced by the development
of consumption and by the intensity of the fever, decreased
materially in the patients while using the benzoate, showing
that this method is not capable of checking the progress of the
disease.
Corresponding with this are also the observations in the
stethoscopic changes during the treatment. Of the ten pa¬
tients who used the inhalations for some length of time, two
were suffering from incipient consumption, seven had more or
less large solidificatious, and in one a cavity had already
formed. In the two first mentioned, only slight dullness and
scarce rattling was to be found in the apex of the lungs at the
beginning of the treatment $ after the use of the inhalations, in
six or seven weeks, the rattling sounds were more numerous,
more extended aud had become more sonorous. Still more
clearly was the progress of the phthisical process demonstrated
in the patients presenting solidificatious at the beginning ; the
solidification became more complete, or extended to formerly not
attacked parts, or cavities commenced to be formed . When
cavities existed at the beginning, these increased in size.
The result of the observations shows that the inhalations of
1880] Current Medical Literature. 1125
benzoate of soda has no influence on phthisis. It is quite
characteristic to see the phthisical process developed step by
step in patients who at the beginning of the treatment pre¬
sented nothing abnormous in their vocal chords and the mu¬
cous membrane of the larynx; these parts are easily and
directly irrigated by the solution of benzoate of soda, and yet
we see them in the beginning turn red, later they swell and
become rugged and finally present ulcerations of a progressive
tubercular character.
The astonishing success obtained by Rokitansky in Inns¬
bruck, in treating phthisis with inhalations of a solution of
benzoate of soda, induced Guttman to test the efficacy of the
remedy ; 3 of the 15 reported cases from Iunsbruck,
were said to be almost in a dying condition when the treat¬
ment was instituted and were discharged entirely cured ; 2
of the patients were free from fever in a week already and the
3rd one in ten days ; at the same time their weight increased
rapidly.
Encouraged by these experiences Guttman selected for his
experiments advanced cases of phthisis, and supposes that a
treatment of three weeks duration must be sufficient to formau
opinion about its value. The experiments with benzoate ot
soda were- tried on 31 persons, their ages ranging from
17 to 56 years. In the majority of these the disease was far
advanced ; especially were such patients selected who showed
a decidedly hectic type, low temperature in the morning, high
temperature at night, or such who showed a certain uniformity
in their temperature, presuming that the benzoate of soda,
under such circumstances, had the best chance to show its
efficacy.
Fifteen of the thirty-one patients used the treatment for
three weeks, the others for a shorter period. Out of the whole
number 9 died, 2 requested to be discharged, the rest re¬
mained yet in the hospital.
i'lot in a single case, not even in the patients who daily
inhaled 2 pounds of the solution (solution containing 5 per
cent of benzoate of soda) was the temperature reduced to the
smallest extent; neither when the remedy was given internally
at a dose of 2 drachms a day.
On the weight the remedy did not show any influence, in
most of the patients there was noticed a progressive decrease
in weight, in the same way as before they were using the
inhalations. As a matter of course, neither fever nor weight
being influenced by the benzoate of soda, the local — stetlios-
copic — conditions remained unchanged.
According to Guttman7s experiments not a single symptom in
phthisis was improved. At times the inhalations produced
nausea and vomiting; 2 jiatients got haemoptysis, which possi¬
bly might have been caused by the fatiguing process, as they
had not had any haemoptysis for a long time previously. .
1120
Current Medical Literature.
| June
These being the results of experiments pursued for 3 weeks,
it is difficult to understand how the opposite results have been
obtained in Innsbruck. According to the above, Guttman is
satisfied that benzoate of soda is entirely inefficacious in phthi¬
sis. — ( Berliner Idinische Wochenschrift).
OXALATE OF CERIUM AS A COUGH REMEDY,
[Medical Record .]
Dr. Andrew H. Smith, chairman of the Committee on Re¬
storatives, New York Therapeutical Society, at the meeting held
April 9th, 1880, reported cases illustrating the different degrees
of success obtained in the use of the oxalate of cerium in the
treatment of cough. The report was based upon eighty-four
cases furnished by reliable observers.
Dr. Cheesman, had used the remedy in hospital practice from
July 1st to November 1st, 1879, allowing it to take the place of
all sedatives, including opium, in the daily average of phthisis
patients. It was uniformly administered in the form of dry
powder, and notes were taken iu 69 trials. In 39, marked
relief followed ; in 19, the cough was moderately relieved, and
in 11 no relief whatsoever was afforded. The 11 cases where
the remedy was inefficient, 9 were in the third stages of the
disease, and in 8 the Philadelphia preparation was used. In
all the cases where the cough was relieved Merck’s oxalate of
cerium was used. The drug was given, as a rule, two or three
weeks, and often intermitted to test its efficacy. Five grains
were given on waking in the morning and at bed time as the
average dose ; occasionally a dose of five grains in the middle of
the day was given with marked benefit. Dr. George Bayles
also reported his observations ; in addition to the benefit derived
in phthisical patients lie had experienced benefit from its use
iu whooping-cough. It produced no bad effects on the
stomach.
The conclusiDns reached by the committee were the follow¬
ing:
1. Oxalate of cirium could be safely administered in doses of
10 grains, three times a day, for many days in succession.
2. The only unpleasant symptom, when so used, was slight
dryness of the mouth that appeared after several days.
3. It was probably the most efficient when administered dry
on the tongue.
4. Its effects were not produced until two or three days after
its use was begun, and lasted two or three days after the rem¬
edy was discontinued.
5. It was most efficacious in the treatment of chronic cough,
and the initial dose should be 5 grains.
6. In the majority of cases it had not proved an efficient
cough medicine for any considerable length of time, but could
be regarded as a valuable agent to be employed iu alteration
with other remedies. .
Current Medical Literature.
1127
1880]
7. It did not disturb the stomach; on the contrary, it relieved
nausea and improved digestion.
8. Different preparations upon the market were not equal in
value; and when success was not obtained by one, another
should be substituted.
HYDROBROMIC ETHER.
Dr. Lawreuce Turnbull, in The Medical and Surgical Reporter,
contributes a very thorough article on the new anaesthetic.
The following conclusions are arrived at.
1. That liydrobromic ether is an anaesthetic which, with
care, may safely be administered to man and auimals.
2. That hydrobromic ether is more rapid in producing
anaesthesia than even chloroform, and is eliminated, by respi¬
ration and the kidneys, more rapidly than any other of this class
of agents.
3. That the heart and respiration are but very slightly
affected unless employed in excessive quantities.
4. Vomiting is more rare than with ether or chloroform.
5. That owing to its Oder being more rapidly removed, it
can be used with comfort in a private office or the patient’s
chamber ; and as a rule, the odor is more agreeable than that
of ordinary ether.
6. Hydrobromic ether not being inflammable, and produc¬
ing its anaesthetic influence on the muscles of the throat, any
operation can be performed on the mouth and throat with satis¬
faction to the surgeon and comfort to the patient.
7. In vivisections it acts more promptly than ether upon
auimals, requiring, as a rule, only two minutes to bring a dog
under its influence, and is not fatal, like chloroform.
How often was there nausea or vomiting during the use of
hydrobromic ether ? In one hundred cases there were twelve
cases of slight nausea after the operation, and eight cases of
vomiting during the operation, but always when the patient
had partaken freely of food of a solid character just prior to the
use of the amesthetic.
Asphyxia. This disagreeable and painful symptom was not
noticed in any of the cases.
Fainting. In no instance was there any evidence of fainting.
Hysterical excitement. This was noticed in some six cases,
but soon passed away, leaving no bad symptoms.
Prostration. In four cases was there some prostration,
evinced by cold moisture on the hands and face, but of very
short duration.
The rapidity with which patients come under the ancesthetic in¬
fluence of hydrobromic ether : Ten cases in one minute and a
half, twenty in two minutes, ten in two minutes and a half,
forty in three minutes, ten in four minutes, and ten in five
minutes.
1128
Current Medical Literature.
[June
How long did it take to recover consciousness from the effects of
hydrobromic ether ? In fifty cases from two miuutes to two
minutes and a half ; in thirty cases three minutes ; in twenty
cases four and a half to five minutes.
Struggling, coughing or gagging, which occurs so frequently
during etherization, was very rare under the anaesthetic influ¬
ence of hydrobromic ether. This form of anaesthetic is not apt
to produce headache. No giddiness attends the use of hydro¬
bromic ether.
BURNS AND SCALDS.
The Allgemeine Wiener Zeitung says one of the best but least
known agents is oil of peppermint. Applied by pencil or cloth
to the wound, it gives prompt ease from pain and leads to a
rapid cure without scars. This oil should always be kept on
hand. Previous to its application the burnt part may be kept
under water. It is sometimes advisable to dilute it one-half with
glycerine. In this form it is an excellent application to frozen
extremities. — Canadian Journal of Medical Sciences.
NOTES.
Keith, of Edinburgh, has performed ovariotomy seventy
times in succession without a fatal result, and oue hundred
times with only three deaths.
THE HYPODERMIC INJECTION OF QUININE IN PERNICIOUS
MALARIAL FEVER.
Translated by Dr. Ciiarlhs Faykt, Paris.
In answer to my special inquiries about the method in use
among Roman physicians, in the treatment of a case of per¬
nicious fever, by means of the hypodermic injections of quinine,
I received the following details from Dr. Gr. Petacci, physician
of the hospital of Zoccoletto in Rome, one of the physicians of
the late Pope Pius IX ; details which were of such interest and
value to myself, that it is with true pleasure I communicate
the same to my fellow practitioners of the South.
I translate from the Italian :
“When I am called to treat a case of pernicious fever by
means of the hypodermic injections of bi-sulphate of quinine, I
use a solution in the proportion of one to ten of distilled water,
without the addition of auv acid. The bi-sulphate dissolving,
as you well know, in distilled water. With this solution, con¬
secutive suppurations are not to be feared. As soon as the
pernicious attack begins to decline, 1 practice the injections,
using a solution of 2 grammes of bi-sulphate of quinine in 18
or 20 grammes of distilled water (40 grains of quinine bi-sul-
phate in 3yj water). If I am sure to have sufficient length ot
1880]
Current Medical Literature.
1129
time, I inject this solution at two different times more or less
distant, otherwise (as I always prefer), I inject at once the
whole solution above given. Moreover, if during the apyrexia
the patient can swallow, I add a few doses of sulphate of qui¬
nine by internal use ; if not, after a few hours’ interval I prac¬
tice other small injections, 60 centigrammes (12 grains) at a
time, for example. But. if I have no certain indications that
the first injection has been absorbed, or if the attack has
threatened narrowly the life of the patient, I repeat these in¬
jections in larger doses.
“ In order to avoid so many perforations of the skin, each
time I introduce the canula, I inject through it succes¬
sively three syringefuls, injecting slowly, not to produce too
much irritation and to render the absorption more easy.
“The regions I select are the gastric and epigastric; and
having a great number of perforations to make, I extend
the punctures all over the abdomen. It seems to me, that
in these regions, not only the absorption may be more easy,
but that, also are avoided so many inconveniences and se¬
rious consequences which, too often I have seen follow in
other parts.”
Dr. Petacci, writes that last autumn cases of pernicious fever
of the most varied forms were rife in Rome and neighboring
country. I believe Roman physicians use this term pernicious
fever more commonly than we do. If I understand aright, all
cases of malarial fever which terminate fatally in a short time,
all cases accompanied from the first, by uncommonly serious
symptoms, be they ataxic, algid, apoplectic, comatose, sopo¬
rose, congestive, haemorrhagic, choleric, dysenteric, pneumonic,
etc., receive the common appellation of pernicious, would
only be excepted cases in which the complication takes the
lead, such as pneumouia, etc., and deaths from malarial ca¬
chexia and its complications, diarrhoea, etc. etc.
In this letter of Doctor Petacci, I call special attention to
what seemed to me the extraordinary doses of quinine used
hypodermically and to the fact that these injections are not
followed in the experience of Dr. Petacci, by consecutive sup¬
purations or any other serious consequences, if the proper
solution of bi*sulphate is used and the gastric region selected.
Allow me to terminate with the motto, which the physician
should always bear in mind : “ Of two evils,” but “that’s the
question !”
TWO CASES OF POPLITEAL ANEURISM CURED BY ESMARCH’S
BANDAGE.
Mr. 0. Heath read this paper. The first patient was a coal¬
miner, aged 32, with a small popliteal aneurism. Flexion of
the knee having been tried without effect, Esmarch’s elastic
bandage was applied below the knee, and an elastic bandage
1130
Current Medical Literature.
| June
and cord above the knee, so that the sac was kept tense with
blood and pulseless. This was borne for one hour without
anaesthetics, and for two hours under the influence of bi-chlor¬
ide of ethylene, and at the end of the three hours the sac had
become solidified. The patient had been exhibited to the
Society at a previous meeting, and had now gone home to
Wales. The second patient was a potman, aged 37, with a
small popliteal aneurism, presumably tubular. Esmarch’s ban¬
dage was applied above and below the knee; but it was
noted that, though pulsation was arrested, the sac was not ren¬
dered so tense as in the former case. On removal, after three
hours, pulsation returned as strongly as before. Digital com¬
pression of the femoral was then maintained for three hours
witli marked effect, but without curing the aneurism. A
second application of Esmarch’s bandages rendering the sac
tense, and producing local ecchymosis, was successful in stop¬
ping the pulsation permanently. Mr. Heath laid stress upon
the importance of putting no pressure upon the aneurism itself,
and of keeping it tense with blood in order to induce coagula¬
tion of the contents of the sac. — British Medical Journal.
TREATMENT OF METRORRHAGIA BY INFUSION OF BLACK
COFFEE.
Dr. Despres ( Aheille Medicale) recommends the use of this
method, which he says has succeeded with him already in three
severe cases. The first was a case of a metrorrhagia follow¬
ing confinement, which had resisted all the ordinary methods.
The second was a case of metrorrhagia due to anaemia. It
had equally resisted all treatment. The third case was ob¬
served in a young woman, aged 26, subject to metrorrhagia,
recurring every fifteen days and lasting eight days at a time.
Rest in bed and cold compresses had not produced any result.
Despres gave from three to six cups of strong coffee daily.
Iu this dose it produced agitation, sleeplessness, sometimes
even a sort of intoxication. — London Medical Record.
NICKEL PLATING WITHOUT A BATTERY.
The Engineer publishes Prof. Slatba’s new unpatented pro¬
cess for nickel-plating in the wet way without the use of a
battery. To a dilute solution of chloride of zinc (5 to 10 per
cent.) enough nickel sulphate is to be added to impart a de¬
cidedly green color to it, and the solution is then to be heated
to boiling in a porcelain vessel. The clouding of the liquid
from the separation of the basic zinc salt need not be heeded
as it will not interfere with the effectiveness of the bath. The
articles to be nickel -plated are first freed from oxide or grease,
and then suspended in the solution from 30 to 60 minutes, the
bath being kept at a boiling temperature. When the articles
1880J
Current Medical Literature.
1131
are observed to be uniformly coated they may be removed,
washed in water, in which a little chalk is suspended, dried,
and finally polished with chalk or other suitable material. By
the substitution of a cobalt salt instead of nickel, objects may
be similarly coated with cobalt.
EXPERIMENTS UPON THE STRENGTH OF ANTISEPTICS.
By ARTHUR T. CABOT, M. D.,
Surgical antiseptic preparations may be divided into two
classes : (1) those which are meant to be actively destructive
to the lower organisms which cause putrefaction, and
(2) those which oppose the approach of these organisms
to wounded parts already aseptic. Among the first class
are to be counted the solutions for washing parts to be
operated on, for cleansing wounds already exposed to the air,
and for furnishing an antiseptic shower (spray) over wounds
during operation and exposure. The second class comprises
the gauze and cotton and the various oils and salves used to
protect wounds from the action of the septic orgauisms in the
air.
It is with the autiseptics of the first class, with the actively
destructive antiseptics, that this paper has to do. Prepara¬
tions of this class to be effective must act quickly. Whether
they be used to destroy the putrefactive germs in a wound
long exposed to the air, or those just settling out of the air
upon a fresh wound, they have but a short time during which
they can act with their full vigor, being in either case rapidly
diluted and neutralized by the blood and exudations from the
wounded surface.
The power of an antiseptic solution is usually tested by
immersing in it some putrescible substance,* or by adding it to
a sugar solution into which a ferment is also introduced! and
theu noticing its effect in hindering putrefaction and ferment¬
ation. These tests are defective in that they give us no idea
of the rapidity of action of the antiseptic. Further, the more
volatile antiseptics, which, on account perhaps of their vola¬
tility, are rapid in their action, after destroying the germs
existing in the fluids would escape, leaving the solution exposed
to the germs of the air, while those of less volatility and
slower action would offer a much longer protection and might
well be used in the protective preparations of the second class.
Another not uncommon test for an antiseptic is the observation
under a microscope of its power of arresting the movements of
the bacteria in a foul solution.! We have, however, no proof
that the activity of the bacteria is a measure of their power of
exciting putrefaction, and many quiet forms are capable of
* Billroth, Untersnchmigen ueber Coccobacteria septica, page ‘205.
t Dr. L. Lewin, Dae Thymol, ein Antisepticum und Autifermentativum, Virchow’s
Archiv, B. 56, S. 164.
| Billroth, loc. cit., page 210
7
1132 Giirrent Medical Literature .• [June
inducing fermentative changes. In endeavoring to apply this
test, too, I have found the active movements of the bacteria
checked by solutions so dilute that little or no destructive anti¬
septic action could be claimed for them.
Finally, the clinical trial of an antiseptic, though it will lead
finally to a tolerably correct appreciation of its worth, is a slow
and uncertain means of judging, involving as it does so many
varying conditions.
The method which has been used in the following tests avoids,
I think, the objections which may be made to all of these. It
is as follows : —
Ten cc. of the antiseptic to be tested are added to three cc. of
a foul solution. After a certain measured time, two drops of
the resulting mixture are transferred to an aseptic solution,
which is carefully protected from the air, put aside, and watch¬
ed for the first evidences of putrefaction. Suppose the putre¬
factive elements, be they bacteria or chemical ferments, have
preserved their vitality during this time of contact with the
antiseptic ; they are released from further antiseptic action
when these two drops mix with, and are diluted in, the aseptic
solution, and are then free to set up putrefactive changes in it.
If, therefore, putrefaction appears in the test solution, we know
that the antiseptic had not acted long enough upon the germs
of putrefaction to destroy them. We repeat the experiment
with a longer time of exposure, and so proceed till we reach the
time that proves sufficient for the destruction of the putrefac¬
tive elements, and we then find that the aseptic solution con¬
tinues clear and sweet. The sign of putrefaction which was
relied upon in these experiments was the appearance of cloudi¬
ness, due to the presence of micro-organisms, and their pre¬
sence or absence was always verified by the microscope.
I have prepared a table of these “ personal equations” of a
few of the better known antiseptics. Before giving it, however,
I will detail briefly the minutiae of the tests of which I have
described the general features and objects.
The aseptic solution is prepared by boiling several small pieces of meat
with a large quantity of water in a glass flask purified by exposure to
the flame of an alcohol lamp. This flask is stopped with a rubber cork
perforated by two glass tubes for convenience of decanting. The tubes
are bent downwards, and the ends are carefully protected with carbolized
gauze. The cork and tubes are carefully cleansed beforehand with car¬
bolic acid. The resulting solution, if made with lean meat, settles «lear ;
if the meat is fat, the solution is rendered cloudy by fine oil drops, and
must be*prepared again.
This solution when used is decanted into wine-glasses previously cleaned
by exposure to alcohol flame, and these are then covered with inverted
watch-glasses, and the whole by bell-glasses, all of which have likewise
been exposed to high heat.
The solution thus protected will keep for an indefinite length of time
without a sign of putrefaction.
It is into glasses thus prepared that the minute quantities of the mixed
antiseptic and foul solution are transferred, and in them tne minutest
changes in the fluid can be easily observed.
Current Medical Literature.
1333
1880]
To anticipate some of the objections which may be made as
to the accuracy of these experiments, I would say that I ex¬
pected to meet with great inconsistencies in my results, due to
the accidental entry of germs into my test glasses. Contrary,
however, to this expectation, my results were very uniform and
constant, although the experiments were distributed over a
space of two years. In each case the result obtained was
verified by several additional experiments.
Of the antiseptics examined the rapidity of action (“ personal
equation ”) was determined as follows : —
Acidi carbolici 1-20* .
Liquor sodas chlorinatas 1-10.
Acidi salicylici 1-240
Thymol 1-500 .
Thymol 1-1000.
Acidi carbolici 1-40
Potas. permang 1-960.
Zinci chloridi 1-12
Alum acetatist .
. 5 seconds.
.. 15 30 seconds.
. 3 minutes.
. 3 minutes.
. 4 minutes.
. 4 minutes.
over 6 minutes,
over 6 minutes,
over 6 minutes.
It will be seen by this table that carbolic acid in the strength
of one part to twenty of water is almost instantaneous in its
action. At least five seconds are required for the thorough
mixing of the acid with the foul solution, and after this the
resulting mixture is incapable of exciting putrefaction.
Next to this in efficacy comes the solution of chlorinated
soda, made by adding one part of the liquor sodee chlorinatae
to ten parts of water. This I found remarkably certain in its
action.
Of the action of salicylic acid I would say that it was ex¬
tremely uncertain. Some specimens of the acid seemed wholly
destitute of antiseptic power. The result recorded above was
obtained with the best of a number of samples procured from
different reliable druggists.
The solution of this strength could only be made by the aid
of a small quantity of alcohol. Salicylic acid is said to be solu¬
ble in three hundred parts of water, but many trials showed
that this solution was impossible without the aid of heat, and
that part, at least, of the acid crystallized out in two or three
days.
Although thymol in solution of one part to one thousand of
water is equally effective with carbolic acid one to lorty, yet
the solution of double this strength, made with the addition of
a little glycerine and alcohol, falls far short of the stronger
preparation of the rival drug.
Permanganate of potash was noticed to effect the destruction
of the minuter organisms in a comparatively short time (three
to four minutes), but some large forms of penicillium (among
* The numbers in this table indicate the parts of water to one part of the antiseptic.
t Preparation recommended by Mr. Paul Burns in London Modieal Record, April 15,
1879, page 168.
1134 Current Medical Literature. | June
other penicillium glaucum) resisted its action for a much longer
time.
Lastly, I would notice the inefficient action of chloride of
zinc, which many distinguished surgeons* have preferred to
any other preparation for cleansing deep wounds long exposed
to the air. 1 can only surmise that the action on which its
reputation is based is upon the tissues themselves rather than
upon the organisms, and that it closes the channels of absorp¬
tion against the entry of septic poisons much as a light cauter¬
ization with nitrate of silver does.
I am led to conclude, then, that of the preparations examined
the five per cent, solution of carbolic acid is the most proper
to use when a rapid action is desired, notably in the shower or
spray thrown over a wound during operation and dressing.
When carbolic poisoning is feared or already present, the
solution of chlorinated soda is by far the most powerful substi¬
tute that can be used. The rapidity of action of this latter
antiseptic renders it well adapted for use as a gargle in diph¬
theria, or as a mouth wash when a foul discharge is present.
When a strongly antiseptic action is not required, as in wash¬
ing a wound successfully aseptic, or when long contact of the
antiseptic with the wound is probable, as in washing out a
cavity with a continued current, some of the milder antiseptics
may be safe and agreeable substitutes.
Some preparations clinically ranking as antiseptics owe their
reputation to other powers than that of destroying septic ma¬
terial. — Boston Med. and Surg. Jour., Nov. 25.
NOTES ON CYSTORRHAGIA FROM RETENTION OF URINE.t
By John W. S. Gouley, M. D.,
Professor of Diseases of the Genito-Urinary System in the Medical Department of the
University of the City of New York ; Surgeon to Bellevue Hospital, etc.
When hemorrhage occurs from the mucous membrane of the
bladder, the word cystorrhagia should be used in preference to
haematuria, since the latter has a wider significance; being ap¬
plied alike to the passage of bloody urine from the kidney,
from its pelvis, from the ureter, the bladder, or the uretha.
Cystorrhagia may occur as a consequence of disease, of injury,
or of the too precipitate evacuation of an over-distended blad¬
der. It is of the last-named cause that I now wish particularly
to speak.
Civiale regards over-distention of the bladder as “ the most
common of all the causes of hsematuria.” This excellent observer
sayst “ that when hsematuria depends upon over-distension of
the bladder by the accumulation of urine or by a forced iujec-
*Lister, Volkmann, and others.
tRead before the Medical Society of the State of New York, February, 1880.
;Maladies des organea g6nito-urinaires, vol. iii., p. 360.
Current Medical Literature.
1135
1880]
tion, the blood seems to ooze indistinctly from every part of
the mucous surface,” but he does not explain the mechanism of
this general oozing. Nor does Mercier, or any other author
with whose works I am familiar, appear to solve the problem.
I believe that generally there is no hemorrhage as long as the
bladder remains distended ; but the moment the distention
ceases, — either by rupture of this viscusor by the too precipitate
withdrawal of the urine or water through a catheter — the ooz¬
ing begins, and this is due to rupture of thousands of the
capillaries of the mucous membrane, owing to a sudden change
in their condition. For in such over-distention of the bladder,
the mucous membrane as well as the muscular coat is greatly
over-stretched, its capillaries are likewise stretched and weak¬
ened in consequence. When, therefore, the mechanical sup¬
port given- by the accumulated urine is suddenly removed, the
extreme tension of the vesical parieties is succeeded by extreme
flaccidity ; the almost empty capillaries are instantly gorged
with blood, and their delicate walls give way before the sudden
impulse of the refluent blood, which soon begins to ooze from
thousands of minute rents of the mucous membrane.
It is well known that free hemorrhage often succeeds the es¬
cape of pus from large, tense abscesses that have been hastily
emptied ; and this phenomenon has generally and correctly
been attributed to the too sudden removal of the pressure ex¬
erted by the pus upon the small vessels which lie almost naked
on the wall of the abscess. If this be true here, why not so in a
diseased bladder ? The analogy is perhaps greater in those
cases where hemorrhage has occurred from the surface of
smooth membranes, such as that of the tunica vaginalis, after
the sudden evacuation of large hydroceles, or as that of cysts
of inordinate capacity which have been incised or tapped. The
general oozing of blood, which sometimes occurs from the
surface of a diseased peritoneum after ovariotomy, furnishes
another illustration.
Since writing the above, I had occasion to read Horace Stap¬
ler’s thesis on vesical haematuria caused by tuberculization,*
in which he credits Civiale with being the first to call attention
to retention of urine as a cause of haematuria, but he says that
“ Civiale does not explain the mechanism of hsematuria caused
by retention of urine,” * * * and asks, “ could it not be
attributed to the sudden dispaiition of the pressure which the
urine exerted upon the parieties of the bladder, similarly to the
phenomenon observed after puncture of certain cysts of the
thyroid body P
I wish to be clearly understood as not claiming that hemor¬
rhage invariably, though I believe it frequently, follows the
precipitate evacuation of the over-distended bladder, for I
have, on several occasions, suddenly withdrawn as many as
'Paris, 1874, pp. 8. 9.
1136 Current Medical Literature. | June
four pints, and have read of one, and even two gallons being
removed by the catheter without subsequent hemorrhage.
The hemorrhages in question occur usually ih middle and ad¬
vanced life, especially where the vesical mucous membrane is
not absolutely healthy, and in those patients whose blood¬
vessels are already weakening. Cystorrhagia from over-dis-
tention is very uncommon in young adults and adolescents,
and of extreme rarity in children.
The explanation of cystorrhagia just given is applied more
particularly to bladders which are not much altered by disease ;
but I have no doubt that hemorrhage does occur from disten¬
tion of certain diseased bladders the moment the distention
takes place, and this is shown in the first urine that appears,
whereas, in the class of cases before mentioned, the first urine
drawn is clear and entirely free from blood. In several such
cases which Civiale cites he only incidentally states that the
first urine expelled was always clear, and that blood appeared
the next time the bladder was emptied. It is evident, in those
cases, that the blood began to ooze only after the removal of
the pressure exerted upon the capillaries by the urine. Mer-
cier* makes a statement which corroborates this view; he says,
“ often two-thirds or three fourths of the urine contained in the
bladder come out free from blood, and it is only toward the end
that the fluid appears redder and redder and he further says
that “ this appearance has been wrongly ascribed to the pre¬
cipitation of blood in the has fond P He himself attributes the
hemorrhage to the action of the muscular coat of the bladder,
which, he says, fairly squeezes the blood out of the congested
mucous membrane like water squeezed out of a sponge. Un¬
fortunately for this theory and for patients, the very reverse
of contraction too frequently follows the sudden evacuation of
the bladder. If powerful contraction could always follow the
precipitate evacuation of the over distended bladder, there would
be no hemorrhage, or, if any occurred, it would soon cease, in
consequence of this contraction of the muscular coat, and of
retraction of the mucous membrane, and of its underlying con¬
nective tissue.
In chronic cystitis with sclerosis of the mucous membrane,
retention of urine, giving rise to comparatively little disten¬
tion of the bladder, will cause hemorrhage from cracking or
tearing of the unyielding mucous membrane, and the first
urine drawn will be bloody. Hemorrhage doubtless follows
distention from accumulation of urine in other diseased condi¬
tions of the bladder, such as papillomatous, tubercular, or can¬
cerous degeneration, etc.
A word here concerning diagnosis may not be out of place.
The main point is to determine whether Qr not the hemorrhage
be cystic, for the bladder may become filled with blood which
*Reoherchos anatomiques, pathologiques, etc. Paris, 1844, p. 141.
Current Medical Literature.
1137
1880]
has come from another source. For instance, there may be
free bleeding from the kidney (neptirorrliagia), due to a lacera¬
tion of this organ, to a vascular cancer which has finally in¬
volved its pelvis, to tubercular disease ; or, the hemorrhage
may be owing to extreme congestion, as that occurring after
the ingestion of certain poisons — among others phenic acid ;
or, from prolonged exposure to the fumes of turpentine — on
turpentine ships or in shops. Within a couple of years I have
had two cases of haematuria, whose diagnosis was cleared by a
few questions. Both men were workers in a varnish factory,
and, for several weeks, had been passing bloody urine. They
were advised to stpp work, and, in a short time after, the urine
became clear. My attention was called to this action of the
fumes of turpentine many years ago, by the late Dr. Charles
E. Isaacs.
There may be from the pelvis of the kidney very abundant
and continuous hemorrhage. When this pyelorrhagia is the
result of cancerous degeneration, it will not be long before the
diagnosis is verified by an autopsy ; but when it arises from
other causes, such as parasites, it may remain obscure for a
long time, if not altogether, unless careful and frequent micro¬
scopic examinations of the fluid be made. In other cases the
diagnosis may be easy. One of my patients almost always,
after drinking one or two glasses of champagne, suffers from
haematuria (probably nephrorrhagia or pyelorrhagia) for two
or three days, and, in the very bloody urine that he passes, is
able to collect fifty or sixty round uric acid calculi, the largest
of which scarcely exceeds in size an ordinary pin’s head. The
hemorrhage may be from the ureter (ureterorrhagia), and may
be caused by a rough calculus during its transit from the renal
pelvis to the bladder. The uriue passed by such a patient
sometimes contains long, leech-like clots, and this fact, taken
in conjunction with the general symptoms, leaves no doubt as
to the origin of the hemorrhage. Iji a case of very persistent
haematuria, I was able to determine the source of the hemor¬
rhage from the several circumstances presently to be stated.
The first was, that no retention of urine had occurred ; the sec¬
ond, that the urine ordinarily contained at least two-thirds
blood ; the third, that it was at times perfectly clear j the
fourth, that the hemorrhage would be preceded by a very dis¬
tressing ureteric and pyelic colic on the right side ; and the
fifth, that the urine frequently contained firm bdelloid clots five
or six inches long. These facts, together with the existence of
a tumor in the right flank, led me to regard the case as one of
ureterorrhagia, due either to an impacted calculus, or to malig¬
nant disease. The patient died in the course of a few months,
and the autopsy revealed a very vascular, primary cancer of
the right ureter, a little above its middle.
I have said that the bladder may be rapidly filled by blood
coming from some one of the sources before named, but if the
1138
Current Medical Literature.
[June
blood does not as rapidly coagulate, it will be expelled ; and if
by good luck its flow into tlie bladder be checked, as was shown
in the case of cancer just mentioned, by impaction of a clot in
the ureter, there will follow ureteric and pyelic colic, and
while this lasts the urine secreted on the sound side— at first
tinged by the little blood remaining in the bladder— will come
away clear, and as soon as the impacted clot is dislodged and
carried into the bladder, the urine will again be bloody. It
may be proper to syringe out the bladder during the ureteric
colic, in order to wash away the remaining blood, — then if the
water afterward injected comes away clear, it is reasonable to
suppose that the hemorrhage is not cystic.
But if the hemorrhage has been so abundant as to cause
great distention of the bladder, with clots, the case will be at¬
tended with a two-fold danger, and the prognosis may be unfa¬
vorable; for if then the distended bladder be suddenly evacu¬
ated, there will probably be hemorrhage from its mucous mem¬
brane in addition to the bleeding which may have come from
the ureter, renal pelvis, or kidney. When all the sources of
hemorrhage already indicated have been excluded, and the loss
of blood is not from the urethra — (urethral hemorrhage can be
at once diagnosticated by passing a catheter into the bladder.
If, after the first ounce or thereabouts, the urine drawn be
limpid, it is certain that the blood which had previously
escaped had not come from the bladder. In some cases of
hemorrhage from the deep urethra, the blood often enters the
bladder, but this is easily made out) — then its vesical origin is
fairly established.
Cystororrhagia is known to occur from ulceration of the
bladder, from injuries inflicted by the movements of a calculus,
from some forms of acute and chronic cystitis, from the per¬
foration of small veins by certain parasites, from tubercular or
cancerous disease, from papillomata, and from violence ; but
in the class of cases under consideration, retention of urine is
its principal factor in certain instances of diseased, while in
comparatively healthy bladders, or in the atonied bladders of
elderly men with prostatic enlargement, its most frequent
exciting cause is the sudden withdrawal of the urine by which
the organ had been greatly over-distended.
The first urine drawn, as before said, is usually clear and
free from blood, the second is blood-red ; afterward it grows
dark and diugy, until it becomes chocolate-colored, and finally
assumes a tarry appearance and consistency, and acquires a
disagreeable odor similar to that of decayed, dried codfish.
These changes in the character of the blood are due partly to
the action of the urine, partly to the admixture of mucus, of
which there is hypersecretion, and to the development of am¬
monia. In such cases the effusion of blood is considerable, but
not always sufficient for the formation of coagula ; for as long
as there is a fair proportion of urine, no coagulation takes
Current Medical Literature.
1131)
1880]
place, but when the flow is rapid and exceeds the urine in
amount, the bladder will soon be filled with clots, even to great
over-distention. Cystororrhagia may last from a few hours to
two or even three weeks if not checked by appropriate treat¬
ment.
The constitutional effects will of course, depend upon the pre¬
vious physical condition of the patient, the amount of blood lost
daily, and the extent and severity of the ensuing cystitis.
Prompt and intelligent interference will soon arrest the bleed¬
ing and generally save the patient. The danger to life is not
so much from the severity of the hemorrhage as from the ex¬
tent of injury to the capillary vessels and mucous membrane.
What is here most to be dreaded is the supervention of general
cystitis, which is so apt to be followed by double ureteritis and
pyelonephritis. When these complications have occurred there
is oliguria, then anuria, which is soon followed by a typhoidal
condition, with low muttering delirium, and death, all within a
week or ten days after the first evacuating catheterism that
had given issue to three or four pints of clear urine.
Perhaps the recital of the history of a typical case of cys-
torrhagia from the too precipitate evacuation of a distended
bladder, taken from my note-book, will illustrate several im¬
portant points that I may have failed to make plain.
On September 2, 1875, I saw, in consultation with a medical
gentleman, in a nieghboring city, Mr. S. B., aged sixty-three,
who had “ for ten years suffered more or less from his bladder,’
and had had occasional attacks of retention of urine, all owing
to prostatic enlargement. Two years before our interview he
had a retention of urine, relieved by the catheter which caused
considerable urethral, but no vesical hemorrhage. On the
evening of August 23, 1875, while sitting upon the stone steps
in front of his house, he felt chilly, but thought little of this
and went to bed at his usual hour. On rising in the morning
he experienced trouble in voiding his urine, and was finally
unable to pass a single drop. His bladder having become
painfully distended in the course of twenty-four hours, he sum¬
moned his physician who relieved him at once, byr the catheter,
of about three pints of clear urine. A second catheterism, on
the same day, gave issue to bloody urine, and from that time
all the urine drawn off was highly charged with blood. On
account of the persistence of the hemorrhage, the doctor
requested me to see his patient. When I arrived at the house
(at 3 p. m.) I found Mr. B., a pallid, slender-built man, walking
the floor nervously, and in great agony- from distention of the
bladder, though the doctor had drawn off his urine in the
morning. His general condition was fair, and he had had no
febrile reaction for a week. On digital examination per rec¬
tum, the prostate was found tumid but not very large. A
metallic catheter of short curve, similar to Mercier’s, encoun-
8
1140 Current Medical Literature. [June
tered a medium prostatic obstruction, which was easily sur¬
mounted. A soft rubber Nelaton catheter, which was then
introduced, gave issue to a pint and a half of fetid, thick, alka¬
line, tarry fluid, consisting of about an equal amount of blood
and urine, but the blood was thoroughly mixed with the urine
and there was no coagulum. I expressed the opinion that the
blood had probably oozed out of numerous minute vessels from
a considerable extent of the vesical mucous membrane. The
doctor said that, at first, the hemorrhage was much more pro¬
fuse, and that there were clots which frequently closed the eye
of the catheter. Inasmuch as the bleeding had thus far been
kept up by the frequent distention of the viscus, I suggested,
as the prime indication in the case, complete drainage of the
bladder for, at least, twenty-four hours. This was affected by
introducing, and retaining in position, a gum-elastic N61aton
catheter. An occasional vesical injection of two ounces of
weak tannin solution was also advised, likewise ice in the rec¬
tum, absolute rest in the recumbent posture, and twenty-grain
doses of quinine dissolved in dilute sulphuric acid. The doc¬
tor had already given twenty-minim doses of fluid extract of
ergot, and I advised their continuance. He had also irrigated
the bladder with salicylic acid solution, with the effeet of deo¬
dorizing the urine temporarily. From the time I introduced
the catheter no more urine was allowed to accumulate in the
bladder, and the blood was frequently washed away with the
styptic solutions. This course of treatment had the effect,
within two days, of arresting the hemorrhage and of controlling
the consequent cystitis. I saw the patient in the course of t.wo
months, when he said that he felt as well as usual. Three
years after, he had had no recurrence of hemorrhage.
PREVENTIVE TREATMENT.
If sufferers from prostatic and vesical trouble were always
under the watchful eyes of intelligent physicians, their bladders
would not be permitted to become over-distended, and this one
cause of cystorrhagia would not exist. But as over-distention
now occurs so frequently, let us see in what way relief may be
given and cystorrhagia prevented.
Nothing can be more simple ; the bladder should be emptied
very gradually in the course of twelve, twenty-four, or forty-
eight hours, and in certain extreme cases, even several days
(as suggested by Sir Benjamin Brodie).* One of the ways of
accomplishing this is to introduce a soft catheter and secure it
in position, then allow the urine to trickle through it slowly by
partially obstructingt the distal orifice with a finger, so that
in the course of five or six minutes not more than eight
ounces will have escaped ; and to repeat this every two hours
*Brodie : Lect. on Dis. of Urinary Organa. London, 1835, p. 101.
tCiviale.
Current Medical Literature.
1141
1880]
until the bladder is emptied. If the urine drawn be very fetid,
the process should be modified as follows : immediately after
drawing the first half-pint of urine, eight ounces of warm water,
in which has been dissolved a scruple of biborate of soda,
should be injected into the bladder, then a pint of urine drawn,
and at once half a pint of borax solution thrown in. This
should be repeated at the first sitting six or eight times, or
until the whole of the offensive urine is gotten rid of, and the
bladder contains nothing but the clear borax solution ; then
every two hours, and in some cases even every three hours, half
a pint of the fluid — now mixed with newly secreted urine —
should be drawn off, until the bladder is completely empty.
In this way a bland fluid will have been substituted for decom¬
posed and irritating urine, the hydrostatic pressure will not
have been removed too suddenly, and thus cystorrhagia will
have been prevented.
Sometimes polyuria follows the first catheterism to such a
degree as to make it necessary to draw off one instead of half a
piut, and do this every hour instead of two hours, otherwise
the vesical distention would be unrelieved. To illustrate this
point, let me relate the history of a case of inordinate polyuria
without glycosuria. I have never known a patient to secrete
so much normal urine in the same space of time.
Mr. P. D., set. 67, stout, weighihg about 200 lbs., suffering
from prostatic hypertrophy and stone in the bladder, was sent
to mo by a medical friend early in March, 1879. Mr. D. had, at
different times, for a period ot twenty years, passed gravel and
alse well-formed small uric acid calculi. He was subject to
polyuria which would be caused by almost any diuretic. He
could never take cider, ale, tincture of the chloride of iron,
copaiba, or cubebs, without provoking great increase in the
urinary secretion. For six consecutive weeks he passed four
pints of urine daily, and for two additional weeks, six pints
daily. At the end of that time— that is, March 1, 1878 — his
bladder became over-distended, and the urine came away gut-
tatim. On this account he was catheterized, and three pints of
clear urine drawn in the first hour at intervals of twenty min¬
utes The catheter was tied in position, and one pint of urine
was drawn off every hour for twenty-seven consecutive hours,
when the amount began to diminish until it was reduced to six
pints every twenty-four hours. In the course of about three
months it was gradually reduced to four pints, and so continued
until March,- 1879, when I relieved his bladder of the irritation
which had been caused by several small stones. When he left
the city, toward the end of March, he was making three pints
of urine daily, and was in excellent physical condition.
TREATMENT OF CYSTORRHAGIA.
When cystorrhagia has taken place, besides enjoining abso¬
lute rest in the horizontal posture, the surgeon should take
1142 • Current Medical Literature. | June
means to prevent the bladder from becoming distended with
bloody urine. But if, when he arrives, he finds hypogastric
dullness extending to or into the umbilical region, he should
draw off, through a gum catheter, only a pint of uriue, then
throw in half a pint of the borax solution — as mentioned under
the head of preventive treatment — and draw half a pint of fluid,
and repeat the process until the fluid becomes clear, or nearly
so. Afterward, every hour or two hours, the stopper of the
catheter should be removed, and half a pint of fluid allowed to
flow, until the bladder is completely empty. For that purpose,
the catheter should be retained in position twenty-four hours,
very rarely longer. This drainage alone will often have the
effect of checking the hemorrhage, especially if the muscular
coat of the bladder soon begins to regain its contractility,
which can be sometimes hastened by occasionally throwing in
two or three ounces of' weak, cold watery solution of tannin, of
alum, or of almost any other astringent. Ice in the rectum,
applied according to the plan of Cazenave, is a valuable adju
vant.
The next indication is to guard against general acute cystitis,
the supervention of which would be the most serious accident
that could well happen in such cases, except, of course, rupture
of the bladder.
Hemorrhage is more apt to recur in cases of pre-existing
atony of the bladder. Therefore, it is important to begin to
treat this atony as soon as the bladder has been emptied.
When cystorrhagia occurs in cases of cystitis, with sclerosis
of the mucous membrane, whether the distention be caused by
retention of uriue or by a forced injection — which latter is
sometimes used in their treatment — drainage is essential ; no
urine should be allowed to accumulate, and stypic injections in
small quantities should be employed, and gallic acid, or some
of the other haemostatics, will be indicated. In such cases the
hemorrhage is not usually abundant. The danger lies in the
aggravation of the cystitis.
The most serious hemorrhages are those which occur from
papillomatous or cancerous tumors. I have a specimen of the
former, in which hemorrhage was the immediate cause of death.
Although so great an authority as Civiale seems to attach
little importance to general treatment, I am sure you will agree
with me that it has utility, and should not be rejected. I
would recommend the exhibitin of ergot (15 to 20 minims of the
fluid extract every two or three hours), or of gallic acid, dis¬
solved in glycerine, or of quinine, with an equal quantity of
dilute sulphuric acid, or of tincture of the chloride of iron, etc.
All these medicinal agents have their value, and any one of
them will often answer the purpose. But when the desired
effect has been obtained, the dose should be reduced, and the
medicine discontinued as soon as possible, otherwise the digest¬
ive organs will surely suffer.
Current Medical Literature.
1143
1880J
When it happens, in eystorrhagia, that no fluid runs through
the catheter after it has been successfully introduced into the
bladder, it may be that a clot has become impacted in the
catheter, or that the bladder is filled with coagula, aud little if
any urine.
What, in like circumstances, should be the conduct of the
surgeon ? He should withdraw the catheter, aud if he find in it
a clot, wash it out, or take a clean catheter and introduce that,
and if there be fluid blood aud urine, it will of course flow freely.
But suppose the bladder to be filled with clotted blood, what
then is he to do ? In this there is a difference of opinion.
Chopart advises the injection of water through the catheter
to break up the clots, and if they do not come away, to intro¬
duce into the distal end of the catheter the nozzle of a syringe
with which to make aspiration of the broken-down clots, and
‘cites several cases in which this was successfully accomplished.
A number of his contemporaries had like successes. Howship,
and also Sir Benjamin Brodie, advocated this process.
Phillips cites Leroy as having extracted a little more than
four pounds of coagula from a man’s bladder, with the aid of
aspiration made through a catheter which he was obliged to
introduce one hundred aud fifty times in the space of six hours.
Though Civiale approved of repeated injections of warm
water to soften or dissolve the clots, as recommended by Ver-
dier, he condemned aspiration. Other modern surgeons are
against aspiration of the clots, but their objections are not
tenable. The principal objection made is, that the removal of
the clots will excite fresh bleeding either by affording a cavity
into which more blood may be poured, or by allowing the plugs
to escape from the torn extremities of the capillaries. They
also urge that the clots do no harm, aud will, in a couple of
days, be dissolved by the urine. It is a misapprehension of the
true state of things that has led the opponents of aspiration to
condemn this practice, inaugurated as it was by some of the
best surgeons of the last century. Injections and aspirations
jiroperly done, cannot and will not give rise to fresh bleeding ;
it is the hasty removal of the contents of the bladder, as I think
I have shown, that will provoke hemorrhage, aud it is the very
thing which every good surgeon should avoid. It is not good
surgery to allow a bladder to become over distended with blood
and then to wait forty-eight hours for the urine to dissolve the
clots, while the patient is in the throes of vesical distention
and tenesmus. I think that in such a case the indications for
mechanical iuterference are exceedingly plain. But, I repeat,
the vesical contents must never be hastily removed, otherwise
there will necessarily follow fresh hemorrhage. In eudeavor-
ing to free a bladder greatly distended with clotted blood
which cannot pass through an ordinary catheter, the way to
proceed is to use a soft catheter with one large eye, or a metal¬
lic Mercier catheter as large as can be introduced, then to
1144 Current Medical Literature. | June
inject two or three ounces of warm borax solution (diluted
acetic acid has been recommended for dissolving clots) $ if
nothing hows, the instrument should be moved gently to and
fro and rotated to the right and left so as to break up the clots ;
then aspiration made either with a syringe, as recommended
by Chopart, or with Bigelow’s rubber-bag. No attempt should
be made to aspirate more than three or four ounces of clots, or
grumous blood, at a time. The surgeon should continue, at the
same sitting, to make alternate injections and aspirations,
never withdrawing more than he has injected, so that the con¬
tents of the bladder will remain about the same, until all the
blood has been removed and the returning liquid is nearly
clear. After this, every hour or two hours, as the case requires,
a few ounces, rarely more than eight, should be drawn off until
the bladder is empty. Gallic acid or other agents can, in the
meantime, be administered, and afterward the bladder may be
irrigated with such astringent solutions as are necessary. I
feel quite sure that such a course would not only prove efficient,
but much safer than the expectant plan just referred to.
“ When the coagula are not dissolved,” says Paul of Aegina,
“ make an incision in the perinaeum as in cases of calculus ; and
having removed the clots of blood, accomplish the cure in a
proper manner.” This operation of perineal cystotomy was
revived by Larrey and others of his time, in cases where the
clots were too dense to be broken up by the catheter. The
operation is reported to have been performed under the auspi¬
ces of Sir Astley Cooper, by Mr. Copeland Hutchinson, with
the result of extracting a pound of coagula, but the patient
died in three days. Civiale very properly condemns this heroic
and ordinarily unjustifiable procedure, and suggests in its stead
the employment of the lithotrite to break up the clot when it is
too dense to be reduced by the catheter or aspirator. — N. Y.
Medical Record. • . .
THE NEW ANAESTHETIC— THE BROMIDE OF ETHYL.
By J. R. Levis, H. D.,
Surgeon to the Pennsylvania Hospital and to the Jefferson College Hospital.
It is generally admitted that there are essentials of anaesthe¬
sia which are not satisfactorily attained by the anaesthetics in
ordinary use. The inconveniences of ether and the dangers of
chloroform have suggested further inquiry among the large
number of chemical substances which are capable of producing
insensibility to the impression of pain.
In April, 1879, my attention was directed to the bromide of
ethyl by Dr. Laurence Turnbull, of this city, who was, I believe,
the first to experiment on the human subject with its anaes¬
thetic properties, testing it originally on himself and after¬
wards on patients undergoing surgical operations, but its
physiological action on some of the lower animals had been
previously determined by other experimenters.
1880]
Current Medical Literature.
1145
I have since that time continued to give practical attention
to the subject of the anaesthetic use of tbe bromide of ethyl,
and, whilst recognizing the fact that a very large number of
administrations is essential to determine its merits compara¬
tively with other agents, I have now had sufficient experience
upon which to, at least, base some very decided impressions of
its value.
Its principal physiological characteristics which will concern
the surgeon arc its rapidity of action and the quickness of re¬
covery from its effects.
As far as observed by me, it does not influence the circula¬
tion, excepting to sometimes produce a slight increase in the
rapidity of the heart’s action and in arterial tension or pres¬
sure. The cerebral anmmia and the fatal syncope of cardiac
depression to which chloroform is liable, are dangers which do
not appear to threaten in the anaesthesia of the bromide of
ethyl.
Respiration is but little influenced by the bromide of ethyl,
as I have administered it, beyond the ordinary characteristics
of all anaesthetic sleep ; but in this respect its action seems
more to resemble that of ether than of chloroform. While
making these assertions, I fully recognize the fact that the
ultimate effects of all anaesthetics show that they are depress¬
ing agents.
Nausea and vomiting appear to occur less frequently in the
anaesthesia of the bromide of ethyl than in that of ether and
of chloroform, and the rapidity of recovery from its effects
must render such impressions very brief and transient.
Commencing with the occasional and very cautious use of
the agent, I have more recently adopted it to the exclusion of
other anaesthetics, and am recording a series of detailed obser¬
vations as to its effects.
Bromide of ethyl, or hydrobromic ether, is a colorless liquid,
with a specific gravity a little greater than that of water. It
has a decided and characteristic odor, which is thought to re¬
semble that of chloroform, but is less agreeable. It vaporizes
more readily than chloroform, and in this respect and in den¬
sity is intermediate between ether and chloroform. It seems to
be entirely eliminated through the lungs, and in this regard
has a decided advantage as to safety over chloroform. The
high vaporizing point of chloroform does not permit a rapid
elimination from the body, and it is not entirely removed by
the lungs. So, when some secreting organ happens to be,
from disease, incapacitated, the nervous system is liable to be¬
come overwhelmed. The odor of the bromide of ethyl remains
for a longer time on the breath of a patient than does that of
ether and chloroform, but it seems to be quickly dissipated
from the apartment in which it has been used. Its vapor is
quite unirritating to the respiratory passages when inhaled,
1146 Current Medical Literature. [June
and in this quality lias the advantage over both ether and
chloroform.
General excitement and the tendency to struggle occur
far less frequently than in the early stages of ' the anaesthesia
of ether, and, apparently, even in that of chloroform.
It is evident that the impression on the motor centres
must be very rapid, and I estimate that complete anaes¬
thesia is accomplished in one-third less time than is the
case with* chloroform. The recovery from its effects is even
comparatively more rapid, iu the greater number of cases
the time not exceeding two minutes after the inhalation has
ceased. The pupils dilate as soon as complete anaesthesia
is induced, and, as the sentient state returns, they resume
their normal condition. I suggest that the condition of the
pupils may be an index and guide in the administration.
Anaesthesia with the bromide of ethyl is usually effected in
from two to three minutes. The most rapid production of com¬
plete insensibility, in my experience, has been in one minute,
in the case of a girl eight years old ; the longest period has
not in any case exceeded four minutes. When carefully ad¬
ministered, the quantity consumed has varied from one fluid-
draclim in the case of a child, iridectomy being performed, to
eleven drachms used during an amputation of the forearm of
an adult, occupying forty minutes, including the ligation of the
vessels and the dressing of the stump.
The quantity of the article consumed in effecting anaesthesia
will greatly depend on the method and manner of using it.
Much of it is, of course, wasted by diffusion in the atmosphere.
With great regard for economy, this waste may be prevented
by imperviously covering the material on which it is poured.
My own plan, with adults, is to pour two drachms of the bro¬
mide of ethyl on a small napkin folded up to a space of about
four inches square, and then laid on a larger napkin, folded so
as to be large enough to cover the entire face of the patient. It
is well to secure the two napkins together with a pin.
The vapor of the bromide of ethyl is not inflammable ; indeed,
when dense, it extinguishes a flame if brought into contact
with it. In this respect it is free from the danger incident to
ether when administered at night in proximity to lights, or
when the actual cautery is used. The article used by me was
made by the firm of Powers & Weightman, manufacturing
chemists of this city.
The ordinary essentials of the proper and safe production of
anajsthesia are required in the use of the bromide of ethyl.
That these essential details are apt, through ignorance or care¬
lessness, to be disregarded, every practical surgeon is aware,
and the frequent difficulties and occasional calamities will attest.
When it is stated that whole pints of ether, or many ounces of
chloroform were used in the production of anaesthesia in a sin¬
gle case, he knows where was the fault. When it is asserted
Current Medical Literature.
1147
1880]
that “ ether would not act and chloroform had to be resorted
to,” he knows why it “ would not act.”
It is becoming evident that the dread of unavoidable disas¬
ters from chloroform and the inconveniences of ether are tend¬
ing to prevent their humane administration in many cases
where the blessing of anaesthesia is due to the sufferer. This
is particularly so in localities where etherization, simple and
safe as it is, seems strangely ignored. In a prominent French
hospital I not long ago witnessed the application of the actual
cautery and other painful procedures without the resource of
anmsthesia.
Whilst feeling inclined to impress caution in regard to the
use of so powerful an agent as the bromide of ethyl, I am, from
a basis of experience, inclined to recommend its use to the
profession. — Phil. Med. Times , Jan. 17*
SUCCESSFUL TREATMENT OF OBSTINATE UNUNITED FRAC
TURES BY TRANSPLANTATION OF OSSEOUS TISSUE.
This operation has been performed by Nussbaum, in Munich.
He reports in Schmidt’s Jahrbiicher two successful cases. The
first was that of an officer having a gunshot fracture of the
right ulna, which healed with pseudarthrosis. The distance
between the fractured ends was five centimeters. The radius
was intact. The false joint were laid open. A longitudinal
piece of bone from the upper fragment, sufficiently long to fill
the space between the fragments, was chisseled out and ante-
verted, without severing its periosteal connection, so as to touch
the denuded end of the lower fragment. The wound was closed
by sutures, and a fenestrated plaster of Paris bandage was ap¬
plied. At first there was considerable reactive inflammation,
in spite of which the uniting of the pieces of bone took place.
Six weeks afterward there was very slight abnormal mobility,
so that pronation and supination were yet difficult. One year
after, however, the function of the arm was so far restored that
the patient -was able to resume his duties in the field. The sec¬
ond case was that of a builder, 27 years old, who had a com¬
pound fracture of the left ulna, twelve centimeters below the
olecranon. The wound healed in a short time under Lister’s
dressing, but one piece of bone, three centimeters long, and
several smaller pieces came out, leaving a pseudarthrosis about
three centimeters in length, rendering the arm useless. The
old methods of treatment were resorted to without avail.
Finally the false joint was laid open and a piece of the upper
fragment five centimeters in length bisected longitudinally
and turned over without severing the periosteal connection at
its lower extremity, and applied to the denuded surface of the
lower fragment. A drainage tube was placed in the wound
9
1148 Current Medical Literature. |June
and Lister’s dressiug applied. Sixty-seven days after the pa¬
tient was allowed to make the first movements of pronation
and supination, and four weeks later the arm was sufficiently
strong to allow of his resuming work. This operation is mainly
of use in cases of pseudarthrosis of the forearm in which only
one bone is involved, and is preferable to resection. — Chicago
Med. Gaz ., April 5.
ANTISEPTIC TREATMENT OF A BULLET WOUND PENETRATING
THE KNEE-JOINT.
One of the most brilliant proofs ot the advantage of anti¬
septic treatment is recorded by R. Yolkmann in the Central-
blatt flir Chirurgie, No. 29, 1878. A medical student, 24 years
old, was brought into the hospital, who had an hour and a half
before, received a pistol-bullet wound in the upper epiphysis of
the right tibia. At that time the synovial fluid had escaped
from the wound, and at the time of his entrance the cavity
was distended with blood. The bullet entered near the lateral
border of the ligamentum patellae, and passed transversely 5.8
centimeters into the caput tibiae. At the extremity of the path
of the bullet a hard body could be felt. A longitudinal incision
was made and the wound enlarged until the bullet could be ex¬
tracted with a sharp gouge. While the wound was being chis¬
eled out succussion of air and blood in the articular cavity was
audible. The articular cavity was then opened above the
patella, washed out, and a drainage tube inserted. A drainage
tube was also inserted in the wound of the tibia. Strict anti¬
septic precautions were observed during the operation and in
the after treatment. Under this treatment all went extremely
well. On the fourth day the drainage tube was removed from
the articular cavity, and two days later the tube was removed
from the wound of the tibia. Six weeks later the patient was
allowed ro walk, and in two and a half months the functions
of the knee-joint were completely restored. Before the intro¬
duction of the Lister method, a penetrating bullet wound of the
knee-joint would have indicated amputation. In the Franco-
German war, the results of statistics of results from excisions
of the knee-joint for such lesions were so unfavorable that sur¬
geons generally preferred to amputate to save life. Such con¬
servative treatment as that employed in this case would have
been considered criminal at that time. — Chicago Med. Gazette ,
April 5.
THE BOGUS DIPLOMA BUSINESS.
A week or two ago the Committee of the Methodist Confer¬
ence to which was referred the charges against Rev. T. B. Mil-
Current Medical Literature.
1149
1880]
ler, M. D., thio dean of the Philadelphia University of Medicine
and Surgery, reported that after full investigation they found
both charges and specifications amply sustained, and sentenced
the offender to deposition from the Christian ministry and ex¬
pulsion from the Methodist Episcopal Church.
A few days later the stock and fixtures of this precious insti¬
tution were seized aud sold at constable’s sale, for rent. We
have no expectation, howevjai', that this pestilent nuisance is
eradicated. It will continue to put up its head until all con¬
nected with it get their just dues in a public prison. Some
general measure should be devised to reach these diploma sell¬
ing concerns here and elsewhere. According to the Cincinnati
Lancet , there are within the limits of that city already half a
dozen so-called medical colleges not possessing a shadow of
legal authority to issue diplomas. This issue of diplomas with¬
out legal incorporation as a college is by no means so uncom¬
mon in other States, as, for iustance, New York, as might be
supposed. In veterinary, as well as general medicine, there
are several schools in that city whose diplomas are frauds upon
the body politic, or, at least, no better than certificates of pro¬
ficiency issued by men who have no proper claim to the prefix -
of Professor, and some of them none to the degree of Doctor or
Medicine or Veterinary Surgeon. — Med. and Surg. Reporter ,
April 3rd.
HYGIENE OF THE SCHOOL-ROOM IN ITS RELATION TO LIGHT.
The following are the conclusions of a paper read before the
Societe de Biologie by Dr. Javal, director of the laboratory of
Opthalmology, at the Sorboune, published in the Gazette Heb-
domadaire, October 17, 1879, and noticed in the Medical News
and Abstract, January, 1880 :
1. It is proved that the causes of short-sightedness are hab¬
itually a prolonged application of sight during childhood, com¬
bined with insufficient light.
2. In our climate illumination by diffused light never attains,
even in the open air, to an injurious intensity.
3. The belief that bilateral light is injurious to the preserva¬
tion of sight does not rest on any theoretical basis.
4. According to most recent statistics there are schools in
which, the light being bilateral, myopia is comparatively rare ;
and there exists others in which unilateral light is had under
most favorable conditions, nevertheless myopia is as frequent
as in the worst arranged schools. Experience is certainly not
in favor of unilateral light.
5. Sufficient light, by means of windows arranged on one side
can only be obtained if the width of the room does not exceed
the height of the lintels of the windows above the door.
1150
Current Medical Literature.
| June
0. Light from behind, if it comes from above, may be use¬
fully combined with lateral light; the light from a glazed
roof is excellent.
7. Bilateral light should be preferred on all accounts. In
this system, the width of the school-room being for the same
height of windows twice as great as in the case of unilateral
light, the intensity of the light in the middle of the room
(which is the least benefited portion) is double that obtained
by the same distance from windows where unilateral light is
used. However, the width of the school-room must never ex¬
ceed double the height of the windows.
8. Great importance must be attached to placing the school
toward the east, and the axis should be directed from north-
northeast to southwest ; a deviation of more thau forty
degrees from the direction north south should never be allowed
except in exceptional climatic conditions.
9. The master should face the south.
l6. Finally, it is absolutely indispensable to reserve on every
side of the school-room a strip of inalienable ground, of which
the width should be double the height of the loftiest buildings
that could be erected ; allowing for the progress of civilization
which has multiplied high-storied buildings to an extent hith¬
erto unknown in the country. This last condition is the most
important of all. — Chicago Med. Oaz ., April 5.
CURE FOR VOMITING OF PREGNANCY.
Dilatation of the cervical canal for the vomiting of pregnancy
is now regarded not only an efficient means of treatment,
but reasonably safe. The dilatation should not, however, be
carried to the interior of the uterine cavity, but should rather
be confined to the lower portion of the constricted part of the
cervical canal, and even here need not be extensive. It may
be accomplished with the index finger, which should be gently
carried through the external os with the rotating movement,
until one-half of the first phalanx has been introduced. This
may be easily accomplished with the multipara, but with the
primipara it will generally be necessary to enlarge the os by
previous dilatation, until room enough has been gained to ad¬
mit the finger. The statistics of this method of treatment are
not sufficiently large to warrant us in saying that it is wholly
unattended with danger of abortion, but from records of sev¬
eral cases, since 1875, it may be said that it is a safe and sure
remedy. It was discovered by Copman in 1875, when he
dilated for the purpose of producing an abortion for the relief
of vomiting, and instead of causing the abortion he cured the
vomiting. — Chicago Med. Oaz., March 5.
MEADOWS’ TABLE FOR ESTIMATING THE PROBABLE DURATION OF PREGNANCY.
Recommended by Dr. E. O. F. Roler, Professor of Obstetrics and Diseases of Women and Children in Chicago Medical College.
December-
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If time of conception is not known, calculate f/om a date one week in advance of last appearanee of menses.
1152
Editorial.
| June
CAUSES OF FATIGUE IN READING.
An important study has been made of this subject by Dr.
Javal, director of the Laboratory of Ophthalmology of the
Sorbonne, published in the Annales d1 Oculist ique. The fatigue
of the eyes which is so often complained of by literary men he
believes due to a permanent tension of accomodatiou ; reading
requires constant, steady strain of the eyes, while many other
occupations demanding close, do not need constant, sight. His
researches extend to the question, of great economical impor¬
tance, given a surface of paper and a number of words to print
upon it, what rule will secure the maximum of legibility t The
answer is : Other things being equal , the legibility of a printed
page does not depend on the height of the letters , but on their
breadth. This fact is of special importance in the preparation
of school books, and Dr. Laval’s suggestions should receive the
attention of publishers, type founders and school boards. —
Med. and Surg. Reporter , April 3.
VALEDICTORY.
The present number closes the seventh volume of the journal,
and the third under the present managemeut. The assurances
of success vouchsafed to us when we embarked in the enter¬
prise, have been fully realized, and future prospects are flatter¬
ing. The circulation has materially increased until the meas¬
ure of success in the past, warrants further efforts on our
part to enlarge its sphere of usefulness. When the prospectus
of the present volume was sent out a monthly issue of eighty
pages was guaranteed. Still we have not kept within our
limits, for the numbers will average nearer one hundred pages.
It is the intention of the editors to have the eighth volume
increased still further, and each number contain one hundred
pages of reading matter, making an annual volume of twelve
hundred pages.
The large number of foreign exchanges will enable our
readers to learn from French, Spanish, Italian, German, Nor¬
wegian and Danish journals, whatever of practical importance
that can be gleaned from them, and conscientious and pains
taking translators will have charge of this department. The
New Orleans Medical and Surgical Association and Orleans
Parish Medical Society, will continue to publish the valuabl
Obituary.
1153
1880]
papers read at their meetings, and clinical records of import¬
ance will be a prominent feature. With the incentive of con¬
tinued patronage, the editors issue their next number with
more than ordinary zeal, and their efforts, as in the past, will
be to make The New Oelans Medical and Surgical Jour¬
nal, the exponent of Southern medicine and Southern medi¬
cal literature.
©bituarg.
Dr. SAM’L CHOPPIN.
After an illness of only 48 hours Dr. Samuel Choppin, died
of pneumonia, May 2d, 1880, at 8:10 o’clock, at his residence,
in New Orleans.
The distinguished physician was born at Baton Rouge, in this
State, in the year 1828.
On becoming of the proper age he began his medical studies
at the Medical College of Louisiana, now a part of the Univer¬
sity of Louisiana. After passing two years as resident student
at the Charity Hospital he graduated in 1850. He then weut
to Europe and spent two years in Paris and Italy, pursuing his
studies. On returning to New Orleans he, with his colleague,
Dr. C. Beard, was appointed Demonstrator of Anatomy in the
Medical College, and for five years he discharged the duties of
this office.
During this time he was also House Surgeon of the Charity
Hospital, where he made an enviable record for himself as a
surgeon and administrator. These duties, while onerous, did
not prevent him from devoting a portion of his time to litera¬
ture, and we find him acting as one of the editors of the Medi¬
cal News and Hospital Gazette. •
He was one of the founders of the New Orleans School of Medi¬
cine. This educational venture soon achieved reputation and
success, and so rapid was its growth that the last class previous
to the war numbered 200 students. At the outset of the civil
troubles he offered his services to the Southern cause, and
served as medical inspector and surgeon-in-chief to Gen.
Beauregard during the sieges of Charleston and Petersburg.
1154
Obituary.
[June
His career in the army was marked by capacity of the high¬
est order and elicited euloginms from Lee, Beauregard and other
leaders of the Confederacy, and did much to advance his repu¬
tation as a distinguished surgeon.
At the close of the war he returned to New Orleans and en¬
tered into a copartnership with his friend, Dr. C. Beard, for the
practice of his profession. His great energy, zeal and skill
soon created for him a clientelle as large, remunerative and
appreciative as any physician has ever acquired in this city.
Although not a politician Dr. Choppin took a deep interest
in public affairs, and in the memorable scenes of the 14th of
September, 1874, he was a prominent actor.
Upon the advent of the Nicholls Government he was ap¬
pointed President of the Board of Health, and occupied the
position until a few weeks since.
His administration of affairs reflected honor and credit upon
himself, and did much to advance the welfare of the State. He
did this, too, at the sacrifice. of great personal interests, almost
up to the moment of his death.
In the July No. of the .Journal there will appear a biograph¬
ical sketch of this distinguished surgeon.
COL. T. S. HARDEE.
Died at his residence in New Orleans, May 21st, 1880, Col.
Thomas Sydenham Hardee, Chief State Engineer of Louisiana.
Col. Hardee was born near Savannah, Ga., December, 1832.
He was educated at Athens Ga., and studied engineering at
West Point, under Prof. Mahan and Gen’l. McClellan. Emi¬
nent before the war as R. R. Engineer, the advent of hostilities
afforded a field where his remarkable powers were recognized,
and he served in the Confederate Army, as Lt. Col. of Engineers.
Since that time he has been prominent in his profession, and
his views always commanded attention.
As a member of the Louisiana State Board of Health, mem¬
ber of the Yellow Fever Commission, and member of the com¬
mittee, from the National Board of Health, investigating yel¬
low fever in Cuba, his professional worth won the regard of
his colleagues.
1880]
Reviews and Book Notices.
1155
Reviews and Book Notices.
Our Homes. By Henry Hartshorn, A. M., M. D. Formerly
Professor of Hygiene, in the University of Pennsylvania,
etc. Philadelphia, Presley Bakiston, 1880. New Orleans.
Armand Hawkins, 196^ Canal street. Price 50 cents.
The American Health Primers, so admirably adapted to the
wants of the community afford quite a library of good common
sense teaching and should be more widely known and appreciated .
In the volume before us, the views of the author are not ex¬
travagant, and the practical hints in regard to the location
of houses, directions bearing upon their proper ventila¬
tion, light, warmth, water supply, drainage, etc, are wisely and
tersely given.
We wish the “American Health Primers” a wide-spread
circulation.
A Practical Handbook of Medical Chemistry applied to Clinical
Research , and the detection of Poisons. Partly based on
“ Bowman’s Medical Chemistry.” By William H. Greene,
M. D., Demonstrator of Chemistry in the Medical Depart¬
ment in the University of Pennsylvania, etc., etc. Phila¬
delphia : Henry C. Lea’s Son & Co. New Orleans :
Armand Hawkins, 196£ Canal street. 12 mo. Pp. 310.
Price $1 75.
After an introductory chapter on manipulation the work is
presented in three parts corresponding to the most natural
division of the subject.
The first part embraces a brief description of the proximate
principles which take part in normal and pathological vital
action, and the characteristics by which they are identified
are demonstrated.
The second part is a consideration of the more important
liquids and solids of the body, together with the processes by
which they may be analyzed. The methods given embrace
those which yield the most accurate results in hands not spec¬
ially skilled in chemical manipulations.
10
1156 Reviews and Boole Notices. [June
The third part of the book treats of the detection of the more
ordinary poisons and is especially practical.
The large number of cuts illustrating the work adds much to
its value. The publishers present the work beautifully printed
and strongly bound in cloth at a very low price.
A Manual of Pathological Histology . By V. Cornil, Assistant
Professor in the Faculty of Medicine of Paris, and L. Rau-
vier, Professor in the College of France. Translated with
notes and additions by E. O. Shakespeare, A. M., M. D.,
Opthalmic Surgeon and Microscopist to the Philadelphia
Hospital ,etc., and J. Henry C. Simes, M. D. Demonstrator
of Pathological Histology and Lecturer on Histology in
the University of Pennsylvania. With three hundred
and sixty illustrations on wood. Philadelphia : Henry
C. Lea. New Orleans : Armand Hawkins, 196£ Canal
street. 8vo. pp. 784. Price $5 50.
The translation into English of the work of Cornil and Ran.
vier, has added one of the most complete volumes on patholog¬
ical history, we have ever seen. The plan of study embraced
within its pages is essentially practical. Normal issues are
discussed, and, after their thorough demonstration, we are, then
able to compare any pathological change which has occurred
to them. Thus side by side, physiological and pathological
anatomy go hand in hand, affording that best of all processes
in demonstrations, comparison. The admirable arrangement
of the work affords facility in the study of any part of the
human economy.
Part 1st is a study of general pathological anatomy and
embraces in its sub-divisions cells and normal tissues, altera¬
tions of cells, inflammation and tumors. Part 2nd, diseases of
organs and tissues, lesions of bones, lesions of cartilage, lesions
of muscular tissue, etc. Part 3rd is devoted to the pathology
of the resperatory and digestive systems and various organs
and glands, the genito urinary apparatus, and closes with a
chapter on the pathological anatomy of the skin. All through
the work we note the great care bestowed upon the descriptions
of normal tissues, thus affording precision in the study of the
abnormal.
Reviews and Booh Notices.
1157
1880]
The American editors have added much of interest, and
deserve warm thanks for the creditable manner they have ful¬
filled their task. The plates are admirable, many we under¬
stand are taken from the u Medical and Surgical History of the
late War.” A complete index is added.
Sore Throat , its Nature , Varieties and Treatment ; including the
connection beticeen Affections of the Throat and other Diseases.
By Prosser James, M. D., Lecturer in Materia Medica and
Therapeutics at London Hosp.; Phys. to Hosp. for Dis. of
Throat and Chest, etc. Fourth edition, illustrated with
hand-colored plates. 12mo. Pp. 318. Philadelphia :
Lindsay & Blakiston. 1880. [Sold by Armand Hawkins,
196£ Canal street, New Orleans. Price $2 25.]
The third edition, which was sold in about three months, was
a thorough revision of the preceding ; but, in the long interval
between the second and third editions, the author was gratified
to observe that his new doctrines had gained general adoption,
and that the measures which he disapproved had been rejected
by the profession.
The 23 chapters of the work are grouped in three parts, or
general heads, as follows: I. Preliminary sketch of the whole
subject j II. Diffused Affections; III. Diseases of Individual
Organs.
Chapter X. treats of Exudative Sore Throat, or Croup and
Diphtheria! As to the unity or diversity of the two, the author
seems rather unsettled between the French notion on the one
hand and the German on the other. By way of distinction,
allusion is simply made to the anatomical seat of the false
membrane, which is said in croup to involve only the ephithe-
lium, while in diphtheria the deeper structure is affected, even
to loss of substance. On this point he sums up as follows :
“ This distinction, therefore, must be given up, or it must be
admitted that croupous inflammation may set up the constitu¬
tional symptoms of diphtheria; while, then, we cannot point to
any anatomical differences between croup and diphtheria, the
two affections form sufficiently clear clinical groups to warrant
us in speaking of each separately.”
1158 Reviews and Book Notices. [June
They are accordingly considered apart from each other ; but,
unless one had previously made up his mind on the question of
identity, he would not be likely to come to a clear conclusion
from reading these pages. Th^ distinctions have been drawn
so clearly by other writers, that this failure must be regarded
as a serious defect, and it is quite unsatisfactory to one de¬
sirous of knowing the author’s real opinion. Nevertheless, on
the point of treatment he is sufficiently precise and copious.
Having relieved our mind on what we regard as the weak¬
est chapter of the work, we feel free now to express general
commendation of it as a whole. Though not, strictly speakiug,
a monograph, it has the copiousness wrhich attaches to these
productions, without becoming over-tiresome. According to
the prevailing custom, the throat affections are fairly entitled
to a special treatise, and this is so far the best we have seeu.
S. 8. H.
Post-Mortem Examinations , with special reference to Medico-legal
Practice. By Prof. Rudolph Virchow, of the Berlin Charite
Hospital. Translated from the second German edition by
Hr. T. P. Smith. 12mo. Pp. 145. Philadelphia : Presley
Blakiston. 1880. (Sold by Armaud Hawkins, 196£ Canal
street, New Orleans.]
This little volume consists of three essentially distinct parts,
all having important relations to the main object — to afford a
reliable guide in the performance of autopsies. The first part
gives minute directions for the examination of all the organs,
the proper performance of which, in the opinion of the distin¬
guished author, should occupy about three hours. The second
part illustrates the first, by presenting the full notes made by
the author in the post-mortem examination of four different
subjects, selected with reference to interesting features. The
third part contains the Regulations for the Guidance of Med¬
ical Jurists in conducting Post mortem examinations for legal
purposes, adopted for use in the German empire.
The importance of minute and complete examination of a
dead body is well illustrated in the report of the second case
examined. This was one of suicide by guushot wound of the
head. Death was found to have resulted from suffocation,
1880] Reviews and Boole Notices. 1159
caused by pulmonary oedema, which was induced by the pres*
sure of extravasated blood on the medulla oblongata.
The simple fact that this work is by the greatest jmthologist
of the age, is sufficient to give it the stamp of authority, as far
as it goes, for it must not be supposed that pathology is even
touched, nor morbid anatomy beyond the four cases offered as
examples in practice. S. S. H.
A Guide to the Practical Examination of XJrine. For the use of
Physicians and Students. By James Tyson, M. D., Prof.
Gen. Path, and Morb. Auat., TJniv. Pa., etc. Third edi¬
tion, revised and corrected, with illustrations. 12 mo. Pp.
183. Philadelphia : Lindsay & Blakiston, 1880.
The first edition of this work appeared in Nov., 1874, and the
second in April, 1878. The demand for a new editiou in less
than eighteen months, shows its appreciation by the profession
The analysis of urinary constituents includes both the method
of precise quantitative estimation and that of approximative
valuation ; and the descriptions of the various processes are
clear and concise. The illustrations are sufficiently copious for
illustration of microscopical appearances.
Frequent reference is made to the work of Hoffman and
Ultzmann, which received notice at our hands a few months
ago. Dr. Tyson’s book, besides being smaller, is easier of refer¬
ence, from a more systematic arrangement of matter.
S. S. H.
A Practical Treatise on Sea-Sickness ; its Symptoms, Nature and
Treatment. By George M. Beard, A. M., M. D., etc. 12
mo. Pp. 74. New York : E. B. Treat. 1880.
The author regards sea-sickness as a functional disease of
the central nervous system, chiefly of the brain. In some
cases it becomes quite daugerous, or even fatal, from nervous
exhaustion and inanition. He is not disposed to regard this
malady lightly, and does not allow that it is ever of the slight¬
est advantage to the sufferer; all the benefit of a voyage being
derived from the pure, bracing atmosphere, and other favorable
conditions, to which sea-sickness is only a drawback.
11G0
Bools and Pamphlets Received.
[June
The cause of the complaint is attributed to the agitation of
the nervous system by mechanical concussions produced by the
motion of the vessel. Americans suffer more than Europeans,
women more than men, and delicate women especially, on ac¬
count of weaker nervous organization. The extremes of life,
infancy and old age, exhibit diminished liability to the com¬
plaint, but of this fact no satisfactory explanation is given.
The treatment recommended begins by the preliminary use
of the bromides, and he gives preference to the sodium bromide.
He would commence its administration from one to three days
before sailing, so as to induce moderate bromization before be¬
coming liable to sea-sickness, aud this condition should be
maintained through the voyage, if necessary. In some cases
he uses sulphate of atropia, either alone or in combination
with the bromide. For the sick headache, which sometimes is
quite distressing, he recommends citrate of caffeine and canna¬
bis indica — the latter being preferable in the eveuing, as it
rather promotes than prevents sleep.
The author professes great confidence in the remedies above
named, from a somewhat extended experience; and his judg¬
ment is fortified by the experience of I)r. W. F. Hutchinson, of
Providence, with the same bromide in conjunction with minute
doses of ipecac.
Until now sea-sickness has been one of the opprobria medi-
corum, and it would be as remarkable as it would be a blessing
to humanity, if the teaching of Dr. Beard should be happily
confirmed by the multitude who go down to the sea in ships.
S. S. II.
Books and Pamphlets Received,
A Text-Booh of Physiology. By M. Foster, M. A., M. D., F
R. S., Prelector in Physiology and Fellow of Trinity College,
Cambridge. From the Third and Revised English Edition,
with Notes and Additions. By Edward T. Reichert, M. D.,
1880] Books and Pamphlets Received. 1101
Demonstrator of Experimental Therapeutics, University of
Pennsylvania.
Modern Medical Therapeutics , a Compendium of Recent For¬
mulae and Specific Therapeutical Directions , from the Practice of
Eminent Contemporary Physicians , American and Foreign. By
George H. Napheys, A. M., M. D., etc.
A Practical Treatise on Sea-Sickness. Its Symptoms, Nature
and Treatment. By George M. Beard, A. M., M. D., Fellow of
the New York Academy of Medicine, etc. etc.
Diseases of the Maxillary Sinus. By Edward Bork, M. D.,
member of the Medical and Chirurgical Faculty of Maryland
and Baltimore Medical Association, etc., etc.
Modern Abuse of Gymecology. By Clifton E. Wing, M. D.,
Boston Mass.
The Black Arts in Medicine , with Anniversary Address. By
John D. Jackson, A. M., M. D., Member of the Kentucky State
Medical Society, etc. Edited by L. S. McMurtry, A. M., M. D.
Re-opening of the Famous Faugier, White Sulphur Springs Va.,
Season of 1880.
Report on Drainage and Sewerage. By John Roy, New Or¬
leans, La.
On the Removal of Foreign Bodies from the Eye. With Four
Cases. By Charles Stedman Bull, M. D., Surgeon and Pathol¬
ogist to the New York Eye and Ear Infirmary. Re-print from
the Archives of Ophthalmology, March, 1880.
Second Edition of Malaria, and its Affects. By J. W. Young,
M. D.
Measles not a Trivial Disease. A Report on the Present Epi -
demic in Brooklyn, and its Treatment by the Board of Health. By
J. H. Raymond, M. D.
Progress in the Management of Contagious Disease, by the
Brooklyn Board of Health. By J. H. Raymond, M. D.
A Case of Intr a- Ovarian Pregnancy with Post-Mortem Exam¬
ination. By Talbot Jones, M. D., St Paul, Minn. Re-print from
the American Journal of the Medical Sciences.
| J une
1162 Meteorological and Mortality Tables.
Meteorological Summary — April.
Station — New Orleans.
a .
0 .
.2.2*0
— < ^ a
c8 £
<D ®
WH +-»
^ <D
ci <E>
CD U
ss
^[3
Date.
>1 ft
‘5 3
pm
Cg S
C3 d}
Q H
m s
c3 3
QP
P> t-i <£.
<o -r C
Q.S
«
1
30.06
66.7
72.0
S. E.
2
29.95
70.5
90.0
South
1.78
3
29.99
75.5
80.7
S. W.
.01
4
30.04
75.7
81.7
s. w.
5
30.05
75.0
77 0
s. w.
6
30.02
76.2
74.7
s. w.
7
30.06
68.0
67.7
N. E.
.02
8
30.18
53.2
75.3
North
.82
9
30.28
57.5
44.0
North
10
30.18
62.7
48.0
South
11
30.19
66.2
48.3
N. W.
12
30.38
58.0
57.7
East.
13
30.27
63.7
66.0
S. E.
14
30.14
70.7
78.0
S. E.
.02
15
30.03
73.2
80 0
South
16
29-98
76.0
79.3
South
17
30.02
76.2
77.0
South
18
29.95
76.2
75.3
South
19
29.95
74.7
79.7
South
1 .25
20
30.09
69.0
85 . 7
North
1.95
21
30.11
73.5
84.3
North
.63
22
29.98
76.0
77.7
South
23
29.88
77.2
78.3
South
24
29.88
76.0
80.0
South
25
29 99
77.7
78.0
S. E.
26
30.05
76 7
73.3
North
27
30*12
74..
67.0
East.
28
30.05
75.7
78.7
South
.21
29
30.10
732
76.0
North
.19
30
31
30.29
70.0
54.3
North
....
Sums
Means
30.075
71.2
72.8
South
6.88
General Items.
Highest Barometer, 30.442, on 12tli.
Lowest Barometer, 29.862, on 24th.
Monthly Range of Barometer, 0.580.
Highest Temperature, 84° on 25th.
Lowest Temperature, 42° on 8th, 9th.
Monthly Range of Temperature, 35°.
Greatest Daily Range of Temperature,
22° on 13th, 14th.
Least Daily Range of Temp., 7° on 2d.
Mean of Maximum Temperatures, 77°6.
Mean of Minimum Temperatures, 64°8.
Mean Daily Range of Temp., 12°8.
Prevailing Direction ofWind, South.
Total Movement of Wind, 6,289 miles.
Highest Velocity of Wind and Direc¬
tion, 28 miles, North, on 29th.
Number of Clear Days, 7.
Number of Fair Days, 12.
Number of Cloudy days on which no
Rain fell, 6.
Number of Cloudy Days on which
Rain fell, 5. Total number of days
on which rain fell, 10.
Dates of Luna Halos, 21st.
COMPARATIVE TEMPERATURE.
1871 .
1876 .
69c.l
1872 .
1877...
68°. 6
1873 . 67c.O
1878. .
71°.5
1874 . 65°. 6
1879...
6 7°. 9
1875 . 65°. 3
1880...
71c.2
COMPARATIVE
PRECIPITATION
1871 . inches.
1 1876:
6.41
inches
1872 . “
1 1877:
4.79
((
1873.. 174 “
j 1878;
1.51
“
1874.13.62 “
1879;
9.17
(i
1875.. 8.05 “
1 1880:
6.88
U
GEORGE H. ROHE,
Sergeant, Signal Corps, U. S. A.
Mortality in New Orleans from April 17th, 1880, to
May 15th, inclusive.
Week Ending.
Yellow
Fever.
Malarial
Fever.
Consump¬
tion-
Small¬
pox
Pneu¬
monia.
Total
Mortality.
April
24
0
1
25
0
8
102
May
1
0
5
10
0
3
111
May
8
0
5
23
0
10
124 .
May
15
0
13
13
0
6
126
Total.
...
0
24
79
0
27
463
Index to Vol. VII.
Abortions, Larcerated Cervix Uteri,
probable cause of . 912
Double Pneumonia . 737
Acid, Salicylic use of . 274
Carbolic, use of in Shingles.. 494
Antidote for . 1058
Ague, Treatment of by Quinetum Sul¬
phate . 276
Albuminuria, Physiological . 279
Alimentation, Reetai-Defibrinated
Blood for . 803
Allen, Thoms, J., M.D., case of Fibroid
Polypus of Uterus . 528
American Publio Health Association,
Report of Committee . 606, 646
Ammoniatum Cuprum in Neuralgia
of the fifth . 485
Anaesthetic, Bromide of Ethyl ....1144
Aneurism, Internal, value of Chlo-
ide of Barium for.... 711
Popliteal, cured by Es¬
march’s Bandage ....1129
Animal Heat — Flint’s Experiments
upon . 705
Animals — Transmission of Hydro¬
phobia from man to . 1066 1 Burns and Scalds
Anti Fat — Sea Weed as an . 70S;
Antiseptics, Experiments upon the
strength of . 1131
Apothecary vs. the Doctor . 570
Arabs, Bedouins . 489
Arsenic, Hypodermic infection of, for
Chorea . - . 1063
Arthritis, Rheumatic, Acute . 583
Atony, Vesical, Treatment of by
Ergotine Injections . . . 825
Atropia Physiological Action of.... 1114
Autopsy Society of Paris . 710
Blood, Transfusion of through the
Peritoneum . 949
Blood, Defebrinated for Rectal Ali¬
mentation . 803
Bogus Diploma Business . Ii48
Books and Pamphlets . .76, 293, 418, 501
578, 744, 838, 921, 1000, 1081, 1 160
Book Reviews. (See Reviews and
Book Notices. )
Brewer, W. P., M. D., Annual Ad¬
dress before the N. O. Medi¬
cal and Surgical Associa¬
tion . 685
Menorrhagia Treated by
Plugging the Uterus.. .. 778
Breeches . . 63
Bright’s Disease, Hydrological Treat¬
ment of . . . 243. 786
Bromide of Ethyl . 1144
Bromine in Laryngeal Croup . 493
Broncho tomy, Remarks on after
Treatment ©f . 438
Brown-Sequard, Theories of the
Nervous System . . 722
Bruises, Chlorine Water for . 62
. 1128
Recurrent,
Barium Chloride, value of in Inter¬
nal Aneurism . 711
Bedouin Arabs . 489
Beef and Ice Cream . . 4$5
Bemiss, J. H., M. D. — Leprosy, a few
cases of . 923
Benzoate of Soda in Phthisis . 1123
Bellevue Training-School for Nurses 813
Bickham, C. J., M. D., Puerperal
Mania, case of . 779
Birth, Child weighing twenty-three
and a half pounds.... 277
Treatment of Umbilical Cord 710
Bladder, Recurrent Calculus, Treat¬
ment, of . . 447
Blatta, Orientalis Action of . 63
Blood, as a stimulantt and Food. . . . 819
Calculus of Bladder,
Treatment of . 477
Carbolic Acid in Shingles . 494
Antidote for . .1058
Carditis, Chronic Rheumatic . 483
Cerebro-Spinal-Meningitis . 60
Cerium, Oxalate, as a Cough Reme¬
dy . 1126
Cervix Uteri, Application of Iodine
for Vomiting during Gestation 706
In cases of Placenta Previa 802
Lacerated, Probable Cause of
Recurring Abortions . 912
Csesarean Operations in Louisia¬
na . 456, 923
Chancre and Chancroid, Diagnostic
differences of . 237
Chaulmoogra Oil in Leprosy . . 395
Children’s Diseases, Recent Progress
in Treatment of . 477
Children, Necessity ,of Providing
Water to Drink . 492
Children, Weight of California and
Australian .- . 825
Cholera, A True Neurosis . 816
Causes of, Report of Sani¬
tary Commissioner oflndia.1047
Chorea, Treatment by Hypodermic
Injection of Arsenic . 1063
IV
Index to Vol. VII.
Chloral, Croton, Therapeutic Value
of . . . 802
Chloride of Barium in Internal An¬
eurism . 711
Chlorine Water for Bruises . 62
Chloroform, in Dyspepsia . 64
Effects of Ethidene and
Ether in Blood Pressure 804
Club-Foot, Treatment of . 972
Cod Liver Oil with Ether, use of .. 804
Coffee, Black, for Metrorrhagia . 1130
Consumption, Salesbury Plan in ... . 822
Contagion, Nature of . 539
Corn Doctors, Progress of . 708
Correspondence . 53, 387, 783, 863, 946
Cough Mixture, Sir Wm. Gull’s _ 732
Cremation in its Medico-Legal As¬
pect . 977
Croton Chloral, Therapeutic Value
of . 802
Croup, Bromine jn . 493
Cuprum, Ammoniatum, in Neuralgia
of the Fifth . 485
Cystitis, Tamponing Vagina for. . . . 970
Cystorrhagia from Retention of
Urine . . 1134
Treatmeut of . 1141
Czerny’s Operation for Hernia .... 971
Dabney, T. S., M. D., Reflex Sciatica
and Lumbago cured by removal
of cause, Stricture of Urethra. . 944
Day, E. L., M. D., Magnetism as an
Anesthetic in Surgical Opera¬
tions . 311
Davidson, J. P., M. D., Pernicious
Fever, its Variety and Treat¬
ment . 747
Decisions, Recent . 1056
Dell Orto, John, M. D., Nature of
Contagion . 539
Delannay on Fecundity and Sexual¬
ity . 701
Delusions, Cases of Peculiar . 909
Dermatophony . 281
Dermatology, Recent Progress in
* 535, 606, 1033
External Treatment of
Skin Diseases . 466
De Roaldes, A. W., M. D., Contribu¬
tion to the Hydrological Treat¬
ment of Bright’s Disease . 243
Diabetes, Sacharine . 492
Mellitus . 790, 872
Dicephalus Monster . . 61
Diet and Liquor Drinking . 66
Digitalis in Suppression of Urine,
External use of . 67
Diphtheria, Sudden Death in . 487
Notes on (Milk of Sul¬
phur) Sulphur Precipi-
tatum as a Topical Ap¬
plication for . 731
Diohtheritic Poison . 492
Disease, Prevention of, Prophyaxis
in Person . 667
Disease, Rectal Feeding in . 1059
Dootors and Clergymen . 912
Doctors vs. Apothecaries . 507
Drug Smoking . 491
Druggists, Percentages of . 722
Dugas, L. A., M. D., on the Treat¬
ment of Fractures of the Clav¬
icle and of Acute Orchitis . 681
Dyspepsia, Chloroform for . 64
Editorial . 77, 411, 1152
A Correction . . 1068
An Omission . 1068
Blanks of Superintendent of Cen¬
sus . 79
Doctors vs. Apothecary . 570
Erratum . 1070
Fighting Yellow Fever . . 495
Hypodermic Injection of Morphia. 572
Hydrate of Chloral . 1069
Iberville Medical Society . 984
Louisiana State Medical Society . . 826
Louisiana State Medical Society.. 1067
Louisiana State Board Health .... 1067
Louisiana State Medical Society
Proceedings . 1070
Merited Promotion . 818
New Orleans in 1879 . 657
Necrology . 984
Proceedings of the Attakapas
Medical Society . 1076
Parish Medical Society . 980
Potts, W. A. L., M. D . 285
Prof. S. D. Gross, M. D . 982
Photograph of Dr. Gross . 984
The Yellow Fever Canard . 1068
University of Louisiana, Medical
Department . 981
Valedictory . 1152
Yellow Fever outbreak of 1879.. 282
Yellow Fever, Creole Immunity
from . . . 283
Elliot, Jno. B., M. D., Prevention of
Disease, Prophylaxis in Person . . 667
Emotions, decay of . 734
Endo-Pericarditis, Complicated with
Erysipelas of face . 629
Epidemics from a Chemical Stand¬
point . . . 470
Epilepsy, Menstrual — Oophorecto¬
my performed for . 726
Epilepsy — Pfleger on the Cerebral
Pathology of . 913
Epilepsy, Relation of to Insanity. .. 950
Ergot, Hypodermic administration
of . 941
Ergotine Injections for Vesical
Atony . 325
Erosion of the Teeth, Nitrate of Sil¬
ver in.. . 1024
Index to Vol. VII.
v
Erratum . 1070
Erysipelas caused by sewer gas .... 468
of the Face, complicated
with Endo-Pericarditis 629
Evolution, Historic, Perception of
Colors . 275
Eye, Regeneration of . 490
Eye Troubles, Some Remarks on ... . 853
Ether with Cod Liver Oil . 804
and Ethidene in Blood Pres¬
sure, and Effects of Chloro¬
form . 804
Hypodermic Injection of, in
Sciatica . 819
Hydrobromic . 1127
Ethyl, Bromide . 1144
Experiments upon the Strength of
Antiseptics . 1131
Fecundity and Sexuality, Delannay
on . 701
Female, Man, Arigo and Toriani.... 718
Fever, Yellow ...... 29, 221, 273, 297, 343
Yellow, History of, in Can¬
ton, Miss., in 1.878 . 600
Yellow, History of, in NewOr-
leans in 1879 . 615
Intermittent, in Finland.... 459
Mushroom, or Highland Ma¬
larial . 732
Pernicious, Its Variety and
Treatment.. . 747
Pernicious Malarial, Hypo¬
dermic Injection of Quinine
for . 1128
Intermittent, Physical Cause
of . 801
Worm, Periodic Case of . 850
Fibroid Polypus of Uterus, Case of 528
Finger, Amputated, Re-union of - 863
Fistula in Ano, Modification of Op¬
eration for . 911
Fissured Nipples . . 1055
Flint on the Source of Muscular
Power . 702
Experiments on Animal Heat.. 705
Foot-Binding in China . 968
Foot, Club, Treatment of . 729
Fox, D. R., M, D., Topography of
Plaquemines Parish . 307
Fort, Wiley K., M. D , Remarks on
Skull Fracture . . 426
Fracture, Obstinate, Ununited, treat¬
ment of . .1147
Oblique, cure of . 298
Remarks on . - - - 426
of Clavicle Treatment of. . - 681
Franklin, C. H., M. D., Resuscitation
of Still Born Infants . 384
Friedrichs, A. G., M. D., Influence of
Diseased Teeth upon the General
System . 363
IFriedrichs, George J., D. D. S., Ni-
| trate of Silver in Erosion of the
Teeth . 1024
Garson on Inequality in Length of
Lower Limbs . . 975
Gastrotomy . 260
Gates, A. S., M. D., Surgical Notes
on Oblique Inguinal Hernia in
Female, Gunshot Wound in
Shoulder Joint . 1027
Germ Theory, Argument for — . 735
Gestation, Iodine applied to Cervix
Uteri for Vomiting in Pregnanoy 706
Gull, Sir William, Cough Mixture.. 732
Great Pox and Small Pox . 65
Greer, R. A., Re-union of an Amputa¬
ted Finger . 862
Gross, Prof. S. D., M. D., Visit to
New Orleans . 982, 984
Gunshot Wound of Uterus — Bullet
Traversing six months Foetus —
recovery of patient . 423
Hsematinic Properties of Dialyzed
Iron . 389
Hiematuria, Malarial . 449
Hemorrhage, Post Partum Treat¬
ment of . 561
from the Genital Organs during
Pregnancy and Parturition. . .. 896
Hemorrhages, Uterine, Hot Water
Application to Head for . 563
Haemorrhoids, cure of by Hypoder¬
mic Syringe . 255
Hammonds, J. D., M. D., Malarial
Hematuria . 449
Hardy, M., M. D., on the Examina¬
tion of Urine in Diabetes Mellitus 872
Harris, Robert P., M, D., Caesarean
Operations in Louisiana . . .456, 938
Hays, G. A. B., M. D., Gunshot
Wound of Uterus — Bullet Tra¬
versing Six Months Foetus — Re¬
covery of patient . 423
Heinamann, Carl, M, D., Contribu¬
tions to the knowledge of Yel¬
low Fever ( vomito) in Mexico. . . 1039
Hemiplegia and Gastralgic Attacks
with Hiematemesis in Ataxic
Disease, curative influence of
Magnets . 884
Hernia, Czerny’s Operation for cure
of . 971
Oblique Inguinal in Female.
Notes on . 1027
Herrick, S. S., M. D., case of Periodic
Worm Fever . 850
Holt, Joseph, M, D. Chain of Cir¬
cumstances connected with the
appeaaance of Yellow Fever in
New Orleans, in 1879 . 375
VI
Index to Vol VII.
Homoepathic Confectionary . 63
Homicide, Remarkable case of . 62
Hospitals, Ventilation of . 485
Horse, substitute for the . . 64
Hot Springs . 974
Ilydromic Ether . 1127
Hygiene of School Room, in its Re¬
lation to Light . 1147
Hypodermic injection of Quinine in
Pernicious Malarial Fever . 1128
Hydrophobia, cured by Kurara. .390, 564
Transmission of from Man to
Animal . 1066
Hypodermic Syringe in Hemorrhoids 255
Injection of Morphine.. 572
Use of Quinine . 563
Injection of Ether in
Sciatica . __ 819
Administration of Er¬
got . . 941
Injection of Arsenic for
Chorea . 1063
Ice Cream and Beef . 485
Identity, Personal Loss of . 725
Inefficiency in Expert Testimony. . 59
Inebriety and Allied Nervous Dis
eases in America . 699
Inebriates, Legislation for . 808
Infants. Purulent Opthalmia in _ 281
Resuscitation of Still-Born _ 384
Infantile Opthalmia, Prevention of. 731
Inguinal, Oblique Hernia in Female,
Gun-shot Wound of Shoulder
Joint, Surgical Notes on . 1027
Insanity, Relation of to Epilepsy.. . 950
In its Relations to the General
Practitioner of Medicine . . 961
Intermittent Fever in Finland . 459
Fever, Physical Cause of . 801
Iodide and Bromide of Potassium in
Albuminuria . 409
Iodine, Application of to Cervix-
Uteri for Vomiting in Gestation 706
Iodoform, Deodorized . 494
Iron, Dialyzed, Haemetinic Proper¬
ties of . 389
Iron Preparations, Misuse of . 1065
Johns Hopkins University and
Higher Education . 955
Jones, Joseph, M. D., Treatment of
Yellow Fever . 20, 221, 297, 343
Jones, John T., M. D., Physiological
Action of Atropia.- . 1114
Kava-Kava and its Blennostatic
Properties . 815
Kidney, Extirpation of . . 217
Kidney, Construction and Functions
of . 1003
Kiss, Danger in . - . 714
Klebs on the Contagion of Syphilis 398
Knee-joint, Bullet Wound of, Anti¬
septic Treatment of . . 1148
Koumiss, Imitation, Preparation of. 272
Select Formula . 707
Kurare in Hydrophobia . 390, 564
Labors, First, Comparative Dangers
of . 407
Lanng, O. R., M. D., Some Remarks
on Common Eye-trouble . 853
Leg, Ulcer of, Chronic Treatment of 974
Lewis, E. S., M. D., Chronic Inver¬
sion of the Uterus of
five months’ standing
Reduced by Emmet’s
Method . 456
M. D., Chronic Inver¬
sion of Uterus of fifteen
months’ standing Re¬
duced by Manipulation
and Sustained Elastic
Pressure . . 860
Leprosy, Chaulmoogra Oil in . 395
Probable Cause of . 915
Cases of . 923
Limbs, Garson on Inequality of.... 975
Lister’s Method . 910
Logan, Samuel, M. D., Differential
Diagnosis of Tumors in the Scro¬
tum . . 1083
Long, Crawford W., M. D., Statue to 566
Love, A. C„ M. D., Hypodermic Ad¬
ministration of Ergot . 941
Lumbago, Reflex Sciatica cured by
removal of Cause, Stricture of
Urethra . 944
Magnetism as an Anesthetic in Sur¬
gical Operations . 311
Malarial Hasmaturia . 449
Malarial, Highland, or Mushroom Fe¬
ver . 732
Malarial Fever, Pernicious, Hypo¬
dermic Injection df Quinine in.. 1128
Mammary Tumors, Their Differential
Diagnosis . 884
Man, Female, Arigo and Fiorani.... 718
Man, Transmission of Hydrophobia
from Man to Animals . 1066
Mania, Puerpural, Case of . 779
Meningitis, Cerebro-Spinal . '.. 60
Menstrual Epilepsy, Oophorectomy
performed for . 726
Menorrhagia, Ovarian, Oophorecto¬
my performed for.. .. 728
Treated by Plugging
the Uterus . 778
Metalotherapy . 270
Index to Vot. VII.
Vll
Metorological Reports-
Novel Idea . 490
For May . 1879 . 80 Nurses, Bellevue Training School for 813
For June . — . '296
For July . — . 422 Obituary —
For August . — . 502 John Maynard Woodworth, M. D. 54
For September.. — . 582 Win. A. L. Potts, M. D . 285
For October .... — . . 666 Thomas Kennard, M. D . 739
For November . . — . 746 Thomas A. Cook, M. D . 984
For December .. — . 841 Samuel W. Rawlins . 984
For January - 1880 . 922 Samuel Choppin, M. D . 1153
For February . . — 1002 Col. T. S. Hardee . . .1154
For March . — . 1082 Oblique Inguinal Hernia in Female.
For April . — . 1162 Notes on.... . 1027
Metrorrhagia, Treatment of . 1130 Observations on the Digestion of
Microscopical Examination by Ha- Milk . 481
vana Yellow Fever Commissionl017 Obstetric Practice in Siam, Notes
Miles, A. B., M. D., Remarks on the on . 463
after Treatment Oil, Cod Liver, with Ether, use of 804
of Bronchotomy 438 Oophorectomy performed for Ovari-
Examination of I an Menorrhagia . 728
the Negro Thomas Oophorectomy performed for Men-
in his Control over strual Epilepsy . 726
Muscular Move- Opthalmia, Purulent, in Infants. .. . 281
ments.. .. ....... 771 Infantile, Prevention of 731
Plugging the Cervix 702 Orchitis Acute, Treatment of . 681
Milk, Observation on the. Digestion Ovarian Menorrhagia, Oophorectomy
of . 481 performed for . 728
Monster Dicephalus . 61 Ovariotomy, Notes on . __..1128
Morphia, Hypodermic Injection of. . 572 Ovariotomy, cases of . 464
Mortuary Reports op New Orleans— Oxalate of Cerium as a Cough Rem-
Frcm May 25, ’79, to June 23, 1879 80; edy.. . 1126
From June 23, ’79, to July 20, 1879 296
From July 20, ’79, to Aug. 24, 1879 422| Pernicious Malarial Fever, Hypoder-
From Aug. 24, ’79, to Sept. 21, 1879 502 mic Injection of Quinine in . . .1128
From Sept. 21, ’79, to Oct. 19, 1879 582 Personal — John W. Ross, M. D . 828
From Oct. 19, ’79, to Nov. 23, 1879 666 Peritoneal Adhesions, Artificial For-
From Nov. 23, ’79, to Dec. 21, 1879 746 mations of . 689
From Dec. 21, ’79, to Jan. 18, 1880. 841 Phthisis, Benzoate of Soda in _ .1123
From Jan. 18. ’80, to Feb. 15. 1880. 922 Plaster Bandage Saw . 1121
From Feb. 15, 1880, to Mch 21, ’80. 100*! Prof. S. D. Gross, M. D . 982, 984
From Mch. 21, ’80, to April 17, ’80. 1082jPeritoneum, Transfusion of Blood
From April 17, ’80, to May 15, ’80. 1162 Permeability of a Stone Wall - 66
Muscular Power, Examination of Pernicious Fever, Its Variety and
the Negro Thomas.. . 77 1 1 Treatment . 747
Muscular Power, Flint on the Source Ptleger on the Cerebral Pathology of
of . . 7021 Epilepsy . 913
Mushroom Fever or Highlaud Mala- Pharmacy and Proprietary Medi¬
na] . . 732{ cines, Proposed Law of.... .. 401
;Phymosis . . 64
Nasal Polypi, Speedy cure of . 1061,Physiological Albuminuria . 279
Nature of Contagion . 539j Question . 566
Neuralgia of the fifth Cuprum Am- Phthisis. (See Consumption.) .
moniatum in . . 485 Pilocarpine in the Pruritus of Preg-
Nervous Maladies of Uncultivated nancy . 825
people . 721 Placenta Posture in the expulsion of, 271
Nervous System, Brown-Sequard’s | Previa, Condition of the
Theories of . 722
Nickel Plating without a battery .. 1130
Nipples, Fissured . 1055
Nipples, Sore . 493
Nitre, Sweet Spirits, Poisoning from 64
Nitrate of Silver in Erosion of the
Teeth . 1024
Cervix-Uteri in cases of. 802
Pneumonia Croupous, Clinical His¬
tory of . . . 1
Double, and Abortion. 737
Poisoning from Sweet Spirits of
Nitre . . . 64
with Salacylate of Sodium 272
Index to Vol. VII.
viii .
Poison, Diphtheritic . 492
of the Toad . 564
Polypus, Fibroid, of Uterus, case of 528
Nasal, speedy cure of - . . 1061
Pomegranate, Therapeutic Action of
the four Alkaloids of the . 795
Popliteal Aneurism cured by Es¬
march’s Bandage . 1129
Potasium Bromide, and Iodide, in
Albuminuria . 409
Treatment in Obstinate
cases of vomiting . 410
Posture in the Expulsion of the Pla¬
centa . . . 281
Post Partum Haemorrhage, Treat¬
ment of . 561
Pregnancy, Treatment of, dnring
Sickness . 282
Pruritus, Pilocarpin in.. .825
and Parturition, Haemor¬
rhage from genital or¬
gans, during.. . 896
Vomiting in, cure of - 1150
Meadows’ Table for Es¬
timating Duration of. .1151
Preventive Treatment of. 1140
Prentiss, D. W., M. D., Croupous
Pneumonia, Clinical History of. 1
Proceedings of Societies (See Societies.)
Pruritus in Pregnancy, Pilocarpin
in . 825
Puerpural Mania, case of . 779
Purulent Opthalmia of Infants . 281
Quinetum Sulphate, in Treatment
of Ague . .. 276
Quinine, for Hypodermic Use . 563
Recent Progress in the Treatmrnt of
Children’s Diseases . 477
Rectal Alimentation, Defibrinated
Blood for . 803
Feeding in Disease . 1059j
Regeneration of the Eye . 490
Results of Treatment in Vieima .... 722
Reviews and Book Notices.
Atlas of Human Anatomy, Godlee 414
Advantages and Accidents of Arti¬
ficial Anesthesia, Turnbull . 497
Analysis of the Urine, Hoffman... 574
American Health Primers, Wilson 577
Atlas of Skin Diseases, Duhring. . 665
Annual Address President Ken¬
tucky State Medical Society,
Todd . 744
Brain Work and Overwork, Wood 988
Biographical Dictionary of Phys¬
icians, Atkinson . 985
Clinical Treatise on Diseases of
the Liver, Frerichs . 72
Cell Doctrine — Its History, etc —
Tyson . 292
Complimentary Dinner given to
Professor S. D. Gross in Phila¬
delphia, L. <fe B . 496
Clinical Treatise on the Diseases
of the Nervous System, Rosen¬
thal . 573
Clinical Medicine, Systematic
Treatise on the Diagnosis and
Treatment of Disease, etc.,
Flint . 659
Diseases of the Abdomen, etc.,
Hubershon . . 70
Diseases of Live Stock and their
most efficient Remedies, Tellor . . 72
Demonstrations of Anatomy, Ellis 75
Diseases of the Intestines and
Peritoneum, Bristo we . 415
De Bow’s Review . 574
Diseases of Women, Tait . 742
Diseases of Stomach, Haberslion 919
Epitome of Skin Diseases, Fox.. 414
First Step in Chemical Principles,
Leffman . 665
Grounds of a Homoeopath’s Faith,
etc., Jones . 575
Guide to the Practical Examina¬
tion of Urine. For the use
of Physicians and Stu¬
dents, Tyson . 1159
to Surgical Diagnosis,
Heath . 920
Galvestou Medical Journal . 989
Hearing and How to Keep it, Bur¬
net . . 74
Hints in Obstetric Procedure, At¬
kinson . . . .... 75
Harvey and his Discovery, DeCosta 293
Heart and its Diseases, with their
Treatment, Fothingill . 498
Hypodermic Injection of Morphia,
Kane . 997
Headache’s, their Nature, Causes
and Treatment, Day . 1078
Infant Feeding and its Influence
on Life, Routh . 833
Indiana Medical Reporter ... _ 989
Lectures on Electricity in its rela¬
tion to Medicine and Surgery,
Rockwell . . . 69
Long Life and How to reach it,
Richardson . 291
Laws of Therapeutics dr the Sci¬
ence and Art of Medicine, Kidd 416
Manual of Examination of the
Eye, Landolt . 71
of Physical Diagnosis, De-
lafield . 73
of the Principles and Prac¬
tice of Operative Sur¬
gery, Smith . 418
of Midwifery for Midwives
and Medical Students,
Barns . 743
Index to Vol. VII.
IX
Manual of Pathological Histology,
Corvil .... ... .. 1156
Materia Medica and Therapeutics,
Phillips . 573
Naval Hygiene — Human Health
and the means of Preventing
Disease, Wilson . 289
Optbalmic, Out-Patient Practice,
Higgins . 1 . 74
Outlines of the Practice of Medi¬
cine, etc., Fenwick . 833
Our Homes, Hartshorne . . 1155
Potts, Disease, Its Pathology and
Mechanical Treatment, Schaffer, 68
Posological Table, Rice . 291
Principles and Practice of Surgery,
Treatise on Surgical Diseases
and Injuries, Agoew . 413
Physiology and Histology of the
Cerebral Convolutions, Richet... 499
Photographic Illustration of Skin
Diseases, Fox . 743, 1080
Pocket Therapeutics and Dose
Book, Stewart . 832
Post Mortem Examinations with
special reference to Medico-Le¬
gal Practice, Virchow . 1158
Practical Treatise on Nervous Ex¬
haustion, Beard . 9r6
Practitioner . 989
Practical Handbook of Medical
Chemistry applied to
Chemical Research, and
the Delection of Poi¬
sons, Greene . . . 1155
Treatise on Sea-Sickness,
Its Symptoms, Nature
and Treatment. Beard.. 1159
Pharmacopia of the British Hospi¬
tal tor Diseases of the Skin, ,
Squire . 291
Pathological Anatomy of the Ear,
Schwartz . 415
Real-Encyclopadia der Gesarnm-
ten Heikundy, Euleuburg. 577
Report of the St. Louis Medical
Society on Yellow Fever. Ford.. 660
Sore Throat, Its Nature, Var eties
and Treatment, including the
connection between Affections
of the Throat and other Dis¬
eases, James . 1157
Spermatorrlnea, Its Causes, Symp¬
toms, etc., Bartholow . 68
Student’s Pocket Lexicon. Longley 663
System of Midwifery, including
the Diseases of Pregnancy and
the Puerperal State, Leishmau.. 918
Sexual Neurot-is. Kent . 919
Student’s Guide to Diseases of the
Eye, Nettleship . 989
Skin Diseases, including their
Definition, Symptoms, etc., Mor¬
ris . 999
Treatise on Practical Surgery,
etc., Mears . 73
Tabular Handbook of Ausculta¬
tion and Percussiou, for Stu¬
dents, Clapp . 292
Treatise on the Theory and Prac¬
tice of Medicine, Bristo we . 828
Text Book of Physiology, Foster 830
Transactions of the American
Medical Association . 834
Treatise on the Science and Prac¬
tice of Midwifery, Playfair . 917
Throat and the Voice, Cohen . 920
Therapeutics of Gynecology and
Obstetrics, Atkinson . 988
Transactions of the Illinois Medi-
ical Society . 990
Transactions of the Medical Soci¬
ety of Virginia . 992
Transactions of the Medical Soci¬
ety of Pennsylvania. .. . 995
Theory7 and Practice of Medicine,
Roberts . • . . 1079
Winter and its Dangers, Osgood 664
Richardson, T. G., M. D., Diagnos¬
tic Differences
between Chan¬
cre and Chan¬
croid . . 237
Singular Case of
Recurrent Cal-
calus of the
Bladder . 447
Rheumatic, Arthritis, Acute . 583
Rohe, George H., M. D., Re¬
cent Progress in Dermatology,
. . . 535, 626, 1033
Ross, Jno., W., M. D., Personal,
Merited Promotion . 828
Salicylate of Sodium, Poisoning
with . . . 272
Salicylic Acid, use of. . 274
Sanitary Administration, Relation
of State to the Individual.... 691
Sanitary Commission of India as to
the Cause of Cholera . 1047
Sanitary Science, new Relations in 480
Schuppert, M., M. D , Cure of Obli¬
que Fracture of Thigh
Bone, etc . 298
Vaccination as a Pro¬
tection against
Small Pox . 503
Sciatica, Hypodemic Injection of
Ether in . 819
Reflex or Lumbago, cured
by Removal of cause. Stric¬
ture of Urethra. . . 944
Scalds and Burns.. . .1128
Scrotum, Differential Diagaosis of
Tumors in . . 1083
Scrofula, Remarkable case of . 631
X
Index to Vol. VII.
Sea Weed, as an “ Anti Fat ”.. . . . 708
Semmes, A. T., M. D., History of Yel¬
low Fever at Canton, Miss., in
1878 . 600
Sepulture, Intra Mural Report of in
New Orleans . 45
Sevier, W. R., M. D., Toxemic Dis¬
eases and their Treatment . 843
Sexuality and Fecundity, Delannav
on . 701
Shingles, Carbolic Acid for . 494
Shively, C., M. D., Case of Fortign
body in the Windpipe . 533
Sigmond. Carl, M. £>., Lectures
upon the Modern Treatment of
Syphilis . 869
Skin Diseases (see Dermatalogy)1024
Skull, How to Measure . 60
Remarks on Fracture of . 426
Small-Pox, Vaccination as a Protec¬
tion against.... . 503
Smoking, Drug . 491
Smyth, A. W., M. D , Extirpation of
a Floating Kidney 217
Interpretations of the
Structure and Func¬
tions of the Kidney. .1003
Society Proceedings
Louisiana State Medical Asso¬
ciation, Session of 1879, 81,100,
297-307 311-315 318
Regulations of the Parish Medi¬
cal Association . 334
Proceedings of the Attakapas
Medical Association . 740-1076
Annual Address before the New
Orleans Medical and Surgical
Association . 685
Iberville Medical Association. . . 984
American Public Health Associ¬
ation, Report of Committee 606-646
Louisiana State Medical, Pro¬
ceedings. Session of 1880 .. .1070
Soda, Benzoate, in Phthisis . 1123
Soda, Bi-Sulphate in Urticaua . . 63
Sodium, Salicylate, Poisoning with 272
Sore Nipples . 493
Spaying for some of the Disorders of
Mensrtual Life . 567
Sudden Deaths in Diphtheria . 487
Sugar, Perfected Test for . 723
Sulphate, Quinetum, in Treatment
of Ague . 276
Sulphur Precipitatum, Notes on
(milk of sulphur) as a Topical
Application in Diphtheria . 731
Sugical, Notes on. Oblique Inguinal
Hernia in Female ; Gun-shot
Wound of Shoulder Joint . 1027
Suture, Dry . . 67
Stammeiiug . 272
Sternberg. Geo. M , M. D., Microsco¬
pical Investigations of the Ha¬
vana Yellow Fever Commission 1017
Stricture of Urethra, causing Rellex
Sciatica and Lumbago, cured by
removal of . 944
Syphilis, Contagion of, by Klebs - 398
Does it constitute absolute
obstacle to Marriage.... 633
Modern Treatment of . 869
Child infected through the
Utero-Placeutal circula¬
tion . 1059
Tamponing the Vagina for Cystitis 970
Teeth, Diseased, Influence of upon
the General System . 363
Erosion of, Nitrate of Silver
in . 1024
Tetanus . 976 977
Therapeutics, present state of . 547
Action of the four al¬
kaloids of the Gra-
nitum (or Pome¬
granate) . .
Thomas, Negro, His Control of Mus- 975
cular Movements . .
Topography of the parish of Plaque- 771
mines .
Toxemic Diseases and their Treat 307
ment . 843
Toad, Poison of . 564
Tumors. Mammary — Their Differen¬
tial Diagnosis. . 886
Turpentine, use of, in Whooping
Cough . 58
Transactions of Societies (See Soci¬
eties. )
Transfusion of Blood through the
Peritoneum . 949
Translations,
Hypodermic Injection of Qui¬
nine in Pernicious Malarial
Fever . . 1128
Trueheart, C. W., M. D., Plaster-
Bandage Saw . 1121
Tumors in Scrotum, Differen¬
tial Diagnosis of . 1C83
Cesarean and Utero-Ovari an Am¬
putation . 57
Hydrophobia cured by Kurara . . 390
Intermittent Fever in Finland.. 459
Erysipilis of the Face, Compli¬
cated with EndoPericarditis. . 629
Note of a Remarkable Case of
Scrofula . 631
Does Syphilis Constitute an Ab¬
solute Obstacle to Marriage. . 633
On Artificial Formation of Peri¬
toneal Adhesions . 689
Bright’s Disease . 786
Diabetes Mellitus . 790, 872
Therapeutic Action of the four
Alkaloids of the Granitum
fPommegranate) . 795
Index to Vol. VII.
xi
Lectures upon the Modern Treat¬
ment of Syphilis . 869
Curative Effects of Magnets in
some Forms of Hanuiplegia
and Gastralgic Attacks with
H;ematemesis in Ataxic Dis¬
ease . 884
Transfusion of Blood through
the Peritonium . 941)
Contribution to the knowledge
of Yellow Fever in Mexico by
Dr. Carl Heinemann . 10391
Ulcer of the Leg, Chronic, Treat¬
ment of, by Martin’s Bandage. . 974
Umbilical Cord, Treatment of, after
Birth . 710
University of Louisiana, Medical
Department . : . 981 j
University, John Hopains and High
er Education, etc . 955
ITtero Ovarian, Amputation, accord¬
ing to methods of
Dr. Porro, of Pavia 55 [
Cesarean, case of _ 57
Amputation . 394
Uterine Intra, Medications, Notes on
404-719
Therapeutics . 489
Haemorrhages, H<vt Water
Applications to Head for. 563
Uterus, Gunshot Wound of _ .. 423
Chronic Inversion of five
months standing, cured.. 456j
Fibroid Polypus of . 528
Chronic Inversion of fifteen
mouths standing cured... 860
Menorrhagia, Treated by
plugging of the . 778
Urine, External use of Digitalis in
Suppression of . . . 67
Retention of, in Elderly Men 812
Examination of, in Diabetes
Mellitus . 790-872,
Urticaria, Bi-Sulphate of Soda, for 63[
Vaccination as a Protection against
Small Pox . 503
Vagina, Tamponing of, for Cystitis. 970
Ventilation of Hospitals . 485
Vesical Atony, Treated by Ergotine
Injection . 825
Victory, Dangerous . 730
Vomiting, Obstinate, Treatment by
Iodide of Potassium ... . 410
In Gestation, Treated
with Iodine applied to
the Cervix Uteri . 706
In Pregnancy, case of. .1150
Watson, on the External Organs of
Generation in Animals and iu
Heimophrodites . 809
Weindahl, J. IT., M. I> . , Acute Rheu¬
matics Arthritis . 583
Whooping Cough. Turpentine in.. 58
Windpipe, ease of Foreign Body in 583
Worm Fever, Periodic, case of . 850
Womanhood, Case of Early . 488
Wounds, Principle Conditions for the
immediate Union of .. .. 565
of Knee JOint, Antiseptic
Treatment of . 1148
Yellow Fever, Treatment of _ 29, 221 >
273, 297, 343
Chain of circumstan¬
ces connected with
the appearance of,
in New Orleans, in
1879 . 375, 615
History of, at Can¬
ton, Miss., iu 1878.. 600
Microscopical Exam¬
inations by the Ha¬
vana Commission'. .1017
In Mexico, Contribu¬
tions to the Knowl¬
edge of, by Dr. Carl
Heinemann . 1039
1
MENSMAN’S PEPT0NI2ED BEEF TONIC.
The great necessity for a tiuid food that would possess all the elements necessary for the
support of the system having- been long felt by the Medical Profession, we cull attention to this
preparation, containing the entire nutritious properties of the muscular fibre, blood, bone and
brain of a healthy bullock, dissolved by aid of heat and pepsin, and preserved by spirit ; thus
constituting a perfect nutritive, reconstructive tonic.
_ It is not a mere stimulant, like the now fashionable extracts of beef, but contains blood-
making, force- generating and life sustaining properties, pre-eminently calculated to support the
system under the exhausting and wasting process of fevers and other acute diseases, and to rebuild
and reeruit the tissues and forces, whether lost in "the destructive march of such affections, or in¬
duced by over- work, general debility, or the more tedious forms of chronic disease. It is friendly
and helpful to the most delicate stomach, and where there is a fair remnant to build on, will
reconstruct the most shattered and enfeebled constitution. It is entirely free from any drugs.
Dispensed in 1 6 oz. bottles.
“13.R,. NXEJViSM^TV’S BEEF tonic
“ Is a complete representative of ieali and fat beef, bone, blood and muscle. It consists of
all the properties which combine in the development of the animal body, which are liquefied by
an artificial process, stimulating' natural digestion, and retaining all of their nlimeatary values. It contains in their perfection
all the natural elements of the meat in their natural quantitative relations, without their extraneous or indigestible properties,
and therefore requiring the least possible effort on the part of the stomach for its conversion into chyle, and its immediate
absorption by the system
“ This tonic is free from any drugs or chemicals, and is a great invigorator and recuperant I have used this preparation in
several cases of sickness of a character which enables me to give the most favorable opinion of its great value, in extreme sick¬
ness, Some of the cases referred to are hemorrhage of the bowels, typhoid fever, bilious fever, inflammation of the bowels,
where the greatest possible prostration wai present, and in which I fouud this meat tonic to accomplish results 1 could not obtain
with any other preparation. It is a gentle stimulant, and allays the peculiar irritation of the stomach, which destroys the appe
tite in all forms of disease, when the tone of the stomach is destroyed.”
“We published the above article in the November Number of 1877, and will say that we have prescribed the tonic daily to
date with the very best results. —AV. Med. Eclectic .”
The Best Three Tonics of the Pharmacopoeia:
IRON, PHOSPHOROUS AND CALISAYA.
We call the attention of the Profession to our preparation of the above estimable Tonics, as combined in our elegant and
palatable FEKKO-PHOSPHOKATED ELIXIR OF CALISAYA BARK, a combination of the Pyrophosphate of Iron and Calisaya
never before attained, in which the nauseous inkiness of the Iron and astringeney of the Calisaya are overcome, without any
injury to fctheir active tonic principles, and blended into a t beautiful Amber-colored Cordial, delicious to the taste and accepta¬
ble to the most delicate stomach. This preparation is made directly from the ROYAL CALISAYA BARK, not from its ALKA¬
LOIDS OR THEIR SALTS — being unlike other preparations called Elixir of Calisaya and Iron,” which are simply an ELIXIR
OF QUININE AND IRON. Our Elixir can be depended upon as being a true Elixir of Calisaya Bark with iron. Each dessert¬
spoonful contains seven and a half grains Royal Calisaya Bark and two grains Pyrophosphate of Iron.
PURE COD-LIYER OIL,
Manufactured on the Seashore from Fresh and Selected Livers.
The universal demand for Cod-Liver Oil that can be depended upon as strictly pure and scientifically prepared, having been
long felt by the Medical Profession, we were induced to undertake its manufacture at the Fishing Stations where the fish arc
brought to lend every few hours, and the Livers consequently are in great perfection.
This oil is manufactured by us on the seashore, with the greatest care, from fresh, healthy Livers, of the Cod only, without
the aid of any chemicals, by the simplest possible process and lowest temperature by which the Oil can be separated from the
cells of the Livers. It is nearly devoid of color, odor and flavor — having a bland lish-like, and to most persons, not unpleasant
taste. It is so sweet and pure that it can be retained by the stomach when other kind* fail, and patients soon become fond of it.
The secret of making good Cod- Liver Oil lies in the proper application of the proper degree of heat : too much or too little
will seriously injure the quality. Great attention to cleanliness is absolutely necessary to produce sweet Cod-Liver OiL The ran-
eid Oil found in the market is the make of manufacturers who are careless about these matters.
Prof. Parker, of New York, says : ** 1 have tried almost every other manufacturer’# Oil, ami give yours the decided pre¬
ference.
Prof. Hays, State Assayer of Massachusetts, after a full analysis of it, says : “ It is the best for foreign or domestic use.”
After years of experimenting, the Medical Profession of Europe and America, who have studied the effects of different Cod-
Liver Oils, have unanimously decided the light straw-colored Cod-Liver Oil to be far superior to any of the brown Oils .
SURGICAL INSTRUMENT DEPARTMENT,
Under the direction and personal supervision of W. F. FORD, Instrument Maker to St. Luke’s, Mt. Sinai, New York State
Women’s Hospitals, Bellevue, and all the other New York Hospitals.
MANUFACTURERS, IMPORTERS, WHOLESALE AND RETAIL DEALERS IN
Surgical, Dental, Orthopaedic Instruments, Catheters, Trusses, Supporters, Silk Stockings, Ear Trumpets, Spiints, Anatomical
Preparations, Local Anaesthesia Apparatus, Laryngoscopes, Othalmosoopes, Hypodermic Syringes, Axilla
Thermometers, etc., etc.
IS* Special attention given to the manufacture of Instruments to order, i
Surgeons and Physicians.
exact accordance with patterns furnished by
CASWELL HAZARD & CO.,
Family and Manufacturing Chemists, New York,
t.jy-80.
2
SEABURY h JOHHSOH,
Originators and Manufacturers of U. S. Pharmacopoeia Medicinal and
Surgical
POROUS AND SPREAD,
I IV RUBBER COMBINATION.
NEW YORK AMD LONDON.
Received highest and only Award (Medal and Special Diploma of Merit) over all
Foreign and Home Competitors in 1876.
THE JURORS’ • AWARD IS SUBSTANTIALLY:
ORIGINALITY — The successful application of rubber as a base for all medici
nal and mechanical plasters.
RELIABILITY and general excellence of manufactures.
Facts concerning Medicinal Plasters in Rubber Combination.
India-rubber-spread and Porous Plasters possess indisputable ad¬
vantages over all other Plasters: [1] The Rubber Combination preserves
the incorporated drug or extract from decomposition or volatilization ; [2]
They adhere closer and tinner ; [3] They do not soil the skin or linen ; [4]
They are always pliable, and never become hard or brittle ; [5] They ad¬
here without heat or moisture ; [6] An increased effect is obtained by being
porous, as the Plaster neither slides nor moves from its affixed position.
BELLADONNA PLASTER, U. S. P.
IN RUBBER COMBINATION.
Messrs. SEABURY & JOHNSON claim that theirs is the most thor¬
oughly reliable and only strictly officinal Belladonna Plaster ever offered
the medical profession. It is an improvement on other Belladonna
Plasters in several important particulars. First, it is incorporated with
the officinal alcoholic extract only. Secondly, it is freed from all stimulat¬
ing qualities, thereby insuring the uninfluenced sedative action of Bella¬
donna. Thirdly, it adheres with greater tenacity than others. Physicians
have been prejudiced in favor of Allen’s English Extract ; but recent analysis,
fairly conducted by competent chemists, emphatically condemns the In¬
spissated Extract as a mild and unstable product, representing but one-
half or less than one- half of the strength of the U. S. P. Alchoholic Extract
of Belladonna. The following result, published in the Ametican Journal oj
Pharmacy, in April, 1876, p. 145, is furnished for your consideration, which
ndicates the following percentage of Atropia in the respective extracts :
Alcoholic Extract of Belladonna, U. S. P . 2,571
Allen’s English Extract . . 1,411
Herring’s English Extract . 1,179
The practitioner, as well as ourselves, has but one choice.
Considering these features from a professional standpoint, we offer a
Belladonna Plaster which cannot be improved upon,
3
SALIOYLATED SURGEONS’
RUBBER ADHESIVE PLASTER.
This article has met with unprece¬
dented success, and has been em¬
phatically pronounced by our most
skillful General and Orthopaedic Sur¬
geons, as “ the best Surgeons’ Adhe¬
sive Plaster known.” It is applied
without heat or moisture, conforms
uickly to the parts; is perfectly
exible and waterproof, and is ready
for use at any moment. It is free
from irritating properties and very
healing. In counter-extension it has
no equal, as it does not move or slide
after being applied. Our India
Rubber Adhesive Plaster is also
spread on twilled linen, which re¬
sists the most powerful strain. In
addition to these general improve¬
ments, the plaster being impervious
to water, wounds can be cleansed
without removing the plaster, ob¬
viating the necessity of constant re¬
dressing, saving labor and time.
Whenever continued powerful adhesion
is required, it should be procured in
porous form.
MUSTARD PLASTER
SPREAD ON COTTON CLOTH.
Our Mustard Plaster is a decided
improvement over the best French
makes ; the mustard is manipulated
so as to exclude all the moisture, re¬
taining unimpaired by such treat¬
ment its essential properties. They
are always reliable, conform quickly
to the part, and when thoroughly
wet do not break into pieces, as is the
case with all other mustard plasters.
They do not crack or peel off, and
can be removed without soiling the
skin or linen. Being manufactured
only of pure mustard, they are perfect¬
ly free from Croton Oil or other
dangerous substitutes, often em¬
ployed to induce intense irritation.
RUBBER BUSTER PLASTER.
(Camphorated) B. P, STRENGTH,
This article has a splendid repu¬
tation ; its characteristic action is
not impaired by age in any climate.
The whole fly is incorporated, which
by constant manipulation is thor¬
oughly and beautifully combined
with the plaster. Its properties are
developed quicker, and it blisters in less
time than the cerate.
It never fails to blister when used
as directed. In addition to its supe¬
rior efficacy as a vesicant, we in¬
corporate a sufficient quantity of
Camphor, which, with the Olive Oil,
used on the face of the plaster, pre¬
vents Strangury. This improvement
will be appreciated by every practi¬
tioner. It is more reliable than any
known cantharidal preparation.
CAPSICUM PLASTER.
Recently this article has crept
into favor with our most esteemed
physicians, and judging from results
it is doubtless the best rubefacient
known. It has the specific action of
mustard without its objections. The
characteristic action of Capsicum is
uniformly maintained from twenty-
four to forty- eight hours, without
blistering, being mild, continuous'
and stimulating. This plaster is
spread in rubber combination and in
porous form. Experience has taught
practitioners that the Oleo Resin of
Capsicum is too violent, frequently
vesicating; we incorporate the crude
drug in sufficient quantity, without
risk to the patient. Our Capsicum
Plasters will be found more practi¬
cal for general use than the so-called
Mustard or Capsicum Papers.
G^SPECIAL NOTICE TO PHYSICIANS.^^
Quality is of great importance to the practitioner— by reliable preparations he supple¬
ments his own skill. You can therefore rest assured that every article we manufacture is
of strict pharmacopcea strength, and incorporated with perfectly reliable Extracts and
Drugs, well selected, carefully and conscientiously prepared, and manufactured invariably
under the personal superintendence of one of our firm. Our whole attention and study is
devoted entirely to the art of Plaster making , and we are ready at all times to receive sug¬
gestions from the fraternity, which may be of benefit to all.
8EABURY JOHNSON,
21 Platt Street, New York.
All of the above articles sold by Druggists everywhere. Always specify
SEABURY & JOHNSON’S PLASTERS.
R AMPLER SENT TO PHYSICIANS ON APPLICATION.
4
WYETH’S DIALYSED IRON.
(FERR UM DIAL YSATUM. )
A Pure Neutral Solution of Peroxide of Iron in the Colloid Form
The Result of Endosmosis and Difusion with Distilled Water.
PREPARED SOLELY BY
JOHN WYETH & BRO..
PHILADELPHIA.
This article possesses great advantages over every other ferruginous preparation
heretofore introduced, as it is a solution of Iron in as nearly as possible the form in which
it exists in the blood. It is a preparation of invariable strength and purity, obtained by
a process of dialysation, the Iron being separated from its combinations by endosmosis,
according to the law ot diffusion of liquids. It has no styptic taste, does not blacken the
teeth, disturb the stomach or constipate the bowels.
It affords, therefore, the very best mode of administering
IJF L03NT
in cases where the use of this remedy is indicated.
Physicians and Apothecaries will appreciate how important is the fact that, as an
antidote for Poisoning by Arsenic, Dialysed Iron is quite as efficient as the Hydrated
Sesquioxide (hitherto the best remedy known in such cases) and has the great advantage
of being always ready for immediate use. It will now doubtless be found in every drug
store to supply such an emergency.
Pull directions accompany each Bottle.
In addition to this Solution, we prepare a Syrup which is pleasantly flavored, but as
the Solution is tasteless, we recommend it in preference; Physicians will find our
DIALYSED IRON in all the leading Drug Stores in the United States and Canada.
It is put up in bottles retailing for ONE DOLLAR, containing sufficient for two
months treatment. Large size is intended for hospital and dispensing. Retail at 11.50.
Price Lists, &c-, &c. , sent on application.
JOHN WYETH & BRO., Phila.
Now on hand for the trade by G. R. FINLAY & CO., E, J. HART & CO.
Samples to Physicians free on application to
Alex. K. Finlay.
Dispensing Druggist , New Orleans.
Compressed Peptonic Pills.
Each Pill contains 1 grain pure Pepsin, 1 grain pure Pancreatine Lacto Phosphate of
Lime and Lactic Acid, and therefore represents 10 grains of the ordinary or Saccha-
rated Pepsin and 10 grains Pancreatine as usually prescribed and dispensed. Physi¬
cians have found these Pills to give prompt relief in many forms of Dyspepsia and Indi¬
gestion. They will be of permanent benefit in all cases of enfeebled digestion, produced
from want of' proper secretion of gastric juice. Physicians will appreciate the great
advantage of the mode of preparation of these Pills in the absence of sugar or starch,
which is present in all the ordinary Pepsin and Pancreatine Compounds, the increased
benefit to the Dyspeptic being due to a full and effective dose of tbe Pepsin and Pancre¬
atine in soluble combination, and small bulk free from the really hurtful addition of sugar.
Bose— One Pill after eating or when suffering from Indigestion, Lump in the Throat
or Flatulence. For children reduce the Pill to powder and give one-fourth to one-half.
JOHN WYETH & BRO.
Chemists , Philadelphia.
t.8.79
5
££F
Extract of Beef, Citrate of Iron and Sherry Wine.
In this p eparation are combined the stimulant properties of Wine and the nutriment
of Beef with the tonic powers of Ikon, the effect of which on the blood is so justly valued.
The peculiar feature of this combination is that it
COMBINES NUTRIMENT WITH STIMULUS.
In the majority of cases, along with failure of strength, and indeed as one cause of that
failure, there is an inability to digest nourishing food. Hence it is very desirable to furnish
nourishment in a form acceptable t<> the stomach, at the same time we excite this organ to
do its duty. On the other band, again, wine stimulus although needed, is ill borne if given
by itself, producing headache, excitement, and other symptoms which may be avoided by
the addition of nutritious substance, such as the Essence of Beef.
Prompt results will follow its use in cases of sudden exhaustion, arising either from acute
or chvouic diseases, and will prove a
VALUABLE RESTORATIVE FOR ALL CONVALESCENTS.
As a Nutritive Tonic it would be indicated in the treatment of impaired nutrition, im-
.poverishment of the blood, and in all the various forms of general debility. Each table¬
spoonful coni ains the Essenc » of one ounce of Beef, with two grains of Citrate of Iron, dis¬
solved in Sherry Wine. With a view to making the article more palatable a portion of
the beef is in the first pla^e partially roasted, as experience has shown that it is better
borne by the stomach, and can be administered for a longer period when this is done.
Adult Dose— One tablespoonful between meals, and when suffering from fatigue or ex¬
haustion.
Dose for Children should be reduced according to the age.
JOHN WYETH & BB.O., Chemists.
1412 Walnut Street, Philadelphia.
ABSORBENT COTTGH,
FOR
Hospitals, Dispensaries, Physicians, Dentists,
Druggists, Photographers, etc., etc.
- - -
The article furnished by ns -will be found superior to any other on account
of the facilities we possess for the manufacture, and the care taken at every
step of the process.
Not only iu general surgery, but especially in gynaecological practice,
Absorbent Cotton has found great favor. It differs little from ordinary
cotton in appearance, except in its uniformly fine quality and pure white
color, freedom from all impurities, — being entirely cleansed from oil, resin
and all foreign matter.
The property of instantly absorbing liquids, its exquisite softness and
great cheapness render it, an invaluable substitute for Patent Lint, Charpie
or Sponge.
We put up our Absorbent Cotton in neat and convenient packages, con¬
taining one pound, one-quarter pound and two ounces.
A descriptive Circular will be forwarded on application. Samples con¬
taining two ounces will be sent free of postage, on receipt of twenty cents.
JOHN WYETH & BRO,
Manufacturing Chemists , Philadelphia.
6
Office of I. L. LYONS,
Importer and Wholesale Druggist,
Corner Camp and Gtravier Streets,
Nero (Means, £a.
JOHN WYETH & BROTHER’S
Fluid Extracts, Elixirs, Wines, Dialysed Iron,
Compressed Powders or Pills, Etc., Etc.
I have in stock a full line of the Fluid Extracts,
Elixirs, Syrups, Wines, Compressed Powders, Dialysed
Iron, and other medicinal preparations, manufactured by
John Wyeth & Brother, Philadelphia.
The goods manufactured by this firm are deservedly
popular, and give great satisfaction. I have every con¬
fidence in the claims of the manufacturers as to the
quality of their products. Their large sale and popu¬
larity with the best retail trade for many years is the
strongest evidence of their care in selecting the choicest
drugs, with careful manipulation and intelligent manu¬
facture. I can supply these preparations on as favorable
terms as the manufacturers, and will send free of charge,
on application, their price lists, dose books, and samples
of their goods.
Very Truly Yours,
I. L. Lyons.
t.B-79.
7
College of Physicians
(Medical Department of Columbia College,)
CORNER OF FOURTH AVENUE AND 23d STREET,
New York City.
SEVENTY-THIRD SESSION, 1879-’80.
FACULTY OF MEDICINE.
LONZO CLARK, M.D., President and Professor of.
Pathology and Practical Medicine.
WILLARD PARKER, M.D., Professor of Clinical Sur-
JOHN^m ALTON,
M.D., Professor of Physiology and
Hygiene.
THOMAS M. MARKOE. M.D., Professor of Surgery.
T. GAILLARD THOMAS, M.D., Professor of Gynae¬
cology.
JOHN T. METCALFE. M,D„ Emeritus Professor of
Clinical Medicine.
HENRY B. SANDS, M.D., Professor of the Practice of
Surgery.
JAMES W. McLANE, M.D., Professor of Obstetrics
and the Diseases of Children.
THOMAS T, SABINE, M.D., Professor of Anatomy.
CHARLES F, CHANDLER. Ph D., Professor of Chem¬
istry and Medical Jurisprudence.
EDWARD CURTIS, M.D., Professor of Materia Medica
and Therapeutics.
FRANCIS DELAFIELD, M.D„ Adjunct Professor of
Pathology and Practical Medicine.
JOHN G. CURTIS, M.D., Adjunct Professor of Physi¬
ology and Hygiene; Seccetary of the Faculty.
WM, DETMOLD, M.D., Emeritus Professor of Military
and Clinical Surgery.
WILLIAM H. DRAPER, M.D., Clinical Professor of
Diseases of the Skin.
CORNELIUS R. AGNEW, M,D., Clinical Professor of
Diseases of the Eye and Ear.
ABRAHAM JACOBI, M.D., Clinical Professor of Dis
FESSENDEX CN.W0'nS, M.D., Clinical Professor of
EDWAKlfc.^SEGUIN'k.D., Clinical Professor of Dis-
eases of the Mind and Nervous System.
GEO, M, LEFFERTS, M.D., Clinical Professor of Laryn¬
goscopy and Diseases of the Throat.
CHARLES McBURNEY, M.D., Demonstrator of Anat¬
omy.
WM. T. BULL,, M,D., Ass’t Demonstrate of Anatomy.
FRANCIS DELAFIELD. M.D..
Director of the Pathological Laboratory of the Alumni Association.
FACULTY OF THE SPRING SESSION.
JAMES L. LITTLE, M.D.. Lecturer on Operative Sur¬
gery and Surgical Dressings.
GEORGE G. WHEELOCK, M,D„ Lecturer on Physical
Diagnosis.
ROBERT F. WEIR, M D.. Lecturer on Diseases of the
Genito-Urinary Organs.
H. KNAPP, M.D,, Lecturer on Diseases of the Eye and
Ear.
T. A. McBRIDE. M.D. Lecturer on Symptomatology.
CHARLES McBURNEY, Lecturer on the Anatomy of
the Nerves.
THE COLLEGIATE YEAR embraces a special Spring and a regular Winter Session, attendance at the latter
only being required for the graduating course, The Spring Session begins in March, and continues till June 1st. The
Regular Winter Session for 1879-80 begins October 1st, and continues till March.
TUITION is by the following methods ; —
I. Didactic Lectures— Dnrihg the Winter Session from five to six lectures are given daily by the Faculty.
Attendance obligatory. During the Spring Session two lectures are given daily by the Faculty of the Spring
Session. Attendance optional.
II. Clinical Teaching- Ten Clinics, covering all departments of Medicine and Surgery, are held weekly
throughout the entire year in the College Building. In addition, the Faculty give daily clinics at the larger City
Hospitals and Dispensaries (such as the Bellevue. Charity, New York and Roosevelt Hospitals, the New York Eye
and Ear Infirmary, etc. ) as a regular feature of the College curriculum. Attendance optional.
III. Recitations are held daily throughout both Sessions. Attendance optional.
IV. Personal Instruction — Cases of ObstetHcs are furnished without charge. Personal instruction is given in
Practical Anatomy, Operative Surgei'y , Minor Surgery , Physical Diagnosis, Ophthalmology , Otology ,
Laryngoscopy , and in Normal and Pathological Histology. Attendance optional, except upon Practical Anatomy.
Expenses — The necessary expenses are a yearly matriculation fee ( $5, good for a collegiate year), tho fees for
the lectures of the Winter Session ($20 for the course on each branch, or $140 for the entire curriculum), the Practi¬
cal Anatomy fee ($10. and a small charge for material), and a Graduation Fee of $30 The graduating course re¬
quires three years’ study. attendance upon two full winter courses of lectures, and upon one course of Practical An¬
atomy. Remissions and reductions of lecture fees are made to graduates and students who have already attended
two mil courses. All fees are payable in advance. Board can be had for from $5 to $9 a week, and the Clerk of
the College will aid students in obtaining it.
For the Annual Catalogue and Announcement, or for further information, address JOHN G. CURTIS. M.D.,
Secretary of the Faculty, College of Physicians and Surgeons, corner of Twenty-Third Street and Fourth Avenue,
New Yprk.
jy.3t.
8
University I City of New York.
MEDICAL DEPARTMENT.
410 East Twenty-Sixth St, opposite Bellevue Hospital, New York.'
THIRTY-NINTH SESSION, I879-’80.
FACULTY OF MEDICINE.
REV. HOWARD CROSBY, M.D., LED., Chancellor
of the University.
ALFRED C. POST, M.D., LED., Emeritus Professor
of Clinical Surgery ; President of the Faculty.
CHARLES 1X8 LLE PARDEE, M.D., Professor of
Diseases of the Ear.; Dean of the Faculty.
JOHN T. DARBY, M.D., Emeritus Professor of Surgery.
JOHN C. DRAPER, M.D., LED., Professor of Chem¬
istry.
ALFRED L. LOOMIS, M.D., Professor of Pathology
and Practice of Medicine.
WILLIAM DARLING, A.M., M.D., F.R.C.S., Pro¬
fessor of Anatomy.
WILLIAM II, THOMSON, M.D , Professor of Materia
Medica and Therapeutics.
J, W. S, ARNOLD, M.D„ Professor of Physiology and
Histology.
J. WIL LISTON WRIGHT, M.D., Professor of Surgery.
WM. M. POLK, M.D., Professor of Obstetrics and the
Diseases of Women and Children.
FANEUIL D, WEIS8E, M.D., Professor of Practical
and Surgical Anatomy.
LEWIS A. STIMSON M.D,, Professor of Pathological
Anatomy.
A. L. RANNEY. M.D.. Adjunct Professor of Anatomy.
JOSEPH E. WINTERS, M.D., Demonstrator of An
atomy.
POST-GRADUATE FACULTY.
D. B. ST. JOHN R008A, M.D., Professor of Ophthal-
mology.
WM. A, HAMMOND, M.D , Professor of Diseases of
the Mind and Nervous System.
STEPHEN SMITH, M.D,, Professor of Orthopedic
Surgery.
J. W. S. GOULEY, M.D., Professor of Diseases of the
Genito-Urinary System.
MONTROSE A. FALLEN, M.D., Professor of Gyne¬
cology.
HENRY G. PIFFAR1), M.D., Professor of Dermatology.
A. E. MACDONALD, M.D., Professor of Medical Juris,
prudence.
THE COLLEGIATE YEAR is divided into three Sessions : A Preliminary Session, a Regular Winter Session,
and a Spring Session.
THE PRELIMINARY SESSION will commence September 17, 1879, and will continue until the dpening of the
Regular Winter Session. It will be conducted on the plan of that Session.
THE REGULAR WINTER SESSION will commence on the first of October, 1879, and end about the first
of March, 1880.
The location of the new College edifice being immediately opposite the gate of Bellevue Hospital, and a few
steps from the ferry to Charity Hospital, Blackwell’s Island, the Students of the University Medical College are
entabled to enjoy the advantages afforded by these Hospitals with the least possible loss of time. The Professors of
the practical Chairs are connected with the Hospitals, and the University Students are admitted to all the Clinics
given therein, free of charge.
In addition to the daily Hospital Clinics, there are eight Clinics each week in the College Uuilding. Five Di¬
dactic Lectures will be given daily in the College building, and Evening Recitations will be conducted by the Pro¬
fessors of Chemistry, Practice, Anatomy, Materia Medica, etc., Physiology, Surgery, and Obstetrics, upon the sub.
jects of their lectures.
THE SPRING SESSION embraces a period of twelve weeks, beginning in the first week of March, and ending
the last week of May, The daily Clinics, Recitations, and Special Practical Courses, will be the same as in the
Winter Session, and there will be* Lectures on Special Subjects by the members of the Post-Graduate Faculty.
THE DISSECTING ROOM is open throughout the entire Collegiate year; material is abundant and it is
furnished free of charge.
STUDENTS WHO HAVE STUDIED TWO YEARS, and who have attended two full Courses of Lectures, may
be admitted to examination in Chemistry, Anatomy, and Physiology, and, if successful, will be examined at the ex¬
piration of their full course of study, on Practice, Materia Medica and Therapeutics, Surgery, and Obstetrics; but
those who prefer it may have all their examinations at the close of their full term.
EEES
For Course of Lectures .
Matriculation .
Demonstrator’s Fee (including material for Dissection) .
Graduation Fee .
Post-Graduate Certificate .
$140 00
5 00
. 10 00
. 30 00
. 30 00
For further particulars and circulars, address the Dean.
Prof. CHAS. INSLEE PARDEE, M. D,,
University Medical College, 410 East 26th St., New York City.
jy.4t.
Zf
40
IMPORTANT TO PHYSICIANS I
The fact that Sulphate of Quinine is only soluble in over 700 parts of
water is not generally known, or if known is not usually considered, except
in prescriptions, when this difficulty is overcome by the addition of Acid ;
and the further fact that Bi-Sulphate of Quinine is soluble in only
10 parts of water is as little appreciated.
McKesson & Robbins have paid much attention to the subject of put¬
ting Quinine into Pills, in a condition approaching that of a solution, and
have at last succeeded in their BI-SULPHATE OF QUININE
PILLS, and offer the same to the profession, confident that they will
stand any test for solubility and prompt action. Physicians will please al¬
ways specify McK. & R. Bi-Sulph. Quinine Pills, and they will
not be disappointed in results.
Note.— With no reference to respectable druggists, we would say that
cases have come to our knowledge and have been noted, where other pills
have been substituted on prescriptions for ours.
POWDERED PURIFIED CHINOIDINE.
Containing all the Non-Crystalizable Alkaloids of Cinchona Bark.
Similar preparations have been lately offered in market AT HIGH
PRICES under different fancy appellations, and claims made for the same
as of equal efficiency with Quinine.
As a great demand exists for a cheap anti-malarial remedy, we intro¬
duce this preparation at low figures ; and, in order that tlyB profession may
judge practically of its merits, will forward a sample to any physician’s
address, or mail one ounce upon receipt of FIFTY CENTS.
Yours respectfully,
McKesson & robbins.
Wholesale Druggists and Manufacturing Chemists,
91 FTJLTOZT ST., JTJZW YOJUT.
ADVERTISEMENTS.
ii
THE BEST AND CHEAPEST NATURAL APERIENT.
1.0 X DON MEDICAL
RECORD.
“Hunyadi Janos.— The most pleasant and
owing: to the smallness of its dose, the
cheapest of all the natural aperient
waters.1’
J'rom Prof. MA CXA MA H A,
Prof. of Materia Medico,
Royal College of Surgeons in
Ireland.
'* Far the most valuable and palatable
of "ur aperient mineral waters. I have
been agreeably surprised with the result of
a clinical investigation.”
Specially approved by the Academy of Medicine, of Paris , and its Sale in France
authorized by decree of the French Government
MEDALS AWARDED, EYOXS 187ti, VIENNA 1873, PARIS 1878.
THE BRITISH MEDICAL
•JOURNAL.
“ Hunyadi Janos. —The most agreeable, //
safest and most efficacious aperient water it—
which has been brought under our notice.” ' **
TflE LANCET.
” Hunyadi .Janos. Huron Liebig affi
that its richness in aperient salts surpasses
that of all other known wator*.”
Uses of Hfinyadi Janos acco^,,xg Opinions of Eminent Authorities.
1. For habitual constipation.
‘‘None so prompt, mild, and can bo so well borne for a length of time.” — Prof.
Seiko el BKittt, •* Uuiver ity of HrosUu.”
2. By persons inclined to obe- .
sity, co gestive, and gouty
disorders.
“I have used the Hunyadi Janos wat’-r in many cases of tiie rheumatic and gouty
diathesis with very marked benefit. In cases accompanied with great obesity 1 prefer it
to any other laxative. ” — Prof. Lewis A. Sayre M.D.. * B llevue Hospital, Now York.”
“ Preferred to 1‘riedrichshall and Pulna. bviho^e who have tried them.” — Prof. Aitkkn,
Pi It. 8., • '<>!!. -v'. ’
•of great use in catarrhal conditions of the pile-ducts and bowels, and for congestion
of the liver and other organs.” — • Medical Times and (Gazette.”
3. In chronic affections of the
organs -*f respiration and
Circulation.
“ Produces remarkable relief in chronic diseases symptomi tie of affection* of the ab
dominal and thoracic organs, and in serous effusions with impediment of respiration and
circulation.”— Prof. Alois Martin, 44 Royal M*dical Councillor, University of Munich.”
4. Against haemorrhoids, and
portal and hepatic congestion.
" The most certain and the roost, comfortable in its actipn of al' - the aperient waters.
Tlie special indications for its use are. in costiveness (especially in that of pregnancy ), in
poirt«l congestion with tendency to hremorrhoids. and in sluggi h action of the liver.” —
Inspector General Macphkrson, M..D, Author of ** Baths and Well* of Kurooe.”
5. During Pregnancy ; for
nursery use ; and in many
female disorders.
l prescribe none but this.” — Baron v. Scanzoni ” Wurzbunr.”
44 1 prefer this to any and ev ry other.”— Dr. Marion Sims, ‘‘New York.l Honorary Fellow
Obstetrical Society of Loudon and Dublin.”
6. In bilious attacks and sick
headaches.
44 l ha e made use of the Hunyadi Janos mineral water ever since its introduction into
this country, atnd with ever increasing satisfaction. It is highly beneficial to persons of
sedentary habit, and in what are called bilious attacks.”— I)R. Silver, Lecturer on "linical
Medicine. Charing-Cros* Il-.spita).
7. Against evil consequences
of indiscretion in Diet.
“Has invariably good and prompt success ; a most valuable item in the balneological
treasury.” — Prof. Virchow, Berlin.
For ordinary aperient purposes a half wineglas'sful of the Hunyadi Water may be taken at
bed-time, or a whieglasaful taken in tlie morning fasting. It is most efficacious when warmed to
a temperature not below tiO deg., or when an equal quantity of hot water is added to it.
IXXJJNYAJDI JANOS MINERAL WATER.
INDISPENSABLE TiJ THE TRAVELLING PUBLIC.
To secure the genuine Water, require bottles with a blue label bearing the name,
Tlie APOLLINARIS COMPANY, Limitefl, 19 Regent St,, Lonfloiij Euglanfl.
Sole Agents for the EDTpriF TIT? T) ATW 0 Pfl 41 and 43rWarren St.,
United States J? IliljJJiA. Ufj JjAil I U uU., New York.
9
* CODMAN & SHURTLEFF’S
ATOMIZING APPARATUS
All its joints are liard-
soldered.
Every one is tested by
hydrostatic pressure, to
more than one hundred
pounds to the square
inch.
It cannot be injured by
exhaustion of water, or
any attainable pressure,
and will last for many
years.
It does not throw
spirts of hot water ; is
convenient, durable,
ET PRICES REDUCED.^
Jj
F
The Complete Steam Atomizer— [Patented March 24, 1868].
portable, compact, and
cheap, in the best sense
of the word. Price $5.00
Postage 59c.
Brass parts, nick_
plated, additional, $2.00
Neatly made, stron
Black walnut Box, with
convenient Handle,
additional, $2.50. Post¬
age 44c.
COOMAN 4 SHUKTIEFF,
CODMAN & SHURTLEFF,
BOSTON.
The Boston Atomizer— [ Patented]. Shurtleff's Atomising Apparatus — | Patented].
The most desirable Hand Apparatus. Rubber warranted of the very best quality.
Valves imperishable, every one carefully fitted, and will work perfectly in all positions
Price $3 50.
The Bulbs are adapted to all the Atomizing tubes made by us.
Each of the above Apparatus is supplied with two carefully-made annealed glass
Atomizing Tnbes, and accompained with directions for use. Each' Apparatus is carefully
packed for transportation, and warranted perfect.
The Anticeptic Atomizer, with Regulatiag self-acting cut-off,
$15.00, $25.00, $45.00, and $50.00
45.00
4.00
3.00
3-00
2.50
2.50
25 cents to 15.00
Atomizer by Compressed Air
Dr. Oliver’s Atomizer
Dr. Clark’s Atomizer
The Constant Atomizer
Dr. Anight’ s Atomizer
'J he Boston Atomizer (see out)
Atomizing tubes in great variety
(Postage 20o. )
“ 20c.
“ 12c.
“ 16c.
For full description see New Pamphlet on Atomization of Liquids with Formula! of
many articles of the Materia Medica successfully employed in the practice of a well-known
American practitioner, together with descriptions ot the best forms of apparatus, which
will be sent, post-paid, on application.
Plaster Bandages and Bandage Machines, Artioles for Antiseptic Surgery, Aspirators,
Clinical Thermometers, Crutches, Air Cushions, Wheel Chairs and Articles for Invalids,
Mechanical Appliances for all deformities and deticiences, Trusses, Elastio Hose, etc.
Electrical Instruments for all Medical and Surgical uses, Hypodermic Syringes, Ice and
Hot Water Bags, Manikins, Models, Skeletons, Skulls, etc., etc. Naturalists’ Instruments
Sphygmographs, Splints and I racture Apparatus, Stethoscopes, Syringes of all k nds,
Teeth Forceps, Test Cases, Transfusion Instruments. French Rubber Urinals, TJrino-
metere. Vaccine Virus, Veterinary Instruments, Waldenburg’s Pneumatio Apparatus,
etc., etc.
Surgical Instruments and Medical Appliances of every description promptly repaired.
Having our factory, with steam power, ample machinery, and experienced workmen,
connected with our store, we can promptly make to order in the best manner, and from
almost any material, new instruments and apparatus, and supply new inventions on fav¬
orable terms. Instruments bearing our name are fully warranted. With hardly an ex¬
ception they are the product of our own factory, and made under our own personal super¬
vision, by skilled workmen, w’-o, being paid" for their time, are not likely to slight their
work tb ough haste.
New Uustrated Catalogue postpaid on application:
CQDMAI7 « SSCURTI.KFF,
Makers and Importers of Superior Surgical Instruments, etc., etc.,
13 and 15 Tremont Street. Boston.
B t.F.79.al.
10
OFFICE OF
^TEOMMEE^
Extract of Malt
COMPANY,
FREMONT, OHIO.
DEAR SIR:—
FREMONT , OHIO, April , 1873.
It is now five years since we first introduced and began the manufacture
of Extract of Malt in the United States. It lias been our aim to furnish
the medical profession in America with a malt-extract equal to the best
German make, and (by saving the expenses of importation) much cheaper
than the foreign article can be afforded. For the manner in which our
efforts have been appreciated by the medical profession, we desire to ex¬
press our warmest thanks.
The difficulties attending the manufacture of Extract of Malt in large
quantities, can be overcome only by that kind of skill which is acquired
by experience. Its constituents must receive no injury by the process
and good flavor and keeping quality, adapting it to all climates, must
characterize the product. All are familiar with the striking difference
between certain celebrated brands of ale an ! porter —and yet the poorest
as well as the best, is, or should be, produced from barley malt and hops.
Success greatly depends, of course, up< n the employment of none but the
best material; but it is by the use of specific and long tried procedures
that results are obtained which are so difficult to rival.
We do ourselves but simple justice, in stating that our entire attention is
and for many years has been, exclusively devoted to the manufacture of
Extract of Malt for medical purposes, and that we give our undivided
personal attention to each step i : the delicate process by which ^Extract of
Malt of excellent quality can alone be made.
Under these circumstances, it is unreasonable to suppose that the various
manufacturers of fluid extracts, elixirs, pills, &c., who (attracted by the
high reputation of our Extract of Malt) have rec ntly, in various sections
of the country, undertaken the manufacture of a similar article, should
generally succeed in producing it of a quality according with the fulsome
praise with which their advertisements are filled. While being perfectly
willing to let the reputation of our Extract of Malt rest upon its real
merits, we owe it to the medical profession, is well as to ourselved. to
give warning against imposition.
It has come to our knowledge that certain articles extensively advertised
as “pure” and “genuine extract of malt,” are composed chiefly of the
t.Jy-79.
11
substance called graph sugar or maltine, which, as is well known is the
product of the action of sulphuric acid upon starch subjected to a high
temperature. This artificial grape sugar or glucose which is extensively
manufactured from oorn starch, is now being used in immense quantities,
instead of ordinary cane sugar, in the sophistication of confectionery,
sugarhouse syrup, “ strained honey,” native wines, and canned fruits, and
by some brewers in the manufacture of beer and ale. The cheapness of
this artificial product of Indian corn, constitutes the chief inducement for
this species of substitution for barley malt and cane sugar.
Again, an extract of malted grain is manufactured for the purpose of
obtaining diastase, which (simple and variously combined) is much used
in medicine. The appearance of the extract is but slightly changed by
being deprived of this important constituent, although, it is unnecessary
to add, that its value as a medicinal agent is thereby greatly impaired.
Nevertheless, this very substance, which is little more than refuse material,
in the manufacture of diastase, is now being offered for pure malt extrac.
It is malt extract prepared from Barley malt combined with the proper
proportion of Hops, that has been for many years the standard medicinal-
nutritive employed by the medical faculty of Europe, and especially of
Germany. Its value has beeu established by experience, and its use in
the treatment of almost all forms of disease of nutrition is constantly ex¬
tending. We shall continue to devote the most scrupulous attention of
the maintenance of the reputation of our malt extract, by the careful
selection of material and by unwearied personal attention to manufactur¬
ing details.
Attention is respectfully directed to the 'accompanying extract from
Ziemssen, aud also to our circular and testimonials elsewhere printed.
Very Respectfully,
TROMMER EXTRACT OF MALT CO.
[From Zieimsen's Oyclopcedia of the Practice of Medicine, Vol. XVI, page 474;]
“The Malt Extract prepared from Trommer’s receipt is designed to
fulfil much the same purpose as Cod-liver oil, carbo-hydrates (malt-sugar,
dextrin,) taking the place of fatty matter. The simple (much or little
hopped) and the Chalybeate form of Malt Extract are coming more'&nd
more into favor as substitutes for the oil ; they are more palatable and
more easily digested, and should, therefore, be preferred in the dyspeptic
forms of anaemia. During the last few years Malt Extract has almost
entirely taken the place of Cod Liver Oil in the treatment of phthisis,’ and
other wasting diseases at the Basle hospital, and we have as yet found no
reason for returning to the use of the latter remedy. The Extract may be
given from one to three times a day in doses varying from a teaspoonful
to a tablespoonful in milk, broth, beer, or wine.”
t.Jy-79.
12
< — | T ES O M M E R, S’ | -
The rapidly increasing demand for onr Improved Extract of Malt, during the four
years that it has been manufactured and offered to the medical profession in America,
justifies the belief that in its production here we are meeting a generally felt want.
Long experience in manufacturing Malt Extract has enabled us to completely overcome
the many difficulties attending its manufacture in large quantity; ana we positively
assure the profession that our Extract of Malt is not only perfectly pure and reliab’e,
but that it will keep for years, in any climate, without fermenting or molding, and that
its flavor actually improves by age. Our Extract is guaranteed to equal, in every respect,
the best German make, while, by avoiding the expense of importation, it is afforded at
less than half the price of the foreign article.
The Malt from which it is made, is obtained by carefully malting the very best quality
of selected Toronto Canada Barley. The extract is prepared by an improved process,
which prevents injury to its properties or flavor by excess of heat. IT REPRESENTS
THE SOLUBLE CONSTITUENTS OF MALT AND HOPS, viz: Malt, sugar, dex¬
trine, diastase, resin and bitter of hops, phosphates of lime and magnesia, and alkaline
salts.
Attention is invited to the following analysis of this Extract, as given by S. H. Douglas,
Professor of Chemistry, University of Michigan, Ann Arbor.
TROMMER EXTRACT OF MALT CO.: — I enclose herewith my analysis of your
Extract of Malt :
Malt Sugar 46.1; Dextrine, Hop-bitter, Extractive Matter, 23.6; Albuminous Matter
[Diastase, ] 2.469 , Ash — Phosphates, 1.712. Alkalies .377; Water, 25.7. Total, 99.958.
In comparing the above analysis with that of the Extract of Malt of the German
Pharmacopoea, as given by Hager, that has been so generally received by the profession,
I find it to substantiaAv agree with that article
Yours truly. SILAS H DOUGLAS,
Prof, of Analytical and Applied Chemistry.
This invaluable preparation is highly recommended by the medical profession, as a most
effective therapeutic agent, for the restoration of delicate and exhausted constitutions. It
is very nutritious, being rich in both muscle and fat producing materials.
The very large proportion of Diastase renders it most effective in those forms of disease
originating in imperfect digestion of the starchy elements of food.
A. single dose of the Improved Tfommer’s Extract of Malt, contains a larger quantity
of the active properties, of Malt, than a pint of the best ale or porter ; and not having
undergone fermentation," is absolutely free from alcohol and carbonic acid.
The dose for adults is from a dessert to a tablespoonful three times daily It is best
taken after meals, pure, or mixed with a glass of milk, or in water, wine, or any kind of
spirituous liquor. Each bottle contains 1J Lbs. of the Extract.
Our preparations of Malt are for sale by druggists generally tkrcughout the
United States and Canadas, at the following prices
Extract of Malt, with Hops, plain. .
91 00
44
u
44
44
Pyrophosphate of Iron, Ferrated ...
1 00
u
a
44
44
Cod Liver Oil. ....
1 00
u
44
44
44
Cod Liver Oil and Iodide of Iron,
1 00
u
u
<4
44
Cod Liver Oil and Phosphorus, * •
1 00
it
44
44
44
Hypo phosphites,
1 50
u
44
44
44
Iodides ..... .
1 50
a
44
44
((
Alteratives, - - - . -
1 50
41
44
44
14
Citrate of Iron and Quinia, «
1 50
u
44
44
44
Pepsin, --••••
1 50
MAN UPAC I'UliKl) BY
TROMMER EXTRACT OF MALT CO., - - - FREMONT, OHIO.
tJy-79.
t
13
G. R. FIHLAY & CO.,
IMPORTERS
AND
No. 35 Magazine St. and 12 Bank Place,
NEW ORLEANS, LA.
We keep constantly on hand a large and complete stock ox
bought exclusively for CASH, and are prepared to fill all orders entrusted
to our care with accuracy aud dispatch, and at the lowest
possible market rates.
We deal in none but
First Glass
and all medicines sold by us are
GUARANTEED TO BE FRESH AND UNADULTERATED
The success of the physician often depends on the quality of the drug
prescribed by him, and we believe our patrons will bear us out in the as¬
sertion that the quality of the goods we supply cannot be surpassed.
We are Agents for some of the LARGEST MANUFACTURING ESTAB¬
LISHMENTS (both of this country and Europe) of
CHEMICALS,
PHARMACISTS’ PREPARATIONS,
SURGICAL INSTRUMENTS AND APPLIANCES.
aud all orders will be filled with attention to furnishing such manufactures
as are designated. A full stock of
Pure Liquors and Wines of all kinds
are also kept on hand for medicinal purposes.
t.jy-79.
11
([SUCCESSOR TO BALL, LYONS & CO. )
40, 42, 44 CAMP and 111, 113, 115, 117 GRA VIER STS.,
NEW ORLEANS, LA.
DEALER IN
Drugs, Chemicals, Essential Oils,
Chemical Apparatus, Surgical Instruments, Electric Apparatus, Medi¬
cine Chests, Saddle Bags, Trusses, Supporters, Silk Stockings,
Sponges, and all articles used in Medicine and Surgery.
FINE MINES AND LIQUORS,
PERFUMERY, FANCY GOODS, PAINTS, OILS, DYE STUFFS, GLASS, ETC.;
Importer of
FRENCH, ENGLISH AND GERMAN DRUGS AND CHEMICALS.
Importer of Swedish Leeches,
Importer of English Solid Extracts,
Importer of Bat I ley's Liqnor Opii Sed.,
Liquor Ergot, Cinchona, Buchu, Taraxacum, etc.,
Importer of French, English and German Proprietary
Medioines, Perfumery and Drug Sundries
Only direct Importer in the South of Norwegian or Bergen Cod Liver Oil,
White and Brown.
Agent for GEO. TIEMANN & CO.’S SURGICAL INSTRUMENTS,
Which we Sell at Makers’ Prices.
Agent for W. R. WARNER & CO.’S SUGAR COATED PILLS
Agent for
SHARPE dk DOHMES' AND HENRY THAYER & CO'S
SOLID AND FLUID EXTRACTS.
Agent for
JNO. WYETH dk BROS FLUID EXTRACTS, ELIXIRS , WINES,
DIALYSED IRON, COMPRESSED PILLS , AC.. dkC.
Agent for
DR. L. A. BABCOCK’S SILVER UTERINE SUPPORTER,
dr. McIntoshs uterine supporter,
DR. STEPHENSONS UTERINE SUPPORTER.
BLUE LICK, POLAND, BETHESDA AND BLADON WATER.
Always in stock a full line of
CARPENTER'S, ELLIOTS, ALOE & HERNSTEINS AND LESLIE'S
SADDLE BAGS, FRESH HUMAN AND BOVINE VACCINE.
The extensive Dispensing Department and complete Laboratory connected with my
Wholesale Business enables me to give that careful attention to Physicians' Orders ne¬
cessary to ensure tilling them satisfactorily.
Having always exercised the greatest care in the selection of the crude materials em¬
ployed. and making all pharmaceutical preparations of standard strength, in strict accord¬
ance with established and recognized formulas, I have earned and am entitled to the con¬
fidence of the profession,
I. L. LYONS.
t-jy-80
15
Pharmaceutical and Medicinal Preparations
FROM LABORATORY OF
Ia Ea. XiTQITS,
(Successor to BALL, LYONS & CO.)
Wholesale Druggist and Pharmacist,
40, 42, 44 CAMP St. and 111, 113, 115, 117 GRAYIER St.
MBIT ORLEANS, LA.
During my many years’ experience I have. always recognized the importance of estab¬
lishing in our midst a LABORATORY which would enable Physicians to procure at home,
with a guarantee of purity and reliability, the many, elegant and really scientific prepara¬
tions which have of late j-ears become so popular with practitioners and patients. Sup¬
plied with the MOST APPROVED APPARATUS, and in charge of intelligent and ex¬
perienced pharmaceutists, I may justly claim the products ot my laboratory to be ex-
colled by none in the country, and to be far superior to most others of foreign manufacture.
I cannot attempt here to enumerate all the extensive list of my preparations, and will
only call attention to the leading ones, which have, by their absolute reliability, elicited
the praise and approbation of the leading physicians in this city.
I also beg to add that I am prepared to manufacture at short notice any pharmaceutical
preparation which physicians may be unable to procur e elsewhere.
COD LIVER OIL with PHOSPHATE OF LIME;
COD LIVER OIL with LACTO-PHOSPHATE OF LIME ;
COD LIVER OIL with SOLUBLE PHOSPHATE OF LIME ;
COD LIVER OIL, FERRATED;
COD LIVER OIL, _ ODO-FERRATED ;
COD LIVER OIL. PHOSPHORATED;
BERGEN COD LIVER OIL, WHITE ;
BERGEN COD LIVER OIL, BROWN.
NUTRITIVE ELIXIR , (Beef, Cognac and Bitter
Orange) NUTRITIVE ELIXIR , FERRATED,
designed as SUBSTITUTES FOR DUCROS ’
ELIXIR, at more moderate prices.
ELIXIR BI8MLUH
ELIXIR CAI.IS Y/ and PYROPHOG.
IRON,
ELIXIR CALISAYA IRON and STRYCH
NIA.
ELIXIR CALTSAYA, IRON, STRYCH
NIA and BISMUTH.
ELIXIR CALISAYA, IRON, PEPSINE
and BISMUTH.
ELIXIR GIT. LITHIA.
i'.LIXIR PHOSPHATE IRON, QUININE
and STRYCHNIA.
ELIXIR PYROFHOS. IRON, QUININE
and STRYCHINA.
ELIXIR PEPSINE.
ELIXIR PEPSINE and BISMUTH.
ELIXIR PEPSINE, BISMUTH and
STVRCHNIA.
ELIXIR PEPSINE, BISMUTH. STRYCH
NIA and IRON.
ELIXIR VAL. AMMONIA
ELIXIR VAL. AMMONIA and QUININE.
ELIXIR GUARANA.
LIQUOR PEPSINE.
LIQUOR BISMUTH.
SYRUP PHOSPHATES COMP.
SYRUP HYPOPnOPHITES COMP.
SYRUP LACTO-PHOSPHATE IRON.
SYRUP LACTO PHOSPHATE LIME
SYRUP IRON, free from taste and acid.
SYRUP PHOSPH. IRON, QUININE and
STRYCHNIA.
SYRDP IOD. IRON and MANG.
SYRUP HYD. CHLORAL.
SYRUP LAOTO-PHOS. LIME and PEP¬
SINE.
SYRUP LACTO-PHOS. LIME and IRON
WINE, BEEF and IRON.
WINE, BEEF, IRON and CINCHONA.
WINE, PEPSINE.
WINE, IRON BITTER.
WINE CINCHONA, (Quinquina Robiquet.)
WINE CINCHONA. FERRUGINEUX
(Quinquina Robiquet.)
WINE WILD CHERRY.
WINE WILD CHERRY, FERRATED
ELIXIR TARAX. COMP, for masking Qui¬
nine.
FLUID EXTRACT ERGOT prepared from the selected grains, and all fluid
Extracts of STANDARD STRENGTH.
All new and rare chemicals kept in stock.
I. T,.
LYONS.
t-jy-80
16
NOW READY.
<Pte f mtitiowfs $efmnce ftoflfe,
ADAPTED TO THE USE OF
THE PHYSICIAN, THE PHARMACIST, and the STUDENT.
General Information for the Practitioner, Therapeutic and Practical
Hints. How to conduct a Post-mortem Examination.
Dietetic Rules and Precepts.
By RICHARD J DUNGLISON, M.D.
Preface to the Work.
From personal experience of the wants of the busy practitioner, the author is confident
that a work of ready reference containing, in a compact and tangible shape, information
of a purely practical character, will prove a desirable addition to his medical arma¬
mentarium The physician is frequently at a loss to know in what direction to look, in
order to procure such facts and hints as are here collected, some of which are widely
scattered through voluminous professional treatises or the — in many instances — inac¬
cessible pages ot medical periodicals ; while the other original suggest io- « and precepts
offered for his guidance will, it is believed, meet many of his daily needs. The cordial
indorsement of the objects of the work, with which the author has already been favored
by leading and active members of the profession, induces him to indulge the hope that it
may become an indispensable companion as a handy-hook for every-day consultation.
Bound in Cloth. Octavo. Price $3.50.
Sent free, by mail, upon receipt of price.
LINDSAY & BLAKISTON, Publishers,
No. 25 South Sixth Street , Phila.
PTHECjlRI Ap CHEMIS™
115 EAST MARKET, LOUISVILLE, KY„
Manufactures by his Improved Method
^sSaccharated Pepsin,
which has proven, its sup. riority over other Pepsins by its greater strength, by its stabil¬
ity and uniformity, and by its almost entire tastelessness.
CONCENTRATED DRY PEPSIN,
of which one grain digests 100 to 125 grains of coagulated albumen in 4 to 6 hours, and
LIQUID PEPSIN,
of which one ounce dissolves 90 grains of albumen.
ALL ARTICLES WARRANTED.
t4y-79
17
DK. McINTOSH’S
Natural Uterine Supporter.
No instrument hu ever been placed before the medioal profession which has given
such universal satisfaction. The combination is such that the Physician is able to meet
every indication of Uterine Displacements. Falling Womb, Auteversion, Retroversion
and Flexions are overcome by this instrument, where others fail ; this is proven by the
fact that since its introduction to the Profession it has come into more general nse than
all other instruments combined.
Among the many reasons which recommend this Supporter to the Physician is its
self-adjusting qualities. The Physician after applying it need have no fear that he will
be called in haste to remove or readjust it as is often the case with rings and various
pessaries held in position by presure against the vaginal wall, as the patient can remove
it at will aud replace it without assistance.
The Abdominal Supporter is a broad morroco leather belt with elastic straps to buckle
around the hips, with concave front so shaped as to hold up the abdomen. The Uterine
Support is a cup and stem made of highly polished hard rubber, very light and durable,
shaped to fit the neck of the womb, with openings for the secretions to pass out, as
shown by the cuts. Cups are made with extended lips to correct flexions and versions of
the womb.
The cup and stem is suspended to the belt by two soft elastic Rubber Tubes, which
are fastened to the front of the belt by simple loops, passed down through the stem of
the cup and up to the back of the belt. These soft rubber tubes being elastic adapt
themselves to all the varying positions of the body and perform the service of ligaments
of the womb.
The instrument is very comfortable to the patient, can be removed or replaced by her
at will, can be worn at all times, will not interfere with nature’s necessities, will not
corrode, and is lighter than metal. It will answer for all cases of Anteversion, Retrover¬
sions, or any Flexions of the Womb, and is used by the leading Physicians with never
failing success even in the most difficult cases.
Price— to Physicians $8.00; to Patients, $12 00.
Instruments sent by mail, at our risk, on receipt of Price, with 16 cents added for
postage, or by Express. O. O D.
Dr. McINTOSH’S NATURAL UTERINE SUPPORTER 00.
192 Jackson Street, Chicago, III.
Our valuable pamphlet “ Some Practical Facts about Displacements of the Womt>,’
will be sent you free t n application.
INTERNATIONAL EXHIBITION, PHILADELPHIA, 1876.
AWARD
For “ General Excellence in Manufacture.”
II. FLATTEN ft SOI,
224 WILLIAM ST., (Established 1836.;
OF ALL KINDS.
NEW YORK.
iEB,
Also , EMPTY CAPSULES— 5 SIZES ,
For the easy administration of nauseous medicinal preparations.
STSOLE AGENTS FOR BLAIR’S GOUT AND RHEUMATIC PILLS.
Samples and Price Lists sent on application. Sold by all Druggists.
c jyiy-
TO PHYSICIANS.
The scarcity and high prices of Cinchona barks and Sulphate of Quinia, and
the prospect of only a slight reduction in these prices, makes the present a
favorable opportunity of calling the attention of the profession to the combina¬
tion of all the bark alkaloids.
Much attention has been given to this subject in Europe and India.
The growing appreciation by the medical profession of the United States of
CINCHO-QUININE
is due to the fact that it retains the important alkaloids in combination, — a
combination which in practice is preferable to perfect isolation or separation of
these alkaloids.
In addition to its superior efficacy as a tonic and anti-periodic, it has the following advantages,
which greatly increase its value to physicians : —
ist, It exerts the full therapeutic influence of Sulphate of Quinine, in the same doses, with¬
out oppressing the stomach, creating nausea, or producing cerebral distress, as the Sulphate of
Quinine frequently does ; and it produces much less constitutional disturbance.
2d, It has the great advantage of being nearly tasteless. The bitter is very slight, and not un¬
pleasant to the most sensitive, delicate woman or child.
3d, It is less costly : the price will fluctuate with the rise and fall of barks, but will always be
much less than the Sulphate of Quinine.
4th, It meets indications not met by that Salt.
The following well-known Analytical Chemists say : —
“University of Pennsylvania, Jan. 22, 1875. lamination for quinine, quinidine, and cinchonine,
“ I have tested Cincho-Quinine, and have foundjand hereby certify that I found these alkaloids in
it to contain quinine, quinidine, cinchonine, cincho-i Cincho-Quinine.
* * ^T'xr"’rT C. GILBERT WHEELER,
Professor of Chemistry.’'
“ I have made a careful analysis of the contents of
a bottle of your Cincho-Quinine, and find it to con¬
tain quinine, quinidine, cinchonine, and cinchoni-
ditte.
S. P. SHARPLES, State Assayer of Mass.
nidine. F. A. GENTH,
Professor of Chemistry and Mineralogy .’ ’
“ Laboratory of the University of Chicago,
Feb. 1, 1875.
“ I hereby certify that I have made a chemical ex¬
amination of the contents of a bottle of Cincho-
Quinine • and by direction I made a qualitative ex-
TESTIMONIALS.
“Wbllpleet, Mass., Nov. 17, 1876,
“ I have used Cincho-Quinine, and can say with¬
out any hesitation it has proved superior to the sul¬
phate of quinine. J. G. JOHNSON, M.D.”
“ Martinsburg, Mo., Aug. 15, 1876.
“ I use the Cincho-Quinine altogether among
children, preferring it to the sulphate.
DR. E. R. DOUGLASS.”
“Liverpool, Penn., June i, 1876.
“ I have used Cincho-Quinine, obtaining better
results than from the sulphate in those cases in
which quinine is indicated.
DR. I. C. BARLOTT.”
“ Renfrow’s Station, Tbnn., July 4, 1876.
“ I am well pleased with the Cincho-Quinine,
and think it is a better preparation than the sul¬
phate. W. H. HALBERT.”
“St. Louis, Mo., April, 187^
“ I regard it as one of the most valuable additions
ever made to our materia medica.
GEORGE C. PITZER, M.D.”
“ Richmond, Va., March 28, 1877.
“ I believe that the combination of the several
cinchona alkaloids is more generally useful in prac¬
tice than the sulphate of quinine uncombined.
“Yours truly, LANDON B. EDWARDS, M.D.
Member Pa. State Board of Health,
and Sec’y and Treas. Medical Society of Pal’
“ Centrbvillb, Mich.
“ I have used several ounces of the Cincho-Qui-
ninb, and have not found it to fail in a single in¬
stance. I have used no sulphate of quinine in my
practice since I commenced the use of the Cincho-
Quinine, as I prefer it. F. C. BATEMAN, M.D.”
“North-Eastern Free Medical Dispensary,
908 East Cumberland St., Philadelphia, Penn.,
Feb. 29, 1876.
“In typhoid and typhus fevers I always prescribe
the Cincho-Quinine in conjunction with other ap¬
propriate medicines, the result being as favorable as
with former cases where the sulphate had been used.
“ F. A. GAMAGE, M.D.”
Price-Lists and Descriptive Catalogues furnished upon application.
BILLINGS, CLAPP & CO., Manufacturing Chemists,
(SUCCESSORS TO JAMES R. NICHOLS & CO.)
BOSTON, MASS.
t.jy-7y.
19
BELLEVUE HOSPITAL MEDICAL COLLEGE,
CITY OF NEW YORK,
MEMBER OF THE AMERICAN MEDICAL COLLEGE ASSOCIATION.
SESSIONS OF 1879-1880.
THB COLLEGIATE YEAR in this Institution embraces a preliminary Autumnal Term, the Regular Winter
Session, and a Spring Session.
THE PRELIMINARY AUTUMNAL TERM for 1879- ’90 will begin on Wednesday, September 17th. 18ft, and
continue until the opening of the Regular Session. During this term, instruction, consisting of didactic lectures upon
special subjects and daily clinical lectures, will be given, as heretofore, by the entire Faculty, in the same number
and order as during the Regular Session. Students expecting to attend the Regular Session are recommended to
attend the Preliminary Term, but such attendance is not required.
THE REGULAR SESSION will begin on Wednesday, October l9t, 1879, and end about the 1st of March, 1880.
During this Session, in addition to four didactic lectures on every week day except Saturday, two oy three hours
are daily allotted to clinical instruction.
THB SPRING SESSION consists chiefly of recitations from Text-Books. This Session begins on the 1st of
March and continues uatil the 1st of June. During this Session, daily recitations in all the departments are held
by a corps of examiners appointed by the Faculty. Short courses of lectures are given on special subjects, and
regular clinics are held Ifc the Hospital and in the College Building.
FACULTY :
ISAAC E. TAYLOR, M. D.,
Emeritus Professor of Obstetrics and Diseases of Women, and President of the Faculty.
JAMES R. WOOD, M. D., LL. D., FORDYCE BARKER, M. D., LL. D.,
Emeritus Professor of Surgery. Professor of Clinical Mid- wlfery and Diseases of Women.
AUSTIN FLINT, M. D.,
Professor of the Principles and Practice of Medicine and
Clinical Medicine.
W. H. VAN BUREN, M. D ,
Professor of Principles and Practice of Surgery, Dis¬
eases of Genito-Urinary System, and Clini¬
cal Surgery.
LEWIS A. SAYRE, M. D..
Professor of Orthopedic Surgery and Clinical Surgery.
ALEXANDER B. MOTT. M. D.,
Professor of Clinical and Operative Surgery.
WILLIAM T. LUSK, M. D„
Professor of Obstetrics and Diseases of Women and
Children, and Clinical Midwifery.
A. A. SMITH, M. D.,
Lecturer on Materia Medica and Therapeutics, and
Clinical Medicine.
AUSTIN FLINT, Jr., M. D.,
Professor of Physiology and Physiological Anatomy,
and Secretary of the Faculty.
JOSEPH D. BRYANT, M. D.,
Professor of General, Descriptive and Surgical Anatomy
R. OGDEN DOREMUS, M. D., LL. D..
Profeasor of Chemistry and Toxicology.
EDWARD G. JANEWAY, M. D.,
Professor of Pathological Anatomy and Histology,
Diseases of the Nervous System, and Clinical
Medicine-
PROFESSORS OF SPECIAL DEPARTMENTS, ETC.
HENRY D. NOYES, M. D.,
Professor of Ophthalmology and Otology.
J. LEWIS SMITH, M. D.,
Clinical Professor ef Diseases of Children.
EDWARD L. KEYES, M. D ,
Professor of Dermatology, and Adjunct to the Chair of
Principles of Surgery.
JOHN P. GRAY M. D., LL. D.,
Professor of Psychological Medicine and Medical Juris¬
prudence.
ERSK1NE MASON, M. D.
Clinical Professor of Surgery.
LEROY MILTON YALE, M. D.,
Lecturer Adjunct upon Orthopedic Surgery.
JOSEPH W. HOWE, M. D„
Professor of Clinical Surgery.
BEVERLY ROBINSON, M D.,
Lecturer upon Clinical Medicine.
FRANK H. BOS WORTH. M. D.,
Lecturer upon Diseases of the Throat.
CHARLES A. DOREMUS. M. D., Ph D ,
Lecturer upon Practical Chemistry and Toxicology.
FREDERICK S. DENNIS, M. D., M. R. C. S.,
WILLIAM H WELCH, M. D.,
Demonstrators of Anatomy.
FEES FOR THE REGULAR SESSION;
Fees for Tickets to all Lectures during the Preliminary and Regular Term, including Clinical Lectures . . $140
Matriculation Fee . . . jj
Dissection Fee (including material for dissection ) . . .
Graduation Fee . . . . . . 30
FEES FOR THE SPRING SESSION:
Matriculation ( Ticket valid for the following Winter) . ..'.t;..V 1 . • J
Dissection (Tickets valid forthe following Winter) . . . - . . . . 10
For the Annual Circular and Catalogue, giving regulations for graduation and other Information, address
Prof. AUSTIN FLINT, Jr., Secretary, Bellevtfe Hospital Medical Colloge.
r jy.m
3SS 3SSS
20
THEOPHIIiTTS REDWOOD, Ph.D., F. C. S. Professor of Chemistry and Pbarmaoy
to the Pharmaceutical Society of Great Britain, says, in reference to this preparation : —
“ UNGUENTUM PETROLEI appears to be obtained from crude Petroleum by
fractional distillation and subsequent purification. Products of a similar description have
been introduced in pharmacy, and recommended as substitutes for animal or vegetable
fats in the preparation of ointments or liniments.
“Among these the UNGUENTUM PETROLEI is distinguished by its having a
firmer consistence and a higher melting point, and in these respects it resembles pure lard,
from which it differs in that it is entirely free from liability to become rancid or to under¬
go any chemical change. It has an amber color, and a smooth, jellv-like appearance and
is almost wholly free from odor or taste. It is free from, and insoluble in, water. It is
very slightly soluble in rectified spirit, but very soluble in ether, in fixed oils and fats. I
am of opinion that its characters and properties are such as to render it a valuable adjunct
to our Materia Medica.”
I)R. TILBURY FOX, LONDON, writes r “ I like the UNGUENTUM PETROLEI
very much indeed, and shall not fail to prescribe it ”
FROM “THE LANCET,” LONDON, OCTOBER 20th, 1878. “Semi-transparent,
pale yellow in color, and perfectly free from offensive smell. We consider it a valuable
preparation, and hope its use will become as common in England as it is said to be in
America.”
FROM “THE MEDICAL TIMES AND GAZETTE.” LONDON; OCTOBER, 20th,
1878. “ The substance introduced under the name of UNGUENTUM PETROLEIis of about
the consistence of good lard, has no smell, keeps any length of time, apparently without be¬
coming rancid, and may be exposed to any kind of atmosphere without undergoing chemical
change. It has long been, we understand, in use in America, where it enjoys a wide-spread
popularity; and it will, we doubt not, come into extensive use here also, as a vehicle for
makinir ointments, as a demulcent in various diseases of the skin, and as a lubricant.’’
PREPARED BY
E. E. HOUGHTON & CO.,
211 SOUTH FRONT STREET, PHILADELPHIA.
XOW HEADY.
GYNECOLOGICAL- TRANSACTIONS.
Volume II.
Containing the papers read at the Second, Annual
Meeting of the American Gynecological Society, held \ in
Boston in June, 1877, and the discussions to which they
gave rise.
700 pages, 12 chroma -lithographic plates, and many
other illustrations ; besides a Bibliographical Index- to
current Obstetric and, Gynecological Literature.
8vo. cloth, $6, SO.
HOUGHTON, OSGOOD & CO., BOSTON.
fi.1y.79.
r
21
JEFFERSON MEDICAL COLLEGE,
The Fifty -fifth Session of the Jefferson Medical College will begin on Wednesday , October \st,
1879, and will continue until the 1st of March 1880. Preliminary
Lectures will be held from Monday, 8th of September.
PROFESSORS.
JOSEPH PANCOAST, M.D.,
General, Descriptive, A Surgical Anatomy, ( Emeritus. )
8. D. GROSS, M.D., I.L.D.. D.C.L. Oxon.
Institutes and Practice of Surgery.
ELLEKSLIE WALLACE, M.D.,
Obstetrics and Diseases of Women and Children.
J. M. DA COSTA M.D.,
Practice of Medicine.
J. AITKIN MEIGS, M.D.,
Institutes of Medicine and Medical Jurisprudence.
WM. H. PANCOAST, M.D.,
General, Descriptive, and Surgical Anatomy.
ROBERT E. ROGERS, M.D.,
Medical Chemistry and Toxicology.
ROBERTS BARTHOLOW, M.D.,
Materia Medica and General Therapeutics.
CLINICAL INSTRUCTION is given daily at the HOSPITAL OF THE JEFFERSON MEDICAL COLLEGE
throughout the year by McmberB of the Faculty, and by the Hospital Staff, which is constituted as follows : —
Surgeons.
JOHN H. BRINTON M.D.,
8. W. GROSS, M.D.,
K. J. LEVIS, M.D.
Ophthalmic Surgeon.
WILLIAM THOMPSON, M.D.
A SUMMER COURSE of Lectures is
Aural Surgeon.
L. TURNBULL, M.D.
Physicians.
J. SOLIS-COHEN, M.D.,
JAMES C. WILSON. M.D.,
OLIVER P. REX. M.D.,
W. W. VANVALZAH, M.D.
Gynaecologists.
F. H. GETCHELL, M.D,
J. EWING MEARS, M.D.
Pathologist.
MORRIS LONGSTRETIl, M.D.
given, begining In the third week in March, 1880, and extending through
the months of April, May, and to the middle of June. There is no additional charge for this Course to matriculates
of the College, except a registration fee of five dollars ; non-matriculates pay thirty -five dollars, which is,
however, credited on the amount of fees paid for the ensuing Winter Course.
fees.
$5 00
140 00
10 00
30 00
The Annual Announcement, giving full particulars, will be sent on application to
Matriculation Fee (paid oncel
Ticket of each Professor (7) $20
Practical Anatomy
Graduation Fee
ELLERSLIE WALLACE, Lean .
E. N. FRESHMAN & BROS.,
AdTorbisiBi i
186 W FOURTH ST., CINCINNATI, O.
Are authorized to receive advertisements for this paper, Estimates furnished free
upon application.
tgjTSend two stamps for our Advertisers’ Manual.
t.jy-79
22
TO THE MEDICAL PROFESSION.
t K .F .1. 1 jf i i. 7 l I i « I a X JT '7 L 1. I l l
MALTINE.
(EXTRACT OF MALTED BARLEY, WHEAT AND OATS.)
THIS PREPARATION CONTAINS
— FROM —
THREE TO FIVE TIMES THE MEDICINAL
— AND —
NUTRITIVE ELEMENTS FOUND IN EXTRACT OF MALT.
MALTINE is a highly concentrated extract of malted Barley, Wheat and
Oats, containing, undiminished and unimpaired, all the medicinal and
nutritious principles found in these cereals. By the most carefully conducted
scientific process, ive are enabled to offer to the medical profession a perfect
article, possessing from three to five times the therapeutic and nutritive
merit of any foreign or domestic Extract of Malt.
In support of our claims, we invite the attention of the profession to the following
points, viz. :
FIRST— In the manufacture of MALTTNE, the evaporation necessary to reduce it to its
great density is conducted in vacuo, at a temperature ranging from 100° to 120°
Fahr. ; while most manufacturers of Extract of Malt resort to “open pan” or
low pressure steam boiling, by neither of which processes can the extract be so
produced as to preserve the Diastase, Phosphates and Albuminoids on which its
remedial value so greatly depends, and the product is either of a dark color or
of low specific gravity, possessing little virtue aside from the saccharine matter
which it contains.*
SECOND— Carbon, Hydrogen, Nitrogen, Phosphorus, Sulphur, Iron, Magnesium and
Potassium are essential elements in the food of man, and it is only in MALTINE,
containing the combined properties of malted Barley. Wheat and Oats, that all
these principles can be found in the proper proportions; Extract of Malt made
from Barley alone is wanting in some of the most important of these elements.
THIRD — Gluten is the most nutritious principle fouud in the cereals, and is the only
vegetable substance which will, alone, support life for any great lengih of time.
It is composed of three distinct nitrogenous principles, together with fatty and
inorganic matters, and is analogous to animal fibrin. MALTINE contains
twenty times the quantity of Gluten found in any Extract of Malt.
FOURTH — Leibig says : “ Wheat and Oats stand first among our list of cereals in com¬
bining all the elements in proportions necessary to support animal life. They are
especially rich in muscular and fat producing elements.” The only reason we use
Malted Barley in the manufacture of MALTINE is that it contains larger pro¬
portions of mineral matters (bone producers) and Diastase. It is deficient in all
other essential elements.
We believe that any practitioner will readily recognize the superiority of
MALTINE, and would request a trial and comparison of merits with any article
offered for similar uses.
*As a sure test for Diastase, and the Albuminoids, a small quantity should be put in a test tube or small
rial, largely diluted with Water, and heated to the boiling point, when the Albumen, if present, will coagulate,
and appear in little floculent particles throughout the liquid. If the extract remains clear, it is proof that it has
already been coagulated by excessive heat, and removed by filtration dining the process of manufacturing. Any
eat which will coagulate Albumen will inevitably dCstrOv the digestive powtfr of Diastase.
23
The Nitrogenous constituents of M rALTINE have a composition identi¬
cal with that of the chief constituents of the blood, and therefore
contain nearly every element requisite for the REPRODUC¬
TION' OF THE HUMAN BODY.
MALTINE AND ITS COMPOUNDS
can undoubtedly be used with greater success than any other remedy now known, in
cases of General and Nervous Debility, Indigestion, Imperfect Nutrition and Defi¬
cient Lactatian ; Pulmonary Affections, such as Phthisis, Coughs, Colds, Hoarse¬
ness, Irritation of the Mucous Membranes and Difficult Expectoration ; Cholera
Infantum and Wasting Diseases of Children and Adults ; Convalescence from
Fevers, and whenever it is necessary to increase the vital forces and build up the
system.
WE MANUFACTURE THE FOLLOWING PREPARATIONS, THE FORMULAS
AND DOSES OF WHICH ARE GIVEN IN OUR DOSE BOOKS ANTD ON THE LABEL
ATTACHED TO EACH BOTTLE :
MALTINE WITH HOPS.
MALTINE, FERRATED:
This combination is specially indicated in Anaemia and Chlorosis, and in all cases of Defective Nutrition
where Iron is deficient in the system.
MALTINE WITH PHOSPHATES IRON AND QUINIA :
A powerful general and nutritive tonic.
MALTINE WITH PHOS. IRON, QUINIA &L STRYCHNIA :
A powerful nutritive, general and nervous tonic.
MALTINE WITH PEPSIN AND PANCREATINE:
One of the most effective combinations in Dyspepsia, Cholera Infantum, and all diseases resulting from
imperfect nutrition. It contains three of the all-important digestive agents, Diastase being one
of the constituents of the MALTINE. We believe there are few cases of Dyspepsia which will
not readily yield to the medicinal properties of the above combination, while the system is in¬
vigorated by its nutritive qualities.
MALTINE WITH BEEF AND IRON:
One of the most valuable combinations in cases of General Debility, when there is deficient nutrition
and a deficiency of Iron in the system,
MALTINE WITH ALTERATIVES:
In this pr paration MALTINE is combined with the most valuable Alteratives known, such as Iodides
Bromides, and Chlorides, and will fully meet the requirements of the practitioners in Svphllia,
Scrofula, and all depraved conditions of the blood.
MALTINE WINE :
This preparation contains all the medicinal and nutritive constituents of MALTINE, less 60 per cent, of
the transformed starch or glucose, which renders the preparation lighter and more acceptable to
some stomachs, and is recommended only in such cases.
MALTINE WINE WITH PEPSIN AND PANCREATINE:
(Each fluid ounce of MALTINE WINE contains 15 grains pure PEPSIN and 15 grains pure PANCREATINE. )
We can recommend this preparation to the Medical Profession as being the most important remedy ever
brought to their notice in all cases of Dyspepsia and Imperfect Nutrition, when the system needs
invigorating and replenishing. It will be found, we believe, a perfect remedy in Vomiting in
Pregnancy, Cholera Infantum, and wasting diseases of children, and in Constipation and
Chronic Diarrhoea resulting from mal-nutrition. It will agree with the most Irritable stomach.
MALTO-YERBINE :
(Each pint of the above preparation contains 13 ounces of MALTINE, 2 ounces CARRAGEEN, andl ounce
YERBINE. )
With the nutritive, emollient, and demulcent propeoties of MALTINE and CARRAGEEN, and the expec¬
torant qualities of YERBINE, (active principle of Yerba Santa), we offer this preparation to the
Profession with the fullest confidence that it is the most perfect remedy yet produced in Chronic
Pulmonary Affections, Irritation of the Mucous Membrane, Difficult Expectoration, Bronchitis,
and ordinary Coughs and Colds.
The dose of all preparations of MALTINE and compounds is from a dessert to a tablespoonful
We also manufacture a perfectly prepared Extract ok Malt, from Barley only.
MALTIFTE preparations are sold at the same prices as Extract of Malt and its
combinations, and are put up in half-pint, pint and five-pint amber bottles ; each bottle
enclosed in a folding paper box.
REED & CARNRICK,
Manufacturing Pharmacists,
»•, 196 and 198 Fulton Street, New York.
d.78.tf.
24
DEXTRO-QUININE IN INTERMITTENT FEVER.
1 1
ill
% ■fe-
. ]
&
*i *
mi
Number of
Paroxysms
after.
Dose and
Mode of
Exhibition.
Total
Amount
Exhibited.
Remarks , Pathological and Physiological
Phenomena, etc.
Reported by
J. 8. 8.
d. y. w.
27
14
14
5
0
0
10 grs. at
bedtime.
8 grs. at
bedtime.
30 grs.
24 grs.
1 have louud Dextro-Quinine fully equal to
the Sulphate of Quinia, with almost none of
the disagreeable symptoms of the latter.
F. C. Huge
man, M- D.,
Seafdrd, L. 1.
Emma L.
16
60 or
more
0
5 grs. every
three hours,
in glycerine,
without in
termission,
only during
frbrile ex¬
acerbations,
etc.
30 grs.
Patient was very much prostrated with
typho-malanal fever; been uuder the care of
another physician ; was called in on the third
week. I then : rescribed 5 grs. of Dextro-Qui¬
nine every three hours, in glycerine, when, as
it were by magic, all the grave symptoms
abated at once, und the patient made rapid
recovery.
Alex. F. Jo¬
seph M. *D:,
Napoleon, Ind.
Mrs. 8.,
Double Quo-
tidian. Had
taken large
doses Cin-
chonidia sul¬
phate with¬
out effect.
22
Bru¬
nette.
Mar¬
ried.
No
chil¬
dren.
6
0
20 grs, di
vided int«
chart. No. v.
one every
two hours.
20 grs.
Had first paroxysm Nov. 20, Ha. m.. again
at 4 p. m. Prescribed Cinclionidia sulphate,
grs. xxx., chart No, v. One to be taken every
two hours.
Nov. 21. Return of paroxysm at 6 a. M,and
4 p. m. Gave Cinchonidia sulphate, grs. xiv.
chart. No. v. One to betaken every two hours.
Nov. 22. Return of paroxysm at same time
as on preceding days. Prescribed Dextro-Qui¬
nine. grs. xx , chart. No. v. One to be taken
every two hours. No return of chill since that
date, and highly pleased with my experience.
N. H, Maa
ring, M. D.
liigdon, Ind.
1. de L., fe¬
male. Ter¬
tian. Ha
bituated to
Quinia.
19
Mar¬
ried.
2
0
15 grs. in 3
doses of 5
grs. taken at
intervals of
4$, hour,
commencing
four hours
before ex¬
pected par¬
oxysm. Ta¬
ken in cap¬
sule.
15 grs.
Dilatation Of pupil; tinnitus auiium severe,
but not so much so as on former occasions
when Sulphate of Quinia was used. Directed
her to take 10 grains on the third day, but she
did not do so. Twelve days have elapsed
without return of chills. Is taking citrate of
iron and strychnia.
Frank 8.
James, Ph. D.f
M. D., Osceola,
Ark.
Jennie 8.,
colored.
Quotidian.
Has “ used
Quinine and
everything
else, ’ as she
herself 'ex¬
pressed it.
25
M ir-
ried.
Unknown,
but a very
large num¬
ber.
1
1(1 grs, in 4
doses, in cap¬
sule, with
1-16 gr.
Morphacet.,
to be taken
at hour
intep* v a 1 s ,
com m e n c-
iug four
hours before
expected
paroxysm
48 grs.
On first evening after exhibition of Dextro-
Quinine had a very slight ague, followed by
considerable fever, Which, however, soon par¬
sed off. Gave ilydrarg. Chlor. Mite, grs. x,
at bedtime, which caused three or four opera
tions of the bowels. The Dextro-Quinine wus
continued the next day. Missed chill for first
time ill over a month. Thought it best to con¬
tinue medicine (without Morphia) another day.
Has had no return up to to-day (10 days). Did
not complain of tinnitus.
Frank 8.
James, Ph. D„
M. D., Osceolo,
Ark,
M ary B.
34&
3
|
0
1 gr., in
solution,
every three
hours.
16 grs.
Commenced Dextro-Quinine just after last
paroxysm; it acted excellently It is now
more than four weeks since she took the
remedy ; there has been no return. She is now
in the enjoyment of good health.
G. H. Berry,
M. D , New
York City.
Edward
Libby, Ter¬
tian.
24
9 or 10
0
Two 12-
grain doses
at half-hour
intervals.
34 grs.
Had been taken Sulphate of Quiuia in 5 gr.
doses for some time with little or no elfecu
Has had no chill sinco the Dextro-Quinine was
administered (more than a month having
elap-ed). and the result is entirely satisfactory.
H, A. Wey¬
mouth, M. D.,
Saco, Me.
Marv Cava-
no ugh. Quo
tidian.
1
3
One a day
for six
months.
0
2 grs., in
powder ,
every two
to three
hours.
15 grs.
Little girl had been complainfhg with chills
and fever for over six months ; had used Sul¬
phate of Qrinit:, Tincture Chinchona, Chinco-
Quinine,etc. Had taken great quantities of
Sulphate of Quinia , without effecting a cure.
I gave in all about 15 grs. of Dextro-Quinine,
and she never has had any chill since.
This one case in p articular I think a remark -
abl one. The little girl had had chills regu-
J. H- Strubls,
M. D.. 8 ton-
they and the family thought, under any circumstances. I was directly after, and gave 2 grs. Dextro
Quinine .n powder, every two to three hours, and to my great surprise, as well as every one else’s she failed
to have any more chills. I then put her on a tonic of iron, and she io noweryoying good health.
I consider the Dextro-Quinine far superior to any of the preparations of Quinine, and from what I have seen of
its medicinal effects, I do not hesitate to recommend it as superior to all other remedies in Remittent and Inter¬
mittent Fevera
DEXTltO-Q UININE sent by mail , at the rate of $1.60 per ounce , to
Physicians who cannot he supplied by their local Druggist. Address
KEASBEY & MATTISON, Philadelphia.
6#" Send for Complete List of Clinioal Reports*
25
The Nitrogenous constituents of MALTINE have a composition identi¬
cal with that of the chief constituents of the blood, and therefore
contain nearly every element requisite for the REPRODUC¬
TION' OF THE HUMAN BODY.
MALTINE AND ITS COMPOUNDS
can undoubtedly he used with greater success than any other remedy now lcnown, in 4
cases of General and Nervous Debility, Indigestion, Imperfect Nutrition and Defi¬
cient Lactation ; Pulmonary Affections, such as Phthisis, Coughs, Colds, Hoarse¬
ness. Irritation of the Mucous Membranes and Difficult Expectoration ; Cholera
Infantum and Wasting Diseases of Children and Adults; Convalescence from
Fevers, and whenever it is necessary to increase the vital forces and build up the
system.
AVE MANUFACTURE THE FOLLOWING PREPARATIONS, THE FORMULA
AND DOSES OF WHICH ARK GIVEN IN OUR DOSE BOORS AND ON THE LABES
ATTACHED TO EACH BOTTLE :
MALTINE WITH HOPS.
MALTINE, FERRATED :
This combination is specially indicated in Antemia and Chlorosis, and in all cases of Defective Nutrition
where Iron is deficient in the system,
MALTINE WITH PHOSPHATES IRON AND QUINIA :
A powerful general and nutritive tonic.
MALTINE WITH PHOS. IRON, QUINIA &, STRYCHNIA :
A powerful nutritive, general and nervous tonic.
MALTINE WITH PEPSIN AND PANCREATINE:
One of the most effective combinations in Dyspepsia, Cholera Infantum, and all diseases resulting from
imperfect nutrition. It contains three of the all-important digestive agents, Diastase being one
of the constituents of the MALTINE. We believe there are few cases of Dyspepsia which will
not readily yield to the medicinal properties of the above combination, while the system is in¬
vigorated by its nutritive qualities.
MALTINE WITH BEEF AND IRON:
One of the most valuable combinations in cases of General Debility, when there is deficient nutrition
and a deficiency of Iron in the system,
MALTINE WITH ALTERATIVES:
In this pr paration MALTINE is combined with the most valuable Alteratives known, such as Iodides
Bromides, and Chlorides, and will fully meet the requirements of the practitioners in Syphilis,
Scrofula, and all depraved conditions of the blood.
MALTINE WINE :
This preparation contains all the medicinal and nutritive constituents of MALTINE, less 60 per cent, of
the transformed starch or glucose, which renders the preparation lighter and more acceptable to
some stomachs, and is recommended only in such cases.
MALTINE WINE WITH PEPSIN AND PANCREATINE:
(Each fluid ounce of MALTINE WINE contains 15 grains pure PEPSIN and 15 grains pure PANCREATINE. )
We can recommend this preparation to the Medical Profession as being the most important remedy ever
brought to their notice in all cases of Dyspepsia and Imperfect Nutrition, when the system needs
invigorating and replenishing. It will be found, we believe, a perfect remedy in Vomiting in
Pregnancy, Cholera Infantum, and wasting diseases of children, and in Constipation and
Chronic Diarrhoea resulting from mal-nutrition. It will agree with the most Irritable stomach.
M ALTO-YERBINE :
i Each pint of the above preparation contains 13 ounces of MALTINE, 2 ounces CARRAGEEN, andl ounce
YRRBINE.)
With the nutritive, emollient, and demulcent propeoties of MALTINE and CARRAGEEN, and the expec¬
torant qualities of YERBINE, (active principle of Yerba Santa), we offer this preparation to the
Profession with the fullest confidence that it is the most perfect remedy yet produced in Chronic
Pulmonary Affections, Irritation of the Mucous Membrane, Difficult Expectoration, Bronchitis,
and ordinary Coughs and Colds.
The dose of all preparations of MALTINE and compounds is from a dessert to a tablespoonful
We also manufacture a perfectly prepared Extract of Malt, from Barley only.
MALTINE preparations are sold at the same prices as Extract of Malt and its
combinations, and are put up in half-pint, pint and five-pint amber bottles ; each bottle
enclosed in a folding paper box.
REED & CARNRICK,
Manufacturing Pharmacists,
196 and 198 Fulton Street, New York.
d.78.tf.
2(5
DEXTRO-QUININE IN INTERMITTENT FEVER.
•
Name and
Sex
of Patient
m
-iii
s
iti
Dose and
Mode of
Exhibition.
i
Total
Amount
Exhibited.
Remarks , Pathological and Physiological
Phenomena, etc.
Reported by
J. S. S.
D. V. W.
27
14
14
5
0
10 grs. at
bedtime.
8 grs. at
bedtime.
30 gr..
24 grs.
1 have louud Dextro-Quinine fully equal to
the Sulphate of Quinia, with almost none of
the disagreeable symptoms of the latter.
V. C. H age-
man, M- D.,
Seaford, 1.. 1.
Emma L.
lb
CO or
more
0
5 grs. every
three hours,
in glycerine,
without in¬
termission,
only during
frbrile ex¬
acerbations,
etc.
:)0 grs.
Patient was very much prostrated with
typho-mnlanal fever; beCn under the cure pf
another physician ; was called in on the third
week. I then ; re scribed 5 grs. of Dextro-Qui¬
nine every three hours, in glycerine, when, as
it were by magic, all the grave symptoms
abated at once, and the patient made rapid
recovery.
. Alex. F. Jo¬
seph M. D;,
Napoleon, Ind.
Air*, ft.,
Double Quo •
tidian . Had
taken large
doses Cin-
chonidia sul¬
phate with¬
out effect.
22
Bru¬
nette.
Mar¬
ried.
Mo
chil¬
dren.
0
0
21) grs, di
vided int"
chart. No. v.
o li e every
two hours.
20 grs.
Had first paroxysm Nov. 20, b a. m.. again
at 4 p. m. Prescribed Cinchonidia sulphate,
grs. xxx., chart. No. v. One to be taken every
two hours.
Nov. 21. Return of paroxysm at 6 a. m, and
4 p. m. Gave Cinchonidia sulphate, grs. xiv.
chart. No. v. One to betuken every two hours.
Nov, 22. Return of paroxysm at same time
as on preceding days. Prescribed Dextro-Qui¬
nine. grs. xx , chart. No. v. One to be taken
every two hours. No return of chill since that
date, and highly pleased with my experience.
N\ H, Man
ring. M. I).
Kigdon, Ind.
1. de L., fe¬
male. Ter¬
tian. 11a
bituated to
Quinia.
lil
M»ir-
riou.
2
0
15 grs. in 3
doses of 5
grs. taken at
intervals of
^ hour,
commencing
four hours
before ex¬
pected par¬
oxysm. Ta¬
ken in cap¬
sule.
15 gr,.
Dilatation of pupil; tinnitus aurium severe,
but not so much so as on former occasions
when Sulphate of Quinia was used. Directed
her to take 10 grains on the third day, but she
did not do so. Twelve days have elapsed
without return of chills. Is taking citrate of
iron and strychnia.
Frank S.
James, Ph. D.,
M. D., Osceola,
Ark.
Jennie ft.,
coloivd,
Quotidian,
lias ’* used
Quinine and
everything
else,” as she
herself ‘ex-
pressed it.
2->
M »r-
ried.
UllKllOWll.
but a very
large num¬
ber.
1
lb grs, in 4
doses, in cap¬
sule, with
1-16 gr.
Morphacet.,
to be taken
at ^ hour
inte,r v a 1 s ,
com m e n c-
ing four
hours before
ex pecteu
paroxysm
48 grs.
On first evening after exhibition of Dextro-
Quinine had a very slight ague, followed by
considerable fever, Which, however, soon pas¬
sed otf. Gave Hydrarg. Chlor. Mite, grs. x.
al bedtime, which caused three or four opera¬
tions of the bowels. The Dextro-Quinine was
continued the next day. Missed chill for first
time in over a month. Thought it best to con
tinue medicine (without Morphia) another day.
Has had no return up to to-day ( *0 days). Did
not complain of tinnitus.
Frank S.
Janies, Ph. D.,
M. D., Osceolo,
Ark.
Mary 15.
3k.
0
0
1 gr., in
solution,
every three
hours.
16 grs.
Commenced Dextro-Quinine just aferlast
paroxysm; it acted excellently It is m-w
more than four weeks since she took the
remedy ; there has been no return. She is now
in the enjoyment of good health.
G. If. Berry,
M. D , New
York City.
Edward
Libby, Ter¬
tian.
24
0 or 10
0
T w O' 12
grain doses
at half* hour
intervals.
34 grs.
Had been taken Sulphate of Quinia in 5 gr.
doses for some time with little or noeffec..
Has had no chill sinca the Dextro-Quinine was
administered (more than a month having
elap-ed). and the result is entirely satisfactory.
H. A. Wey¬
mouth, M. li.,
Saco, Me.
Marv Chvh-
nough. Quo
tidian.
3
One a day
for six
months.
0
2 grs , in
powder,
every t w o
to three
hours.
15 grs.
Little girl had been complaining with chills
and fever for over six months ; had used Sul
phate of Quinia, Tincture Chinchona, Chinco-
Quinine, etc. Had taken great quantities of
Sulphate of Quinia , without effecting a curt.
I gave in all about lb grs. of Dextro-Quinine ,
and she never has had any chill since.
This one case in particular I think a remark -
abl one. The little girl had had chills regu-
J. H- Strnble,
M. D.. Stan-
they and the family thought, under any circumstances. I was called directly after, and gave 2 grs . Dextro
Quinine in powder, every two to three hours, and to my great surprise, as well as every one else’s she failed
to have Any more chills. I then put her on a tonic of iron, and she io now enjoying good health.
1 consider the Dextro-Quinine far superior toanv of the preparations of Quinine, and from what I have seen of
its medicinal effects, I do not hesitate to recommend it as superior to all other remedies in Remittent and Inter¬
mittent Fevers.
DEXTRO-QUININE sentby mail, at the rate of $l.(iO per ounce, to
Physicians who cannot he supplied by their local Druggist, Address
KE ABBEY & MATTISON, Philadelphia.
ESP Send for Complete List of Clinical Reports*
I
TABLE OF CONTENTS.
Original Communications—
By M. SCHUPPERT, M. D.
Vaccination as a Protection Against Small-
Pox before the Tribunal of Common Sense 503
By THOS. J. ALLEN, M. D.
A Case of Fibroid Polypus of the Uterus. . .528
By C. SHILVEY, M. D.
Case of Foreign Body in the Windpipe... . . .533
By GEORGE H. ROHE, M. D.
Recent Progress in Dermatology . 535
By JOHN DELL’ ORTO, M. D.
The Natuie of Contagion . 539
Current Medical Literature—
The Present state of Therapeutics . 547
The Treatment of Post Partum Hemorrhage.. 561
Quinine for Hypodermic Use . 563
Hot Applications to the Head in Uterine
Haemorrhages . 563
PAGE.
The Poison of the Toad . 564
Curare in Hydrophobia . 564
The Principal Conditions for the Immediate
Union of Wounds . . 565
The Statue of Dr. Crawford W. Long— the
Discoverer of Anaesthesia . 566
A Physiological Question . 56
The Operation of Spaying for Some of the
Disorders of Menstrual Life . 567
Editorial—
The Doctor vs. the Apothecary . 570
Hypodermic Injection of Morphia . 572
Reviews and Book Notices. . . 573
Books and Pamphlets Received . 578
Meteorological Summary, September, 1879 _ 582
Mortality in New Orleans from September, 21,
1879, to October 19, 1879, inclusive . 582
IMPORTANT TO PHYSICIANS!
A great saving of valuable time may be made by using the
PHYSICIANS' DAY BOOK AND LEDGER.
These books exhibit, at a glance, under date of occurrence, every visit made, the length of time
consumed, whether day or night, and to which member of the family. The Day Book alse includes
The Daily Cash Account and Obstetric Record,
OF GREAT VALUE.
On application with stamp the publishers will send to any physician a full descriptive circular with
specimen pages. Physicians who are using the books are'delighted with them. The sales have been
very large, and the fourteenth edition is now in press.
Agents Wanted.
THE HEHRY BILL PUBLISHING CO., Norwich, Ct.
TO PHYSICIANS.
The scarcity and high prices of Cinchona barks and Sulphate of Quinia, and
the prospect of only a slight reduction in these prices, makes the present a
favorable opportunity of calling the attention of the profession to the combina¬
tion of all the bark alkaloids.
Much attention has been given to this subject in Europe and India.
The growing appreciation by the medical profession of the United States of
CINCHO-QUININE
is due to the fact that it retains the important alkaloids in combination, — a
combination which in practice is preferable to perfect isolation or separation of
these alkaloids.
In addition to its superior efficacy as a tonic and anti-periodic, it has the following advantages,
which greatly increase its value to physicians : —
1st, It exerts the full therapeutic influence of Sulphate of Quinine, in the same doses , with¬
out oppressing the stomach, creating nausea, or producing cerebral distress, as the Sulphate of
Quinine frequently does ; and it produces much less constitutional disturbance.
2d, It has the great advantage of being nearly tasteless. The bitter is very slight, and not un¬
pleasant to the most sensitive, delicate woman or child.
3d, It is less costly : the price will fluctuate with the rise and fall of barks, but will always be
much less than the Sulphate of Quinine.
4th, It meets indications not met by that Salt.
The following well-known Analytical Chemists say : —
“University of Pennsylvania, Jan. 22, 1875. lamination for quinine , quinidine , and cinchonine ,
“ I have tested Cincho-Quinine, and have foundand hereby certify that I found these alkaloids in
it to contain quinine, quinidine, cinchonine, cincho- Cincho-Quinine.
nidine. F. A. GENTH,
Professor of Chemistry and Mineralogy .”
“Laboratory of the University of Chicago,
Feb. 1, 1875.
C. GILBERT WHEELER,
Professor of Chemistry
“ I have made a careful analysis of the contents of
a bottle of your Cincho-Quinine, and find it to con-
“ I hereby certify that I have made a chemical ex-ltain quinine , quinidine, cinchonine, and cinchotii-
amination of the contents of a bottle of Cincho-I dine.
Quinine" and by direction I made a qualitative ex-1 S. P. SHARPLES, State Assay er of Mass.”
TESTIMONIALS.
“Wellfi.eet, Mass., Nov. 17, 1876.
“ I have used Cincho-Quinine, and can say with¬
out any hesitation it has proved superior to the sul¬
phate of quinine. J. G. JOHNSON, M.D.”
“ Martinsburg, Mo., Aug. 15, 1876.
“ I use the Cincho-Quinine altogether among
children, preferring it to the sulphate.
DR. E. R. DOUGLASS.”
‘Liverpool, Penn, June 1, 1876.
“ Richmond, Va., March 28, 1877.
“ I believe that the combination of the several
cinchona alkaloids is more generally useful in prac¬
tice than the sulphate of quinine uncombined.
“Yours truly, LANDON B. EDWARDS, M.D.
Memben Va. State Board of Health,
and Sec'y and Treas. Medical Society of Va.”
“ Centreville, Mich.
I have used several ounces of the Cincho-Qui-
“I have used Cincho-Quinine, obtaining better;NINE< an^ have not found it to fail in a single in-
results than from the sulphate in those cases in stance. I have used no sulphate of quinine in my
wEtoV, is ;„Hinatprt j practice since i commenced the use ot the Lincho-
Quinine, as J prefer it. F. C. BATEMAN, M.D.”
“ North-Eastern Free Medical Eiispensary,
908 East Cumberland St., Philadelphia, Penn.,
Feb. 29, 1876.
“ In typhoid and typhus fevers I always prescribe
the Cincho-Quinine in conjunction with other ap¬
propriate medicines, the result being as favorable as
with former cases w here the sulphate had been used.
“ F. A. GAMAGE, M.D.”
which quinine is indicated.
DR. I. C. BARLOTT.”
“ Renfrow’s Station, Tenn., July 4, 1876.
“ I am well pleased with the Cincho-Quinine,
and think it is a better preparation than the sul¬
phate. W. H. HALBERT.”
“St. Louis, Mo., April, 187^
“ I regard it as one of the most valuable additions
ever made to our materia medica.
GEORGE C. PITZER, M.D.”
Price-Lists and Descriptive Catalogues furnished upon application.
BILLINGS, CLAPP & CO., Manufacturing Chemists,
(SUCCESSORS TO JAMES R. NICHOLS & CO.)
BOSTON, MASS.
fi ADVERTISEMENTS.
BROOKLYN, N. Y.
The Reading and Recitation Term will commence October 2, 1879, ami
close at the beginning of the Regular Term.
The Regular Term will op..n February 2, 1880, and continue five months.
faculty of the college.
DANIEL AYRES, M D., 1 L. D ,
Emeritus Professor of Surgical Pathology ana Clinical Surgery.
SAMUEL G. ARMOR. M. D , LL.D.,
Professor of the Principles and Prac ice of Medicine and Clinical Medicine, and Dean ol'
tne Faculty.
GEORGE W. PLYMPTON, M.D.,
Professor of Chemistry and Toxicology.
CORYDON L. FORD, M.D., ,
Professor of Anatomy.
ALEXANDER J. C. SKENE. M.D.,
Professor of the Medical and Surgical Diseases of Women, and Diseases of Children.
JARVIS S. WRIGHT, M.D.,
Professor of the Principles and Practice of Surgery and Clinical Surgery and Registrar.
JOSEPH H. RAYMOND, M.D.,
Professor of Phjsiology and Microscopic Anatomy.
EDWARD SEAMAN BUNKER, M.D.,
Professor of Histology and General Pathology.
JOHN D. RUSHMORE, M.D .
Professor of Principles and Practice of Obstetrics and Clinical Obstetrics.
JOHN A. McCORKLE, M I),
Lecturer on Materia Medina and Therapeutics.
The Faculty, by the establishment of The Reading and Recitation Term, give a
thorough systematic training in the elements of medical science. To this end, ihe instruc¬
tion for junior students is confined to the primary branches , and consists mainly of reci¬
tations from standard text books. Senior students aie admitted to higher studies.
The Regular Term embraces usual Course of Didactic and Chemical Lectures and a
thorough graded system of instruction in the practical branches.
There are over 12U0,patients treated annually in the hospital, which is under the con¬
trol of the College authorities, and therefore available for practical teaching. Advanced
students in classes of ten or more accompany the Clinical Teacher in his daily hospital
service. By this system of constant rotation of classes, from the Medical to the Surgical
tvards of the Hospital, the student receives the largest possible amount of instruction
daily in all the practical branches. This mode of teaching is peculiar to the Long Islaud
College Hospital, the Clinical advantages of which are unsurpassed in this country.
For Circulars, address —
Prof. S. G. ARMOR, M.D. Dean.
E. N. FRESHMAN & BROS.,
Advertising Agents,
ISO TP. FOURTH ST., CINCINNATI, O.
Are authorized to receive advertisements for this paper, Estimates furnished free
upon application.
Send two stamps for our Advertisers' Manual .
BE CAREFUL TO SPECIFY ftflc&ESSON & ROBBINS'.
IMPORTANT TO PHYSICIANS!
The fact that Sulphate of Quinine is only soluble in over 700 parts of
water is not generally known, or if known is not usually considered, except
in prescriptions, when this difficulty is overcome by the addition of Acid ;
and the further fact that Bi-Sulphatc of Quinine is soluble in only
IO parts of water is as little appreciated.
McKesson & Robp.ixs have paid much attention to the subject of put¬
ting Quinine into Pills, in a condition approaching that of a solution, and
have at last succeeded in their BI^SULPHATE OF QUININE
PILLS, and offer the same to the profession, confident that they will
stand any test for solubility and prompt action. Physicians will please al¬
ways specify ftflcK. & R„ Bi-Sulph. Quinine Pills, and they will
not bo disappointed in results.
Note,— With no reference to respectable druggists, we would say that
cases have come to our knowledge and have been noted, where other pills
have been substituted on prescriptions for ours.
POWDERED PURIFIED CHINOIDINE.
Containing all the Non-Crystal izable Alkaloids of Cinchona Rack.
Similar preparations have been lately offered in muiket AT HIGH
PRICES under different fancy appellations, and claims made for the same
as of equal efficiency with Quinine.
As a great demand exists for a cheap anti-malarial remedy, we intro¬
duce this preparation at low figures ; and, in order that tho profession may
judge practically of its merits, will forward a sample to any physician’s
address, or mail one ounce upon receipt of FIFTY CENTS.
Yours respectfully,
McKesson & robbins.
Wholesale Druggists and Manufacturing Chemists,
91 T’TJTTOJST ST., JVTW T OJRK.
ADVERTISEMENTS.
iv
THE BEST AND CHEAPEST NATURAL APERIENT.
lO.VBO.V MEDICAL
RECORD.
“Hunyadi Janos.— The most pleasant and
owing to the smallness of it* dose, tho
cheapest of all the natural aperient
waters.”
From Prof. MACNAMARA,
Prof. of Materia Medico.
Royal College of Surgeons in,
Ireland.
“ Far the most valuable and palatable
of "ur aperient mineral water*. I have
been agreeably surprised with Iho result of
a clinical investigation.”
Specially approved by the Academy of Medicine of Paris, and its Sale in France
authorized by decree of the French Government
MEDALS AWARDED, LYONS 1872, VIENNA 1873, PARIS 1878.
THE BRITISH MEDICAL
JOURNAL.
” Hunyapi Janos. —The most agreeable,
safest ami most efficacious aperient water
which has been brought under our notice.”
THE LANCET.
“ Hunyapi Janos. -Baron Liebig affirms
»hat its richness in aperient salt* surpasses
that of all other known wator*.”
Uses of Hunyadi Janos ACC°rR™NG Opinions of Eminent Authorities.
1. For habitual constipation.
“None so prompt, mild, and can be so well borne for a length of time.” — Prof
Spikgklbkko, “ Univer* ity of Breslau.”
2. By persons inclined to obe¬
sity. congestive, and gouty
disorders.
“I have used the Hunyadi Janos water in many cases of the rheumatic Hnd gouty
diathesis with very marked benefit. In ca*es accompanied with great obesity I prefer it
to any other laxative.”— Prof. Lewis A. Sayre M.D.. “B-dlevue Hospital, New York.”
“ Preferred to Fried richshall and Pulna by those who have tried them.” — Prof. Aitkkn,
F.R.S.. “ Netlcy.”
“Of great use in catarrhal conditions of the pile-ducts and bowels, and for congestion
of the liver and other organs.” — “ Medical Times and Gazette.”
3. In chronic a flections ol the
organs of respiration and
Circulation.
“ Produces remarkable relief in chronic diseases symptomatic of affections of the ab
dominal and thoracic organs, and in serous effusions with impediment of respiration and
circulation.” — Prof. Alois Martin, “ Koyal Medical Councillor, University of Munich.”
4. Against hiemorrhoids. and
portal and hepatic congestion.
“ The most certain and the most comfortable in its action of all the aperient waters.
The special indications for its use are. in costiveness (especially in that of pregnancy), in
portal congestion with tendency to haemorrhoid* . and in sluggish action of the liver.” —
Inspector General Macphkrson, M..D, Author of “ Baths and Wells of Eurooe.”
5. During Pregnancy ; for
nursery use ; and in many
female disorders.
“ I prescribe none but this.” — Baron v. Scanzoni *' Wurzbursr.”
“ I prefer this to any and every other.”— Dr. Marion Sims, “ New York.lHonorary Fellow
Obstetrical Society of London and Dublin.”
6. In bilious attacks and sick
headaches.
44 1 have made use of the Hunyadi Janos mineral water ever since its introduction into
this country, and with ever increasing satisfaction. It is highly beneficial to persons of
sedentary habit, and in what are called bilious attacks.”— Dr. Silver, Lecturer on Clinical
Medicine. Charing-Cross Hospital.
7. Against evil consequences
of indiscretion in Diet.
44 Has invariably good and prompt success ; a most valuable item in the balneological
treasury.” — Prof. Virchow, Berlin.
For ordinary aperient purposes a half wineglassful of the Hunyadi Water may be taken at
bed-time, or a wineglassful taken in the morning fasting. It is most efficacious vrhen warmed to
a temperature not below 60 deg., or when an equal quantity of hot water is added to it.
HUNYADI JANOS MINERAL WATER.
INDISPENSABLE TO THE TRAVELLING PUBLIC.
To secure the geuuine Water, require bottles with a blue label bearing the name,
Tie APOLLIMRIS COMPANY, Limited, 19 Regent St, Lonioi, England
Sole Agents for the TPDPTIV TIP T3ADV Q Hfl 41 and 43 Warren St.
United States i? JtillUiA. Uili Mill & ID., New York.
9
Dr
cells ; also Pocket Induction Apparatus BEWARE OF IMITATIONS.
For the genuine, send for Illustrated Catalogue.
Address \
For which he has received 21 Letters Patent
for improvements, rendering them superior to
all others, as verified by award of First Premium
at Centennial ; also First Premium by Ameri¬
can Institute from 1872 to 1870 inclusive, and, in
1875, Gold Medal.
iES’Please note the following, for which the
GOLD MEDAL
was awarded by American Institute in 1875, to
distinguish the Apparatus as of The First Order
of importance :
Dr, J erome Kidder’s Improved No, 1.
Physician’s Office Electro Medical Apparatus.
Dr, Jerome Kidder’s Improved No. 2.
Dr, Jerome Kidder’s Improved No, 3,
Physician’s Visiting M achine ( another Form ) .
Dr. Jerome Kidder's Improved No, 4.
Office and Family Machine.
Dr. Jerome Kidder’s Improved No, 5.
Tip Battery Ten Current Machine (see cut).
A most perfect and convenient apparatus,
the invention of Dr. Kidder. We also manufac¬
ture superior D alvanic Batteries, from 6 to 36
ALBERT KIDDER & CO.,
Successors, 820 Brodway , J\ew York.
Microscopes for Physicians.
Walk’s new working Microscope is original in design and the lowest-
priced Microscope of really good quality in market.
Send for Illustrated Catalogue, free.
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10
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SA C CHAR ATE D PEPSIN,
Prepared from the Stomach of the hog, Uniform in Strength, and free from
unpleasant odor and taste. Ten grains of Saccharated Pepsin,
dissolved in one ounce of water, with addition of ten drops
of muriatic acid, will completely dissolve 150 grains
of coagulated albumen, at a temperature of
100 to 150° F., in 4 to 6 hours.
We also prepare a full line of Perfectly Soluble
SUGAR COATED PILLS,
Comprising all the officinal and other well-known favorite formulae.
These PILLS are all Prepared with the Utmost Care, under our Immediate
Supervision.
The DRUGS entering into their Composition are of the Best Quality.
The Quantities and Proportions are Invariably as Represented on the Labels
The Excipients to make the Masses are Carefully Chosen in each Case, to
make the Pill Permanently Soluble in the Fluids of the Stomach and
Bowels.
The Sugar Coating will be found very Soluble, and not Excelled by any
other in point of Beauty or Finish.
Catalogues giving Composition, Doses, etc., of all our Preparations Mailed to
Physicians by applying to us direct, or to our wholesale agent ,
I. L. LYONS,
Importer and Wholesale Druggist,
• 4S «& 44 CAMP STEET,
NEW ORLEANS, LA.
ag’79.1y.
11
ISTO'W READY.
frattitioucr’s *§,tUxmt fSooli,
ADAPTED TO THE DSE OF
THE PHYSICIAN, THE PHARMACIST, and the STUDENT.
general Information for the Practitioner, Therapeutic and Practical
Hints. How to conduct a Post-mortem Examination.
Dietetic Rules and Precepts.
By RICHARD J DUNGLISON, M.D.
Pbeface to the Woke.
From personal experience of the wants of the busy practitioner, the author is confident
that a work of ready reference containing, in a compact and tangible shape, information
of a purely practical character, will prove a desirable addition to his medical arma¬
mentarium. The physician is frequently at a loss to know in what direction to look, in
order to procure such facts and hints as are here collected, some of which are widely
scattered through voluminous professional treatises or the— in many instances — inac¬
cessible pages ot medical periodicals ; while the other original suggestin' s and precepts
ottered for his guidance will, it is believed, meet many of his daily needs. The cordial
indorsement of the objects of the work, with which the author has already been favored
by leading and active members of the profession, induces him to indulge the hope that it
may become an indispensable companion as a handy-book for every-day consultation.
Bound in Cloth. Octavo. Price $3.50.
Sent free, by mail , upon receipt of price.
LINDSAY & BLAKISTON, Publishers,
' No. 25 South Sixth Street , Phila.
APOTHECARY AND CHEMIST,
115 EAST MARKET, LOUISVILLE, KY„
Manufactures by his Improved Method
^^Saccharated Pepsin
which has proven its sup riority over other Pepsins by its greater strength, by its stabil¬
ity and uniformity, and by its almost entire tastelessness.
CONCENTRATED DRY PEPSIN,
of which one grain digests 100 to 125 grains of coagulated albumen in 4 to 6 hours, and
LIQ UIIO PEPSIN,
of which one ounce dissolves 90 grains of albumen.
ALL ARTICLES WARRANTED.
12
^SUCCESSOR TO BALL, LYONS & CO.)
G^WHOLESALEc
a
fmfljfe* t pljapamt*
40, 42. 44 CAMP and W. 113, 115, 111 GRAHER STS.,
NEW ORLEANS, LA.
DEALER IN
Drugs, Chemicals, Essential Oils,
Chemical Apparatus, Surgical Instruments, Electric Apparatus, Medi¬
cine Chests, Saddle Bags, Trusses, Supporters, Silk Stockings,
Sponges, and alt articles used in Medicine and Surgery.
FINE WINES AND LIQUORS,
PERFUMERY, FANCY GOODS, PAINTS, OILS, DYE STUFFS, GLASS, ETC,;
>
Importer of
FRENCH, ENGLISH AND GERMAN DRUGS AND CHEMICALS.
Importer of Swedish Leeches,
Importer of English Solid Extracts,
Importer of Batt ley’s Liquor Opii Sed.,
Liquor Ergot, Cinchona, Buchu, Taraxacum, etc.,
Importer of French, English and German Proprietary
Medicines, Perfumery and Drug Sundries
Only direct Importer in the South of Norwegian or Bergen Cod Liver Oil,
White and Brown.
Agent for GEO. TIEMANN & OO.’S SURGICAL INSTRUMENTS,
Which we Sell at Makers’ Prices.
Agent for W. R. WARNER & CO.’S SUGAR COATED PILLS
Agent for
SHARPE <£ DOHMES’ AND HENRY THAYER & COS
SOLID AND FLUID EXTRACTS.
Agent for
JNO. WYETH dk BRO'S FLUID EXTRACTS, ELIXIRS, WINES,
DIALYSED IRON, COMPRESSED PILLS, <&C., dtO
Agent for
DR. L. A. BABCOCK'S SILVER UTERINE SUPPORTER,
dr. McIntoshs uterine supporter,
DR. STEPHENSONS UTERINE SUPPORTER.
BLUE LICK, POLAND, BETHESDA AND BLADON WATER.
Always in stock a full line of
CARPENTER'S, ELLIOTS, ALOE <£• HERN STEIN' S AND LESLIE'S
SADDLE BAGS, FRESH HUMAN AND BOVINE VACCINE.
The extensive Dispensing Department and complete Laboratory connected with my
Wholesale Business enables me to give that careful attention to Physicians’ Orders ne¬
cessary to ensure filling them satisfactorily.
Having always exercised the greatest care in the selection of the crude materials em¬
ployed, and making all pharmaceutical preparations of standard strength, in strict accord¬
ance with established and recognized formulas, I have earned and am entitled to the con¬
fidence of the profession.
X. L. LYONS.
Hy-80-
Pharmaceutical and Medicinal Preparations
FROM LABORATORY OF
I. X*.
(Successor to BALL, LYONS & CO.)
Wholesale Druggist and Pharmacist,
40, 42, 44 CAMP St. and 111, 113, 115, 117 GRAVIER St.
NEW' ORLEANS, LA.
During my many years’ experience I have always recognized the importance of estab¬
lishing in our midst a LABORATORY which would enable Physicians to procure at home,
with a guarantee of purity and reliability, the many, elegant aiid really scientific prepara¬
tions which have of late years become so popular with practitioners and patients. Sup¬
plied with the MOST APPROVED APPARATUS, and in charge of intelligent and ex¬
perienced pharmaceutists, I may justly claim the products oir my laboratory to be ex-
colled by none in the country, and to he far superior to most others of foreign manufacture.
I cannot attempt here to enumerate all the extensive list of my preparations, and will
only call attei tion to the leading ones, which have, by their absolute reliability, elicited
the praise and approbation of the leading physicians iu this city.
I also beg to add that I am prepared to manufacture at short notice any pharmaceutical
preparation which physicians may be unable to procure elsewhere.
COD LIVER OIL with PHOSPHATE OF LIME;
COD LIVER OIL with LAOTO-PHOSPHATE OF LIME ;
COD LIVER OIL with SOLUBLE PHOSPHATE OF LIME;
COD LIVER OIL, FERRATED ;
COD LIVER OIL, IODO- FERRATED ;
COD LIVER OIL. PHOSPHORATED;
BERGEN COD LIVER OIL, WHITE ;
BERGEN COD LIVER OIL, BROWN.
NUTRITIVE ELIXIR , ( Reef Cognac and Ritter
Orange) NUTRITIVE ELIXIR , FERRATED ,
designed as SUBSTITUTES FOR DUCROS’
ELIXIR , at more moderate prices .
ELIXIR BISMUTH
ELIXIR C ALISA YA and PYROPHOL.
IRON,
ELIXIR CALISAYA. IRON and STRYCH
NIA.
ELIXIR CALISAYA, IRON, STRYCH
NIA and BISMUTH,
ELIXIR CALISAYA, IRON, PEPSINE
ami BISMUTH.
ELIXIR CIT. LITHTA.
ELIXIR PHOSPHATE IRON, QUININE
and STRYCHNIA.
ELIXIR PYROFHOS. IRON, QUININE
and STRYCHINA.
ELIXIR PEPSINE.
ELIXIR PEPSINE and BISMUTH.
ELIXIR PEPSINE, BISMUTH and
STYRCHNIA.
ELIXIR PEPSINE, BISMUTH. STRYCH
NIA and IRON.
ELIXIR VAL. AMMONIA.
ELIXIR VAL. AMMONIA and QUININE.
ELIXIR GUAR AN A.
LIQUOR PEPSINE.
LIQUOR BISMUTH.
SYRUP PHOSPHATES COMP.
SYRUP HYPOPHOPHITES COMP.
SYRUP LACTO-PHOSPHATE IRON.
SYRUP LACTO PHOSPHATE LIME.
SYRUP IRON, free from taste and acid.
SYRUP PHOSPH. IRON, QUININE and
STRYCHNIA.
SYRUP IOD. IRON and MANG.
SYRUP HYD. CHLORAL.
SYRUP LAOTO-PHOS. LIME and PEP¬
SINE.
SYRUP LACTO-PHOS. LIME and IRON
WINE, BEEF and IRON.
WINE, BEEF, IRON aDd CINCHONA.
WINE, PEPSINE.
WINE, IRON BITTER.
WINE CINCHONA, (Quinquina Robiquet.)
WINE CINCHONA. FERRUGINEUX
(Quinquina Robiquet.)
WINE WILD CHERRY.
WINE WILD CHERRY, FERRATED.
ELIXIR TARAX. COMP, for masking Qui¬
nine.
FLUID EXTRACT ERGOT prepared from the selected grains, and all fluid
Extracts of STANDARD STRENGTH.
All new and rare chemicals kept in stock.
I. L. LYONS.
t-Jy-ao
14
\
I>2{. McKVTOSH’S
Natural Uterine Supporter.
No instrument has ever been placed before the medical profession which has given
such universal satisfaction. The combination is such that the Physician is able to meet
every indication of Uterine Displacements. Falling Womb, Anteversion, Retroversion
and Flexions are overcome by this instrument, where others fail ; this is proven by the
fact that since its introduction to the Profession it has come into more general use than
all other instruments combined.
Among the many reasons which recommend this Supporter to the Physician is its
self-adjusting qualities. The Physician after applying it need have no fear that he will
be called in haste to remove or readjust it as is often the case with rings and various
pessaries held in position by presure against the vaginal wall, as the patient can remove
it at will and replace it without assistance.
The Abdominal Supporter is a broad morroco leather belt with elastic straps to buckle
around the hips, with concave front so shaped as to hold up the abdomen. The Uterine
Support is a cup and stem made of highly polished hard rubber, very light and durable,
shaped to fit the neck of the womb, with openings for the secretions to pass out, as
shown by the cuts. Cups are made with extended lips to correct flexions and versions of
the womb.
The cup and stem is suspended to the belt by two soft elastic Rubber Tubes, which
are fastened to the front of the belt by simple loops, passed down through the stem of
the cup and up to the back of the belt. These soft rubber tubes being elastic adapt
themselves to all the varying positions of the body and perform the service cf ligaments
of the womb.
The instrument is very comfortable to the patient, can be removed or replaced by her
at will, can be worn at all times, will not interfere with nature’s necessities, will not
corrode, and is lighter than metal. It will answer for all cases of Anteversion, Retrover¬
sions, or any Flexions of the Womb, and is used by the leading Physicians with never
failing success even in the most difficult cases.
Price— to Physicians $8.00; to Patients, $12.00.
Instruments sent by mail, at our risk, on receipt of Price, with 16 cents added for
postage, or by Express, O. O D.
Dr. McINTOSH’S NATURAL UTERINE SUPPORTER CO.
192 Jackson Street, Chicago, III.
Our valuable pamphlet “ Some Practical Facts about Displacements of the Womb,’
will be sent you free on application, -
INTERNATIONAL EXHIBITION, PHILADELPHIA, 1876.
AWARD
For “General Excellence in Manufacture.”
II. PLilTII &; goi.
224 WILLIAM ST., (Established 1836.; NEW YORK.
OF ALL KINDS.
Also, EMPTY CAPSULES— 5 SIZES .
For the easy administration of nauseous medicinal preparations.
GPSOLE AGENTS FOR BLAIR’S GOUT AND RHEUMATIC PILLS.
Samples and Price Lists sent on application. Sold by all Druggists.
jy-iy-
15
BELLEVUE HOSPITAL MEDICAL COLLEGE,
CITY OF NEW YORK,
MEMBER OP THE AMERICAN MEDICAL COLLEGE ASSOCIATION.
SESSIONS OF 1879-1880.
THB COLLEGIATE YEAR in this Institution embraces a preliminary Autumnal Term, the Regular Winter
Session, and a Spring Session.
THE PRELIMINARY AUTUMNAL TERM for 1879-’ BO will begin on Wednesday, September 17th, 1870, and
continue until the opening of the Regular Session. During this term, instruction, consisting of didactic lectures upon
special subjects and daily clinical lectures, will be given, as heretofore, by the entire Faculty, in the same number
and order as during the Regular Session. Students expecting to attend the Regular Session are recommended to
attend the Preliminary Term, but such attendance is not required.
THE REGULAR SESSION will begin on Wednesday, October 1st, 1879, and end about th6 1st of March, 1880.
During this Session, in addition to four didactic lectures on every week day except Saturday, two or three hours
are daily allotted to clinical instruction.
THE SPRING SESSION consists chiefly of recitations from Text-Books. This Session begins on the 1st of
March and continues until the 1st of June. During this Session, daily recitations in all the departments are held
by a corps of examiners appointed by the Faculty. Short courses of lectures are given on special subjects, and
regular clinics are held in tho Hospital and in the College Building.
FACULTY:
ISAAC E. TAYLOR, M. D.,
Emeritus Professor of Obstetrics and Diseases of Women, and President of the Faculty.
JAMES R. WOOD, M. D., LL. D., FORDYCE BARKER, M. D., LL. D.f
Emeritus Professor of Surgery. Professor of Clinical Midwifery and Diseases of Women.
AUSTIN FLINT, M. D.,
Professor of the Principles and Practice of Medicine and
Clinical Medicine.
W. H. VAN BUREN, M. D ,
Professor of Principles and Practice of Surgery, Dis¬
eases of Genito-Urinary System, and Clini¬
cal Surgery.
LEWIS A. SAYRE. M. D..
Professor of Orthopedic Surgery and Clinical Surgery.
ALEXANDER B. MOTT. M. D.,
Professor of Clinical and Operative Surgery.
WILLIAM T. LUSK, M. D„
Professor of Obstetrics and Diseases of Women and
Children, and Clinical Midwifery.
\
A. A. SMITH, M. D.,
Lecturer on Materia Medica and Therapeutics, and
Clinical Medicine.
AUSTIN FLINT, Jr., M. D.,
Professor of Physiology and Physiological Anatomy,
and Secretary of the Faculty.
JOSEPH D. BRYANT, M. D.,
Professor of General, Descriptive and Surgical Anatomy
R. OGDEN DOREMUS, M. D., LL. D.,
Professor of Chemistry and Toxicology.
EDWARD G. JANEWAY, M. D.,
Professor of Pathological Anatomy and Histology,
Diseases of the Nervous System, and Clinical
Medicine.
PROFESSORS OF SPECIAL DEPARTMENTS, ETC.
HENRY D. NOYES, M. D.,
Professor of Ophthalmology and Otology.
J. LEWIS SMITH, M. D.,
Clinical Professor ©f Diseases of Children.
EDWARD L. KEYES, M. D.,
Professor of Dermatology, and Adjunct to the Chair of
Principles of Surgery.
JOHN P. GRAY M. D. , LL. D.,
Professor of Psychological Medicine and Medical Juris¬
prudence.
ERSK1NE MASON, M. D.
Clinical Professor of Surgery.
LEROY MILTON YALE, M. D.,
Lecturer Adjunct upon Orthopedic Surgery.
JOSEPH W. HOWE, M. D.,
Professor of Clinical Surgery.
BEVERLY ROBINSON, M D.,
Lecturer upon Clinical Medicine.
FRANK H. 30SW0RTH, M. D.,
Lecturer upon Diseases of the Throat.
CHARLES A. DOREMUS, M. D., Ph. D.,
Lecturer upon Practical Chemistry and Toxicology.
FREDERICK S. DENNIS, M. D., M. R. (X S.,
WILLIAM H. WELCH, M. D.,
Demonstrators of Anatomy.
FEES FOR THE REGULAR SESSION:
Fees for Ticket* to all Lectures during the Preliminary and Regular Term, including Clinical Lectures .
Matriculation Fee . -jj
Dissection Fee (including material for dissection) . JV
Graduation Fee . - . - . M
FEES FOR THE SPRING SESSIONS
Matriculation (Ticket valid for the following Winter) . $ ®
Recitations, Jlinics, and Lectures . . - . "O
Dissection (Tickets valid for the following Winter) . 10
For the Annual Circular and Catalogue, giving regulations for graduation and other Information, address
Prof! AUSTIN FLINT, Jr., Secretary, Bellevue Hospital Medical College.
* • jy.m
8888 888
16
THEOPHXLUS REDWOOD, Ph.D., F. C. S. Professor of Chemistry and Pharmacy
to the Pharmaceutical Society of Great Britain, says, in reference to this preparation : —
“UNGUENTUM PETROLEI appears to be obtained from crude Petroleum by
fractional distillation and subsequent purification. Products of a similar description have
been introduced in pharmacy, and recommended as substitutes for animal or vegetable
fats in the preparation of ointments or liniments.
“Among these the UNGUENTUM PETIiOLEI is distinguished by its having a
firmer consistence and a higher melting point, and in these respects it resembles pure lard,
from which it differs in that it is entirely free from liability to become raucid or to under¬
go any chemical change. It has an amber color, and a smooth, jelly-like appearance and
is almost wholly free from odor or taste. It is free from, and insoluble in, water. It is
very slightly soluble in rectified spirit, but very soluble in ether, in fixed oils and fats. I
am of opinion that its characters and properties are such as to render it a valuable adjunct
to our Materia Medica.”
DR. TILBURY FOX, LONDON, writes r “ I like the UNGUENTUM PETROLEI
very much indeed, and si all not fail to prescribe it.”
FROM “THE LANCET,” LONDON, OCTOBER 20th, 1878. “Semi-transparent,
pale yellow in color, and perfectly free from offensive smell. We consider it a valuable
preparation, and hope its use will become as common in England as it is said to he in
FROM “THE MEDICAL TIMES AND GAZETTE,” LONDON; OCTOBER, 20th,
1878. “ The substance introduced under the name of UNGUENTUM PETROLEI is of about
the consistence of good lard, has no smell, keeps any length of time, apparently without be¬
coming rancid, and may be exposed to any kind of atmosphere without undergoing chemical
change. It has long been, we understand, in use in America, where it enjoys a wide-spread
popularity ; and it will, we doubt not, come into extensivo use here also, as a vehicle for
making ointments, as a demulcent in various diseases of the skin, and as a lubricant’’
PREPARED BY
E. F. HOUGHTON & CO.,
211 SOUTH FRONT STREET, PHILADELPHIA.
ROW READY.
GYNECOLOGICAL- TRANSACTIONS.
Volume II.
Containing the papers read, at the Second Annual
Meeting of the American Gynecological Society , held in
Boston in June, 1877, and the discussions to which they
gave rise.
700 pages, 12 chromo-lithographic plates, a,nd many
other illustrations ; besides a Bibliographical Index to
current Obstetric and, Gynecological Literature.
8vo. cloth, $6,80.
HOUGHTON, OSGOOD & CO., BOSTON.
t^y.79.
FACTS FROM MISSISSIPPI AHD THE SOUTH.
THE USE OF DEXTRO-QUININE IN INTERMITTENT FEVER.
DA. G., male,
farmer.
Had taken
Quinine, Oin-
ohonidia, Ar¬
senic and a
number ot dif¬
ferent chill
mixtures, pre¬
scribed by as
many different
doctors, be¬
sides various
patent medi¬
cines : all with
no result.
Never had a
chill after the
first dose of
Dex tr o-Q v i-
nine.
•28
18 months
regularly, all
types.
i
0
5 grs. every four
hours throughout
the day, before
the expected chill
followed by use of
ferruginous pre¬
parations.
60 grs.
This gentleman had bad chibs
for 13 months, a relapse from a
Remittent fever during the Sum¬
mer. He had chills in all of its
forms. Had taken Quinine, Arse¬
nic, and several different chill mix¬
tures prepared by as many differ¬
ent doctors, and various patent,
medicines but all to no effect, still
the chill would come. When I re¬
ceived the sample of Dextro- Quin¬
ine I thought that, this would be as
good a case as I could get to try
the merits of the preparation. 1-
gave him 5 grs. every four hours,
beginning the day before the chill
was expected, and he has never
had another chill from that day to
this, four months. He has per¬
formed daily labor every day on the
farm since that day. It is needless
to say that I followed up the treat¬
ment with ferruginous prepara¬
tions. I look upon the Dextro-
Quinine as doing the work. I
think it an excellent remedy > nd
would advise all physicians to give
it a trial in such cases. Sent other
reports two months ago.
Jno. G.
Gunn,
M. D.,
Noxu-
pater,
Miss.
r-
Eve Page, fe¬
male.
35
Chill every
month for 3
months.
1
One 2 gr. pill
every two hours
till six pills or 12
grs. are taken.
24 grs.
I found nothing unusual in this
case and the Dextro- Quinine has
the reputation of breaking these
chronic chills.
T. W.
W right
M. D.,
Pickens
Miss.
o*
A. li.Jemale Child
From 2 weeks
to 6 months.
1
2 to 5 grains.
15 grs.
About the same as Sulphate of
Quinine, except when given in
large doses, does not cause the full¬
ness of the head, and buzzing of the
ears as large doses of Quinine does
sometimes.
D. C.
-
A. B , male.
Adult
40 grs.
H a r d-
man. M.
D.,Cher
ry Grove
Grant
'onnty,
Ark.
Miss A. Ter-
ian.
20
Regularly
for 6 months.
1 0
Three uoses ot
5 grains each.
15 grs
This case (an old chronic case)
never had a chill alter the first dost
of Dextro-Quinine I have alsi
treated many children with like ef¬
fect.
irt
r-
Mr. X. Ter.
tian
Adult
Regularly
for 8 months.
0
20 two gr. pills,
given as usual.
40 grs
I gave 20 pills to an old
chronic case who lived 30 miles
away: and learn he never had an¬
other chill and is now well.
i-
X
Mrs. G., mar¬
ried, no chil¬
dren
36
7
~ Slight.
4 doses of 4 grs.
each, 2 hours
apart; repeated
the same next
day.
32 g s.
The patient could not take qui¬
nine in any form on account of the
great disturbance occasioned to
the stomach and head. Tried va¬
rious patent medicines without re¬
sult, excepting to sicken the stom¬
ach. We conld not get anything
to stay on the stomach until we
tried Dextro- Quinine which acted
admirably. It did not effect either
the head or stomach nor has there
been any return of paroxysms.
C. S
Van c e,
M. D.
Mnrs’hl
Ark.
SEND FOR CLINICAL DETAILS OF 1000 CASES.
4
SEABURY k JOHNSOH,
Originators and Manufacturers of U. S. Pharmacopoeia Medicinal and
Surgical
POROUS AND SPREAD,
I IV RUBBER COMBINATION.
MEW YORK AMD LOMDOM.
Received highest and only Award ( Medal and Special Diploma of Merit) over all
Foreign and Home Competitors in 1876.
THE JURORS’ AWARD IS SUBSTANTIALLY:
ORIGINALITY — The successful application of rubber as a base for all medioi
nal and mechanical plasters.
RELIABILITY and general excellence of manufactures.
Facts concerning Medicinal Flusters in Jtubber Combination.
India-rubber-spread and Porous Plasters possess indisputable ad¬
vantages over all other Plasters: [1] The Rubber Combination preserves
the incorporated drug or extract from decomposition or volatilization ; [2]
They adhere closer and firmer ; [3] They do not soil the skin or linen ; [4]
They are always pliable, and never become hard or brittle ; [5] They ad¬
here without heat or moisture ; [6] An increased effect is obtained by being
porous, as the Plaster neither slides nor moves from its affixed position.
BELLADONNA PLASTER, U. S. P.
IN RUBBER COMBINATION.
Messrs. SEABURY & JOHNSON claim that theirs is the most thor¬
oughly reliable and only strictly officinal Belladonna Plaster ever offered
the medical profession. It is an improvement on other Belladonna
Plasters in several important particulars. First, it is incorporated with
the officinal alcoholic extract only. Secondly, it is freed from all stimulat¬
ing qualities, thereby insuring the uninfluenced sedative action of Bella¬
donna. Thirdly, it adheres with greater tenacity than others. Physicians
have been prejudiced in favor of Allen’s English Extract ; but recent analysis,
fairly conducted by competent chemists, emphatically condemns the In¬
spissated Extract as a mild and unstable product, representing but one-
half or less than one-half of the strength of the U. S. P. Alchoholic Extract
of Belladonna. The following result, published in the American Journal of
Pharmacy, in April, 1876, p. 145, is furnished for your consideration, which
ndi cates the following percentage of Atropia in the respective extracts :
Alcoholic Extract of Belladonna, U. S. P . 2,571
Allen’s English Extract . 1,411
Herring’s English Extract . 1,179
The practitioner, as well as ourselves, has but one choice.
Considering these features from a professional standpoint, we offer a
Belladonna Plaster which cannot be improved upon.
5
SALIOYLATED SURGEONS’
RUBBER ADHESIVE PLASTER.
This article has met with unprece¬
dented success, and has been em¬
phatically pronounced by our most
sk illful General and Orthopaedic Sur¬
geons, as “ the best Surgeons’ Adhe¬
sive Plaster known.” It is applied
without heat or moisture, conforms
quickly to the parts; is perfectly
flexible and waterproof, and is ready
for use at any moment. It is free
from irritating properties and very
healing. In counter-extension it has
no equal, as it does not move or slide
after being applied. Our India
Rubber Adhesive Plaster is also
spread on twilled linen, which re¬
sists the most powerful strain. In
addition to these general improve¬
ments, the plaster being impervious
to water, wounds can be cleansed
without removing the plaster, ob¬
viating the necessity of constant re¬
dressing, saving labor and time.
Whenever continued powerful adhesion
is required, it should be procured in
porous form.
MUSTARD PLASTER
SPREAD ON COTTON CLOTH.
Our Mustard Plaster is a decided
improvement over the best French
makes ; the mustard is manipulated
so as to exclude all the moisture, re¬
taining unimpaired by such treat¬
ment its essential properties. They
are always reliable, conform quickly
to the part, and when thoroughly
wet do not break into pieces, as is the
case with all other mustard plasters.
They do not crack or peel off, and
can be removed without soiling the
skin or linen. Being manufactured
only of pure mustard, they are perfect¬
ly free from Croton Oil or other
dangerous substitutes, often em¬
ployed to induce intense irritation.
RUBBER BUSTER PLASTER.
(Camphorated) B. P. STRENGTH,
This article has a splendid repu¬
tation ; its characteristic action is
not impaired by age in any climate.
The whole fly is incorporated, which
by constant manipulation is thor¬
oughly and beautifully combiued
with the plaster. Its properties are
developed quicker, and it blisters in less
time than the cerate.
It never fails to blister when used
as directed. In addition to its supe¬
rior efficacy as a vesicant, we in¬
corporate a sufficient quantity of
Camphor, which, with the Olive Oil,
used on the face of the plaster, pre¬
vents Strangury. This improvement
will be appreciated by every practi¬
tioner. It is more reliable than any
known cantharidal preparation.
CAPSICUM PLASTER.
Recently this article has crept
into favor with our most esteemed
physicians, and judging from results
it is doubtless the best rubefacient
known. It has the specific action of
mnstard without its objections. The
characteristic action of Capsicum is
uniformly maintained from twenty-
four to forty-eight hours, without
blistering, being mild, continuous*
and stimulating. This plaster is
spread in rubber combination and in
porous form. Experience has taught
practitioners that the Oleo Resin of
Capsicum is too violent, frequently
vesicating; we incorporate the crude
drug in sufficient quantity, without
risk to the patient. Our Capsicum
Plasters will be found more practi¬
cal for general use than the so-called
Mustard or Capsicum Papers.
G^SPECIAL NOTICE TO PHYSICIANS.=^0
Quality is of great importance to the practitioner — by reliable preparations he , xpple -
merits his own skill. You can therefore rest assured that every article we manufacture is
of strict pharmacopcBa strength, and incorporated with perfectly reliable Extracts and
Drugs, well selected, carefully and conscientiously prepared, and manufactured invariably
under the personal superintendence of one of our firm. Our whole attention and study is
devoted entirely to the art of Plaster making, and we are ready at all times to receive sug¬
gestions from the fraternity, which may be of benefit to all.
SEABUR Y eft) JOTIKTSOIXT,
21 Platt Street, New York.
All of the above articles sold by Druggists everywhere. Always specify
SEABTJRY & JOHNSON’S PLASTERS.
SAMPLES SENT TO PHYSICIANS ON APPLICATION.
< | TBOM J*I ERS’ H . >
The rapidly increasing demand for onr Improved Extract of Malt, during the four
years that it has been manufactured and offered to the medical profession in America,
justifies the belief that in its production here we are meeting a generally felt want.
Long experience in manufacturing Malt Extract has enabled us to completely overcome
the many difficulties attending its manufacture in large quantity ; and we positively
assure the profession that our Extract of Malt is not only perfectly pure and reliable,
hut that it will keep 1'or years, in any climate, without fermenting or molding, and that
its flavor actually improves hy age. Our Extract is guaranteed to equal, in every respect,
the best German make, while, by avoiding the expense of importation, it is afforded at
less than half the price of the foreign article.
The Malt from which it is made, ia obtained by carefully malting the very best quality
of selected Toronto Canada Barley. The extract is prepared by an improved process,
which prevents injury to its properties or flavor by excess of heat. IT REPRESENTS
THE SOLUBLE CONSTITUENTS OP MALT AND HOPS, viz: Malt, sugar, dex¬
trine, diastase, resin and bitter of hops, phosphates of lime and magnesia, and alkaline
salts.
Attention is invited to the following analysis of this Extract, as given by S. H. Douglas,
Professor of Chemistry, University of Michigan, Ann Arbor.
TROMMER EXTRACT OF MALT CO.: — I enclose herewith my analysis of your
Extract of Malt :
Malt Sugar 40. 1 ; Dextrine, Hop-bitter, Extractive Matter, 23.6; Albuminous Matter
[Diastase,] 2.469 , Ash — Phosphates, 1.712. Alkalies .377; Water, 25.7. Total, 99.958.
In comparing the above analysis with that of the Extract of Malt of the German
Pharmacopcea, as given by Hager, that has been sc generally received by the profession,
I find it to substantially agree with that article
Yours truly. SILAS H DOUGLAS,
Prof, of Analytica. and Applied Chemistry
This invaluable preparation is highly recommended by the medical profession, as a most
effective therapeutic agent, for the restoration of delicate and exhausted constitutions. It
is very nutritious, being rich in both muscle and fat producing materials.
The very large proportion of Diastase renders it most effective in those forms of disease
originating in imperfect digestion of the starchy elements of food.
A single dose of the Improved Trommer’s Extract of Malt, contains a larger quantity
of the active properties of Malt, than a pint of the best ale or porter ; and not having
nndergone fermentation, is absolutely free from alcohol and carbonic acid.
The dose for ada.ts is from a dessert to a tablespoonful three times daily It is best
taken after meals, pure, or mixed with a glass of milk, or in water, wine, or any kind of
spirituous liquor. Each bottle contains Lbs. of the Extract.
Our preparation# of Malt are for sale by druggists generally throughout the
United States and Canadas, at the following prices
Extract of Malt,
with
Hops, plain. -
81 00
a
it
6S
it
Pyrophosphate of Iron , Ferrate -
1 00
u
44
44
44
Cod Liver Oil, .... «
1 00
*4
a
ii
41
Cod Liver Oil and Iodide of Iron,
1 00
44
u
It
44
Cod Liver Oil and Phosphorus. * *
1 00
4/
44
44
44
Hypo phosphites, -
1 50
44
<4
44
44
Iodides, - «
1 50
44
44
44
a
Alteratives , - - -
2 50
44
44
41
it
Citrate of Iron and Quinta , ’
1 50
44
44
41
44
Pepsin , «
1 50
MANUFACTURED BY
ROMMER EXTRACT OF MALT CO.. - - - FREMONT. OHIO.
7
a, a. FIHLAY k CO.,
IMPORTERS
AND
No. 35 Magazine St. and 12 Bank Place,
NEW ORLEANS, LA.
We keep constantly on hand a large and complete stock ox
bought exclusively for CASH, and are prepared to fill all orders entrusted
to our care with accuracy aud dispatch, and at the lowest
possible market rates.
We deal in none but
and all medicines sold by us are
guaranteed to be fresh and unadulterated
The success of the physician often depends ou the quality of the drug
prescribed by him, and we believe our patrons will bear us out in the as-
sertion that the quality of the goods we supply cannot be surpassed.
We are Agents for some of the LARGEST MANUFACTURING ESTAB¬
LISHMENTS (both of this country aud Europe) of
CHEMICALS,
PHARMACISTS’ PREPARATIONS,
SURGICAL INSTRUMENTS AND APPLIANCES.
aud all orders will be filled with attention to furnishing such manufactures
as are designat* d. A full stock of
Pure Liquors and Wines of all kinds
are also kept on hand for medicinal pwposes.
t,jy-80.
8
OFFICE OF
^TEOMMER^
Extract of Malt
o ois/iip^isr^r,
F li E M ONT, OHIO.
DEAR SIR : —
FREMONT, OHIO , April , 1873.
It is now five years since we first introduced and began tbe manufacture
of Extract of Malt in tbe United States. It has been our aim to furnish
the medical profession in America with a malt-extract equal to the best
Gorman make, and (by saving the expenses of importation) much cheaper
than the foreign article can be ‘afforded. For the manner in which our
efforts have been appreciated by the medical profession, we desire to ex¬
press our warmest thanks.
The difficulties attending the manufacture of Extract of Malt in large
quantities, can be overcome only by that kind, of skill which is acquired
by experience. Its constituents must receive no injury by the process
and good flavor and keeping quality, adapting it to all climates, must
characterize the product. All are familiar with the striking difference
between certain celebrated brands of ale and porter —and yet the poorest
as well as the best, is, or should be, produced from barley malf and hops.
Success greatly depends, of course, upon the employment of none but the
best material ; but it is by the use of specific and long tried procedures
that results are obtained which are so difficult to rival.
We do ourselves but simple justice, in stating that our entire attention is
and. for many years has been, exclusively devoted to the manufacture of
Extract of Malt for medical purposes, and that we give our undivided
personal attention to each step in the delicate process by which 'Extract of
Malt of excellent quality can alone be made.
Under these circumstances, it is unreasonable to suppose that tbe various
manufacturers of fluid extracts, elixirs, pills, &c., who (attracted by the
high reputation of our Extract of Malt) have recently, in various sections
of the country, undertaken the manufacture of a similar article, should
generally succeed in producing it of a quality according with the fulsome
praise with which their advertisements are filled. While being perfectly
willing to let the reputation of our Extract of Malt rest upon its real
merits, we owe it to the medical profession, is well as to ourselved, to
give warning against imposition.
It has come to our knowledge that certain articles extensively advertised
as “pure” and “genuine extract of malt,” are composed chiefly of the
t.Jy-79.
9
substance called graph sugar or maltine, which, as is well known is the
product of the action of sulphuric acid upon starch subjected to a high
temperature. This artificial grape sugar or glucose which is extensively
manufactured from corn starch, is now being used in immense quantities,
instead of ordinary cane sugar, in the sophistication of confectionery,
sugaihouse syrup, “ strained honey,” native wines, and canned fruits, aud
by some brewers in the manufacture of beer and ale. The cheapness of
this artificial product of Indian corn, constitutes the chief inducement for
this species of substitution for barley malt and cane sugar.
Again, an extract of malted graiu is manufactured for the pui’pose of
obtaining diastase, which (simple and variously combined) is much used
in medicine. The appearance of the extract is but slightly changed by
being deprived of this important constituent, although, it is unnecessary
to add, that its value as a medicinal agent is thereby greatly impaired.
Nevertheless, this very substauce, which is little more than refuse material,
in the manufacture of diastase, is now being offered for pure malt extrac.
It is «i alt extract prepared from Barley malt combined with the proper
proportion of Hops, that has been for many years the standard medicinal-
nutritive employed by the medical faculty of Europe, aud especially of
Germany. Its value has beeu established by experience, and its use in
the treatment of almost all forms of disease of nutrition is constantly ex¬
tending. We shall continue to devote the most scrupulous attention of
the maintenance of the reputation of our malt extract, by the careful
selection of material and by unwearied personal attention to manufactur¬
ing details.
Attention is respectfully directed to the accompanying extract from
Zietnssen, and also to our circular and testimonials elsewhere printed.
Very Respectfully,
TROMMER EXTRACT OF MALT CO.
[ From Ziemssen’s Oyclopcedia of the Practice of Medicine, Vol. XVI, page 474:]
“The Malt Extract prepared from Trommer’s receipt is designed to
fulfil much the same purpose as Cod-liver oil, carbo-hydrates (malt-sugar
dextrin,) taking the place of fatty matter. The simple (much or little
hopped) and the Chalybeate form of Malt Extract are coming more and
more into favor as substitutes for the oil ; they are more palatable and
more easily digested, and should, therefore, be preferred in the dyspeptic
forms of amemia. During the last few years Malt Extract has almost
entirely taken the place of Cod Liver Oil in the treatment of phthisis, and
other wasting diseases at the Basle hospital, and we have as yet found no
reason for returning to the use of the latter remedy. The Extract may be
given froiA one to three times a day in doses varying from a teaspoonful
to a tablespoonfnl in milk, broth, beer, or wine.”
t.Jy-79.
1U
THEOPHILUS REDWOOD, Ph.I)., F. C. S. Professor of Chemistry and Pharmacy
to the Pharmaceutical Society of Great Britain, says, in reference to this preparation : —
“UNGUENTUM PETROLEI appears to be obtained from crude Petroleum by
fractional distillation and subsequent purification. Products of a similar description have
been introduced in pharmacy, and recommended as substitutes for animal or vegetable
fats in the preparation of ointments or liniments.
“Among these the U N G U E N T U M PETROLEI is distinguished by its having a
firmer consistence and a liigi er melting point, and in these respects it resembles pure lard,
from which it differs in that it is entirely free from liability to become rancid or to under¬
go any chemical change. It has an amber color, and a smooth, jelly-like appearance and
i's almost wholly free from odor or taste. It is free from, and insoluble in, water. It is
very slightly soluble in rectified spirit, but very solubl i in ether, in fixed oils and fats. I
am of opinion that its characters and properties are such as to render it a valuable adjunct
to our Materia Medica.”
1)R. TILBURY FOX, LONDON, writes , “I like the UNGUENTUM PETROLEI
very much indeed, and si all not fail to prescribe it.'’
FROM “THE LANCET,” LONDON, OCTOBER 20th, 1878. “Semi-transparent,
pale yellow in color, and poriectly free from offensive smell. We consider it a valuable
preparation, and hope its uso will become as common in England as it is said to he in
America.”
FROM “THE MEDICAL TIMES AND GAZETTE,” LONDON; OCTOBER, 20tli,
1878. “ The substance introduced under the Dame ofUNGUENTUM PETROLEIis of about
the consistence ofgoodlard, has no smell, keeps any length oftime. apparently without be¬
coming rancid, and may be exposed to any kind of atmosphe: e without undergoing chemical
change. It has long been, we understand, in uso in America, where it enjoys a wide-spread
popularity ; and it will, we doubt not, come into extensivo uSe here also, as a vehicle for
making ointments, as a demulcent in various diseases of the skin, and as a lubricant.’’
PREPARED BY
E. F. HOUGHTON & CO.,
211 SOUTH FRONT STREET, PHILADELPHIA.
A o It READY.
gynecological” transactions.
Volume II.
Containing the papers read at the Seconal Annual
Meeting of the American Gynecological Society, held, in
Boston in June, 1S77 , and the discussions to which they
gave rise.
700 pages, 13 chromo-litho graphic plates, and many
other illustrations ; besides a Bibliographical Index to
current Obstetric and Gynecological Literature.
8vo. cloth, $6, SO.
HOUGHTON, OSGOOD & CO., BOSTON.
fc.jy-79.
11
NOW READY,
lb* partitioutr’is $tfmm
ADAPTED TO THE USE OF
THE PHYSICIAN, THE PHARMACIST, and the STUDENT.
General Information for the Practitioner. Therapeutic and Practical
Hints. How to conduct a Post-mortem Examination.
Dietetic Rules and Precepts.
By RICHARD J DUNGLISON, M.D.
Preface to the Work.
Prom personal experience of the wants of the busy practitioner, the author is confident
that a work of ready reference containing, in a compact and tangible shape, information
of a purely practical character, will prove a desiiable addition to bis medical arma¬
mentarium. The physician is frequently at a loss to know in what direction to look, in
order to procure such facts and hints as are here collected, some of which are widely
scattered through voluminous professional treati-es or the— in many instances — inac¬
cessible pages ot medical periodicals ; while the other original suggests- « and precepts
offered for his guidance will, it is believed, meet many of his daily needo. The cordial
indorse merit of the objects of the work, with whicli tiie author has already been favored
by leading and active members of the profession, induces him to iudulge the hope that it
may become an indispensable companion as a handy-book for every-day consultation.
Bound in Cloth. Octavo. Price $3.50.
Sent free by mail, upon receipt. 'of price.
DINDSAY & BLAKISTON, Publishers,
• No. 2.> South Sixth Street. Phila.
115 EAST MARKET, LOUISVILLE, KY.,
Manufactures by bis Improved Method
which has proven its sup riority over other Pepsins by its greater strength, by its stabil-
. ity and unit. utility, and by its almost entire tastelessuess.
CONCENTRATED DRY PEPSIN,
of wb' j one grain digests 100 to 125 grains of coagulated albumen in 4 to 0 hours, and
LIQUID PEPSIN,
oft whicli one - mice dissolves 90 grains of albumen.
ALL ARTICLES WARRANTED.
12
1.
s5
('SUCCESSOR TO BALL, LYONS & CO.)
G^WHOLESALEc
40, 42, 44 CAMP and 111, 113, 115 , 117 GRA VIER STS.,
NEW ORLEANS, LA.
DEALER IN
Drugs, Chemicals, Essentia! Oils,
Chemical Apparatus, Surgical Instruments, Electric Apparatus, Medi¬
cine Chests, Saddle Bags, Trusses, Supporters, Silk Stockings,
Sponges, and all articles used in Medicine and Surgery.
FINE WINES AND LIQUORS,
PERFUMERY, FA ROY GOODS, PAINTS, OILS, DYE STUFFS, GLASS, ETO.;
Importer of
FRENCH, ENGLISH AND GERMAN DRUGS AND CHEMICALS.
Importer of Swedish Leeches,
Importer of English Solid Extracts,
Importer of Battley’s Liquor Opii Sed.,
Liquor Ergot, Cinchona, Buchu, Taraxacum, etc.,
Importer of French, English and German Proprietary
Medicines, Perfumery and Drug Sundries
Only direct Importer in the South of Norwegian or Bergen Cod Liver Oil,
White and Brown.
Agent for GEO. TIEMANN & CO.’S SURGICAL INSTRUMENTS-,
Which we Sell at Makers’ Prices.
Agent for W. R. WARNER & CO.’S SUGAR COATED PILLS
Agent, for •
SHARPE <£- DOHMES' AND HENRY THAYER <(■ GO'S
SOLID AND FLUID EXTRACTS.
Agent for
JNO. WYETH & BRO S FLUID EXTRACTS, ELIXIRS, WINES,
DIALYSED IRON, COMPRESSED PILLS ,(«,<£•
Agent for
DR. L. A. BABCOCK’S SILVER UTERINE SUPPORTER,
DR. MCINTOSH'S UTERINE SUPPORTER.
DR. STEPHENSON S UTERINE SUPPORTER.
BLUE LICK, POLAND, BETHESDA AND BLADON WATER,
Always in stock a full line of
CARPENTER’S, ELLIOTS, ALOE tC- HERNSTEIN'S AND LESLIE’S
SADDLE BAGS, FRESH HUMAN AND BOVINE VACCINE
The extensive Dispensing Department and complete Laboratory connected with my
Wholesale Business enables me to give that careful attention to Physicians’ Orders ne¬
cessary to ensure tilling them satisfactorily.
Having always exercised the greatest care in the selection of the crude materials em¬
ployed, and making all pharmaceutical preparations of standard strength, in strict accord¬
ance with established and recognized formulas, I have earned and am entitled to the con¬
fidence of the profession,
I. L. LYONS.
t |y 80-
/
13
Pharmaceutical and Medicinal
from' laboratory of
Preparations
(Successor to BALL, LYONS & CO.)
Wholesale Druggist and Pharmacist,
40, 42, 44 CAMP St. and 111, 113, 115, 117 GEAVIER St.
NEW ORLEANS, LA.
During my many years’ experience I have always recognized the importance of estab¬
lishing in our midst a LABORATORY which would enable Physicians to procure at home,
with a guarantee of purity and reliability, the many, elegant and realty scientific prepara¬
tions v hich have of late years become so popular with practitioners and patients. Sup¬
plied with the MOST APPROVED APPARATUS, and in charge of intelligent and ex¬
perienced pharmaceutists, I may justly claim the products at my laboratory to be ex¬
celled by none in the country, and to be far superior to most others of f oreign manufacture.
I cannot attempt here to enumerate all the extensive list of my preparations, and will
only call attention to the leading ones, which have, by their absolute reliability, elicited
the praise and approbation of the leading physicians in this city.
I also beg to add that I am prepared to manufacture at short notice any pharmaceutical
preparation which physicians may be unable to procure elsewhere.
COD LIVER OIL with PHOSPHATE OF LIME;
COD LIVER OIL with LACTO-PHOSPHATE OF LIME ;
COD LIVER OIL with SOLUBLE PHOSPHATE OF LIME ;
COD LIVER OIL, FERRATED :
COD LIVER OIL, iODO-FERRATED ;
COD LIVER OIL. PHOSPHORATED ;
BERGEN COD LIVER OIL, WHITE ;
3EEGEN COD LIVER OIL, BROWN.
NUTRITIVE ELIXIR, (Reef, Cognac and Ritter
Orange) NUTRITIVE ELIXIR, FERRATED,
designed as SUBSTITUTES FOR DUCROS’
ELIXIR , at more moderate prices .
ELIXIR BISMUTH
ELIXIR CALISaYA and PYR0PH03.
IRON,
ELIXIR CALISAYA, IRON and STRYCH¬
NIA.
ELIXIR CALISAYA, IRON, STRYCH¬
NIA and BISMUTH,
ELIXIR CALISAYA, IRON, PEPSINE
and BISMUTH.
ELIXIR CIT. LITBXA
ELIXIR PHOSPEATE IRON, QUININE
and STRYCHNIA.
ELIXIR PYROFHOS. IRON, QUININE
and STRYCHIN A.
ELIXIR PEPSINE.
ELIXIR PEPSINE and BISMUTH.
ELIXIK PEPSINE, BISMUTH and
STY ROHM A.
ELIXIR PEPSINE, BISMUTH. STRYCH
NIA and IRON.
ELIXIR VAL. AMMONIA
ELIXIR VAL. AMMONIA and QUININE.
ELIXIR GUARANA.
LIQUOR PEPSINE.
LIQUOR BISMUTH.
SYRUP PHOSPHATES COMP.
SYRUP HYPGPHOPHITES COMP.
SYRUP LACTO-PHOSPHATE IRON.
SYRUP LACTO-PHOSPHATE LIME.
SYRUP IRON, free from taste and acid.
SYRUP PHOSPH. IRON, QUININE and
STRYCHNIA.
SYRUP 10 D IKON and MARG.
SYRUP HYD. CHLORAL.
SYRUP LAOXO-PHOS. LIME and PEP¬
SINE.
SYRUP LACTO-PHOS. LIME and IRON.
WINE, BEEF and IRON.
WINE, BEEF, IRON aDd CINCHONA.
WINE, PEPSINE.
WINE, IRON BITTER.
WINE CINCHONA, (Quinqnina Robiquet.)
WINE CINCHONA. FERRUGINEUX,
(Quinquina Robiquet.)
WINE WILD CHERRY.
WINE WILD CHERRY, FERRATED.
ELIXIR TAEAX. COMP, formasking Qui¬
nine.
FLUID EXTRACT ERGOT prepared from the selected grains, and all fluid
Extracts of STANDARD STRENGTH.
All m"v and rare chemicals kept in stock.
I.
L. LYONS.
t-jy-80
14
de. McIntosh s
Natural Uterine Supporter*
No instrument has ever been placed before the medical profession which has given
such universal satisfaction. The combination is such that the Physician is able to meet
every indication of Uterine Displacements. Falling Womb. Anti-version, Retroversion
and Flexions are overcome by this instrument, where others fail ; this is proven by the
fact that since its introduction to the Profession it has come into more general use than
all other instruments combined.
Among the many reasons which recommend this Supporter to the Physician is its
self-adjusting qualities. The Physician after applying it need have no fear that he will
he called in haste to remove or readjust it as is often the case with rings and various
' pessaries hold in position l»y presure against the vaginal wall, as the patient can remove
it at will and replace i t without assistance.
The Abdominal Supporter is a broad morroco leather belt with elastic straps to buckle
around the hips, with concave from, so shaped as to hold up the abdomen. The Uterine
Support is a cup and stem made of highly polished hard rubber, very light and durable,
shaped to fit the neck of the womb, with openings for the secretions to pass out, as
shown by the cuts. Cups are made with extended lips to correct fiexions and versions of
the womb.
The cup and stem is suspended to the belt by two soft elastic Rubber Tubes, which
are fastened to the front of the belt by simple loops, passed down through the stem of
the cnp and up to t he hack of the belt. These soft rubber tubes being elastic adapt
themselves to all the varying positions of the body and perform the service of ligaments
of the womb.
The instrument is very comfortable to the patient, can be removed or replaced by her
at will, can be worn at all times, will not interfere with nature’s necessities, will not
corrode, and is lighter than metal. It will answer for all cases of Anteversion, Retrover¬
sions, or any Flexions of the Womb, and is used by the leading Physicians with never
failing success even in the most difficult cases.
Price -to Physicians $8.00; to Patients, $12 00.
Instruments sent by mail, at our risk, on receipt of Price, with 1C cents added for
postage, or by Express, O. O I).
Dr. McINTOSH’S NATURAL UTERINE SUPPORTER 00,
193 Jackson Street, Chicago, 111,
Our valuable pamphlet “ Some Practical Facts about Displacements of the Womo,’
will be sent you free on application, -
15
BELLEVUE HOSPITAL MEDICAL COLLEGE,
CITY OF NEW YORK,
MEMBER OF THE AMERICAN MEDICAL COLLEGE ASSOCIATION,
SESSIONS . OF 1879 - 1880.
TUB COLLEGIATE YEAR in this Institution embraces a preliminary Autumnal Term, the Regular Winter
Session, and a Spring Session.
THE PRELIMINARY AUTUMNAL TERM for 1879-’80 will begin on Wednesday, September 17th, 1879, and
continue until the opening of the Regular Session. During this term, instruction, consisting of didactic lectures upon
special subjects and daily clinical lectures, will be given, as heretofore, by the entire Faculty, in the same number
and order as during the Regular Session. Students expecting to attend the Regular Session are recommended to
attend the Preliminary Term, but such attendance is not required.
THE ’REGULAR SESSION will begin on Wednesday, October 1st, 1879, and end about the 1st of March, 188CL
During this Session, in addition to four didactic lectures on every week day except Saturday, two or three hours
are daily allotted to clinical instruction.
THE SPRING SESSION consists chiefly of recitations from Text-Books. This Session begins on the 1st of
March and continues until the 1st of June. During this Session, daily recitations in all the departments are held
by a corps of examiners appointed by the Faculty. Short courses of lectures are given 04 special subjects, and
regular clinics are held in tho Hospital and in the College Building.
FACULTY:
ISAAC E. TAYLOR, M. D.,
Emeritus Professor of Obstetrics and Discuses of Women, and President of the Faculty.
JAMES R. WOOD, M. D., LL. D., FORDYCE BARKER, M. D., LL. D,f
Emeritus Professor of Surgery. Professor of Clinical Midwifery and Diseases of Women.
AUSTIN FLINT, M. D.,
Professor of the Principles and Practice of Medicine and
Clinical Medicine.
A. A. SMITH, M. D.,
Lecturer on Materia Medica and Therapeutics, and
Clinical Medicine.
W. H. VAN BUR EX, M. D ,
Professor of Principles and Practice of Surgery, Dis¬
eases of Genito-Ur inary System, and Clini¬
cal Surgery.
LEWIS A. SAYRE. M. D..
Professor of Orthopedic Surgery and Clinical Surgery.
ALEXANDER B. MOTT. M. D.,
Professor of Clinical and Operative Surgery.
WILLIAM T. LUSK, M. D.,
Professor of Obstetrics and Diseases of Women and
Children, and Clinical Midwifery.
AUSTIN FLINT, Jr., M. D.,
Professor of Physiology and Physiological Anatomy,
and Secretary of the Faculty.
JOSEPH D. BRYANT, M. D.,
Professor of General, Descriptive and Surgical Anatomy
R. OGDEN DORKMUS, M. D., LL. D.,
Professor of Chemistry and Toxicology.
EDWARD G. JANEWAY, M. D.,
Professor of Pathological Anatomy and Histology,
Diseases of the Nervous System, and Clinical
Medicihe-
PROFESSORS OF SPECIAL DEPARTMENTS, ETC.
HENRY D. NOYES, M. D ,
Professor of Ophthalmology and Otology.
J. LEWIS SMITH, M. D..
Clinical Professor ©f Diseases of Children.
EDWARD L. KEYES. M. D ,
Professor of Dermatology, and Adjunct to the Chair of
Principles of Surgery.
JOHN P. GUAY M. D., LL. D.,
Professor of Psychological Medicine and Medical Juris¬
prudence.
ERSK1NE MASON, M. D.
Clinical Professor of Surgery.
LEROY MILTON YALE, M. D.,
Lecturer Adjunct upon Orthopedic Surgery.
JOSEPH W. HOWE. M. D.,
Professor of Clinical Surgery.
BEVERLY ROBINSON, M D.,
Lecturer upon Clinical Medicine.
FRANK II BOS' WORT H, M. D.,
Lecturer upon Diseases of the Throat.
CHARLES A. DOREMUS, M. D., Ph. D.,
Lecturer upon Practical Chemistry and Toxicology.
FREDERICK S. DENNIS, M. D., M. R. C. S.,
WILLIAM H. WELCH, M. D.,
Demonstrators of Anatomy.
FEES FOR THE REGULAR SESSION:
Fees for Tickets to all Lectures during the Preliminary and Regular Term, including Clinical Lectures . $140
M atricul ation Fee . - . * J
Dissection Fee (including material for dissection) . *0
Graduation Fee . 30
FEES FOR THE SPRING SESSIONS
Matriculation (Ticket valid for the following Winter) . . $ •*>
Recitations, Dlinica, and Lectures . . ■»
Dissection (Tickets valid for the following Winter) . 10
For the Annual Circular and Catalogue, giving regulations for graduation and other information, address
Prof AUSTIN FLINT, Jr., Secretary, Bellevue Hospital Medical College.
jy.m
ggg gsgg
If)
SHARP & DOHME,
MANUFACTURING
Chemists & Pharmacists,
BALTIMORE, MD,
Manufacturers of all the officinal and other standard
FLUID AND SOLID EXTRACTS,
including all the NEW REMEDIES ;
PURE CHEMICALS, ELIXIRS, SYRUPS, ETC.
SAG GUAR ATE D PEPSIN,
Prepared from the Stomach of the hog, Uniform in Strength, and free from
unpleasant odor and taste. Ten grains of Saccharated Pepsin,
dissolved in one ounce of water, with addition of ten drops
of muriatic acid, will completely dissolve 150 grains
of coagulated albumen, at a temperature of
100 to 150° F., in 4 to 6 hours.
We also prepare a full line of Perfectly Soluble
SUGAR COATED PILLS,
Comprising all the officinal and other well-known favorite formulae.
These PILLS are all Prepared with the Utmost Care, under our Immediate
Supervision.
The DRUGS entering into their Composition are of the Best Quality.
The Quantities and Proportions are Invariably as Represented on the Labels
The Excipients to make the Masses are Carefully Chosen in each Case, to
make the Pill Permanently Soluble in the Fluids of the Stomach and
Bowels.
The Sugar Coating will be found very Soluble, and not Excelled by any
other in point of Beauty or Finish.
Catalogues giving Composition, Doses, etc., of all our Preparations Mailed to
Physicians by applying to vs direct, or to our wholesale agent,
'I. L. LYONS,
Importer and Wholesale Druggist,
4S & 44 CAMP STEET,
NEW ORLEANS, LA.
ag’TO.ly.
17
Dr. Jerome Kiefs Electro Meal Aparatas,
For which he has received 21 Letters Patent
for improvements, rendering them superior to
all others, as verified by award of First Premium
at Centennial ; also First Premium by Ameri¬
can Institute from 1872 to 1879 inclusive, ami, in
1875, Gold Medal.
SriT Please note the following, for which the
GOLD MEDAL.
was awarded by American Institute in 1875, to
distinguish the Apparatus as of The First Order
of importance :
Dr. Jerome Kidder’s Improved No. 1.
Physician's Office Electro Medical Apparatus.
Dr. Jerome Kidder’s Improved No. 2.
Physician’s Visiting Machine, with turn down
Helix
Dr. Jerome Kidder’s Improved No. 3.
Physician’s Visiting Machine (another Form).
Dr. Jerome Kidder’s Improved No. 4,
Office and Family Machine.
Dr. Jerome Kidder's Improved No. 5.
Tip Battery Ten Current Machine (see cut).
A most perfect ahd convenient apparatus,
the invention of Dr. Kidder. We also manufac
ture superior < > alvanic Batteries, from G to 3fi
; also Pocket Induction Apparatus. BEWARE OF IMITATIONS.
Fo the genuine, send for Illustrated Catalogue.
ALBERT KIDDER & CO.,
Successors, 820 Brodway, New York.
Microscopes for Physicians.
Wale’s new working Microscope is original in design and the lowest-
priced Microscope of really good quality in market.
Se: d for Ulus* rated Catalogue, free.
INDUSTRIAL PUBLICATION CO.,
14 Dey Street, New York.
THE LOHDOH LAHCET
Is the oldest Medical Journal in the English language, a d the recognized
exponcut of Medical Science all over the world. The largest and cheapest
Medical Journal in the country — $5.00 per year. Send for prospectus.
Specimen Copies 25 cents each. Address,
THE LONDON LANCET,
14 Dey Street, New York.
The American reprint now contains all the Medical mat’er of the
original edition.
13
CINCH ON I A. (ALKALOID)
Costing less than one-sixth the price of (Juinia, and forming
AN EFFICIENT TASTELESS ANTiPERIODIC.
Since we first invited the particular attention of physicians
to Cinchonia Alkaloid and Cinchonia Mixture, we have been
almost daily in receipt of testimonials to its efficacy.
We have made selections from theso, and collated them ac¬
cording to the portions of the country whence they were
written. We will be happy to mail copies, upon application,
to physicians who have not received them.,
POWERS & WEIGHTMAN, Philadelphia
“ The best of American Manufacture. ‘’—Pk< fs. Van Buren <fc Keyes,
PLANTEN’S CAPSULES,
KNOWN AS RELIABLE NEARLY 50 YEARS.
Premium for “ General Excellence in Manufacture.”
H. PLANTEN & SON, 224 WILLIAM ST., NEW YOKE.
GEliATINS CAFSUXiES
HARD and SOFT of all kinds, also,
RECTAL (Suppository) (3 Sizes), and
EMPTY CAPSULES (7 Sizes)>
Samples sent free. Specify Plaxtex's Capsules on all ordeas. Sold by all Druggists
Sole Agents in the United States for the Great English Remedy,
BLAIR’S OUT AND RHEUMATIC PILLS.
19
CODMAN & SHURTLEFPS ATOMIZING APPARATUSES.
All joints of boiler
are hard- soldered.
Every one is tested by
hydrostatic pressure, to
more than one hundred
pounds to the square
inch.
It cannot be inj ured by
exhaustion of water, or
any attainable pressure,
and will last for many
years.
It does not throw'
spurts of hot water ; is
convenient, durable,
PRICES REDUCED. Jfl
portable, compact, and
cheap, in the best sense
of the word. Price $5.00
Postage 57c.
Brass parts, nickle-
plated, additional, $2 00
Nea ly made, strong
Black walnut Box, with
convenient Handle,
additional, $2.50. Post¬
age 44c.
The Complete S'eam Atomizer— [Patented, 1868].
CODMAN &. SHURTLEFF,
BOSTON.
The Boston Atomizer Patented], Shurtleff's Atomising Apparatus— [Patented',.
The most desir able Hand Apparatus, Rubber warranted of the very best quality.
Valves imperishable, every one carefully fitted, snd will work perfectly in all positions
Prices see below.
The Bulbs are adapted to all the Atomizing tubes made by us.
Each of the above Apparatus is supplied with two carefully-made annealed glass
Atomizing Tubes, and accompanied with directions for use. Each Apparatus is carefully
packed for transportation, and warranted perfect. Also,
Antiseptic Atomizer, very complete and thorough - $12.00 $15.00, $25.00
Atomizer by Compressed Air, with regulating self-acting cut-off • 45 00
Shurtb IT s Atomizer, see cut - - Postage 24 cents - - - 3 00
Dr. Clarke’s Atomizer .... “20 cents - - - 3.00
The Constant Atomizer ... “ 20 cents - - -300
Dr. Height's Atomizer, ... “ 12 cents - - - 2.00
The Boston Atomizer, see cut - - “ 16 cents - - 2.50
Atomizing Tubes in great variety, - 25 cents to 15.00
For full description see New Pamphiei oc Atomization of Liquids with Formula} of
many articles of the Materia Medica successfully employed in thepracticeof a well-known
Ame ican practitioner, together with descriptions of the best forms of apparatus, which
will be sent, post-paid, on application.
Plaster Bandages and Bandage Machines, Articles for Antiseptic Surgery, Aspirators,
Clinic i! Thermometers, Crutches, Air Cushions, Wheel Chairs and Articles for Invalids,
Mechaoical Appliances for all deformities and deticiences, Trusses, Elastic Hose, etc.
Electrical Instruments for all Medical and Surgical uses, Hypodermic Syringes, Ice and
Hot Water Bags, Manikins, Models, Skeletons, Skulls, etc., etc. Naturalists’ Inof .’umei ts
Sphygmographa, Splints and fracture Apparatus, Stethoscopes, Syringes of all k nds,
Teeth Forceps, Test Cases, Transfusion Instruments French Rubber IJriDa'.s Uri no-
meters, Vaccine Virus, Veterinary Instruments, Waldenburg’s Pneumatic Apparatus,
etc., etc.
Surgical Instruments and Medical Appliances of every description promptly repaired.
Having our factory, with steam power, ample machinery, and experienced workmen,
connected with onr store, we can promptly make to order in the best manner, and from
almost any material, new instruments and apparatus, and supply new inventions on fav¬
orable terms. Instruments bearing our name are fully warranted. With hardly an ex¬
ception they are the product of our own factory, and made under our own personal super¬
vision, by skilled workmen, who, being paid" for their time, are not likely to slight their
work through haste.
SRK Ol! R OTHER ADVERTISEMENTS IN SUCCESSIVE NUMHEUS THIS JOURNAL.
New Illustrated Catalogue postpaid on application
CODMAN
Makers and Importers of Superior Surgical Instruments, ate., etc.,
13 and 15 Tremcnt Street. Boston.
In corresponding with Advertisers please mention this Journal.
'•
• • • ' ■
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'
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- ■
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,
1
MENSMAN’S PEPTONIZED BEEF TONIC.
•file great necessity for a fluid f» *d that would possess all the elements necessary for the
support of the system having been long felt by the Medical Profession, we call attention to this
preparation, containing the entire nutritious properties of the muscular ti «re, blood, • one and
brain of a healthy bullock, dissolved by aid of heat and pepsin, and preserved by spirit; thus
constituting a perfect nutritive, reconstructive tonic
It is not a mere stimulant, like the now fashionable extracts of beef, but contains blood-
making, force-generating and life sustaining properties, pre-eminently calculated to support the
system under the exhausting and wasting process of fevers and other acute diseases, and to rebuild
and recruit the tissues and forces, whether lost in the destructive inn -h of such affections, or in¬
duced by over work, general debility, or the more tedious forms of chronic disease. It is friendly
and helpful to the * ost delicate stomach, and where there is a fair remnant to build on, will
reconstruct the most shattered and enfeebled constitution. It is entirely free from any drugs.
Dispensed in 1 6 oz. bottles.
“DU. MENSMAN’S BEEF TONIC
“Is a complete representative of lean and fat beef, bone, blood and muscle. It consists of
all the properties which combine in the development of the animal body, which are liquefied by
an artificial process, stimulating natural digestion, and retaining all of their ah meatary values. It contains in their perfection
all the natural elements of the meat in their natural quantitative relations, without their extraneous or indigestible properties,
and therefore requiring the least possible effort on the part of the stomach for its conversion into chyle, and its immediate
absorption by the system
“ This tonic is free from any drugs or chemicals, and is a great invigorator and recuperant. I have used this preparation in
several cases of sickness of a character which enables me to give the most favorable opinion of its great value, in extreme sick¬
ness. Some of the cases referred to are hemorrhage of the bowels, typhoid fever, bilious fever, inflammation of the bowels,
where the greatest possible prostration was present, and in which I found this meat tonic to accomplish results I could not obtain
with any other preparation. It is a gentle stimulant, and allays the peculiar irritation of the stomach, which destroys the appe
tite in ail forms of disease, when the tone of the stomach is destroyed.”
“Wo published the above article in the November Number of 1877, and will say that we have prescribed the tonic daily to
date with the very best results.— Ed. Med. Eclectic .”
The Best Three Tonics of the Pharmacoposia:
IRON, PHOSPHOROUS AND CALISAYA.
We call the attention of the Profession to our preparation of the above estimable Tonics, as combined in our elegant and
palatable FERKO-PIL >S'HORATED ELIXIR 1 >F CALISAYA BARK, a combination of the Pyrophosphate of Iron and Calisaya
never before attained, in which the nauseous inkiness of the Iron and astringency of the Calisaya are overcome, without any
injury to their active tonic principles, and blended into a beautiful Amber-colored Cordial, delicious to the taste and accepta¬
ble to the most delicate stomach. This preparation is made directly from the ROYAL CALISAYA PARK, not from its ALKA.
LOl DS OR THEIR SALTS— being unlike other preparations called * Elixir of Calisaya and Iron,” which are simply an ELIXIR
OF QUININE AND IRON. Our Elixir can be depended upon as being a true Elixir of Calisaya Bark with iron. Each dessert¬
spoonful contains seven and a half grains Royal Calisaya Bark and two grains Pyrophosphate of Iron.
PURE COD-LITER OIL,
Manufactured on the Seashore from hresh and Selected Livers.
The universal demand for Cod Liver Oil that can be depended upon as strictly pure and scientifically prepared, having been
long felt by the Medical Profession, we were in dttcecl to undertake it* manufacture at the Fishing Stations where the fish ar
brought to L. nd every few hours, and the Livers consequently are in great perfection.
This oil is manufactured by us on the seashore, with the greatest care, from fresh, healthy Livers, of the Cod only, without
the aid of any chemicals, by the simplest possible process and lowest temperature by which the Oil can be separated from the
ceils of the Livers. It is nearly devoid of color, odor and flavor— having a bland fish-like, and to most persons, not unpleasant
taste. It. is so sweet and pure that it can be retained by the stomach when other kinds fail, and patients soon become fond of it.
The secret of making good Cod- Liver Oil lies in the proper application of the proper degree of hear : too much or too little
will seriously injure the quality. Great attention to cleanliness is absolutely necessary to produce sweet Cod-Liver Oil. The fan*
cid Oil found in the market is the make of manufacturers who are careless about these matters.
Prof Parker, of New York, says: “ I have tried almost every other manufacturer’s Oil, and give yours the decided pre¬
ference.
Prof. Hays, State Assurer of Massachusetts, after a full analysis of it, says : “ It is the best for foreign or domestic use.7
After years of experimenting, the Medical Profession of Europe and America, who have studied the effects of different Cod-
Liver Oils, have unanimously decided the light straw-colored Cod-Liver Oil to be far superior to any of the brown Oils.
SURGICAL INSTRUMENT DEPARTMENT.
Under the direction and personal supervision of W. F FORD, Instrument Maker to St. Luke’s, Mt. Sinai, New York State
Women's Hospitals, Bellevue, and all the other New York Hospitals.
MANUFACTURERS, IMPORTERS, WHOLESALE AND RETAIL DEALERS IN
Surgical, Dental. Orthopaedic Instruments, Catheters, Trusses, Supporters, Silk Stockings, Ear Trumpets, Spiints, Anatomical
Preparations, Local Anaesthesia Apparatus. Laryngoscopes, Otlialmoscopes, Hypodermic Syringes, Axilla
Thermometers, etc., etc.
te$T Special attention given to the manufacture of Instruments to order, in exact accordance with patterns furnished by
Sturgeons and Physicians.
CASWELL HAZARD & CO.,
Family and Manufacturing Chemists, New York,
t.jy-80.
2
S2A3UHY k JOHNSON,
Originators and Manufacturers of U. S. Pharmacopoeia Medicinal and
Surgical
I IV
POROUS AND SPREAD,
RUBBER COMBINATION.
NEW YORK AND LONDON.
ueoeived highest and only Award ( Medal and Special Diploma of Merit) over all
Foreign and Home Competitors in 1876.
THE JURORS’ AWARD IS SUBSTANTIALLY:
ORIGINALITY — The successful application of rubber as .a base for all medioi
nal and mechanical plasters.
RELIABILITY and general excellence of manufactures.
Facts concerning Medicinal Plasters in Rubber Combination.
India-rubber-spread and Porous Plasters possess indisputable ad¬
vantages over all other Plasters: [1] The Rubber Combination preserves
the incorporated drug or extract from decomposition or volatilization ; [2]
They adhere closer and firmer ; [3] They do uot soil the skin or linen ; [4]
They are always pliable, and never become hard or brittle ; [5] They ad¬
here without heat or moisture ; [6] An increased effect is obtained by being
porous, as the Plaster neither slides nor moves from its affixed position.
BELLADONNA PLASTER, U. S. P.
IN RUBBER COMBINATION.
Messrs. SEABURY & JOHNSON claim that theirs is the most thor¬
oughly reliable and only strictly officinal Belladonna Plaster ever offered
the medical profession. It is an improvement on other Belladonna
Plasters in several important particulars. First, it is incorporated with
the officinal alcoholic extract only. Secondly, it is freed from all stimulat¬
ing qualities, thereby insuring the uninfluenced sedative action of Bella¬
donna. Thirdly, it adheres with greater tenacity than others. Physicians
have been prejudiced in favor of Allen’s English Extract; but recent analysis,
fairly conducted by competent chemists, emphatically condemns the In¬
spissated Extract as a mild and unstable product, representing but one-
half or less than one-half of the strength * f the U. S P. Alchoholic Extract
of Belladonna. The following result, published in the American Journal o]
Pharmacy , in April, 1876, p. 145, is furnished for your consideration, which
ndicat-s the followin' percentage of Atropia in the respective extracts :
Alcoholic Extract of Belladonna, U. S. P . . 2,571
Allen’s English Extract . 1,411
Herring’s English Extract . . . 1,179
The practitioner, as well as ourselves, has but one choice.
Considering these features from a professional standpoint, we offer a
Belladonna Plaster which cannot be improved upon,
3
SALICYLATED SURGEONS’
RUBBER ADHESIVE PLASTER.
This article has met with unprece¬
dented success, and has been em¬
phatically pronounced by our most
skillful General and Orthopaedic Sur¬
geons, as “ the best Surgeons’ Adhe¬
sive Plaster known.” It is applied
without heat or moisture, conforms
quickly to the parts; is perfectly
flexible and waterproof, and is ready
for use at any moment. It is free
from irritating properties and very
healing. In counter extension it has
no equal, as it does not move or slide
after being applied. Our India
Rubber Adhesive Plaster is also
spread on twilled linen, which re¬
sists the most powerful strain. In
addition to these general improve¬
ments, the piaster being impervious
to water, wounds can be cleansed
without removing the plaster, ob¬
viating the necessity of constant re¬
dressing, saving labor and time.
Whenever continued powerful adhesion
is required, it should he procured in
porous form.
MUSTARD PLASTER
SPREAD ON COTTON CLOTH.
Our Mustard Plaster is a decided
improvement over the best French
makes ; the mustard is manipulate d
so as to exclude all the moisture, re¬
taining unimpaired by such treat¬
ment its essential properties. They
are always reliable , conform quickly
to the part, and when thoioughly
wet do not break into pieces, as is the
case with all other mustard plasters.
They do not crack or peel off, and
can be removed without soiling the
skin or linen. Being manufactured
only of pure mustard, they are perfect¬
ly free from Croton Oil or other
dangerous substitutes, often em¬
ployed to induce intense irritation.
RUBBER BLISTER PLASTER.
(Camphorated) B. P, STRENGTH,
This article has a splendid repu¬
tation ; its characteristic action is
not impaired by age in any climate.
Tne whole fly is incorporated, which
by constant manipulation is thor¬
oughly and beautifully combined
with the plaster. Its properties are
developed quicker, and it blisters in less
time than the cerate. .
It never fails to blister when used
as directed. In addition to its supe¬
rior efficacy as a vesicant, we in¬
corporate a sufficient quantity of
Camphor, which, with ti e Olive Oil,
used on the face of the plaster, pre¬
vents Strangury. This improvement
will be appreciated by every practi¬
tioner. It is more reliable than any
known cautharidal preparation.
CAPSICUM PLASTER.
Recently this article has crept
into favor with our most esteemed
physieians, and judging from results
it is doubtless the best rubefacient
known. It has the specific action of
mustard without its objections. The
characteristic action of Capsicum is
uniformly maintained from twenty-
four to forty -eight hours, without
blistering, being mild, continuous'
and stimulating. This plaster is
spread in rubber combination and in
porous form. Experience has i aught
practitioners that i he oleo Resin of
Capsicum is too violent, frequently
vesicating; we incorporate the rude
drug in sufficient quantity, without
risk to the patient. Our Capsicum
Plasters will be found more practi¬
cal for general use than the so-called
Mustard or Capsicum Papers.
G^SPECIAL NOTICE TO PHYSIGIANS.^^
Quality is of great importance to the practitioner — by reliable preparations he supple¬
ments his own skill. You can therefore rest assured that every article we manufacture is
of strict pharmacopcea strength, and incorporated with perfectly reliable Extracts and
Drugs, well selected, caiefully and conscientiously prepared, and manufactured invariably
under the personal supei intendenee of one of our firm. Oar whole attention and study is
devoted entirely to the art of Plaster making , and we are ready at all times to receive sug¬
gestions from the fraternity, which may be of benefit to all.
& E iY 13 TJ R Y <*? JO nNSOKr,
21 Platt Street, New York.
All of the above articles sold by Druggists everywhere. Always specify
SEABURY &. JOHNSON’S PLASTERS
SAMPLES SENT TO PHYSICIANS ON APPLICATION.
4
DR. L. D. McINTOSH’S
ELECTRIC OR GALVANIC BELT
If this new combination could be seen and
tested by the medical profession, few, if any,
words v ould be needed from us in its favor, for
it combines utility with simplicity in such per¬
fection that seeing it is convincing proof of its
great value. The medical profession to-day
acknowledge, almost universally. Electro-*
Thet apeutics.
This combination is composed of sixteen cells,
placed in pockets on a belt. Each cell is made
of bard vulcanized rubb-r, lined with a copper, cell, which constitutes the negative plate.
The rubber coating perfectly insulates each cell. The positive plates are of zinc, wrapped
in a porous material to absorb the exciting fluid, and prevent contact, with the copper, and
permit, the current, to pass from the copper to tho zinc.
Thus the cells are charged without wetting the belt, and the discomfort following to the
patient. A wire is soldered to each zinc plate, which connects with the copper cell by
entering a tube on its side, thus rendering the belt, pliable.
The McIntosh Electric Belt is superior to all others tor the following reasons :
It is composed of sixteen cells — thus giving a powerful current. A current selector is
so arranged that one or more cells can be used at ph asure. There is not anything
irritating about the Belt, as is the case with all other contrivances where the metal used
is wet with weak acids and placed next to the skin. The electrodes are pieces of metal
covered similar to ordinary battery electrodes, and connected w th the cells by con.iecting
cords. By this arrangement, a curr nt from the Belt can be applied to produce a general
or local effect.
Many physicians who have used this belt in their practice do uot hesitate to recommend
it to the profession.
Our pamphlet on Medical Electricity sent free on application. Address
MclNTOSH GALVANIC BELT AND BATTEHY CO.,
192 and 194 Jackson St., CHICAGO, ILL.
jy->y-
E. N. FRESHMAN & BROS.,
1SH W. FOURTH ST., CINCINNATI, O.
Are authorized to receive advertisements for this paper, Estimates furnished free
upon application.
WWSend two stamps for our Advertisers’ Manual.
t.jy-7S>.
5
Extract of Beef Citrate of Iron and Sherry Wine.
in this eraration are combined the stimulant properties of Wine and the nutriment
of Bbkf with the tonic powers of Ikon, the effect of which on the blood is so justly valued.
The peculiar feature of this combination is that it
COMBINES NUTRIMENT WITS STIMULUS.
In the majority of cases, along with failure of strength, and indeed as one cause of that
failure, there is an inability to digest nourishing food. Hence it is very desirable to furnish
non i ishmeut in a form acceptable to the stomach, at the same time we excite this organ to
do i.s duty. On the other hand, again, wine stimulus although needed, is ill borne if given
by itself, producing headache, excitement, and other symptoms which may be avoided by
the addition of nutritious snbstai.ee. such as the Essence of Beef.
Prompt results will follow its use in cases of sudden exhaustion, arising either from acute
or chronic diseas s. and will prove a
VALUABLE RESTORATIVE FOR ALL CONVALESCENTS.
As a Nutritive Tonic it would be indicated in the treatment of impaired nutrition, im¬
poverishment of the blood. and in all the various forms of general debility. Each table¬
spoon Mil con ains the EssenC" of one ounce of Beef with two grains of Citrate of Iron, dis¬
solved in Sherry Wine. With a view to making the article more palatable a portion of
the beef is in the first place partially roasted, as experience has shown that it is better
borne by the stomach, and can be administered for a longer period when this is done.
A rnu.T Dose— One tablespoonful between meals, and when suffering from fatigue or ex¬
haustion.
Dose fok Children should be reduced according to the age.
JOHN WYETH & BRO Chemists.
) 412 Walnut Street, Philadelphia.
ABSORBENT COTTON,
EOR
Hospitals, Dispensaries, Physicians, Dentists,
Druggists, Photographers, etc., etc.
The article furnished by us will be found superior to any other on account
of the facilities we possess for the manufacture, and the care taken at every
step of the process.
Not only in general surgery, but especially in gynaecological practice,
Absorbent Cotton has found great favor. It differs little from ordinary
cotton in appearance, except in its uniformly tine qnality and pure wdiite
color, freedom from all imparities, — being entirely cleansed from oil, resin
and all foreign matter.
The property of instantly absorbing liquids, its exquisite softness and
great cheapness render it an invaluable substitute for Patent Lint, Charpie
or Sponge.
We put up our Absorbent Cotton in neat and convenient packages, con¬
taining one pound, one-quarter pound and two ounces.
A descriptive Circular will be forwarded on application. Samples con¬
taining two ounces will be sent free of postage, on receipt of twenty cents.
JOHN WYETH & BRO.,
Manufacturing Chemists , Philadelphia.
(5
Office of I. L. LYONS,
Importer and Wholesale Druggist,
Comer Camp and Gravier Streets,
i^etD QDrleana, £a.
JOHN WYETH & BROTHER’S
Fluid _ Extracts, Elixirs, Wines, Dialysed Iron,
Compressed Powders or Pills, Etc., Etc.
/ have in stock a full line of the Fluid Extracts ,
Elixirs , Syrups, Wines, Compressed Powders, Dialysed
Iron, and other medicinal preparations , manufactured by
John Wyeth & Brother, Philadelphia,
The goods manufactured by this firm are deservedly
popular, and give great satisfaction. I have every con¬
fidence in the claims of the manufacturers as to the
quality of their products. Their large sale and popu¬
larity with the best retail trade for many years is the
strongest evidence of their care in selecting the choicest
drugs, with careful manipulation and intelligent manu¬
facture. I can supply these preparations on as favorable
terms as the manufacturers, and will send free of charge,
on application, their price lists, dose books, and samples
of their goods.
Very Truly Yours,
I. L. Lyons.
t.s-79.
7
College of Physicians I Surgeons.
(Medical Department of Columbia College,)
CORNER OF FOURTH A VENUE AND 23d STREET,
New York City.
SEVENTY-THIRD SESSION, 1879-’80.
FACULTY OF MEDICINE.
LONZO CLARK, M.D., President and Professor of
Pathology and Practical Medicine.
WILLARD PARKER, M.D., Professor of Clinical Sur¬
gery
JOHN C. DALTON. M.D., Professor of Physiology and
Hygiene.
THOMAS M. MABKOE, M.D„ Professor of Surgery.
T. GAILLARD THOMAS, M.D., Professor of Gynse-
oology.
JOHN T. METCALFE. M.D„ Emeritus Professor of
Clinical Medicine.
HENRY B. SANDS, M.D., Professor of the Practice of
Surgery.
JAMES W. McLANE, M.D., Professor of Obstetrics
and the Diseases of Children.
THOMAS T. SABINE. M.D., Professor of Anatomy.
CHARLES F, CHANDLER, Ph D, Professor of Chem¬
istry and Medical Jurisprudence.
EDWARD CURTIS, M.D., Professor of Materia Medlca
aud Therapeutics.
FRANCIS DEL AFIELD, M,D.. Adjunct Professor of
Pathologv and Practical Medicine.
JOHN G. CURTIS, M,D., Adjunct Professor of Physi¬
ology and Hygiene ; Seccetary of the Faculty.
WM. DETMOLD, M.D., Emeritus Professor of Military
and Clinical Surgery.
WILLIAM H, DRAPER, M.D., Clinical Professor of
Diseases of the Skin.
CORNELIUS R. AGNEW, M.D., Clinical Professor of
Diseases of the Eye and Ear.
ABRAHAM -ACOBI, M.D., Clinical Professor of Dis
eases of Children.
FESSENDEN N. OTIS, M.D., Clinical Professor of
Venereal Diseases.
EDWARD C, SEGUIN, M.D., Clinical Professor of Dis¬
eases of the Mind and Nervous System. *
GEO, M, LEFFERTS, M.D., Clinical Professor of Lary n¬
goscopy and Diseases of the Throat.
CHARLES McBUKNEY, M.D., Demonstrator of Anat¬
omy.
WM. T. BULL,. M,D„ Ass’t Demonstrate of Anatomy.
FRANCIS DEL AFIELD, M.D.,
Director of the Pathological Laboratory of the Alumni Association.
FACULTY OF THE SPRING SESSION.
JAMES L. LITTLE, M.D., Lecturer on Operative Sur¬
gery and Surgical Dressings.
GEORGE* G. WHEELOCK, M.D., Lecturer ou Physical
Diagnosis.
ROBERT F, WEIR, M D.. Lecturer on Diseases of the
Genito-Urinary Organs.
H. KNAPP, M.D., Lecturer on Diseases of the Eye and
Ear.
T. A. McBRIDE. M.D. Lecturer on Symptomatology.
CHARLES McBURNEY, Lecturer on the Anatomy of
the Nerves.
THE COLLEGIATE YEAR embraces a special Spring and a regular Winter Session, attendance at the latter
only being required for the graduating course. The Spring Session begins in March, and continues till June 1st. 1 lie
Regular Winter Session for 1879-80 begins October 1st, and continues till March.
TUITION is by the following methods
I. Didactic Lectures — Dnring the Winter Session from five to six lectures are given daily by the Faculty-
Attendance obligatory. During the Spring Session two lectures are given daily by the Faculty of the Spring
Session. Attendance optional.
II. Clinical Teaching— Ten Clinics, covering all departments of Medicine and Surgery, are held weekly
throughout the entire year in the College Building. In addition, the Faculty give daily clinics at the larger City
Hospitals and Dispensaries (such as the Bellevue. Charity, New York and Roosevelt Hospitals, the New xork Eye
and Ear Infirmary, etc. ) as a regular feature of the College curriculum. Attendance optional.
III. Recitations are held daily throughout both Sessions. Attendance optional.
IV. Personal Instruction — Cases of Obstetrics are furnished without charge. Personal instruction is given in
Practical Anatomy , Operative Surgery, Minor Surgery, Physical Diagnosis, Ophthalmology, Otology,
Laryngoscopy , and in Normal and Pathological Histology, Attendance optional, except upon Practical Anatomy.
Expenses — The necessary expenses are a yearly matriculation fee ($5, good for a collegiate year), the fees for
the lectures of the VV inter Session ( $20 for the course on each branch or $140 for the entire curriculum), the Practi¬
cal Anatomy fee ($10 and a small charge for material), and a Graduation Fee of $30 l'he graduating course re¬
quires three years’ study, attendance upon two full winter courses of lectures, and upon one course of Practical An¬
atomy. Remissions and reductions of lecture fees are made to graduates and students who have already attended
two full courses. All fees are payable in advance. Board can be had for from $5 to $9 a week, and the Clerk of
the College will aid students in obtaining it.
For the Annual Catalogue and Announcement, or for further information, address JOHN G. CURTIS, M l).,
Secretary of the Faculty, College of Physicians and Surgeons, corner of Twenty- Third Street and Fourth Avenue,
New York.
jy.3t.
8
University I City of New York.
MEDICAL DEPARTMENT.
410 East Twenty-Sixth St, opposite Bellevue Hospital, New York.
THIRTY-NINTH SESSION, 1879-’80.
FACULTY OF MEDICINE.
REV. HOWARD CROSBY, M.D., LL.P., Chancellor
of the University.
ALFRED C. POST. M.D.. LL.D., Emeritus Professor
of Clinical Surgery ; President of the Faculty.
CHARLES INS LEE PARDEE. M.D., Professor of
Diseases of the Ear ; Dean of the Faculty.
JOHNT. DARBY, M.D., Emeritus Professor of Surgery.
JOHN C. DRAPER, M.D., LL.D., Professor of Chem¬
istry.
ALFRED L. LOOMIS, M.D.. Professor of Pathology
and Practice of Medicine.
WILLIAM DARLING, A.M., M.D., F.R.C.S., Pro¬
fessor of Anatomy.
WILLIAM H, THOMSON, M.D , Professor of Materia
Medica and Therapeutics.
.1, W. S, ARNOLD, M.D,, Professor of Physiology and
Histology.
J. WILLISTON WRIGHT, M.D , Professor of Surgery.
WM. M. POLK, M.D., Professor of Obstetrics and the
Diseases of Women and Children.
FANEUIL D. WEISSE, M.D., Professor of Practical
and Surgical Anatomy.
LEWIS A. STIMSON M.D,, Professor of Pathological
Anatomy.
A. L. RANNEY. M.P., Adjunct Professor of Anatomy.
JOSEPH E. WINTERS, M.D., Demonstrator of An¬
atomy.
POST-GRADUATE FACULTY.
D, B. ST. JOHN ROOSA, M.D.. Professor of Ophthal-
moloay.
WM. A. HAMMOND, M.D, Professor of Diseases of
the Mind and Nervous System.
STEPHEN SMITH, M.D., Professor of Orthopedic
Surgery.
J. W. S. GOULEY, M.D., Professor of Diseases of the
Genito- Urinary System.
MONTROSE A. PALLEN, M.D., Professor of Gyne¬
cology.
HENRY G, PIFFARD, M.D., Professor of Dermatology.
A. E. MACDONALD, M.D., Professor of Medical Juris,
prudence.
THE COLLEGIATE YEAR is divided into three ‘Sessions : A Preliminary Session, a Regular Winter Session,
and a Spring Session.
THE PRELIMINARY SESSION will commence September 17, 1879, and will continue until the opening of the
Regular Winter Session. It will be conducted on the plan of that Session.
THE REGULAR WINTER SESSION will commence on the first of October, 1879. and end about the first
of March, 1880.
The location of the newr College edifice being immediately opposite the gate of Bellevue Hospital, and a fewr
steps from the ferry to Charity Hospital, Blackwell’s Island, the Students of the University Medical College are
entabled to enjoy the advantages afforded by these Hospitals with the least possible loss of time. The Professors of
the practical Chairs are connected with the Hospitals, and the University Students are admitted to all the Clinics
given therein, free of charge.
In addition to the daily Hospital Clinics, there are eight Clinics each week in the College building. Five Di¬
dactic Lectures w'ill be given daily in the College building, and Evening Recitations will be conducted by the Pro¬
fessors 6f Chemistry, Practice, Anatomy, Materia Medica, etc., Physiology, Surgery, and Obstetrics, upon the sub.
jects of their lectures.
THE SPRING SESSION embraces a period of twelve w'eeks, beginning in the first week of March, and ending
the last w’eek of May, The daily Clinics, Recitations, and Special Fractical Courses, will be the same as in the
Winter Session, and there will be* Lectures on Special Subjects by the members of the Post-Graduate Faculty.
THE DISSECTING ROOM is open throughout the entire Collegiate year ; material is abundant and it is
furnished free of charge.
STUDENTS WHO HAVE STUDIED TWO YEARS, and who have attended two full Courses of Lectures, may
be admitted to examination in Chemistry, Anatomy, and Physiology, and, if successful, w ill be examined at the ex¬
piration of their full course of study, on Practice, Materia Medica and Therapeutics, Surgery, and Obstetrics; but
those who prefer it may have all their examinations at the close of their full term.
FEES:
For Course of Lectures . $140 00
Matriculation . bOO
Demonstrator’s Fee (including material for Dissection) . 10 00
Graduation Fee . 30 00
Post-Graduate Certificate . 30 00
For further particulars and circulars, address the Dean.
Prof. CHAS. INSLEE PARDEE, M. D.,
University Medical College, 410 East 26th St., New York City.
Jy.4t.
9
VACCINE VIRUS.
In order to meet, properly the continued demand upon us for Animal Virus, we have
established stables for its propagation upon carefully looted Heifers. The lymph used
is of the well known “Beaugency” stock, imported by ourselves expressly for this pur¬
pose. The Jesuit of several years’ experience in supply '"g ’his lymph leads us to believe
th it its excellence is unsurpassed. The establishment is under the care of a competent
physician, who will spare, no pains to produce a perfectly reliable and pure article,
which we are prepared to furnish fresh, daily.
We can also furnish, to those who prefer it, Humanized Virus, from healthy children
procured for us by physicians of undoubted reliability.
All our Virus is put up in strong, air-tight, sealed packages , for safe conveyance by
mail or oxpress, and will be sent (postpaid if by mail) upon the following terms : —
FROM THE HEIFER, 10 large ivory points, well charged on both sides, - - - $1 50
5 large ivory points, “ “ “ - - - 80
Large ivory points, less than 5 “ “ “ each - . - 25
1 Crust, new method, in air-tight Glass Capsule, . 2 00
FROM HE ALTAY INFANTS, 10 small Ivory Points, . 125
I Crust from unruptured Vesicles, . - - -- 2 00
Directions for vaccination with either form of Virus, derived from methods success¬
fully empl ved, will be furnished with Virus if requested.
We will warrant every package of Points and every Crust, giving a fresh supply in
case of failure reported within fifteen days for Points, thirty days for Human,
and ninety days for Kitie Crusts. We can usually furnish "Crusts one remove
from the heifer if preferred.
On account of their unreliability, we have hitherto furnished the usual form of Virus
Crust unwillingly. Under our new method of taking and preserving them, how¬
ever, after careful tests an.t an experience extending over several months, the
results attained have been so satisfactory that we now offer them as not less
active and n-liable than other forms of Virus, wh le less liable to become inert
with lapse of time. We now offer them on very ’avorable terms, and recommend
them or transmission to a distance and in all cases where it is desirable to pre¬
serve Virus for some weeks or months, or to keep a supply at hand for emergen¬
cies.
We also furnish Uncharged Ivory Points, for physicians’ use, at the following
rates: —
Small . per 100, 25 cents; per 1,000 2 00
L i ge . per 100, 50 cents ; per 1,000 4 00
Orders by mail or telegraph answered by return train.
Liberal discounts upon large supplies for Ciiies, Towns, and Institutions,
Scarifying Vacc nator, Steel, Nickel Plated. See cut, each 25 cents.
New Illustrated Catalogue of Surgical Instruments, postpaid, on request.
GODMAK «£ SHURTLEFP,
MAKERS AND IMPORTERS OF
Superior Surgica! Instruments,
13 & 15 TREMONT STREET, BOSTON.
t.F.TO.al.
B
10
OFFICE OF
^^TROMMEEi^s
Extract of Malt
COMPANY,
FREMONT, OHIO.
FREMONT, OHIO , April, 1873.
DEAR SIR ' t
It is now five years since we first introduced and began the manufacture
of Extract of Malt in the United States. It has been our aim to furnish
the medical profession in America with a malt-extract equal to the best
German make, and (by saving the expenses of importation) much cheaper
than the foreign article can be afforded. For the manner in which our
efforts have been appreciated by the medical profession, we desire to ex¬
press our warmest thanks.
The difficulties attending the manufacture of Extract of Malt in large
quantities, can be overcome only by that, kind of. skill which is acquired
by experience. Its constituents must receive no injury by the process
and good flavor and keeping quality, adapting it to all climates, must
characterize the product. All are familiar with the striking difference
between certain celebrated brands of ale and porter —and yet the poorest
as well as the best, is, or should be, produced from barley malt and hops.
Success greatly depends, of course, upon the employment of none but the
best material ; but it is by the use of specific and long tried procedures
that results are obtained which are so difficult to rival.
We do ourselves but simple justice, in stating that our entire attention is
and for many years has been, exclusively devoted to the manufacture of
Extract of Malt for medical purposes, and that we give our undivided
personal attention to each step in the delicate process by which 'Extract of
Malt of excellent quality can alone be made.
Under these circumstances, it is unreasonable to suppose that the various
manufacturers of fluid extracts, elixirs, pills, &c., who (attracted by the
high reputation of our Extract of Malt) have recently, in various sections
of the country, undertaken the manufacture of a similar article, should
generally succeed in producing it of a quality accordiug with the fulsome
praise with which their advertisements are filled. While being perfectly
willing to let the reputation of our Extract of Malt rest upon its real
merits, we owe it to the medical profession, is well as to ourselved, to
give warning against imposition.
It has come to our knowledge that certain articles extensively advertised
as “pure” and “genuine extract of malt,”, are composed chiefly of the
t.Jy-79.
11
substance called grape sugar or maltine, which, as is well known is the
product of the action of sulphuric acid upon starch subjected to a high
temperature. This artificial grape sugar or glucose which is extensively
manufactured from corn starch, is now being used in immense quantities,
instead of ordinary cane sugar, in the sophistication of confectionery,
sugaihouse syrup, “ strained honey,” native wines, and canned fruits, aud
by some brewers in the manufacture of beer and ale. The cheapness of
this artificial product of Indian corn, constitutes the chief inducement for
this species of substitution for barley malt and cane sugar.
Again, an extract of malted grain is manufactured for the purpose of
obtaining diastase, which (simple and variously combined) is much used
in medicine. The appearance of the extract is but slightly changed by
being deprived of this important constituent, although, it is unnecessary
to add, that its value as a medicinal agent is thereby greatly impaired.
Nevertheless, this very substance, which is little more than refuse material,
in the manufacture of diastase, is now being offered for pure malt extrac.
It is malt extract prepared from Barley malt combined with the proper
proportion of Hops, that has been for many years the standard medicinal-
nutritive employed by the medical faculty of Europe, and especially of
Germany. Its value has been established by experience, and its use in
the treatment of almost all forms of disease of nutrition is constantly ex¬
tending. We shall continue to devote the most scrupulous attention of
the maintenance of the reputation of our malt, extract, by the careful
selection of material and by unwearied personal attention to manufactur¬
ing details.
Attention is respectfully directed to the accompanying extract from
Ziemssen, and also to our circular aud testimonials elsewhere printed.
Very Respectfully,
TROMMER EXTRACT OF MALT CO.
[ From Ziemssen’ 8 Oyclopcedia of the Practice of Medicine, Vol. XVI, page 474;]
“The Malt Extract prepared from Trommer’s receipt is designed to
fulfil much the same purpose as Cod-liver oil, carbo-hydrates (malt-sugar,
dextrin,) taking the place of fatty matter. The simple (much or little
hopped) and the Chalybeate form of Malt Extract are coming more and
more into favor as substitutes for the oil ; they are more palatable and
more easily digested, and should, therefore, be preferred in the dyspeptic
forms of antemia. Duriug the last few years Malt Extract has almost
entirely taken the place of Cod Liver Oil in the treatment of phthisis, and
other wasting diseases at the Basle hospital, and we have as yet found no
reason for returning to the use of the latter remedy. The Extract may be
given from one to three times a day in doses varying from a teaspoonful
to a tablespoonful in milk, broth, beer, or wine.”
t.Jy-79.
12
- 1 TEOMMERS’ | - y
The rapidly increasing demand for onr Improved Extract of Malt, daring the four
years that it has been manufactured and offered to the medical profession in America,
justifies the belief that in its production here we are meeting a generally felt want.
Long experience in manufacturing Malt Extract has enabled us to completely overcome
the many difficulties attending its manufacture in large quantity; and we pccitively
assure the profession that our Extract of Malt is not only perfectly pure and reliable,
but that it will keep for years, in any climate, without fermenting or molding, and that
its flavor actually improves by age. Our Extract is guaranteed to equal, in every respect,
tile best German make, while, by' avoiding the expense of importation, it is afforded at
less than half the price of the foreign article.
The Malt from which it is made, io obtained by carefully malting the very best quality
of selected Toronto Canada Barley The extract is prepared by an improved process ,
which prevents injury to its properties or flavor by excess of heat. IT REPRESENTS
THE SOLUBLE CONSTITUENTS OF MALT AND HOPS, viz: Malt, sugar, dex-
trine, diastase, resin and bitter of hops, phosphates of lime and magnesia, and alkaline
salts.
Attention is invited to the following analysis of this Extract, as given by S. H. Douglas,
Professor of Chemistry, University of Michigan, Ann Arbor.
t TROMMER ; XTIiACT OF MALX CO.:— I enclose herewith my analysis of your
Extract of Malt:
' Malt Sugar 46.1 ; Dextrine, Hop-bitter, Extractive Matter, 23.6; Albuminous Matter
[Diastase,] 2 469 , Ash — Phosphates, 1.712. Alkalies .377; Water, 25.7. Total, 99.958.
In comparing the above analysis with that of the Extract of Malt of the German
Pharmacopoea, as given by Hager, that has been sc generally received by the profession,
I find it to substantialiy agree with that article
Yours truly. SILAS H DOUGLAS,
Prof, of Analytical and Applied Chemistry
This invaluable preparation is highly recommended by the medical profession, as a most
effective therapeutic agent, for the restoration of delicate and exhausted constitutions. It
is very nutritions being rich in both muscle and fat producing materials.
The very urge proportion of Diastase renders it most effective in those forms of disease
originating in imperfect digestion of the starchy elements of food.
A single dos« of the Improved Trommer’s Extract of Malt, contains a larger quantity
of the active properties of Malt, than a pint of the best ale or porter ; and not having
undergone fermentation, is absolutely free from alcohol and carbonic acid.
The dose for adu.ts is from a dessert to a tablespoonful three times daily It is best
taken after meals, pure, or mixed with a glass of milk, or in water, wine, or any kind of
spirituous liquor. Each bottle contains 1£ Lfcs. of the Extract.
Our preparations of Mali are for sale by druggists generally throughout the
United States and Canadas , at the following prices
Extract of Malt,
with
Hops, plain . ------
$1 00
a
44
44
44
Pyrophosphate of Iron, Ferrate# ...
1 00
u
44
44
it
Cod Liver Oil , -
1 00
a
44
44
44
Cod Liver Oil and Iodide of Iron ,
1 00
44
it
44
Cod Liver Oil and Phosphorus 3 - -
1 00
«/
44
44
44
Hypoph osphitei, - - -
1 50
44
44
44
44
Iodides . , . .
1 50
44
44
44
44
Alteratives.. - - - * . .
1 50
4i
44
44
44
Citrate of Iron and Quinia, - . •
1 50
44
44
44
44
Pepsin, *•••••
man i: fac n; re dbv
1 50
TROMMER EXTRACT OF MALT CO.. - - - FREMONT. OHIO.
tJy-79.
13
G. R. FIHLAY k GO.,
IMPORTERS
Ho. 35 Magazine St. and 12 Bank Place,
NEW ORLEANS, LA.
We keep constantly on hand a large and complete stock or
bought exclusively for CASH, and are prepared to fill all orders entrusted
to our care with accuracy aud dispatch, and at the lowest
possible market rates.
We deal in none but
^iars-fc. Ql.ass Gapd@»
and all medicines sold by us are
GIMRANJEEQ_ TO BE FRESH AND UNADULTERATED
The success of the physician often depends on the quality of the drug
prescribed by him, aud we believe our patrons will bear us out in the as¬
sertion that the quality of the goods we supply cannot be surpassed.
We are Agents for some of the LARGEST MANUFACTURING ESTAB¬
LISHMENTS (both of this country and Europe) of
CHEMICALS,
PHARMACISTS’ PREPARATIONS,
SURGICAL INSTRUMENTS AND APPLIANCES.
and ad orders will be tilled with attention to furnishing such manufactures
as are designated. A full stock of
Pure Liquors and Wines of all kinds
are also kept on hand for medicinal purposes.
t-jy-79.
14
('SUCCESSOR TO BALL, LYONS &. CO. )
40, 42, 44 GAMP and in. 113, 115, 117 GRAVIER STS.,
NEW ORLEANS, LA.
DEALER IN
Drugs, Chemicals, Essential Oils,
Chemical Apparatus, Surgical Instruments, Electric Apparatus, Medi¬
cine Chests, Saddle Bags, Trusses, Supporters, Silk Stockings,
Sponges, and all articles used in Medicine and Surgery.
FINE WINES AND LIQUORS,
PERFUMERY, FANCY GOODS , PAINTS, OILS, DYE STUFFS, GLASS, ETC.;
Importer of
FRENCH. ENGLISH AND GERMAN DRUGS AND CHEMICALS.
Importer of Swedish Leeches,
Importer of English Solid Extracts,
Importer of Batt ley’s Liquor Opii Sed.,
Liquor Ergot, Cinchona, Buchu, Taraxacum, etc.,
Importer of Erench, English and German Proprietary
Medicines, Perfumery audDrug Sundries
Only direct Importer in the South of Norwegian or Bergen Cod Liver Oil,
White and Brown.
Agent for GEO. TIEMANN & CO.’S SURGICAL INSTRUMENTS,
Which we Sell at Makers' Prices.
Agent for W. R. WARNER & CO.’S SUGAR COATED RILLS
Agent for
HARPE A DOHMES' AND HENRY THAYER A GO'S
SOLID AND FLUID EXTRACTS.
Agent for
JNO. WYETH & BROS FLUID EXTRACTS, ELIXIRS. WINES.
DIALYSED IRON, COMPRESSED PILLS, <60., AC.
Agent for
DR. L. A. BABCOCK’S SILVER UTERINE SUPPORTER,
dr. McIntoshs uterine supporter.
DR STEPHENSON S UTERINE SUPPORTER.
BLUE LICK, POLAND, BETHESDA AND BLADON WATER.
Always in stock a full line of
CARPENTER'S, ELLIOTS ALOE A HERN STEIN'S AND LESLIE'S
SADDLE BAGS, FRESH HUMAN AND BOVINE VACCINE.
The extensive Dispensing Department and complete Laboratory connected with my
Wholesale Business enables me to give that careful attention to Physicians’ Oiders ne¬
cessary to ensure tilling them satisfactorily.
Having always exercised the greatest care in the selection of the crude materials em¬
ployed, and making all pharmaceutical preparations of standard strength, in strict accord¬
ance with established and recognized formulas, I have earned and awf entitled to the con¬
fidence of the profession.
I. L. LYONS.
15
Pharmaceutical and Medicinal Preparations
FROM LABORATORY OF
X. Li. LTQI'TS,
(Successor to BALL, LYONS & CO.)
Wholesale Druggist and Pharmacist
40, 42, 44 CAMP St. and 111, 113, 115, 117 GRAAIER St.
MEW 0 RLE AMS, LA.
During my many years' experience I have always recognized the importance of estab¬
lishing in our midst a LABORATORY which would enable Physicians to procure at home,
with a guarantee of purity and reliability, the many, elegant and really scientific prepara¬
tions w Inch have ol late years become so popular with practitioners and patients. Sup¬
plied with the MOST APPROVED APPARATUS, and in charge of intelligent and ex¬
perienced pharmaceutists, I may justly claim the products of my laboratory to be ex¬
celled by none in the country, and to be far superior to most others of foreign manufacture.
I cannot attempt here to enumerate all the extensive list of my preparations, and will
only call attei tion to the leading ones, which have, by their absolute reliability, elicited
the praise and approbation of the leading ohysicians in this city.
I also beg to add that I am prepared to manufacture at short notice any pharmaceutical
preparation which physicians may be unable to procure elsewhere.
COD LIVER OIL with PHOSPHATE OF LIME ;
COD LIVER OIL with LACTO-PHOSPHATE OF LIME ;
COD LIVER OIL with SOLUBLE PHOSPHATE OF LIME j
COD LIVER OIL, FERRATED;
COD LIVER OIL, IODO-FERRATED ;
COD LIVER OIL. PHOSPHORATED;
BERGEN COD LIVER OIL, WHITE ;
BERGEN COD LIVER OIL, BROWN.
NUTRITIVE ELIXIR , (Beef, Cognac and Bitter
Orange) NUTRITIVE ELIXIR , FERRATED,
designed as SUBSTITUTES FOR DUCROS’
ELIXIR , at more moderate prices .
ELIXIR BISMUTH
ELIXIR C ALISA V A and PYROPHOL.
IRON,
ELIXIR CALISAYA IRON and STRYCH-
Nr a.
ELIXIR tiALISAYA, IRON, STRYCH
NIA and BISMUTH,
ELIXIR OALISAYA, IRON, PEPSINE
a-d BISMUTH.
ELIXIR CIT. LITHA-
ELIXIR PHOSPHATE IRON, QUININE
and STRYCHNIA.
ELIXIR PYROPHOS. IRON, QUININE
and STRYCHINA.
ELTXIR PEPSINE.
ELIXIR PEPSINE and BISMUTH.
ELIXIK PEPSINE, BISMUTH and
STVRCHNIA.
ELIXIR PEPSINE, BISMUTH. STRYCH
NIA and IRON.
ELIXIR VAL. AMMONIA
ELIXIR VAL. AMMONIA and QUININE.
ELIXIR GUARANA.
LIQUOR PEPSINE.
LIQUOR BISMUTH.
SVKUP PHOSPHATES COMP.
SYRUP HYPGPE OPHITES COMP.
SYRUP LACTO-PIIOSPHATE IRON.
SYRUP LACTO PHOSPHATE IN ME
SYRUP IRON, free from taste and acid.
SYRUP PHOSPH. IRON, QUININE and
STRYCHNIA
SYRUP 10 D IKON and HANTG.
SYRUP HYD. CHLORAL.
SYRUP LACTO-PIiOS. LIME and PEP¬
SINE.
SYRUP LACTO-PHOS. LIME and IRON
WINE, BEEF ami IRON.
WINE, BEEF, IRON and CINCHONA.
WINE, PEPSINE.
WINE, IRON BITTER.
WINE CINCHONA. (Quinquina Robiquet.)
WINE CINCHONA. FERRUGINEUX
(Quinquina Robiquet.f
WINE WILD CnERRY.
WINE WILD CHERRY FERRATED
ELIXIR TARAX. COMP, lor masking Qui¬
nine.
FLUID EXTRACT ERGOT prepared from the selected grains, and all fluid
Extracts of STANDARD STRENGTH.
All new and rare chemicals kept in stock.
I. L. LYONS.
16
NOW READY.
lltf ffrartitiouM's gtefnm* ftoofe,
ADAPTED TO THE USE OF
THE PHYSICIAN, THE PHARMACIST, and the STUDENT.
General Information for the Practitioner. Therapeutic and Practical
Hints. How to conduct a Post-mortem Examination.
Dietetic Rules and Precepts.
By RICHARD J DUNGLISON, M.D.
Preface to the Work.
From personal experience of the wants of the busy practitioner, the author is confident
that a work of ready reference containing, in a compact and tangible shape, information
of a purely practical character will prove a desirable addition to his medical arma¬
mentarium The physician is frequently at a loss to know in what direction to look, in
oriter to procure such facts and hints as are here collected, some of which are widely
scattered through voluminous professional treati-es or the— in many instances— inac¬
cessible pages ot medical periodicals ; while the other original suggest ^ ° and precepts
ottered for his guidance will, it is believed, meet many of his daily needs. The cordial
indorsement of the objects of the work, with which tie author has already been favored
by leading and active members of the profession, induces him to indulge the lihpe that it
may become an indispensable companion as a handy-book for every-day consultation.
Bound in Cloth. Octavo. Price $3.50.
Sent free, by mail upon receipt of price.
LINDSAY & BLAKISTON, Publishers,
No. 25 South Sixth Street , Phila.
PQTHECJIRY Ap CHEMIST
115 EAST MARKET. LOUISVILLE. KY„
Manufactures by his Improved Method
Saccharated Pepsin
which has proven its sup riority over other Pepsins by its greater strength, by its stabil¬
ity and uniformity, and by its almost entire tastelessness.
CONCENTRATED DRY PEPSIN,
of which one grain digests 100 to 125 grains of coagulated albumen in 4 to 6 hours, and
PEPSIN,
of which one mince dissolves 90 grains of albumen.
ALL ARTICLES WARRANTED.
t.jy-79
17
Dr. Jerome Kidder’s Electro Medical Apratas,
For which he has received 21 Letters Patent
for improvements, rendering them superior to
all others, as verified by award of First Premium
at Centennial ; also First Premium by Ameri¬
can Institute from 1*72 to J879 inclusive, and, in
1875, Gold Medal.
&W Please note the following, for which the
GOLD MEDAL
was awarded by American Institute in 18:5. to
distinguish the Apparatus as of The First Order
of importance :
Dr. Jerome Kidder’s Improved No. 1.
Physician’s Office Electro Medical Apparatus.
Dr. Jerome Kidder’s Improved No, 2,
Physician’s Visiting Machine, with turn down
Helix
Dr, Jerome Kidder’s Improved No. 3,
Physician’s Visiting Machine (another Form).
Dr. Jerome Kidder's Improved No. 4,
Office and Family Machine.
Dr. Jerome Kidder’s Improved No. 5.
Tip Battery Ten Current Machine (see cut).
A most perfect and convenient apparatus,
the invention of Dr. Kidder. We also manufac¬
ture superior Galvanic Batteries, from f> to 36
cells ; also Pocket Induction Apparatus. BEWARE OF IMITATIONS .
For the genuine, send for Illustrated Catalogue.
Address
ALBERT KIDDER & CO.,
Successors, 820 Brodway , .New York.
- • - - -
Microscopes for Physicians.
Wai.k’s new working Microscope is original in design and the lowest, -
priced Microscope of really good quality in market.
Send for Illust rated Catalogue, free.
INDUSTRIAL PUBLICATION CO.,
14 Dey Street, New York.
THE LOHDOH LAHCET
Is the oldest Medical Journal in tbe English language, and the recognized
exponent of Medical Science all over the world. The largest and cheapest
Medical Journal in the country — $5.00 per year. Send for prospectus.
Specimen Copies 2f> cents each. Address,
THE LONDON LANCET,
14 Dey Street, New York.
The American reprint now contains all the Medical matter of the
original edition.
18
CINCHONIA (ALKALOID)
Costing less than one-sixth the price of Quinta, and forming
AN EFFICIENT TASTELESS ANTIPERIODIC.
Since we first invited the particular attention of physicians
to Cinchonia Alkaloid and Cinchonia Mixture, we have beeu
almost daily in receipt of testimonials to its efficacy .
We have made selections from these, and collated them ac¬
cording to the portions of the country whence they were
written. We will be happy to mail copies, upon application,
to physicians who have hot received them.
POWERS & WEIGHTM AN, Philadelphia.
“ The best of American Manufacture.” — Profs. Van Bui?en & Keyes,
PLANTEN’S CAPSULES,
KNOWN AS RELIABLE NEARLY 50 YEARS.
Premium for “ General Excellence in Manufacture.”
H. PLANTEN & SON, 224 WILLIAM ST., NEW YORK.
HARD AND SOFT CAPSULES
OF ALL KINDS.
RECTAL (Suppository) (3 Sizes),
For administering medication in the rectum, are most readily soluble and far superior to
the ordinary suppositories.
EMPTY CAPSULES (7 Sizes),
For taking medicines free of taste, smell, injury to the teeth, mouth or throat.
lOO by mail, 50 cents.
Samples sent free. Specify Flanten’s Capsules on all orde-is. Sold by all Druggists.
Sole Agents in the United States for the Great English Remedy,
BLAIR’S GOUT AND RHEUMATIC PILLS.
19
9
D
No. 2.
These cuts (two-thirds the actual size) represent a New Hypodermic Syringe of our manufacture.
With the exception of the needles, it is of German Silver, a material chosen as possessing, next to
steel, the greatest regidity and durability, while free from liability to oxydation. The barrel is
formed by a process peculiar to ourselves, securing uniformity of calibre, without soldered joint or
seam. It is plated inside and outside with nickel. The piston is packed in the double parachute
form, with leather prepared expressly for the purpose. It will be found to retain its elasticity, to
operate smoothly, to resist all tendency of fluid to pass above, as of air below it. -A nicely engraved
scale upon the piston-rod indicates minims, thirty being the capacity of the syringe.
Syringes Nos. 2, 3 and 4 have also a screw thread upon the piston-rod, and a traverse nut, thereby
favoring the utmost nicety in the graduation of doses.
No. 3, Compact, has hollow piston-rod to receive one needle, also a protecting cover and fluid
retainer ; it may be carried in the Pocket Instrument or Vial Case, or without any case.
No. 4, Compact, is like No. 3, with the addition of a second needle, carried upon the syringe in
the usual place, protected by a metal shield. Nos. 1 and 2 are put np in neat morocco-covered case,
with vial.
Two sizes of needles are furnished with each instrument, Nos. 1, 2 and 4 ; one only with No. 3.
They are ot refined steel, carefully tempered, and thoroughly plated with gold ; they are of small
diameter and large relative calibre, sharpened to such an angle as will offer least resistance to
penetration, and therefore cause least pain. At the point of union with the socket they are re¬
inforced with an outer covering of German silver, thereby overcoming the tendency to become broken
at this place. They are connected with the barrels by a serew thread!
PRICKS . No. 1 . *3.50. No. 2 . *4.00. Postage, .03.
“ . No. 3 . *2.50. No. 4. . .♦ _ *3.50. “ .02.
No. 3.
These syringes are so thoroughly and strongly made as to be free from the annoying accidents
common to most Hypodermic Syringes : and we believe that for convenience, durability and nicety
of construction, they have no superior.
The above will be sent by return mail on receipt of price and postage.
Hypodermic Syringes of all kinds Promptly Repaired.
Our New Illustrated Catalogue of Surgical Instruments, also a new pamphlet on Inhala¬
tion of Atomized Liquids, by distinguished medical authority, with many valuable formulas, will be
forwarded, postpaid, on application.
Atomizers and articles for Antiseptic Surgery, Aspirators, Clinical Thermometers, Elastic Hose,
Electrical Instruments, Invalid’s Articles, Manikins, Models, Ophthalmoscopes ; Dr. Paquelin's
Thermo- Cautery ; Pessaries. Rubber Hrenals ; Sayre’s Splints, and apparatus for every kind of
deformity; Skeletons, Sphygmographs, Splints, Transfusion Apparatus; Vaccine Virus from our
own stables ; Vetrinary Instruments; Waldenburg’s Pneumatic Apparatus, etc., etc.
See our other Advertisements in successive numbers of This Journal.
CODMAM & SHURTLEFP,
MAKEES AND IMPOETEES OP SUPEEIOE SUEGIOAL INSTEUMENTS,
73 & 15 Tremont Street , Boston , Mass.
IN CORRESPONDING WITH ADVERTISERS PLEASE MENTION THIS JOURNAL.
my.ag.nov.
20
I Laboratory of John Wyeth & Bito.,
\ Philadelphia.
THE NEW AN/ESTHETIC —
ETHYL BROMIDE;
Or, HYDROBROMIC ETHER.
The attention of the Medical profession has been recently
directed- to the many advantages of Bromide of Ethyl as an
Anaesthetic, over Chloroform and Ether. The exhaustive experi¬
ments of Dr. R. J. Levis and of Dr. Laurence Turnbull fully
confirm all the favorable reports of former investigations. Dr.
Levis has employed this agent more frequently, perhaps, than
any other surgeon, and the results of his experiments prove
conclusively its value.
In a large number of the administrations made by Dr
Levis in the Pennsylvania Hospital, the Jeflersou College Hos¬
pital, and in general private surgical practice, he used the
Ethyl manufactured in our laboratory, aud has expressed great
satisfaction in its exhibition, on account of the absence of
unpleasant odor, freedom from the objectionable characteristics
of other Bromides of Ethyl sold, aud on account of the rapid
ethylization of the patients; so much so, that he considers it
deserving of decided preference. Appreciating the great value
of this new Anaesthetic, and realizing that as soon as its
advantages are fully known to the profession at large, it would
supersede those now iu use, we have increased our facilities
for its manufacture, which will enable us to supply any
demand however great. Much of the commercial Bromide of
Ethyl possesses a disagreeable and nauseous odor, — our pro
duct is entirely free from this objection. The advantages of
Ethyl as an Anaesthetic are fully set forth by Dr. Levis in his
papers, published iu the Philadelphia Medical Times , January
17th, and February 14th, 1880.
w
VOL. VII.
JULY, 1879.
No. 1,
The New Orleans (
MEDICAL AND SURGICAL
JOURNAL.
EDITED BY
S. M. REMISS, M. IX,
W. H. WATKINS, M. D. S. S. HERRICK, M. I).
f iiWsfoed MooWy $5 pel* SdidrIk), io gt>bgnce.
Paulum Hepultai distat inertice cclata virtus. — Horace.
TABLE OF CONTENTS:
PAGE.
Original Communications —
By D. WEBSTER PRENTISS, AM., M.D.
A Contribution to the Clinical History of
Croupous Pneninonia. . . 1
By JOSEPH JONES, M. D.
Treatment of Yellow Fever . 29
Report on Intra-Mural Sepulture in the city
of New Orleans . . . .i . 45
Correspondence . 53
OBITUARY — John Maynard Woodworth.. 54
Current Medical Literature—
The Utero-Ovarian Amputation as Comple¬
mentary to the Caesarean Operation accord¬
ing to t he method of Dr. Porro, of Pavia - 55
A Case of Caesarean and Utero-Ovarian Ampu¬
tation . . 57
Turpentine in Whooping-Cough . . 58
A Sanitary Protective Association . 59
Inefficiency in Expert Testimony . 59
Cerebro-Spinal Meningitis . •’ . . f>0
How to measure a Skull . 60
A Diceplmhts Monster . 61
A Remarkable Hoiuicido . . 62
Bruises— Chlorine Water . . . ... 62
Urticaria — Bisulphite of Soda . 63
Breeches . 63
Homoeopathic Confectionery . 63
Action of the Blatta 0“ientalis - - 63
Phymosis. . . 64
PAGE.
Dyspepsia— Chloroform . 64
Poisoniug from an overdose of Sweet Spirits
of Nitre . . . . 64
A Substitute for the Horse . 6 4
Small- Pox and Great Pox . 65
Diet and Liquor Di inking . 66
Tile Permeability of a Stone Wall . 66
The External Use of Digitalis in Suppression
of Urine . . . 67
The Dry Su rare - ...., .. . 67
Reviews and Book Notices . 68
Books and Pamphlets Received . 76
Editorial . 77
't’lio Blanks of tho Superintendent of Census 79
Meteorological Tallin — May, 1879 . 8P
Mortality in New Orleans from May 25, 1879
to June 22. Ie79, inclusive . 80
Abstract Proeee.iings Louisiana State Medi¬
cal Society, Annual Session of 1879, — New
Provisions in the Interests of State Medi¬
cine Proposed for the Constitution of
Louisiana . 81
Adiliess bv tbe ‘ Annual Orator” of the
Louisiana Stale Medical Society — Stanford
E. Chaille, A.M., M.D., Prof. Physiology
and Pathological Anatomy, Medical Depart¬
ment University of Louisiana . 89
Comparative Paiholngy of Malai ial and Yellow
Fevers. — By Joseph Jones, M.D., Professor
of Chemistry andClinical Medicine Medical
Department University of Louisiana; Visit¬
ing Physician of Charity Hospital, New
Orleans . . 106
NEW ORLEANS:
L GRAHAM, PRINTER, 127 GRAVIER STREET.
1 8 7 9.
SHARP & DOHME,
Manufacturing Chemists I Pharmacists,
BALTIMORE, MD.
We respectfully invite the attention of Fhjsicians and Druggists to the Medicinal
Prepaiations of onr manufacture, which will be foui d of superior quality aud io
every respect reliable, all possible caie being used both in selection of material an 1
in their manufacture to produce preparations of uniform strength and of the best
quality oul ••
We preeare all the Officinal and other Standard MEDICINAL SOLID AND FLUID
EXTRACTS, PURE CHEMICALS, and various other Pharmacetitical Preparations, in¬
cluding a full line of SUGAR COATED PILLS AND GRANULES. ELIXIRS,
SYRUPS, SACCHARATED PEPSIN, OLEATE OF MERCURY, ETC., ETC.
Among the late additions to our list of Fluid Extracts we call special attention to
FLUID EXTRACT MISTLETOE, FLUID EXTRACT JABORANDI, (prom >t.
diaphoretic and sialngoyue.) FLUID EXTRACT DAMIANA ( th ■> netv apbrodisia ,)
FLUID EXTRACT EUCALYPTUS, FLUID EXTRACT GITARANA. FLUID E G
TRACT GR1NDELIA ROBUSTA, ILUID EXTRACT BLACK HAW (a pew rente ly
to prevent thieatentd miscarriage.)
Catalogues giving composition doses, etc., of all onr Preparations mailed to
Physicians by applying either direct to us or to our Wholesale Agent,
I. L. LYONS,
Wholesale Druggist aM Importer of English and German Chemicals,
42 and 44 Camp St., New Orleans, La.
MEDAL AWARDED UNIVERSAL EXPOSITION, PARIS. 878.
THREE AWARDS, INTERNATIONAL EXHIBITION, 1876.
w Hance Brothers & White,
MANUFACTURING
CHEMISTS AND PHARMACEUTISTS,
PHILADELPHIA.
Manufacturers of and Dealers in all of the
GALENICAL AND CHEMICAL PREPARATIONS EMPLOYED IN MEDICINE:
Fluid and Solid Medicinal Extracts;
Sugar-Coated Pills and Grannies ; Medicated Elixirs \
RESINOIDS; OLEORESINS;
EXTRACT ERGOT for Hypodermic use; Monobromated Camphor;
SACCHARATED PEPSIN; OLEATE MERCURY;
YELLOW OXIDE MERCURY, ETC,, ETC.
Sulpho-Carbolate Soda; Dialysed I-on;
_ , , . A neutral solution of Oxychlo •
Recommended for treatment oj \ Iron : an admirable substi -
Scarlet Fever and Diphtheria. J tutc for ether iron preparations • ■
(PHYSICIAN’S MEDICAL COMPEND :-a pocketcom-\
patiion and memory prompter in valuable to every Physician. \
Mailed upon Receipt op the Price, $1.00. /
ABSORBENT COTTON.
NEEDED BY EVERY SURGEON AND GYN. ECOLOGIST,
A cheap and convenient SUBSTITUTE FOR SPONGE.
Mailed upon receipt of price— 25 cents per package, or
$1.00 for five packages.
PRICED CATALOGUE MAILED UPON APPLICATION.
Dialysed
Iron,
Of reliable quality,
and unsurpassed in
any particular.
Price, per pint,
50 cents.
To the Medical Profession.
rhe most important remedial agent ever presented to the Profession for Indigestion,
dyspepsia, Vomiting in Pregnancy, Cholera Infantum, Constipation and all Diseases
•rising from imperfect nutrition, containing the five active agents of digestion, viz :
) epsin , Pancreatine, Diastase, or Veg. Piyalin, Lactic and Hydrochloric Acids, in com¬
motion with Sugar of Milk.
FORMULA OF LACTOPEPTINE.
Veg. Ptyalin or Diastase . .4 drachms.
Lactic Acid . . . . 5 fl. drachms.
Hydrochloric Acid . 5 fl. drachma.
IACTOPEPTINE owes its great success solely to the Medical Profession, and is sold almost entirely by
’hysicians’ Pi e.-ci iptions. Its almost universal adoption by the profession is the strongest guarantee we can
ive that its therapeutic value has been roost thoroughly tested.
The undersigned having tested LACTOPEPTINE, recommend it to the proiession.
Sugar of Milk . 40 ounces.
Pepsin . . 8 ounces.
Pancreatine . Bounces.
.LFRFD L. LOOMIS, M. I)..
Professor of Pathology and Practice of Medicine, Uni¬
versity of the City of Sevi York.
EWIS A. SAYRE, M. I).,
Professor of Oithopcedic ■' urgert) and Clinical Sur¬
gery, Bellevue Hospital Medical College.
F. LE ROY SATTERLEE, M I).. Pit. I)..
Professor of Chem., Mat. Med. and Therap ., in the <V.
Y. College of Dent.; Prof, of Chem. and Hygiene
in the Aw. Vet. College, etc., etc.
SAMUEL R. PERCY M. I)..
Professor Materia Medica, New York Medical Collag
. Van Dkveer, M. D.,
Aibany, N. Y.. June 8th. 1878.
Prof, of the Prin and Prac. of Nurse., Albany Med.
Col.; Surg. Albany and St. Peter's Hospitals.
ohn H. Packard, M. D.,
Philadelt.hia, Pa., May 30th, ie78
Pres' t Pa. Co.. Obstet. Society; Surg. Episcopal
and Women's Hospitals.
as. Aitken Meigs, M. D.,
Philadelphia. June 20th. 1878.
Prof, of the Institutes of Med and Med Juris.,
J- ff Medical College ; Phy. to Penn. Hos.
V. VV. Dawson, M D,
Cincinnati. O.. June 21st, 1878.
Prof. Prin. and Prac. Surg. Med. Col. of Ohio ,-
Surg. to Good Samaritan Hospital.
llbekt.F, A. King, M. D.,
Washington, I). C., June 19th, 1878.
Prof, of Obstetrics, University of Vermont.
t W. Yandkli., M. I).,
Louisville. Ky.; March 7th, 1878.
Prof of the Science and Art of Surg., and Clinical
Surg. University of Louisville.
:obt. Rattev, M. D.,
Rome. Ga,, June 7th. 1878.
Emeritus Prof, of Obstetrics, Atlanta Med. Col¬
lege, and Ex Pres. Med. Association of Ga.
LAUDE H. Mastin. M D , LL. D„
Mobile. Ala , June 8tli, 1878.
•of. H. C. Bartlett, Ph. D. F. C. S.,
London, England,
February 22d, 1870.
“I have given LACTOPEPTINE a good thorough trial
and have been greatly pleased with ihe excellent results
that have followed its administration.”
“I have found great satisfaction in the use of LA CTO
Pi'.PTINE, and have ordered it frequently in eases of
Dyspepsia, especially where there is want of tone and
defective secretion.”
“I have used LACTOPEPTINE with very good effect
in a number of cases of Dyspepsia.”
•‘I have used LACTOPEPTINE with great advantage
in cases of feeble digestion.”
“I have nsed -LACTOPEPTINE both in hospital and
private practice, and have found it to answer fully the
purposes f r which it is recommended. As an immediate
aid to the digestive function. I know of no remedy which
acts more directly,”
“I have made much use of LACTOPEPTINE and take
great pleasure in stating that it has rarely disappointed me.
I shall, of course, continue to prescribe it.”
“ I have nsed LACTOPEPTINE in a rax- of Dyspepsia
with satisfaction. I think well of i>.”
“I consider LACTOPEPTINE the very best preparation
of the kind which I have ever employed, and for patients
with feeble digestion I know of nothing which is equal to it..
‘•I find the preparation of LACTOPEPTINE contains
within itself all the principles required to promote s
healthy digestion.”
PRICE LIST.
ACTOPEPTINE (in oz. bottles!. . . per oz. S 1.0)
( “ “ ) . per doz. 10 00
“ (in i lb. '* ) . per lb. 12.00
We also prepare the various Elixirs
and Syrups, in combination with Lacto
peptine.
THE NEW YORK PHARMACAL ASSOCIATION,
2 & 3 COLLEGE PLACE, NEW YORK,
O. BOX 1574.
MEDICAL DEPARTMENT
OK THK
NEW ORLEANS.
FACULTY.
T. G. RICH A RDSON, M.D.,
Professor ofGeneral and Clinical Surgery.
SAMUEL M. BEMISS, M.D.,
Professor of the Theory and Practice of
Medicine and Clinical Medicine.
STANFORD E. CHAILLR, M.D.,
Professor of Physiology and Pathological
Anatomy.
JOSEPH JONES, M.D.,
Professor of Chemistry and Clinical Medi¬
cine.
SAMUEL LOGAN, M.D.,
Professor of Anatomy and v Clinical
Surgery.
ERNEST S. LEWIS, M.IX,
Professor of General and Clinical Obstet¬
rics and Diseases of Women and Childrou.
JOHN B. ELLIOTT, M.D.,
Professor of Materia Medica and Thera¬
peutics and Clinical Medicine.
ALBERT B. MI LEA, M.D.,
Demonstrator of Anatomy.
The next annual course of instruction in this Department (now in the forty-sixth
year of its exsitence) will commence on Monday, the 20th day of October, 1879, and
terminate on Saturday the 14th day of March, 1880. The lirst three weeks of the
term will he devoted exclusively to Clinical Medicine and Surgery at the Charity
Hospital; Practical Chemistry iu the Laboratory; and dissections in the spacious
and airy Anatomical Rooms of the University.
The means of teaching now at the command of the Faculty are unsurpassed in the
United States. Special attention is called to the opportunities presented for
CLINICAL INSTRUCTION.
The Act establishing the University of Louisiana gives the Professors of the
Medical Department the use of the great Chaiity Hospital, as a school of practical
instruction.
The Charity Hospital contains nearly 700 beds, and received, during the last year,
nearly six thousand patients. Its advantages for professional study are unsurpased
by any similar institution in this country. The Medical, Surgical and Obstetrical
Wards are visited by the respective Professors in charge daily, from eight to ten
o’clock A. M.; at which time all the Students are expected to attend, and familiarize
themselves, at the bedside of the patients, with the diagnosis aud treatment of all
forms of injury aud disease.
The regular lectures at the hospital, on Clinical Mediciue by Professors Bemiss,
Elliott and Joseph Jones, Surgery by Professors Richardson and Logan, Diseases ot
Women and Children by Professor Lewis, and Special Pathological Anatomy by
Professor Chailld, will ho delivered in the amphitheater on Monday, Wednesday.
Thursday and Saturday, from 10 to 12 o’clock, A. M.
TLe Administrators of the Hospital elect, annually, twelve resident Students, who are
maintained by the Instntion. All vacancies tilled by competitive examination.
TERMS :
For the Tickets of all the Professors . . $ 140 00
For the Ticket of Practical Anatomy . 10 00
Matriculation Fee . 5 00 ’ ;
Graduation Fee . 30 00
Candidates for graduation are required to be twenty-one years of age ; to have %
studied three years; to have attended t.wro courses of lectures, and to pass a satis¬
factory examination.”
Graduates of other respectable schools are admitted upon payment of the Matricu¬
lation and half lecture fees. They cannot, however, obtain the Diploma of the Uni¬
versity w ithout passing the regular examinations aud paying the usual Graduation
Fee.
As the practical advantages here afforded for a thorough acquaintance with all the
branches of medicine and surgery are quite equal t » those possessed by the schools
of New York and Philadelphia, the same fees are charged.
For further information, address
T. G. RICHARDSON, M. D. Dean.
"For further information npon these points see circnlar.
VOL. VII.
AUGUST, 1879.
No. 2.
The New Orleans
MEDICAL AND SURGICAL
JOURNAL.
EDITED BY
S. M. BEMISS, M. D„
W. II. WATKINS, M. D. S. S. HERRICK, M. D.
Ueto geHes— f titoisljei) Jffootiili) ;ii $5 pel- Bnimio, in et'liaoce.
Paulum sepultas distat inertiie celata virtus. — Horace.
SCOTT & BOWNE’S
PALATABLE
CASTOR OIL,
AN EMULSION.^©
We respectfully submit the above preparation to the Medical Profession, and request them to give it
a trial. They will find it a most desirable mode of administering this useful yet most sickening cathartic.
The Emulsion is not only perfect and permanent, but absolutely palatable, and by our process of
emulsifying it, we seem to have eliminated its griping properties. Physicians report that it is not
only a miluand pleasant laxative and cathartic, but is a most efficient agent in Diarrhoea and Intestinal
Inflammation. It is put np in 4oz bottle that sell for 25 cents, also in quarts for Physicians. to prescribe
as they desire. We will be pleased to send a sample upon application. Express paid.
Formul — 50 per cent. Pure Cold Pressed Castor Oil.
15 per cent. Chemically pure Glycerine.
SCOTT &0 BOWNB,
MANUFACTURING CHEMISTS,
135 Hudson Street, IVew York.
L. Graham, Steam Book and Job Printer, 127 Gravier street, N. O.
SHARP & DOHME,
Manufacturing Chemists I Pharmacists,
BALTIMORE. >11).
We respectfully invite the attention of Physicians and Druggists to the Medicinal
Preparations of our manufacture, which will be found of superior quality and in
every respect reliable, all possible care being used both in selection of material and
in their manufacture to produce preparations of uniform strength and of the best
quality onD.
We prepare all the Officinal and other Standard MEDICINAL SOLID AND FLUID
EXTRACTS, PURE CHEMICALS, and various other Pharmaceutical Preparations , in¬
cluding a full line of SUGAR COATED PILLS AND GRANULES, ELIXIRS,
SYRUPS, SACCHARATED PEPSIN, OLEATE OF MERCURY, ETC., ETC.
Among the late additions to our list of Fluid Extracts we call special attention to
FLUID EXTRACT MISTLETOE, FLUID EXTRACT JABORANDI, (prompt
diaphoretic and sialagogue,) FLUID EXTRACT DAMIANA (the new aphrodisiac,)
FLUID EXTRACT EUCALYPTUS, FLUID EXTRACT GUARANA, FLUID EX¬
TRACT GRINDELIA ROBUSTA, FLUID EXTRACT BLACK HAW (a new remedy
to prevent threatened miscarriage.)
Catalogues giving composition doses, etc., of all our Propagations mailed to
Physicians by applying either direct to us or to our Wholesale Agent,
I. L . LYOITS,
Wholesale Druggist anfl Importer of English and German Chemicals.
42 and 44 Camp St., New Orleans, La.
MEDAL AWARDED UNIVERSAL EXPOSITION, PARIS, 1878.
THREE AWARDS, INTERNATIONAL EXHIBITION, 1876-
are solicited to order our goods either direct or
I Miil'ii (i i imi yu*| ^ y »u are solicited to oraer oi
th£uf their druggist,
• - « 43 A named sample of our manufactures, not
contraband of postal regulations, mailed upon application.
CATALOG-TJES UTK/EE E3"5T 2VEA..IE,.
FLUID & SOLID EXTRACTS
SUGAR COATED PILLS. ELIXIRS.
ALL OF THE CHEMICAL AND PHARMACEUTICAL PREPARATIONS EMPLOYED IN MEDICINE,
A Pocket Companion
AND
Memory Prompter.
Invaluable to every
Physician.
•) A I L E D UPON RECEIPT Or THE PRICE, ONE DOLLAR.
; ft;
OFFICE:— | Callowhill Street, Cokm.r
( OF luARSHALL, t*"1 i : * ’ 1
To the Medical Profession.
The most important remedial agent ever presented to the Profession for Indigestion,
Dyspepsia, Vomiting in Pregnancy, Cholera Infantum, Constipation and all Diseases
arising from imperfect nutrition, containing the five active agents of digestion, viz :
Pepsin, Pancreatine, Diastase, or 1 leg. Ptyalin, Lactic and Hydrochloric Acids, in com¬
bination with Sugar of Milk.
FORMULA OF LACTOPEPTINE.
Sugar of Milk . 40 ounces. 1 Yeg. Ptvalin or Diastase . 4 drachms.
Pepsin . 8 ounces. Lactic Acid . 5 fl. drachms.
Pancreatine . 6 ounces. | Hydrochloric Acid . 5 fl. drachms.
.LACTOPEPTINE owes its great success solely to the Medical Profession, and is sold almost entirely by
Physicians’ Prescriptions. Its almost universal adoption by the profession is the strongest guarantee we can
give that its therapeutic value has been most thoroughly tested.
The undersigned having tested LACTOPEPTINE, recommend it to the prolession.
ALFRED L. LOOMIS, M. D.,
Professor of Pathology and Practice of Medicine, Uni¬
versity of the City of New York.
LEWIS A. SAYRE, M. I).,
Professor of Orthopcedic surgery and Clinical &ur-
gery , Bellevue Hospital Medical College.
F. LE ROY SATTERLEE, M. D., Ph. D.,
Professor of Chem., Mat. Med. and Therap., in the N.
Y. College of Dent.; Prof, of Chem. and Hygiene
in the Am. Yet. College, etc., etc.
SAMUEL R. PERCY, M. D.,
Professor Materia Medica, New York Medical Colleg
A. Yan Dkvf.er, M. D.,
Albany, N. Y., June 8th, 1878.
Prof, of the Prin. and Prac. of Sun.. , Albany Med.
Col.; Surg. Albany and St. Peter's Hospitals.
John II. Packard, M. D.,
Philadelphia, Pa., May 30th, 1878
Pres' t Pa. Co., Obstet. Society; Surg Episcopal
and Women's Hospitals.
Tas. Aitkenf Meigs, M. D.,
Philadelphia, June 20th. 1878.
Prof, of the Institutes of Med and Med. Juris.,
Jeff Medical College ; Phy. to Penn. Hos.
W. W. Dawson, M. D,
Cincinnati, O., June 21st, 1878.
Prof. Prin. and Prac. Surg. Med. Col. of Ohio ;
Surg. to Good Samaritan Hospital.
Albert F, A. Ki.vo, M. D.,
Washington, D. C., June 19th, 1878,
Prof, of Obstetrics, University of Vermont.
D. W. Yandell, M. D„
Louisville. Ky.. March 7th, 1878.
Prof, of the Science and Art of Surg;, and Clinical
Surg. University of Louisville.
Robt. Battev, M. D.,
Rome, Ga., June 7tli, 1878.
Emeritus Prof, of Obstetrics, Atlanta Med. Col¬
lege, and Ex Pres. Med. Association of Ga.
Jlaude H. Mastix, M D., LL. D,,
Mobile. Ala , June 8th, 1878.
Prof. H. C. Bartlett, Ph. D. F. C. S, ,
London, England,
February 22.1, lbi'fi.
I
J
)
j
J
l
1
I
1
“I have given LACTOPEPTINE a good thorough trial
and have been gieatlv pleased with the excellent results-
that have followed its administration.”
“I have found great satisfaction in the use ofLACTO
P..PTINE, and have ordered it frequently in cases of
Dyspepsia, especially whero there is want of tone and
defective secretion.”
“I have used LACTOPEPTINE with very good effect
in a number of cases of Dyspepsia.”
“I have usod LACTOl’EPTINE with great advantage
in cases of feeble digestion.”
“ I have used LACTOPEPTINE both in hospital and
private practice, and have found it to answer fully the
purposes for which it is recommended. As an immediate
aid to the digestive function, I know of no remedy which
acts more directly,"
“I have made much use of LACTOPEPTINE and take
great pleasure in stating that it has rarely disappointed me.
I shall, of course, continue to prescribe it."
“ I have used LACTOPEPTINE in a case of Dyspepsia
with satisfaction. I think well of it.”
“ I consider LACTOPEPTINE the very best preparation
of the kind which I have ever employed, and tor patients
with feeble digestion I know of nothing which is equal to it.
‘•I find the preparation of LACTOPEPTINE contains
within itself all the principle? required to promote a
hralthy digestion.”
LA ETC?.'. 1*1' I p.n ox. Lollies' ... — pei ox. $■ l.< 0
(• “ " ) . per doc. 10.00
“ (in I lb. ) . per lb, 12.C0
We also yrevetre T he j . ious Elhir*
i and Scrubs, in comTimiion yrilh Lac! -3-
j peptine.
THE NEW YORK PHARMAGAL ASSOCIATION,
2 & 3 COLLEGE PLACE, NEW YORK.
t\ O. BOX 1574.
MEDICAL DEPARTMENT
OF THE
NEW ORLEANS.
FACULTY.
T. G. RICHARDSON, M.D.,
SAMUEL LOGAN, M.D.,
Professor of Anatomy and ’ Clinical
Surgery.
Professor of General and Clinical Surgery.
SAMUEL M. BEMISS, M.D.,
Professor of the Theory and Practice of
Medicine and Clinical Medicine.
STANFORD E. CHAILLE, M.D.,
Professor of Physiology and Pathological
Anatomy.
JOSEPH JONES, M.D.,
Professor of Chemistry and Clinical Medi¬
cine.
ERNEST S. LEWIS, M.D.,
Professor of General and Clinical Obstet¬
rics and Diseases of Women and Children.
JOHN B. ELLIOTT, M.D.,
Professor of Materia Medica and Thera¬
peutics an^. Clinical Medicine.
ALBERT B. MILE3, M.D.,
Demonstrator of Anatomy.
The next annual course of instruction in this Department (now in the forty-sixth
year of its exsitence) will commence on Monday, the 20th day of October, 1879, and
terminate on Saturday the 14th day of March, 1880. The first three weeks of the
term will be devoted exclusively to Clinical Medicine and Surgery at the Charity
Hospital; Practical Chemistry in the Laboratory; and dissections in the spacious
and airy Anatomical Rooms of ihe University.
The means of teaching now at the command of the Faculty are unsurpassed in the
United States. Special attention is called to the opportunities presented for
CLINICAL INSTRUCTION.
The Act establishing the University of Louisiana gives the Professors of the
Medical Department the use of the great Charity Hospital, as a school of practical
instruction.
The Charity Hospital contains nearly 700 beds, and received, during the last year,
nearly six thousand patients. Its advantages for professional study are uusurpased
by any similar institution in this country. The Medical, Surgical and Obstetrical
Wards are visited by the respective Professors in charge daily, from eight to ten
o’clock A. M., at which time all the Students are expected to attend, and familiarize
themselves, at the bedside of the patients, with the diagnosis and treatment of all
forms of injury and disease.
The regular lectures at the hospital, on Clinical Medicine by Professors Bemiss,
Elliott and Joseph Jones, Surgery by Professors Richardson and Logan, Diseases of
Women and Children by Professor Lewis, and Special Pathological Anatomy by
Professor Chains, will be delivered in the amphitheater on Monday, Wednesday,
Thursday and Saturday, from 10 to 12 o’clock, A. M.
The Administrators of the Hospital elect, annually, twelve resident Students , who are
maintained by the Instution. All vacancies filled by competitive examination.
TERMS :
For the Tickets of all the Professors . $140 00
For the Ticket of Practical Anatomy ^ . 10 00
Matriculation Fee . 5 00
Graduation Fee . 30 00
Candidates for graduation are required to be twenty-one years of age ; to have
studied three years ; to have attended two courses of lectures, and to pass a satis¬
factory examination.’
Graduates of other respectable schools are admitted upon payment of the Matricu¬
lation and half lecture fees. They cannot, however, obtain the Diploma of the Uni¬
versity without passing the regular examinations and paying the usual Graduation
Fee.
As the practical advantages here afforded for a thorough acquaintance with all the
branches of medicine and surgery are quite equal to those possessed by the schools
of New York and Philadelphia, the same fees are charged.
For further information, address
T. G. RICHARDSON, M. D. Dean.
"For further information upon these points see circular.
/
SEPTEMBER, 1879.
The New Orleans
MEDICAL AND SURGICAL
JOURNAL.
EDITED BY
S. M. BEMISS, M. D.,
W. H. WATKINS, M. D. S. S. HERRICK, M. D.
Ueto Series— f i|61i«l)e8 gi $5 pel- Suntilri, in qdbqnce.
Pauluvi sepultw distat inertia celata virtus. — Horace.
SCOTT & BOWM’S
- ■ ! PALATABLE I
CASTOR OIL,
3S?IN AN EMULSION.^©
We respectfully submit the above preparation to the Medical Profession, and reo-.i 'st them to give it
atrial. They will find it a most desirable mode of administering this usefni yet me ; ’-ening cathartic.
The Emulsion is not only perfect and permanent, but absolutely palatabU < our process of
emulsifying it, we seem to have eliminated its griping properties. Pb- •• ; >■ .t that it is not
only a mila and pleasant laxative and cathartic, but is a most efficient age .be • d Intestinal
Inflammation. It is put np in 4oz bottle that sell for 25 cents, also in - ■ co prescribe
as they desire. We will be pleased to send a sample upon applicatC" •
Formul — 50 per cent. Pure Cold Pressed Castor Oil.
15 per cent. Chemically pure Glycerine.
SCOTT <& A-TIEl,
1 c run r ve? chemists,
135 u ■ Street, New York.
L. Graham, Steam Book and > ‘ n * ei 17 Gravier street, N. O.
SHARP & DOHME,
Manufacturing Chemists 1 Pharmacists,
BALTIMORE. Ml).
We respectfully invite the attention of Physicians and Druggists to the Medicinal
Preparations of our manufacture, which will be found of superior quality and in
every respect reliable, all possible care being used both in selection of material and
in their manufacture to produce preparations of uniform strength and of the best
quality oul.v.
We prepare all the Officinal and other Standard MEDICINAL SOLID AND FLUID
EXTRACTS, PURE CHEMICALS, and various other Pharmaceutical Preparations, in¬
cluding a full line of SUGAR COATED PILLS AND GRANULES. ELIXIRS,
SYRUPS, SACCHARATE1) PEPSIN, OLEATE OF MERCURY, ETC., ETC.
Among the late additions to our list of Fluid Extracts we call special attention to
FLUID EXTRACT MISTLETOE, FLUID EXTRACT JABORANDI, (prompt
diaphoretic and sialagogue,) FLUID EXTRACT DAMIANA (tin new aphrodisiac,)
FLUID EXTRACT EUCALYPTUS, FLUID EXTRACT GUARANA. FLUID EX¬
TRACT GRIN DELI A ROBUSTA, FLUID EXTRACT BLACK HAW (a new remedy
to prevent threatened miscarriage.)
Catalogues giving composition doses, etc., of all our Preparations mailed to
Physicians by applying either direct to us or to our Wholesale Agent,
X. Ij. LYONS,
Wholesale Driest and Importer of Euglisb ant German Chemicals,
42 and 44 Camp St., New Orleans, La.
MEDAL AWARDED UNIVERSAL EXPOSITION, PARIS. 1878.
THREE AWARDS, INTERNATIONAL EXHIBITION, 1876.
* Hance Brothers & White,
MANUFACTURING
CHEMISTS AND PHARMACEUTISTS,
PHILADELPHIA.
Manufacturers of and Dealers in all of the
GALENICAL AND CHEMICAL PREPARATIONS EMPLOYED IN MEDICINE:
Fluid and Solid Medicinal Extracts;
Sugar-Coated Pills and Granules ; Medicated Elixirs;
RESINOIDS; OI/BORESINS ;
EXTRACT ERGOT for Hypodermic use; Monobromated Camphor;
SACCHARATED PEPSIN; OLEATE MERCURY;
YELLOW OXIDE MERCURY. ETC., ETC.
Bulpho-Carbolate Soda ; Dialysed Iron;
' , , . A neutral solution of Oxychlo-
tttcommended for treatment of | ride Iron ; an admirable substi-
Starlet Fever and Diphtheria. ! tutefor other iron preparations.
(PHYSICIAN'S MEDICAL COMPEND a pocket com-\
panion and memory prompter invaluable to every Physician. I
Mailed upon Receipt of the Price, $1.00. /
ABSORBENT COTTON,
NEEDED BY EVERY SURGl-oN AND GYNECOLOGIST.
A cheap and convenient SUBSTITUTE FOR SPONGE.
Mailed upon receipt of price— 25 cents per package, or
$1.00 for five packages.
PRICED CATALOGUE MAILED UPON APPLICATION.
Dialysed
Iron,
Of reliable quality,
and unsurpassed in
any particular.
Price, per pint,
50 cents.
To the Medical Profession.
I I
The most important remedial agent ever presented to the Profession for Indigestion,
Dyspepsia, Vomiting in Pregnancy, Cholera Infantum, Constipation and alt Diseases
arising from imperfect nutrition, containing the five active agents of digestion, vis :
Pepsin, Pancreatine, Diastase, or I /eg. Ptyalin, Lactic and Hydrochloric Acids, in com¬
bination -with Sugar of Milk.
FORMULA OF LACTOPEPTINE.
Sugar of Milk...... . . 40 ounces.
Pepsin . 8 ounces.
Pancreatine . 6 ounces.
Veg. Ptyalin or Diastase . 4 drachms.
Lactic Acid . . . 5 fl. drachms.
Hydrochloric Acid . 5 13. drachms.
LACTOPEPTINE owes its great success solely to the Medical Profession, and is sold almost entirely by
Physicians’ l'r i-.-ci iptions. Its almost universal adoption by the profession is the strongest guarantee we ca*
give that its therapeutic value has been most thoroughly tested.
The undersigned having tested LACTOPEPTINE, recommend it to the profession.
ALFRED L. LOOMIS, M. D..
Professor of Pathology and Practice of Medicine, Uni¬
versity of the City of Sew York.
LEWIS A. SAYRE, M. I).,
Professor of OUhopnedic surgery and Clinical Sur¬
gery, Bellevue Hospital Medical College.
F. LE ROY SATTERLEE, M. D., Pn. D„
Professor of Chem., Mat. Med- and Therap . in the N.
F. College of Dent.; Prof, of Chem. and Hygiene
in the Am. Vet. College, etc., etc.
SAMUEL R. PERCY M. D„
Professor Materia Medica, New York Medical Colley
A. Van Dkveer, M. D.,
Albany, N. Y., June 8th, 1878.
Prof, of the Pri.n and Prac of Sari., Albany Med.
Col.; Surg. Albany and St. Peter's Hospitals.
John H. Packard, M. D.,
Pniladel >h'a, Pa., May 30tli. 1878
Pres't Pa. Go.. Ohstet Society ; Surg. Episcopal
and Women's Hospitals.
Jab. Aitkex Meigs. M. D.,
Philadelphia, June 20rh. 1878.
Prof, of the Institutes of Med and Med Juris.,
Jeff Medical College ; Phy. to Penn. Hos.
W. W. Dawson, M I),
Cincinnati. O., June 21st, 1878.
Prof. Prin. and Prac Surg. Med. Col. of Ohio ;
Surg. to Good Samaritan Hospital.
Albert F, A. Ktxo, M. D ,
Washington, D. C., June 19th, 1878,
Prof, of Obstetrics, University of Vermont.
D. W. Yandell, M. D„
Louisville. Ky., March 7th, 1878.
Prof, of the Science and Art of Surg,, and Clinical
Surg. University of LouisoiUe.
Robt. Battev, M. D.,
Rome. Ga., Jnne 7th. 5878.
Emeritus Prof, of Obstetrics, Atlanta Med. Col¬
lege, and Ex Pres. Med. Association of Ga.
Claude H. Mastin, M D , LL. D„
Mobile, Ala , Juuejith, 1878.
Prof. H, C. Bartlett, Ph D. F. C. S.,
London, England,
February 22d, 1876.
) “I have given LACTOPEPTINE a good tlmrongh trial
) and have been greatly pleased with the excellent result#
j that have followed its administration.”
■) “I have found great satisfaction in the nse ofLACTO
P PTINE, and have ordered it frequently in vases of
( Dyspepsia, especially whero there is want of tone and
) defective secretion.”
| “I have used LACTOPEPTINE with very good effect
| in a number of cases of Dyspepsia.”
“I have used LACTOl’EPTINE with great advantage
in cases of feeble digestion.”
“I have used LACTOPEPTINE both in hospital and
private practice, and have found it to answer fully the
purposes f»r which it is recommended. As an immediate
aid to the digestive function, I know of no remedy which
acts more directly,”
“I have made much use of LACTOPEPTINE and take
great pleasure in stating that it has rarely disappointed mA
I shall, of course, continue to prescribe it.”
“ I have used LACTOPEPTINE in a case of Dyspepsi*
With satisfaction. I think well of it.”
“ I consider LACTOPEPTINE the very best preparation
of the kind which I have ever employed, and tor patient*
with feeble digestion I know of nothing which is equal toil.
‘•I find the preparation of LACTOPEPTINE contain*
within itself all the principles required to promote *
healthy digestion.”
PRICE LIST.
LACTOPEPTINE {in oz. bottles! . per oz. I 1.P0
“ ( '• “ ) . per noz. 10 00
“ (in J !b. “ ) . per lb. I2.C0
We also prepare the various Elixirs
and Syrups, in combination icilh Lacto-
peptine.
THE NEW Y0KK PHARMACAL ASSOCIATION,
2 & 3 COLLEGE PLACE, NEW YORK.
P. O. BOX 1574.
MEDICAL DEPARTMENT
OP THE
3Y EW ORLEANS.
FACULTY.
T. G. RICHARDSON, M.D.,
SAMUEL LOGAN, M.D.,
Professor of Anatomy and F Clinical
Surgery.
Professor of General and Clinical Surgery.
SAMUEL M. BEMISS, M.D.,
Professor of the Theory and Practice of
Medicine and Clinical Medicine.
STANFORD E. CHAILLfi, M.D.,
Professor of Physiology and Pathological
Anatomy.
JOSEPH JONES, M.D.,
Professor of Chemistry and Clinical Medi¬
cine.
ERNEST S. LEWIS, M.D.,
Professor of General and Clinical Obstet¬
rics and Diseases of Women and Children.
JOHN B. ELLIOTT, M.D.,
Professor of Materia Medica and Thera¬
peutics and Clinical Medicine.
ALBERT B. MILES, M.D.,
Demonstrator of Anatomy.
The next annual course of instruction in this Department (now in the forty-sixth
year of its exsiteuce) will commence on Monday, the 20th day of October, 1879, and
terminate on Saturday tho 14th day of March, 1880. The first three weeks of the
term will be devoted exclusively to Clinical Medicine and Surgery at the Charity
Hospital; Practical Chemistry iu the Laboratory; and dissections in the spacious
and airy Anatomical Rooms of the University.
The means of teaching now at the command of the Faculty are unsurpassed in the
United States. Special attention is called to the opportunities presented for
CLINICAL INSTRUCTION.
The Act establishing the University of Louisiana gives the Professors of the
Medical Department the use of the great Charity Hospital, as a school of practical
instruction.
The Charity Hospital contains nearly 700 beds, and received, during the last year,
nearly six thousand patients. Its advantages for professional study are unsurpased
by any similar institution in this country. The Medical, Surgical and Obstetrical
Wards are visited by tho respective Professors in charge daily, from eight to ten
o’clock A. M., at which time all the Students are expected to attend, and familiarize
themselves, at the bedside of the patients, with the diagnosis and treatment of all
forms of injury and disease.
The regular lectures at the hospital, on Clinical Medicine by Professors Bemiss,
Elliott and Joseph Jones, Surgery by Professors Richardson and Logan, Diseases of
Women and Children by Professor Lewis, and Special Pathological Anatomy by
Professor Chaill^, will be delivered in the amphitheater on Monday, Wednesday,
Thursday and Saturday, from 10 to 12 o’clock, A. M.
The Administrators of the Hospital elect, annually, twelve resident Students, who are
maintained by the Iustution. All vacancies filled by competitive examination.
' TERMS :
For the Tickets of all the Professors . $140 00
For the Ticket of Practical Anatomy . 10 00
Matriculation Fee . 5 00
Graduation Fee . . . 30 00
Candidates for graduation are required to be twenty-one years of age ; to have
studied three years; to have attended two courses of lectures, and to pass a satis¬
factory examination.*
Graduates of other respectable schools are admitted upon payment of the Matricu¬
lation and half lecture fees. They cannot, however, obtain the Diploma of the Uni¬
versity without passing the regular examinations and paying the usual Graduation
Fee.
As the practical advantages here afforded for a thorough acquaintance with all the
branches of medicine and surgery are quite equal to those possessed by the schools
of New York and Philadelphia, the same fees are charged.
For further information, address
T. GL RICHARDSON, M. D. Dean.
"For further information upon these points see circular.
v
7 TA
CL-
OCTOBER, 1879.
The New Orleans
MEDICAL AND SURGICAL
JOURNAL.
EDITED BY
S. M. BEMISS, M.D.,
W. H. WATKINS, M. I). S. S. HERRICK, M. D.
Kelu Series— $ iiblisljeS 3Yfoi)iW{| M $5 pel- SdwId, in nctonnw.
Paulam sepulke distat inertias celata virtue. — Horace.
SCOTT & BOWNE’S
] PALATABLE j
CASTOR OIL,
S^IN AN EMULSION.^D
We respectfully submit the above preparation to the Medical Profession, and request tbom to give it
a trial. They will And it a most desirable mode of administering this useful yet most sickening ca thartic.
The Emulsion is not only perlect and permanent, but absolutely palatable, and by our process of
emulsifying it, wo seem to have eliminated its griping properties. Physicians report 1 bat it is not
only a riiila and pit asaut laxative and cathartic, but is a most efficient agent, in Diarrhoea and Intestinal
Inflammation. It is put up in 4oz bottle that sell for 25 cents, also in quarts for Physicians to prescribe
as they desire. We will bo pleased to send a sample upon application. Express paid.
Fokmul — 50 per cent. Pure Cold Pressed Casfor Oil.
15 per cent. Chemically pure Glycerine.
SCOTT BOWlsTE,
MANUFACTURING CHEMISTS ,
1S5 Hudson Street, New York.
L. Graham, Steam Book and Job Printer, 127 Gravier street, N. O.
SHARP & DOHME,
Manufacturing Chemists 1 Pharmacists,
BALTIMORE, MD.
We respectfully invite the attention of Physicians and Druggists to the Medicinal
Preparations of our manufacture, which will be found of superior quality and in
every respect reliable, all possible care being used both in selection of material and
in their manufacture to produce preparations of uniform strength and of the best
quality only.
We prepare all the Officinal and other Standard MEDICINAL SOLID AND FLUID
EXTRACTS, PURE CHEMICALS, and various other Pharmaceutical Preparations , in¬
cluding a full line of SUGAR COATED PILLS AND GRANULES, ELIXIRS,
SYRUPS, SACCHARATED PEPSIN, OLEATE OF MERCURY, ETC., ETC.
Among the late additions to our list of Fluid Extracts we call special attention to
FLUID EXTRACT MISTLETOE, FLUID EXTRACT JABORANDI, (prompt
diaphoretic and sialagogue,) FLUID EXTRACT DAMIANA (the new aphrodisiac,)
FLUID EXTRACT EUCALYPTUS, FLUID EXTRACT GUAR AN A, FLUID EX¬
TRACT GRINDELIA ROBUSTA, FLUID EXTRACT BLACK HAW (a new remedy
to prevent threatened miscarriage.)
Catalogues giving composition doses, etc., of all our Preparations mailed to
Physicians by applying either direct to us or to our Wholesale Agent,
x. Xj. Xj-^-oisrs,
Wholesale Druggist ant Importer of English ant German Chemicals,
42 and 44 Camp St., New Orleans, La.
MEDAL AWARDED UNIVERSAL EXPOSITION, PARIS. 1878.
THREE AWARDS, INTERNATIONAL EXHIBITION, 1876-
fTTr*? Tf "TB II r J are s°Rc^e<^ to order our goods either direct or
■ ■ I M M i pK through their druggist.
■ - ~ A named sample of our manufactures, not
contraband of postal regulations, mailed upon application.
CATALOGUES IFIELEIE ZB'S- ZMZ-AIXj.
i a m >» i ;«Hr
SUGAR COATED PILLS. ELIXIRS.
ALL OF THE CHEMICAL AND PHARMACEUTICAL PREPARATIONS EMPLOYED IN MEDICINE.
T „ A Pocket Companion
AND
Memory Prompter.
Invaluable io every
Physician.
MAILED UPON RECEIPT OF THE PRICE, ONE DOLLAR.
HANCE BROTHERS^
OFFICE • _ f Callowhill Street, Corner
- , ER>j
( of Marshall, j
PHILADELPHIA
To the Medical Profession.
he most important remedial agent ever presented to the Profession for Indigestion,
\ yspepsia , Vomiting in Pregnancy, Cholera Infantum, Constipation and all Diseases
rising from imperfect nutrition, containing the five active agents of digestion, viz :
epsin, Pancreatine, Diastase, or Veg. Ptyalin, Lactic and Hydrochloric Acids, in com¬
motion with Sugar of Milk.
LACTOPEPTINE,
Veg. Ptyalin or Diastase . . 4 drachms.
Lactic Acid . 5 fl. drachms.
i Hydrochloric Acid . 5 fl. drachms.
UCTOPEPTINE owes its great success solely to the Medical Profession, and is sold almost entirely by
hysietans’ Prescriptions. Its almost universal adoption by the profession is the strongest guarantee we can
ive that its therapeutic value has been most thoroughly tested.
Tire undersigned Having tested LACTOPEPTINE, recommend it to the profession.
XF RED L. LOOMIS, M. D.. |F. LE ROY SATTERLEE, M D.. Pit. D,
Professor of Pathology and Practice of Medicine, Uni¬
versity of the City of Nero York.
FORMULA OF
Sugar of Milk . 10 ounces.
Pepsin . 8 ounces.
Pancreatine . 6 ounces.
EWIS A. SAYRE, M. D.,
Professor of Orthopcedic Surgery and Clinical Sur¬
gery, Bellevue Hospital Medical College.
Professor of Chem., Mat. Med. and 'l'herap . in the N.
P. College of Dent. ; Prof, of Chem. and Hygiene
in the Am. Yet. College, etc., etc.
SAMUEL R. PERCY M. D„
Professor Materia Medica, New York Medical College
_ Van Dkveer, M. D.,
Albany. X. Y. June 8th, 1878.
Prof, of the Prin and Prac. of Sure., Albany Med.
Col.; Surg. Albany and St. Peters Hospitals.
dhn H. Packard, M. D.,
Philadelphia, Pa., May 30tli. 1878
Pres' t Pa. Go., Obstet. Society; Surg Episcopal
and Women's Hospitals.
tB. Aitken Meigs, M. D.,
Philadelphia. June 20'h 1878.
Prof, of the Institutes of Med and Med Juris.,
Jeff. Medical College ; Phy. to Penn. Hos.
T. W. Dawson, M, D ,
Cincinnati, O., June 21st, 1878.
Prof. Prin. and Prac. Surg. Med. Col. of Ohio ;
Surg. to Good Samaritan Hospital.
Xbekt F, A. King, M. D ,
"Washington, D. C., June tilth, 1878,
Prof, of Obstetrics, University of Vermont.
>. "W. Yandelt, M. D„
Louisville. Tty., March 7th, 1878,.
Prof, of the Science and Art of Surg,, and Clinical
Surg. University of Louisville.
:obt. Battey, M. D ,
Porno. Ga„ June 7th. 1878.
Emeritus Prof of Obstetrics, Atlanta Med. Col¬
lege, and Ex Pres. Med. Association of Ga.
laude H. Mastin. AT D . LL. D,,
Mobile, Ala , June 8th, 1878.
Tof. H. C. Barti.ett, Ph. D. F. C. S. ,
London, England,
February 22 i, lsTfi.
11 1 have given LACTOPEPTINE a good thorough trial
a and have been greatly pleased with the excellent results
j that have followed its administration.”
] “Ihavefonnd great satisfaction in the use ofLACTO-
( P PTINE, and have ordered it frequently in cases of
( Dyspepsia, especially whero there is want of tone and
) defective secretion.”
] “I have used LACTOPEPTINE with very good effect
I in a number of cases of Dyspepsia.”
“I have used LACTOPEPTIXE with great advantage
in cases of feeble digestion.”
1 “I have used LACTOPEPTINE both in hospital and
| private practice, and have found it to answer fully the
t purposes for which it is recommended. As an immediate
| aid to the digestive function, I know of no remedy which
J acts more directly,”
“I have made much nse of LACTOPEPTIXE and take
f great pleasure in stating that it lias rarely disappointed me.
J I shall, of course, continue to prescribe it.”
|. ” I have used LACTOPEPTIXE in a case of Dyspepsia
j with satisfaction. I think well of it.”
) “I consider LACTOPEPTINE the very best preparation
r of the kind which I have ever employed, and for patients
' with feeble digestion I know of nothing which is equal to it.
) '• I find the preparation of LACTOPEPTINE contains
/ within itself all the principles required to promote a
' healthy digestion.”
PRICE LIST.
.ACTOPEPTIXE (in oz. bottles! - . per oz. $ 1.00
“ ( “ “ ) . perdoz. 10.00
“ (in J lb. “ ) . . per lb, 12.00
We also prepare the various Elixirs
and Syrups, in combination with Lacto -
peptine.
THE NEW YORK PHARMACAL ASSOCIATION,
lO & 12 COLLEGE PLACE, NEW YORK,
j j n. BOX 1 T74.
MEDICAL DEPARTMENT
OF THE
INEW ORLEANS.
FACULTY.
T. G. RICHARDSON, M.D.,
Professor of General ami Clinical Surgery.
SAMUEL M. BEMISS, M.D.,
Professor of the Theory and Practice of
Medicine and Clinical Medicine.
STANFORD E. CHAILLE, M.D ,
Professor of Physiology and Pathological
Anatomy.
JOSEPH JONES, M.D.,
Professor of Chemistry and Clinical Medi¬
cine.
| SAMUEL LOGAN, M.D.,
Professor of Anatomy and Clinical
Surgery.
ERNEST S. LEWIS, M.D.,
Professor of General and Clinical Obstet¬
rics and Diseasesof Women and Children.
JOHN B. ELLIOTT, M.D.,
Professor of Materia Medica and Thera¬
peutics and Clinical Medicine.
ALBERT B. MILE 3, M.D.,
Demonstrator of Anatomy.
The i ext annual course of instruction in this Department (now in the forty-sixth
year of its exsitence) will commence on Monday, the 20th day of October, 1879, and
terminate on Saturday the 14th day of March, 1880. The first three weeks of the
term will be devoted exclusively to Clinical Medicine and Surgery at the Charity
Hospital; Practical Chemistry in the Laboratory; and dissections in the spacious
and airy Anatomical Rooms of the University.
The means of teaching now at ihe command of the Faculty are unsurpassed in the
United States. Special attention is called to the opportunities presented for
CLINICAL INSTRUCTION.
The Act establishing the University of Louisiana gives the Professors of the
Medical Department the use of the great Charity Hospital, as a school of practical
instruction.
The Charity Hospital contains nearly 700 beds, and received, during the last year,
nearly six thousand patients. Its advantages for professional study are unsurpased
by any similar institution in this country. The Medical, Surgical and Obstetrical
Wards are visited by the respective Professors in charge daily, from eight to ten
o’clock A. M., at which time all the Students are expected to attend, and familiarize
themselves, at the bedside of the patients, -with the diagnosis and treatment of all
forms of injury and disease.
The regular lectures at the hospital, on Clinical Medicine by Professors Bemiss,
Elliott and Joseph Jones, Surgery by Professors Richardson and Logan, Diseases of
Women and Children by Professor Lewis, and Special Pathological Anatomy by
Professor Chailld, will be delivered in the amphitheater on Monday, Wednesday,
Thursday and Saturday, from 10 to 12 o’clock, A. M.
The Administrators of the Hospital elect, annually, twelve resident Students, w ho are
maintained by the Instution. All vacancies filled by competitive examination.
TERMS :
For the Tickets of all the Professors . $140 00
For the Ticket of Practical Anatomy . . . 10 00
Matriculation Fee . . . . . 5 00
Graduation Fee . . 30 00
Candidates for graduation are required to be twenty-one years of age ; to have
studied three years ; to have attended two courses of lectures, and to pass a satis¬
factory examination.”
Graduates of other respectable schools are admitted upon payment of the Matricu¬
lation and half lecture fees. They cannot, however, obtain the Diploma of the Uni¬
versity without passing the regular examinations and paying the usual Graduation
Fee.
As the practical advantages here afforded for a thorough acquaintance with all the
branches of medicine and surgery are quite equal to those possessed by the schools
of New York and Philadelphia, the same fees are charged.
For further information, address
T. G. RICHARDSON, M. D. Dean.
*For further information upon these points see circular.
NOVEMBER, 1879.
The New Orleans
MEDICAL AND SURGICAL
JOURNAL.
EDITED BY
S. M. BEMISS, M.D.,
W. H. WATKINS, M. D. S. S. HERRICK, M. D.
Keb §eKes— f iiblisW ?ffoi)lt)lt| si $5 fielc Bsriqio, is suSasce.
Paulurn sepultw distat inertia celata virtue. — Horace.
SCOTT & BOWNE’S
PALATABLE
CASTOR OIL,
G^IN AN EMULSION.^O
We respectfully submit the above preparation to the Medical Profession, and request them to give it
a trial. They will find it a most desirable mode of administering this useful yet most sickening catliartio.
The Emulsion is not only perfect and permanent, but absolutely palatable, and by our process of
emulsifying it, we seem to have eliminated its griping properties. Physicians report that it is not
only a mildand pleasaut laxative and cathartic, but is a most efficient agent in DiarrLcea and Intestinal
Inflammation. It is put up in 4oz bottle t hat sell for 25 cents, also in quarts for Physicians to prescribe
as they desire. We will bo pleased to send a sample upon application. Express paid.
Formul — 50 per cent. Pure Cold Pressed Castor Oil.
15 per cent. Chemically pure Glycerine.
SCOTT &a BOWNB,
MANUFACTURING CHF MISTS,
1S5 Hudson Street, New York.
L. Graham, Steam Book and Job Printer, 127 Gravier street, N. O.
SHARP & DOHME,
Manufacturing Chemists I Pharmacists,
BALTIMORE, MD.
We respectfully invite the attention of Physicians and Druggists to the Medicinal
Preparations of our manufacture, which will be found of superior quality and in
every respect reliable, all possible care being used both in selection of material and
in their manufacture to produce preparations of uniform strength and of th) best
quality only.
We prepare all the Officinal and othei • Standard MEDICINAL SOLID AND FLUID
EXTRACTS, PURE CHEMICALS, and various other Pharmaceutical Preparations, in¬
cluding a full line of SUGAR COATED PILLS AND GRANULES, ELIXIRS,
SYRUPS, SACCHARATED PEPSIN, OLEATE OF MERCURY, ETC., ETC.
Among the late additions to our list of Fluid Extracts we call special attention to
FLUID EXTRACT MISTLETOE, FLUID EXTRACT JABORANDI, (prompt
diaphoretic and sialagogue,) FLUID EXTRACT DAMIANA (tin new aphrodisiac,)
FLUID EXTRACT EUCALYPTUS, FLUID EXTRACT GUARANA, FLUID EX¬
TRACT GRINDELIA ROBUSTA, FLUID EXTRACT BLACK HAW (a new remedy
to prevent threatened miscarriage.)
Catalogues giving composition doses, etc., of all our Preparations mailed to
Physicians by applying either direct to us or to our Wholesale Agent,
X . Xj . LYO XT S ,
Wholesale Druggist and Importer of English and German Chemicals,
42 and 44 Camp St., New Orleans, La.
DR. L. D. McINTOSH’S
ELECTRIC OR GALVANIC BELT
If this new combination could be seen and
tested by the medical profession, few, if any,
words would be needed from us in its favor, for
it combines utility with simplicity in such per¬
fection that seeing it is convincing proof of its
great value. The medical profession to-day
acknowledge, almost universally, Electro-
Therapeutics.
This combination is composed of sixteen cells,
_ placed in pockets on a belt. Each cell is made
of hard vulcanized rubb t, lined with a copper cell, which constitutes the negative plate.
The rubber coating perfectly insulates each cell. The positive plates are of zinc, wrapped
in a porous material to absorb the exciting fluid, and prevent contact with the copper, and
permit the current to pass from the copper to the zinc.
Thus the cells are charged without, wetting the belt, and the discomfort following to the
patient. A wire is soldered to each zinc plate, which connects with the copper cell by
entering a tube on its side, thus rendering the belt pliable.
The McIntosh Electric Belt is superior to all others for the following reasons :
It is composed of sixteen cells— thus giving a powerful current. A current selector is
so arranged that one or more cells can be used at pleasure. There is not anything
irritating about, the Belt, as is the case with all other contrivances where tho metal used
is wet with weak acids and placed next to the skin. The electrodes are pieces of metal
covered similar to ordinary battery electrodes, and connected with the cells by connecting
cords. Bv this arrangement, a current irom the Belt can be applied to produce a general
or local effect.
Many phvsicians wlio have used this belt in their practice do not hesitate to recommend
it to tlie profession.
Our pamphlet on Medical Electricity sent free on application. Address
MclNTOSH GALVANIC BELT AND BATTERY CO.,
192 and 194 Jackson St., CHICAGO, ILL.
jy’TO.ly.
To the Medical Profession
ie most important remedial agent ever presented to the Profession for Indigestion,
fspepsia, Vomiting in Pregnancy, Cholera Infantum, Constipation and all Diseases
ising from imperfect nutrition, containing the five active agents of digestion, viz :
i psin, Pancreatine, Diastase, or Veg. Ptyalin, Lactic and Hydrochloric Acids, in corn-
nation with Sugar of Milk. >
FORMULA OF LACTOFEPTINE.
Sugar of Milk . 40 ounces.
Pepsin . 8 ounces.
Pancreatine . 6 ounces.
Veg. Ptyalin or Diastase . 4 drachms.
Lactic Acid . 5 fl. drachms.
Hydrochloric Acid . 5 fl. drachms.
LAGTOPEPTME owes its great success solely to the Medical Profession, and is sold almost entirely by
I ysicians’ Prescriptions. Its almost universal adoption by the profession is the strongest guarantee we can
?e that its therapeutic value has been most thoroughly tested.
The undersigned Having tested LACTOPEPTINE, recommend it to the profession.
I,FI!ED L. LOOMIS, M. D„
i Professor of Pathology and Practice, of Medicine, Uni-
versity of the City of New Pork.
llWIS A. SAYRE, M. D.,
Professor of Orthopcedic furriery and Clinical Sur¬
gery, Bellevue Hospital Medical College.
F. LE ROY SATTERLEE, M. D., Ph. D ,
Professor of Chem.. Mat. Med. and Therap., in the A.
Y. College of Dent.; Prof, of Chem. and Hygien*
in the Am. Vet. College, etc., etc.
SAMUEL R. PERCY M. D„
Professor Materia Medica, New York Medical College
Van Dkveer, M. D.,
Alb'iny, N. Y., June 8th, 1878.
yr-f. of the Prin and Prac of Sur*., Albany Med.
I Col.; Surg. Albany and St. Peter's Hospitals.
;:N H. Packarh, M. D.,
Philadelphia, Pa., Mar 30th. 1878
| *res't Pa. Co., Obstet. Society; Surg Episcopal
I and Women's Hospitals.
U. Aitken Meigs, M. D.,
Philadelphia, June 20th. 1878.
yrof. of the Institutes of MedXind Med Juris.,
Jeff. Medical College ; Phy. to Penn. Hos.
W. Dawson, M. D,
Cincinnati, O., June 21st, 1878.
°rnf. Prin. and Prac. Surg. Med. Col. of Ohio ;
Surg. to Good Samaritan Hospital.
“I have given LACTOPEPTINE a good thorough trial
and have been greatly pleased with the excellent results
that have followed its administration.”
“I have found great satisfaction in the use ofLACTO-
P. PTINE, and have ordered it frequently in cases of
Dyspepsia, especially where there is want of tone and
defective secretion.”
“ I have used LACTOPEPTINE with very good effect
in a number of cases of Dyspepsia.”
‘‘Ihave used LACTOPEPTINE with great advantage
in cases of feeble digestion.”
,hekt F, A. King, M. D.,
Washington, D. C., June lilth, 1878,
>tof. of Obstetrics, University of Vermont.
1 “I have used L ACTOPEPTINE both in hospital and
| private practice, and have found it to answer fully the
J- purposes for which it is recommended. As an immediate
| aid to the digestive function, I know of no remedy which
J acts more directly,”
W; Yandeli., M. D.,
Louisville. Ky., March 7th, 1878.
f. of the Science, and Art of Surg., and Clinical
^ a rg . University of Louisville.
bt. Battel M. D.,
Rome. Ga., June 7th. 1878.
Emeritus Prof, of Obstetrics , Atlanta Med. Col¬
lege, and Ex Pres. Med. Association of Ga.
I “Ihave made much use of LACTOPEPTINE and take
( great pleasure in stating that it lias rarely disappointed me,
j I shall, of course, continue to prescribe it.”
“ I have used LACTOPEPTINE in a case of Dyspepsia
with satisfaction. I think well of it.”
kui'E H. Mastin, M D , LL. D,,
Mobile, Ala , June 8tb, 1878.
|>f. IT. C. Bartlett, Ph. D. F. C. S.,
London, England,
February 22d, 187f>.
11 1 consider LACTOPEPTINE the very best preparation
of the kind which I have ever employed', and for patients
with feeble digestion I know of nothing which is equal to it.
‘•I find the preparation of LACTOPEPTINE contains
within itself all the principles required to promote a
healthy digestion.”
PRICE LIST.
CTGPEPTINE (in oz. bottles!
“ ( “ “ ).
" (in Jib. “ )
per oz. $ 1.00
.perdoz. 10.00
■ per lb, 12.00
We also prepare the various Elixirs
and Syrups , in combination with Laclo-
peptine.
THE NEW YORK PHARMACAL ASSOCIATION,
lO & 12 COLLEGE PLACE, NEW YORK,
O. BOX 1 574.
MEDICAL DEPARTMENT
OF THE
NEW ORLEANS.
FACULTY.
T. G. RICHARDSON, M.D.,
Professor of General and Clinical Surgery.
SAMUEL M. BEMISS, M IX,
Professor of the Theory and Practice of
Medicine and Clinical Medicine.
STANFORD E. CHAILLE, M.D.,
Professor of Physiology and Pathological
Anatomy.
JOSEPH JONES, M.D.,
Professor of Chemistry and Clinical Medi¬
cine.
SAMUEL LOGAN, M.D.,
Professor of Anatomy and ^Clinical
Surgery.
ERNEST S. LEWIS, M.D.,
Professor of General and Clinical Obstet¬
rics and Diseases of Women and Children.
JOHN B. ELLIOTT, M.D.,
Professor of Materia Medica and Thera¬
peutics and Clinical Medicine.
ALBERT B. MILE3, M.D.,
Demonstrator of Anatomy.
The next annual course of instruction in this Department (now in the forty-sixth
year of its exsitence) will commence on Monday, the 20th day of October, 1879, and
terminate on Saturday the 14th day of March, 1880. The iirst three weeks of the
term will be devoted exclusively to Clinical Medicine and Surgery at the Charity
Hospital; Practical Chemistry in the Laboratory; and dissections in the spacious
and airy Anatomical Rooms of the University.
The means of teaching now at the command of the Faculty are unsurpassed in the
United States. Special attention is called to the opportunities presented for
CLINICAL INSTRUCTION.
The Act establishing the University of Louisiana gives the Professors of the
Medical Department the use of the great Charity Hospital, as a school of practical
instruction.
The Charity Hospital contains nearly 700 beds, and received, during the last year,
nearly six thousand patients. Its advantages for professional study are uusurpasod
by any similar institution in this country. The Medical, Surgical and Obstetrical
Wards are visited by the respective Professors in charge daily, from eight to ten
o’clock A M.. at which time all the Students are expected to attend, and familiarize
themselves, at the bedside of the patients, with the diagnosis and treatment of all
forms of injury and disease.
The regular lectures at the hospital, on Clinical Medicine by Professors Bemiss,
Elliott and Joseph Jones, Surgery by Professors Richardson and Logan, Diseases of
Women and Children by Professor Lewis, and Special Pathological Anatomy by
Professor Chailld, will be delivered in the amphitheater on Monday, Wednesday,
Thursday and Saturday, from 10 to 12 o’clock, A. M.
The Administrators of the Hospital elect, annually, twelve resident Students, who are
maintained by the Iustution. All vacancies filled by competitive examination.
TERMS :
For the Tickets of all the Professors . $140 00
For the Ticket of Practical Anatomy . : . 10 00
Matriculation Fee . . . . 5 00
Graduation Fee . . . 30 00
Candidates for graduation are required to be twenty-oue years of age ; to have
studied three years ; to have attended two courses of lectures, and to pass a satis¬
factory examination. *
Graduates of other respectable schools are admitted upon payment of the Matricu¬
lation and Half lecture fees. They cannot, however, obtain the Diploma of the Uni¬
versity without passing the regular examinations and paying the usual Graduation
Fee.
As the practical advantages here afforded for a thorough acquaintance with all the
branches of medicine and surgery are quite equal to those possessed by the schools
of New York and Philadelphia, the same fees are charged.
For further information, address
T. G. RICHARDSON, M. D. Dean.
"For further information upon these points see circular.
DECEMBER, 1879.
The New Orleans
MEDICAL AND SURGICAL
JOURNAL.
EDITED BY
S. M. BE. MISS, M. !).,
W. H. WATKINS, M. D. S. S. HERRICK, M. D.
ifeto Series— ftiblislject Ijjonririu $5 pet iUvvM, in ^Oanee.
Paulum sepultw distat inertia celata virtus. — Horace.
SCOTT & BOWNE’S
PALATABLE
CASTOR OIL,
C^IN AN EMULSION.^)
We respectfully submit the above preparation to the Medical Profession, and request them to give it
a trial. They will find it a most desirable mode of administering tins useful yet most sickening cathartic.
The Emulsion is not only perfect and permanent, but absolutely palatable, and by our process of
emulsifying it, we seem to have eliminated its griping properties. Physicians report that it is not
only a mild and pleasant laxative and cathartic, but is a most efficient agent in Diarrhoea and Intestinal
Inflammation. It is put np in 4oz bottle that sell for 25 cents, also in quarts for Physicians to prescribe
as they desire. We will be pleased to send a sample upon application. Express paid.
Formul — 50 per cent. Pure Cold Pressed Castor Oil.
15 per cent. Chemically pure Glycerine.
SOOTTii'&l BOWNB,
MANUFACTURING CHEMISTS,
135 Hudson Street, New York.
L. Graham, Steam Book and Job Printer, 127 Gravier street, N. O.
SHARP & DOHME,
Manufacturing Chemists 1 Pharmacists,
BALTIMORE, 31 D.
We respectfully invite the attention of Physicians autl Druggists to the Medicinal
Preparations of our manufacture, which will be found of superior quality aud in
every respect reliable, all possible care being used both in selection of material and
in their manufacture to produce preparations of uniform strength and of the best
quality only.
We prepare all the Officinal ayid other Standard MEDICINAL SOLID AND FLUID
EXTRACTS, PURE CHEMICALS, and various other Pharmaceutical Preparations, in¬
cluding a full line of SUGAR COATED PILLS AND GRANULES, ELIXIRS,
SYRUPS, SACCHARATED PEPSIN, OLEATE OF MERCURY, ETC., ETC.
Among the late additions to our list of Fluid Extracts we call special attention to
FLUID EXTRACT MISTLETOE, FLUID EXTRACT JABORANDI, (prompt
diaphoretic and sialagogue,) FLUID EXTRACT DAMIANA (the new aphrodisiac,}
FLUID EXTRACT EUCALYPTUS, FLUID EXTRACT GUARANA, FLUID EX¬
TRACT GRINDELIA ROBUSTA, FLUID EXTRACT BLACK HAW (a new remedy
to prevent threatened miscarriage.)
Catalogues giving composition doses, etc., of all our Preparations mailed to-
Physicians by applying either direct to us or to our Wholesale Agent,
X. Hi . LYONS,
Wholesale Druggist and Importer of Euglisli and German Chemicals,
42 and 44 Camp St., New Orleans, La.
DR. L. D. McINTOSH’S
ELECTRIC OR GALVANIC RELT
If this new combination could be 86en and
tested by the medical profession, few, if any,
words would be needed from us in its favor, for
it combines utility with simplicity in such per¬
fection that seeing it is convincing proof of its
great value. The medical profession to-day
acknowledge, almost universally, Electro-
Therapeutics.
This combination is composed of sixteen cells,
_ _ placed in pockets on a belt. Each cell is made
of hard vulcanized rubber, lined with a oopper cell, which constitutes the negative plate.
The rubber coating perfectly insulates each cell. The positive plates are of zinc, wrapped
in a porous material to absorb the exciting fluid, and prevent contact with the copper, and
permit the ourrent to pass from the copper to the zinc.
Thus the cells are charged without wetting the belt, and the discomfort following to the
patient. A wire is soldered to each zinc plate, which connects with the copper cell by
entering a tube on its side, thus rendering the belt pliable.
The McIntosh Electric Belt is superior to all others for the following reasons :
It is composed of sixteen cells — thus giving a powerful current. A current selector is
so arranged that one or more cells can be used at pleasure. There is not anything
irritating about the Belt, as is the case with all other contrivances where the metal used
is wet with weak acids and placed next to the skin. The electrodes are pieces of metal
covered similar to ordinary battery electrodes, and connected with the cells by connecting
cords. By this arrangement, a current from the Belt can be applied to produce a general
or local effect.
Many physicians who have used this belt in their practioe do not hesitate to recommend
it to the profession.
Our pamphlet on Medical Eleotricity sent free on application. Address
MclNTOSH GALVANIC BELT AND BATTERY CO.,
192 and 194 Jackson St., CHICAGO, ILL.
jy’79.1y.
To the Medical Profession.
The most important remedial agent ever presented to the Profession for Indigestion,
Dyspepsia, Vomiting in Pregnancy, Cholera Infantum, Constipation and all Diseases
arising from imperfect nutrition, containing the five active agents of digestion, vie :
Pepsin, Pancreatine, Diastase, or Veg. Ply a l in, Lactic and Hydrochloric Acids, in com¬
bination with Sugar of Milk.
FORMULA OF LACTOPEPTINE.
Sugar of Milk . 40 ounces.
Pepsin . 8 ounces.
Pancreatine . ... . . 6 ounces.
Veg. Ptyalin or Diastase . . 4 drachms.
Lactic Acid . 5 fl. drachms.
Hydrochloric Acid . . 5 fl. drachms.
LACTOPEPTINE owes its great success solely to the Medical Profession, and is sold almost entirely by
^Physicians’ Prescripti<
_ escriptions. Its almost universal adoption by the profession is the strongest guarantee we can
give that its therapeutic value has been most thoroughly tested.
The undersigned having tested LACTOPEPTINE, recommend it to the profession.
F. LE ROY SATTERLEE, M. D., Th. D ,
Professor of Ghem., Mat. Med. and Therap., in the N.
Y. College of Dent.; Prof, of Ghem . and Hygiene
in the Am. Vet. College, etc., etc.
SAMUEL R. PERCY. M. D.,
Professor Materia Medica, New York Medical College
ALFRED L. LOOMIS, M. D.,
Professor of Pathology and Practice of Medicine, Uni¬
versity of the City of New York.
I LEWIS A. SAYRE, M. D.,
Professor of Orthopcedic Surgery and Clinical Sur¬
gery, Bellevue Hospital Medical College.
; A. Van Deveer, M. D.,
Albany, N. Y., June 8th, 1878.
i Prof, of the Prin. and Prac. of Sum., Albany Med.
Col.; Surg. Albany and St. Peter's Hospitals.
John H. Packard, M. D.,
Philadelphia, Pa., May 30tl), 1878.
; Pres' t Pa. Co., Obstet. Society; Surg. Episcopal
and Women’s Hospitals.
| Ias. Aitken Meigs, M. D.,
Philadelphia, Jnne 20th. 1878.
fj Prof, of the Institutes of Med. and Med. Juris.,
Jeff. Medical College ; Phy. to Penn. Hos.
Jw. W. Dawson, M, D,
Cincinnati, O., June 21st, 1878.
Prof. Prin. and Prac. Surg. Med. Col. of Ohio ;
Sicrg. to Good Samaritan Hospital.
iliLRERT F, A. King, M. D.,
Washington, D. C., June 19th, 1878,
Prof, of Obstetrics, University of Vermont.
}. W. Yandell, M. D.,
Louisville. Ky., March 7th, 1878.
Prof, of the Science and Art of Surg,, and Clinical
Surg. University of Louisville.
iOBT. Battey, M. D.,
Rome, Ga., June 7th, 1878.
Emeritus Prof, of Obstetrics, Atlanta Med. Col¬
lege, and Ex Pres. Med. Association of Oa.
Ilaude H. Mastin, M. D., LL. D,,
Mobile, Ala., June 8th, 1878.
Jof. H. C. Bartlett, Ph. D. F. C. S. ,
London, England,
February 22d, 1876.
“I have given LACTOPEPTINE a good thorough trial
and have been greatly pleased with the excellent results
that have followed its administration.”
“I have found great satisfaction in the use of LACTO¬
PEPTINE, and have ordered it frequently in cases of
Dyspepsia, especially where there is want of tone and
defective secretion."
“I have used LACTOPEPTINE with very good effect
in a number of cases of Dyspepsia.”
"I have used LACTOI’EPTINE with great advantage
in cases of feeble digestion.”
"I have used LACTOPEPTINE both in hospital and
private practice, and have found it to answer fully the
purposes for which it is recommended. As an immediate
aid to the digestive function, I know of no remedy which
acts more directly,”
“I have made much use of LACTOPEPTINE and take
great pleasure in stating that it has rarely disappointed me.
I shall, of course, continue to prescribe it.”
“ I have used LACTOPEPTINE in a case of Dyspepsia
with satisfaction. I think well of it.”
“ I consider LACTOPEPTINE the very best preparation
of the kind which I have ever employed, and for patients
with feeble digestion I know of nothing which is equal to it.
‘ I find the preparation of LACTOPEPTINE contains
within itself all the principles required to promote a
healthy digestion.”
PRICE LIST.
ACTOPEPTINE (in oz. bottles) - - per oz. $ 1.00
“ ( “ “ ) . perdoz. 10.00
“ (in Jib. “ ) . per lb, 12.00
We also prepare the various Elixirs
and Syrups, in combination with Lacto-
peptine.
THE NEW YORK PHARMACAL ASSOCIATION,
lO & 12 COLLEGE PLACE, NEW YORK.
! ». O. BOX 1574.
MEDICAL DEPARTMENT
OF THE
NEW ORLEANS.
FACULTY.
T. G. RICHARDSON, M.D.,
SAMUEL LOGAN, M.D.,
Professor of Anatomy and .^Clinical
Surgery.
Professor of General and Clinical Surgery.
SAMUEL M. BEMISS, M.D.,
Professor of the Theory and Practice of
Medicine and Clinical Medicine.
STANFORD E. CHAILLfi, M.D.,
Professor of Physiology and Pathological
Anatomy.
JOSEPH JONES, M.D.,
Professor of Chemistry and CliuicalMedi-
cine.
ERNEST S. LEWIS, M.D.,
Professor of General and Clinical Obstet¬
rics and Diseases of Women and Children.
JOHN B. ELLIOTT, M.D.,
Professor of Materia Medica and Thera¬
peutics and Clinical Medicine.
ALBERT B. MILES, M.D.,
Demonstrator of Anatomy.
The next annual course of instruction in this Department (now in the forty-sixth
year of its exsitence) will commence on Monday, the 20th day of October, 1879, and
terminate on Saturday the 14th day of March, 1880. The first three weeks of the
term will be devoted exclusively to Clinical Medicine and Surgery at the Charity
Hospital; Practical Chemistry in the Laboratory; and dissections in the spacious
and airy Anatomical Rooms of the University.
The means of teaching now at the command of the Faculty are unsurpassed in the
United States. Special attention is called to the opportunities presented for
CLINICAL INSTRUCTION.
The Act establishing the University of Louisiana gives the Professors of the
Medical Department the use of the great Charity Hospital, as a school of practical
instruction.
The Charity Hospital contains nearly 700 beds, and received, during the last year,
nearly six thousand patients. Its advantages for professional study are unsurpased
by any similar institution in this country. The Medical, Surgical and Obstetrical
Wards are visited by the respective Professors in charge daily, from eight ro ten
o’clock A. M., at which time all the Students are expected to attend, and familiarize
themselves, at the bedside of the patients, with the diagnosis and treatment of all
forms of injury and disease.
The regular lectures at the hospital, on Clinical Medicine by Professors Bemiss,
Elliott and Joseph Jones, Surgery by Professors Richardson and Logan, Diseases of
Women and Children by Professor Lewis, and Special Pathological Anatomy by
Professor ChaiI16, will be delivered in the amphitheater on Monday, Wednesday,
Thursday and Saturday, from 10 to 12 o’clock, A. M.
The Administrators of the Hospital elect, annually, twelve resident Students, who are
maintained by the Instution. All vacancies filled by competitive examination.
TERMS :
For the Tickets of all the Professors . ..$140 00
For the Ticket of Practical Anatomy . 10 00
Matriculation Fee . 5 00
Graduation Fee . 30 00
Candidates for graduation are required to be twenty-one years of age ; to have
studied three years ; to have attended two courses of lectures, and to pass a satis¬
factory examination.*
Graduates of other respectable schools are admitted upon payment of the Matricu¬
lation and half lecture fees. They cannot, however, obtain the Diploma of the Uni¬
versity without passing the regular examinations and paying the usual Graduation
Fee.
As the practical advantages here afforded for a thorough acquaintance with all the
branches of medicine and surgery are quite eequal to those possessed by the schools
■of New York and Philadelphia, the same fees are charged.
For further information, address
T. G. RICHARDSON, M. D. Dean.
"For further information upon these points see circular.
No. 7.
JANUARY, 1880.
TJTF3 New Orleans
MEDICAL AND SURGICAL
JOURNAL.
EDITED BY
S. M. BEMISS, M. I).,
W. H. WATKINS, M. D. S. S. HERRICK, M. D.
Keto SeKes— f qMistei) Bfoi/ibiy ni $5 pel- Bonijb), in nJOance.
Panlam sepultce distat inertiw celata virtus. — Horace.
SCOTT & BOWNE’S
_ PALATABLE j
CASTOR^ oil,
IN AN EMULSION.^©
We respectfully submit lbe above preparation to the Meiliral Profession, and request them to give it
a trial. They will find it a most desirable mode of administering this useful yet mo.- 1 sickening cathartic.
The Emulsion is not only perfect and permanent, but absolutely palatable, and by our process of
emulsifying it, wo seem to have eliminated its griping properties. Physicians report that it is not
only a mild and pleasant laxative and cathartic, but is a most efficient agent in Diarrhoea and Intestinal
Inflammation. It is put np in 4oz bottle that sell for 25 cents, also in quarts lor Physicians to prescribe
as they desire. We will bo pleased to send a sample upon application. Express paid.
FobmuLt— 50 per cent. Pure Cold Pressed Castor Oil.
15 per cent. Chemically pure Glycorine.
SCOTT &G BOWNB,
MANUFACTURING CHEMISTS,
1Q5 Hudson Street, New York.
L. Graham, Steam Book and Job Printer, 127 Gravier street, N. O.
SHARP & DOHME,
Manufacturing Chemists 1 Pharmacists,
BALTIMORE, MD.
We respectfully invite the attention of Physicians and Druggists to the Medicinal
Preparations of our manufacture, which will be found of superior quality and in
every respect reliable, all possible care being used both in selection of material and
in their manufacture to produce preparations of uniform strength and of the best
quality onl/.
We prepare all the Officinal and other Standard MEDICINAL SOLID AND ELUID
EXTRACTS, PURE CHEMICALS, and various other Pharmaceutical Preparations , in¬
cluding a full line of SUGAR COATED PILLS AND GRANULES, ELIXIRS,
SYRUPS, SACCHARATED PEPSIN, OLEA'fE OF MERCURY, ETC., ETC.
Among the late additions to our list of Fluid Extracts we call special attention to
FLUID EXTRACT MISTLETOE, FLUID EXTRACT JABORANDI, (prompt
diaphoretic and sialagogue,) FLUID EXTRACT DAMIANA (the new aphrodisiac,)
FLUID EXTRACT EUCALYPTUS, FLUID EXTRACT GIT ARAN A, FLUID EX¬
TRACT GRINDELIA ROBUSTA, FLUID EXTRACT BLACK HAW (a new remedy
to prevent threatened miscarriage.)
Catalogues giviug composition doses, etc., of all our Preparations mailed to
Physicians by applying either direct to us or to our Wholesale Agent,
I. L. LTOITS,
Wholesale Druggist anil Importer of English and German Chemicals,
42 and 44 Camp St., New Orleans, La.
DR. L. D. McINTOSH’S
ELECTRIC OR GALVANIC BELT
If this new combination could be seen and
tested by the medical profession, few, if any,
words would be needed from us in its favor, for
it combines utility with simplicity in such per¬
fection that seeing it is convincing proof of its
great value. The medical profession to-day
acknowledge, almost universally, Electro-
Therapeutics.
This combination is composed of sixteen cells,
_ placed in pockets on a belt. Each cell is made
of hard vulcanized rubber, lined with a copper cell, which constitutes the negative plate.
The rubber coating perfectly insulates each cell. The positive plates are of zinc, wrapped
in a porous material to absorb the exciting fluid, and prevent contact with the copper, and
permit the current to pass from the copper to the zinc.
Thus the cells are charged without wetting the belt, and the discomfort following to the
patient. A wire is soldered to each zinc plate, which connects with the copper cell by
entering a tube on its side, thus rendering the belt pliable.
The McIntosh Electric Belt is superior to all others for the followingreasons :
It is composed of sixteen cells — thus giving a powerful current. A current selector is
so arranged that one or more cells can be used at pleasure. There is not anything
irritating about the Belt, as is the case with all other contrivances where the metal used
is wet with weak acids and placed next to the skin. The electrodes are pieces of metal
covered similar to ordinary battery electrodes, and connected with the cells by connecting
cords. By this arrangement, a current from the Belt can be applied to produce a general
or local effect.
Many physicians who have used this belt in their practice do not hesitate to recommend
it to tlie profession.
Our pamphlet on Medical Electricity sent free on application. Address
MclNTOSH GALVANIC BELT AND BATTERY CO.,
192 and 194 Jackson St., CHICAGO, ILL.
jy’79.Xy.
To the Medical Profession
:j The most important remedial agent ever presented to the Profession for Indigestion,
Dyspepsia, Vomiting in Pregnancy, Cholera Infantum, Constipation and all Diseases
arising from imperfect nutrition, containing the five active agents of digestion, viz :
Pepsin, Pancreatine, Diastase, or Veg. Pfyalin, Lactic and Hydrochloric Acids, in com¬
bination with Sugar of Milk.
FORMULA OF LACTOPEPTINE.
Sugar of Milk . . . 40 ounces.
Popsin . 8 ounces.
Pancreatine . 6 ounces.
Veg. Ptyaliu or Diastase . . 4 drachms.
Lactic Acid . 5 fl. drachms.
Hydrochloric Acid . . .5 fl. drachms.
_ LACTOPEPTINE owes its great success solely to the Medical Profession, and is sold almost entirely by
Physicians’ Prescriptions. Its almost universal adoption by the profession is the strongest guarantee wo can
j give that its therapeutic value has been most thoroughly tested.
The undersigned Having tested LACTOPEPTINE, recommend it to the profession.
ALFRED L. LOOMIS, M. D„
Professor of Pathology and Practice of Medicine, Uni¬
versity of the City of New York.
LEWIS A. SAYRE, M. D.,
Professor of Orthopaedic Surgery and Clinical Sur¬
gery, Bellevue Hospital Medical College.
F. LE ROY SATTERLEE, M IX, Ph. I),
Professor of Chem., Mat. Med. and Thcrap., in the N.
Y. College of Dent.; Prof, of Chem. and Hygiene
in the Am. Vet. College, etc., etc.
SAMUEL R. PERCY M. TX,
Professor Materia Medica, New York Medical College
A. Yan Deveer, M. D.,
Albany, N. Y., .Tune 8th, 1878.
Prof, of the Prin. and Prac. of Sur%., Albany Med.
Col.; Surg. Albany and St. Peter's Hospitals.
John H. Packard, M. D.,
Philadelphia, Pa., May 30th, 1878.
Pres t Pa. Co., Obstet. Society; Surg. Episcopal
and Women's Hospitals.
ij Jas. Aitken Meigs, M. D.,
Philadelphia. June 20th, 1878.
Prof, of the Institutes of Med. and Med. Juris.,
Jeff. Medical College ; Phy. to Penn. Hos.
I W. W. Dawson, M, D,
Cincinnati, O., June 21st, 1878.
Prof. Prin. and Prac. Surg. Med. Col. of Ohio ;
Surg. to Good Samaritan Hospital.
Albert F, A. King, M. D.,
Washington, D. C., June 19tb, 1878,.
Prof, of Obstetrics, University of Vermont.
D. W. Yandell, M. D.,
Louisville. Ky.. March 7th, 1878,
Prof, of the Science and Art, of Surg,, and Clinical
Surg. University of Louisville.
Robt. Battey, M, D.,
Rome, Ga., June 7th, 1878.
Emeritus Prof, of Obstetrics, Atlanta Med. Col¬
lege, and Ex Pres. Med. Association of Ga.
Claude H. Mastin'. M D., LL. D,,
Mobile, Ala., June 8th, 1878.
Prof. H. C. Bartlett, Ph. D. F. C. S, ,
London, England,
February 22d, 1876.
“I have given LACTOPEPTINE a good thorough trial
and have been greatly pleased with the excellent results
that have followed its administration.”
“I have found great satisfaction in the use ofLACTO-
PEPTINE, and have ordered it frequently in cases of
Dyspepsia, especially where there is want of tone and
defective secretion.” /—
“I have used LACTOPEPTINE with very good effect
in a number of cases of Dyspepsia.”
“I have used LACTOI’EPTINE with great advantage
in cases of feeble digestion.”
“ I have used LACTOPEPTINE both in hospital and
private practice, and have found it to answer fully the
purposes for which it is recommended. As an immediate
aid to the digestive function, I know of no remedy which,
acts more directly,"
“ I have made much use of LACTOPEPTINE and take
great pleasure in stating that it has rarely disappointed me.
I shall, of course, continue to prescribe it.”
“ I have used LACTOPEPTINE in a case of Dyspepsia
with satisfaction. I think well of it.”
“ I consider LACTOPEPTINE the very best preparation
of the kind which I have ever employed, and tor patients
with feeble digestion I know of nothing which is equal to it.
‘•I find the preparation of LACTOPEPTINE contains
within itself all the principles required to promote a
healthy digestion.”
PRICE LIST.
LACTOPEPTINE (in oz. bottles) . .per oz. $ 1.00
( “ “ ) . perdoz. 10.00
*“ (in J lh. “ ) . per lb, 12.00
We also prepare the various Elixirs
and Syrups, in combination with Lacto -
peptine.
THE NEW YORK PHARMA0AL ASSOCIATION,
lO & 12 COLLEGE PLACE, NEW YORK.
Jr*. O. BOX 1574.
MEDICAL DEPARTMENT
OF THE
1VEW ORLEANS.
FACULTY.
T. G. RICHARDSON, M.D.,
Professor of General and Clinical Surgery.
SAMUEL M. BEMISS, M.D.,
Professor of the Theory and Practice of
Medicine and Clinical Medicine.
STANFORD E. CHAILLE, M.D.,
Professor of Physiology and Pathological
Anatomy.
JOSEPH JONES, M.D.,
Professor of Chemistry and Clinical Medi¬
cine.
SAMUEL LOGAN, M.D.,
Professor of Anatomy and ^Clinical
Surgery.
ERNEST S. LEWIS, M.D.,
Professor of General and Clinical Obstet¬
rics and Diseases of Women and Children.
JOHN B. ELLIOTT, M.D.,
Professor of Materia Medica and Thera¬
peutics and Clinical Medicine.
ALBERT B. MILES, M.D.,
Demonstrator of Anatomy.
The next annual course of instruction in this Department (now in the forty-sixth .
year of its exsitence) will commence on Monday, the 20th day of October, 1879, and
terminate on Saturday the 14th day of March, 1880. The first three weeks of the
term will be devoted exclusively to Clinical Medicine and Surgery at the Charity
Hospital; Practical Chemistry in the Laboratory; and dissections in the spacious
and airy Anatomical Rooms of the University.
The means of teaching now at the command of the Faculty are unsurpassed in the
United States. Special attention is called to the opportunities presented for
CLINICAL INSTRUCTION.
The Act establishing the University of Louisiana gives the Professors of the
Medical Department the use of the great Charity Hospital, as a school of practical
instruction.
The Charity Hospital contains nearly 700 beds, and received, during the last year,
nearly six thousand patients. Its advantages for professional study are uusurpased
by any similar institution in this country. The Medical, Surgical and Obstetrical
Wards are visited by the respective Professors in charge daily, from eight to ten
o’clock A. M., at which time all the Students are expected to attend, and familiarize
themselves, at the bedside of the patients , with the diagnosis and treatment of all
forms of injury and disease.
The regular lectures at the hospital, ou Clinical Medicine by Professors Bemiss,
Elliott and Joseph Jones, Surgery by Professors Richardson and Logan, Diseases of
Women and Children by Professor Lewis, and Special Pathological Anatomy by
Professor Chailld, will be delivered in the amphitheater on Monday, Wednesday,
Thursday and Saturday, from 10 to 12 o’clock, A. M.
The Administrators of the Hospital elect, annually, twelve resident Students, who are
maintained by the Instution. All vacancies filled by competitive examination.
TERMS :
For the Tickets of all the Professors . §140 00
For the Ticket of Practical Anatomy . 10 00
Matriculation Fee . 5 00
Graduation Fee . . . 30 00
Candidates for graduation are required to be twenty-one years of age ; to have
studied three years ; to have attended two courses of lectures, and to pass a satis¬
factory examination.*
Graduates of other respectable schools are admitted upon payment of the Matricu¬
lation and half lecture fees. They eaunot, however, obtain the Diploma of the Uni¬
versity without passing the regular examinations and paying the usual Graduation
Fee.
As the practical advantages here afforded for a thorough acquaintance with all the
branches of medicine and surgery are quite equal to those possessed by the schools
of New York and Philadelphia, the same fees are charged.
For further information, address
T. G. RICHARDSON, M. D. Dean.
"For further information upon these points see circular.
Vot-m FEBRUARY, 1880.
The New Orleans
MEDICAL AND SURGICAL
JOURNAL.
EDITED BY
S. M. BEMISS, M.D.,
W. H. WATKINS, M. D. S. S. HERRICK, M. D.
Heto geHes— 5nMisl)e3 fijoi/fkltj ;ti $5 pel- finmitDi in
Paulnm sepulUe distat inertia i celata virtue. — Horace.
SCOTT &' BOWNE’S
_ | PALATABLE j
CASTOR OIL,
A^IN AN EMULSION.~g0
We respectfully submit the above preparation to the Medical Profession, and request them to give it
a trial. They will find it a most desirable mode of administering this useful yet most sickening cathartic.
The Emulsion is not only perfect and permanent, but absolutely palatable, and by our process of
emulsifying it, we seem to have eliminated its griping pioperties. Physicians report that it is not
only a milu and peasant laxative and cathartic, but is a most efficient agent' in Diarrhoea and Intestinal
Inflammation. It is put np in 4oz bottle that sell for 25 cents, also in quarts tor Physicians to prescribe
as they desire. We will be pleased to send a sample upon application. Express paid.
Fokmul — 50 por cent. Pure Cold Pressed Castor Oil.
15 per cent. Chemically pure Glycerine.
SCOTT &z EOWNE,
MANUFACTURING CHEMISTS,
1S5 Hudson Street, New York.
L. Graham, Steam Book and Job Printer, 127 Gravier street, N. O.
SHARP & DOHME,
Manufacturing Chemists § Pharmacists,
BALTIMORE, MD.
We respectfully invite the attention of Physicians and Druggists to the Medicinal
Preparations of our manufacture, which will be found of superior quality and in
every respect reliable, all possible care being used both in selection of material and
in their manufacture to produce preparations of uniform strength and of tlie best
quality only.
We prepare all the Officinal and other Standard MEDICINAL SOLID AND FLUID
EXTRACTS, PURE CHEMICALS, and various other Pharmaceutical Preparations , in¬
cluding a full line of SUGAR COATED PILLS AND GRANULES, ELIXIRS,
SYRUPS, SACCHARATED PEPSIN, OLEATE OF MERCURY, ETC., ETC,,
Among the late additions to our list of Fluid Extracts we call special attention to
FLUID EXTRACT MISTLETOE, FLUID EXTRACT JABORANDI, (prompt
diaphoretic and sialagogue,) FLUID EXTRACT DAMIANA (th > new aphrodisiac,)
FLUID EXTRACT EUCALYPTUS, FLUID EXTRACT GUARANA, FLUID EX¬
TRACT GRINDELIA ROBUSTA, FLUID EXTRACT BLACK HAW (a new remedy
to prevent threatened miscarriage.)
Catalogues giving composition doses, etci, of all our Preparations mailed to
Physicians by applying either direct to us or to our Wholesale Agent,
X. Ij. LYONS,
Wholesale Drmost aDi Imprter of English and German Chemicals,
42 and 44 Camp St., New Orleans, La.
DR, L. D. MuINTOSH’S
#
ELECTRIC OR GALVANIC RELT
If this new combination could be seen and
tested by the medical profession, few, if any,
words would be needed from us in its favor, for
it, combines utility with simplicity in such per¬
fection that seeing it is convincing proof of its
great value. The medical profession to-day
acknowledge, almost universally, Eleetro-
Therapoutics.
This coinbin tion is comnosed of sixteen cells,
_ placed in pockets oil a belt. Each coll is made
of hard vulcanized rubber, fined with a copper cell, which constitutes the negative plate.
The rubber coating perfectly insulates each cell. The positive plates are of zinc, wrapped
in a porous material to absorb the exciting fluid, and prevent cout ict with the copper, and
permit the current to pass from the copper to the zinc.
Thus the cells are charged without wotting the belt, and the discomfort following to the
patient. A wire is soldered to each zinc plate, which connects with the copper cell by
entering a tube on its side, thus rendering the belt pliable.
The McIntosh Electric Belt is superior to all others for the following reasons :
It is composed of sixteen cells— thus giving a powerful current. A current selector is
so arranged that one or more cells can be used at pleasure. There is not anything
irritating about the Belt, as is the case with all other contrivances where the metal used
is wet with weak acids and placed next to the skin. The electrodes are pieces of metal
covered similar to ordinary battery electrodes, and connected with the cells by connecting
cords. By this arrangement, a current from the Belt can be applied to produce a general
or local effect. _
Many physicians who have used this belt in their practice do not hesitate to recommeDa
it to tlie profession.
Our pamphlet on Medical Eleotrioity sent free on application. Address
McIntosh galvanic belt and battery co.t
192 and 194 Jackson St., CHICAGO, ILL.
jy’W.ly.
To the Medical Profession
The most important remedial agent ever presented to the Profession for Indigestion,
Dyspepsia, Vomiting in Pregnancy, Cholera Infantum, Constipation and all Diseases
arising from imperfect nutrition, containing the five active agents of digestion, viz :
Pepsin, Pancreatine, Diastase, or Veg. Ptyalin, Lactic and Hydrochloric Acids, in com¬
bination with Sugar of Milk.
FORMULA OF LACTOFEFTINE.
Sugar of Milk . 40 ounces. Veg. Ptyalin or Diastase . 4 drachms.
Pepsin . . . 8 ounces. Lactic Acid . 5 fl. drachms.
Pancreatine . 6 ounces. Hydrochloric Acid . 5 fl. drachms.
LACTOPEPTINE owes its great success solely to the Medical Profession, and is sold almost entirely by
Physicians’ Prescriptions. Its almost universal adoption by the profession is the strongest guarantee wo cam
give that its therapeutic value has been most thoroughly tested.
The undersigned having tested LACTOPEPTINE, recommend it to the profession.
ALFRED L. LOOMIS, M. D„
Professor of Pathology and Practice of Medicine, Uni¬
versity of the City of Neio York.
LEWIS A. SAYRE, M. D.,
Professor of Orthopaedic Surgery and Clinical Sur¬
gery, Bellevue Hospital Medical College.
F. LE ROY SATTERLEE, M. D., Ph. D„
Professor of Cliem., Mat. Med. and Therap. in thcN.
Y. College of Dent.; Prof, of Chem and Hygiene
in the Am. Vet. College, etc., etc.
SAMUEL It. PERCY. M. D.,
Professor Materia Medica, New York Medical College
A. Van Dkveer, M. D., 1
Albany, N. Y .Tune 8th, 1878. I
Prof, of the Prin. and Prac. of Surs.., Albany Med.
Col.; Surg. Albany and St. Peter's Hospitals, j
John H. Packard, M. D.,
Philadelphia, Pa., May 30th. 1878
Pres'tPa. Go., Obstet. Society; Surg Episcopal
and Women's Hospitals.
Jas. Aitken Meigs, M. D.,
Philadelphia. -T one 20 ’h 1878.
Prof, of the Institutes of Med and Med Juris.,
Jeff. Medical College ; Phy. to Penn. Hos.
W. W. Dawson M, D ,
Cincinnati, O., June 21st, 1878.
Prof. Prin. and Prac. Surg. Med. Col. of Ohio ;
Surg. to Good Samaritan Hospital.
Albert F, A. King, M. D.,
Washington, D. C-, June 19th, 1878,
Prof, of Obstetrics, University of Vermont.
D. W. Yandeli., M. D.,
Louisville. Ky.. March 7th, 1878,
Prof, of the Science and Art of Surg,, and Clinical
Surg. University of Louisville.
Robt. Battey, M. I)..
Rjftnc, Ga„ June 7th. 1878.
Emeritus Prof, of Obstetrics, Atlanta Med. Col¬
lege, and Ex Pres. Med. Association of Ga.
Claude H. Mastin, M D , LL D,,
Mobile, Ala , June 8th, 1878.
rof. H. C. Bartlett, Ph. D. F. C. S.,
London, England,
February 22d, 1876.
|
I
J
1
1
J
}
I
’ I have given LACTOPEPTINE a good thorough trial
and have been greatly pleased with the excellent results
that have followed its administration.”
“I have found great satisfaction in the use of LACTO-
P2PTINE, and have ordered it frequently in cases of
Dyspepsia, especially where there is want of tone and
defective secretion.”
“I have used LACTOPEPTINE with very good effect
in a number of cases of Dyspepsia.”
“I have used LACTOPEPTINE with great advantage
in cases of feeble digestion.”
“I have used LACTOPEPTINE both in hospital and
private practice, and have found it to answer fully the
purposes for which it is recommended. As an immediate
aid to the digestive function, I know of no remedy which
acts more directly,”
“I have made much use of LACTOPEPTINE and take
great pleasure in stating that it lias rarely disappointed me.
I shall, of course, continue to prescribe it.”
“ I have used LACTOPEPTINE in a case of Dyspepsia
with satisfaction. I think well of it."
“I consider LACTOPEPTINE the very best preparation
of the kind which I have ever employed, and for patients
with feeble digestion 1 know of nothing which is equal to it.
*• I find the preparation of LACTOPEPTINE contains
within itself all the principles required to promote a
healthy digestion.”
PRICE LIST.
uACTOPEPTINE (in oz. bottles) . . • - per oz. $ 1.00
“ ( “ 11 ) . perdoz. 10.00
“ (in J lh. “ ) . . . per lb, 12.00
We also prepare the various Elixirs
and Syrups , in combination with Lacto-
peptine.
THE NEW YORK PHARMACAL ASSOCIATION,
* lO & 12 COLLEGE PLACE, NEW YORK,
t». O. BOX 1574.
MEDICAL DEPARTMENT
or THE
IV EW ORLEANS.
FACULTY.
T. G. RICHARDSON, M.D.,
Professor of General and Clinical Surgery.
SAMUEL M. REMISS, M.D.,
Professor of the Theory arid Practice of
gja§|; Medicine and Clinical Medicine.
STANFORD E. CHAILLE, M.D.,
Professor of Physiology and Pathological
Anatomy.
JOSEPH JONES, M.D.,
Professor of Chemistry and Clinical Medi¬
cine.
SAMUEL LOGAN, M.D.,
Professor of Anatomy & Clinical Surgery.
ERNEST S. LEWIS, M.D.,
Professor of General and Clinical Obstet¬
rics and Diseases of Women and Children.
JOHN B. ELLIOTT, M.D.,
Professor of Materia Medica and Thera¬
peutics and Clinical Medicine.
E. HARRISON, M.D.,
Lecturer on Diseases of the Eye.
ALBERT B. MILES, M.D.,
Demonstrator of Anatomy.
.The next annual course of instruction in this Department (now in the forty-sixth
year of its exsitence) will commence on Monday, the 20th day of October, 1879, and
terminate on Saturday the 14th day of March, 1880. The first three weeks of the
term will be devoted exclusively to Clinical Medicine and Surgery at the Charity
Hospital; Practical Chemistry in the Laboratory; aud dissections in the spacious
and airy Anatomical Rooms of the University.
The means of teaching now at the command of the Faculty are unsurpassed in the
United States. Special attention is called to the opportunities presented for
CLINICAL INSTRUCTION.
The Act establishing the University of Louisiana gives the Professors of the
Medical Department the use of the great Charity Hospital, as a school of practical
instruction.
The Charity Hospital contains nearly 700 beds, and received, duriug the last year,
nearly six thousand patients. Its advantages for professional study are unsurpased
by any similar institution in this country. The Medical, Surgical and Obstetrical
Wards are visited by the respective Professors in charge daily, from eight to ten
o’clock A. M., at which time all the Students are expected to attend, aud familiarize
themselves, at the bedside of the patients, with the diagnosis and treatment of all
forms of injury aud disease.
The regular lectures at the hospital, on Clinical Medicine by Professors Bemiss,
Elliott and Joseph Jones, Surgery by Professors Richardson and Logan, Diseases of
Women and Children by Professor Lewis, aud Special Pathological Anatomy by
Professor Chailld, will be delivered in the amphitheater on Monday, Wednesday,
Thursday and Saturday, 'from 10 to 12 o’clock, A. M.
The Administrators of the Hospital elect, annually, twelve resident Students, who are
maintained by the Instutioni All vacancies tilled by competitive examination.
TERMS :
For the Tickets of all the Professors . $140 00
For the Ticket of Practical Anatomy . 10 00
Matriculation Fee . . . . 5 00
Graduation Fee . . . . . . . 30 00
Candidates for graduation are required to be twenty-one years of ago : to have
studied three years; to have attended two courses of lectures, and to pass a satis¬
factory examination.*
Graduates of other respectable schools are admitted upon payment of the Matricu¬
lation and half lecture fees. They oannot, however, obtain the Diploma of the Uni¬
versity without passing the regular examinations and paying the usual Graduation
Fee.
As the practical advantages hero afforded tor a thorough acquaintance with all the
branches of medicine and surgery are quite equal to those possessed by the schools
of New York and Philadelphia, the same fees are charged.
For further information, address
T. G. RICHARDSON, M. D. Dean.
*For further information upon these points see circular.
VOL. VII.
MARCH, 1880.
No. 9.
The New Orleans
MEDICAL AND SURGICAL
JOURNAL.
EDITED BY
S. M. BEMISS, M. T).,
W. H. WATKINS, M. D. S. S. HERRICK, M. D.
Wets Siries— 'f nWisIteJ MontWj) ;ij $5 pel' Snnuii), in afl'nnte.
Panhiui iepnlicv distit iiiertiw oelata virtu# . — Horace.
SCOTT & BOWNE’S
PALATABLE I
CASTOR OIL,
IN AN EMULSION.
We respectfully submit the above preparation to tbe Medical Profession, and request them to give it
a trial. They will And it a most desirable mode of administering this useful yet most sickening cathartic.
The Emulsion is not only perfect and permanent, but absolutely palatable, and by our process of
emulsifying it, we seem to have eliminated its griping, properties. Physicians report that it is not
only a mild and pleasant laxative and cathartio, but is a most efficient agent in Diarrhoea and Intestinal
Inflammation. It is put np in 4oz bottle that sell for 25 cents, also in quarts for Physicians to prescribe
as they desire. We will be pleased to send a sample upon application. Express paid,
Fokmul— 50 per cent. Pure Cold Pressed Castor OiL . , .
15 per cent Chemically pure Glycerine. ^
SCOTT &c BOWNE,
MANVFA CTUHING CHEMISTS,
1QS Hudson Street, New York.
L. Graham, Steam Book and Job Printer, 127 Gravier street, N. O.
SHARP & DOHME,
Manufacturing Chemists I Pharmacists,
BALTIMORE, MD.
We respectfully invite the attention of Physicians and Druggists t> the Medicinal
Preparations of our manufacture, which will he found of superior quality and in
every respect reliable, all possible care being used both in selection of material and
in their manufacture to produce preparations of uniform strength and of the best
qrality onl.-.
We prepare all the Officinal and other Standard MEDICINAL SOLID AND FLUID
EXTRACTS, PURE CHEMICALS, and various other Pharmaceutical Preparations, in¬
cluding a full line of SUGAR COATED PILLS AND GRANULES, ELIXIRS,
SYRUPS, SACCHARATED PEPSIN, OLEATE OF MERCURY, ETC., ETC
Among the late additions to our list of Fluid Extracts we call special attention to
FLUID EXTRACT MISTLETOE, FLUID EXTRACT JABORANDI, (prompt
diaphoretic and sialagogue,) FLUID EXTRACT DAMIANA (th » new aphrodisiac,)
FLUID EXTRACT EUCALYPTUS, FLUID EXTRACT GUARANA. FLUID EX¬
TRACT GRINDELIA ROBUSTA, FLUID EXTRACT BLACK HAW (a new remedy
to prevent thieatened miscarriage.)
Catalogues giving con position doses, etc., of all our Preparations mailed to
Physicians by applying either direct to us or to our Wholesale Agent,
X. Xj. LYONS,
Wholesale Druggist aril Importer o' English anfl German Chemicals,
42 and 44 Camp St., New Orleans, La.
DR. L. D. Me I K TOSIl’S
ELECTRIC OR GALVANIC BELT
If tli's new combination could be S6en and
■to.- ted by the medical profession, few, if any,
words would be needed from us in its favor, for
lr, combines utility with simplicity in such per¬
fection that seeing it is convincing proof of its
great value. The medical profession to day
acknowledge, almost universally, Electro-
Therapeutics.
This combination is composed of sixteen cells,
placed in pockets on a belt. Each cell is made
of hard vulcanized mbb «r, lined with a copper cell, which constitutes the negative plate.
The rubber coating perfectly insulates each cell. The positive plates are < f zinc, wrapped
in a porous material to absorb the exciting fluid, and prevent cont .ct with the copper, and
permit the current to pass from the copper to the zinc.
Thus the cells are charged without wetting the belt, and the discomfort follow.ng to the
patient. A wire is soldered to each zinc plate, which connects with the copper cell by
entering a tube on its side, thus rendering the belt pliable.
The McIntosh Electric Belt is superior to all others for the following reasons :
It is composed of sixteen cells— thus giving a powerful current. A current selector is
so arranged that one or more cells can be used at pleasure. There is not anything
irritating about the Belt, as is the case with all other contrivances where the metal used
is wet with weak acids and placed next to the skin. The electrodes are pieces of metal
covered r
cords. By
or L>cal effect-*
Many physicians who have used this belt in their practice do not hesitate to recommend
it to the profession.
Our pamphlet on Medical Electricity sent free on application. Address
vitn weaK acias ami piaueu ubai tu iuo otvm. jlud rawwwttc
. similar to ordinary battery electrodes, and connected with the cells by connecting
By this arrangement, a cum nt from the Belt can be applied to produce a general
MclNTOSH GALVANIC BELT AND BATTERY CO.,
192 and 194 Jackson St., CHICAGO, ILL.
jy’79.1y.
To the Medical Profession
The most important remedial agent ever presented to the Profession for Indigestion,
dyspepsia, Vomiting in Pregnancy, Cholera Infantum, Constipation and all Diseases
irising from imperfect nutrition, containing the five active agents of digestion, viz :
°epsin, Pancreatine, Diastase, or Veg. Ptyalin, Lactic and Hydrochloric Acids, in com-
motion with Sugar of Milk.
LACTOPEPTINE.
Veg. Ptyalin or Diastase . 4 clrachms.
I Lactic Acid . 5 fl. drachms.
! Hydrochloric Acid . 5 fl. drachms.
LACTOPEPTINE owes its great success solely to the Medical Profession, and is sold almost entirely by
'physicians’ Pi escriptions. Its almost universal adoption by the profession is the strongest guarantee we can
" five that its therapeutic value has been most thoroughly established.
The undersigned having tested LACTOPEPTINE, recommend it to the profession.
Hlfred L. LOOMTS, M D.,
Professor of Pathology and Practice of Medicine, Uni¬
versity of the City of New .Tori.
IMPEL R. Pl'.ROY, M I).,
Professor Materia Medica, New York Medical College.
FORMULA OF
Sugar of Milk . 40 ounces.
Pepsin . 8 ounces.
Pancreatine . 6 ounces.
F. LE rOY SATTERLEE, M.D.. Ph. D..
Professor of Chem., Mat. Med. and Therap. in the
N. Y. College of Dent.; Prof, of Chem. and
Hygiene in the Am. Vet. College, etc., eta.
is. Aitkin' Meigs, M.D., Philadelphia, Pa.
Prof, of the Institutes of Med. and Med. Juris.,
Jeff. Medical College ; Phy. to Penn. 3os.
W. Dawson, M.D. , Cincinnati, 0''io.
Prof. Prin. and Prac. Surg., Med. Col. of Ohio ;
Surgeon to Good Samaritan Hospital.
lbekt F. A. King, M.D.,
Washington D. C.,
Prof, of Obstetrics, University of Vermont
W. Yanrell, M.D.,
Prof, of the. Science and A rt of Surg. and Clinical
Surg., University of Louisville, Ky.
P. Yandki.l. M.D.
Prof of Clinical Medicine, Diseases of Children,
arid Dermatology, Univer. of Louisville, Ky.
fJnnT. Battey. M.D.. Rome, Ga. \
Emeritus Prof of Obstetrics, Atlanta Med. Col
lege, and Ex-Pres. Med. Association of Oa.
,Ai »E H. Mastin, M.D., LL.D.,
Mobile, Ala.
of B C Bartlett, Ph. D , F. C. S.,
London, England
“ I have used LACTOPEPTINE with very good effect
in a number of case# of Dyspepsia.”
“I have used LACTOPEPTINE with great advantage in
cases of feeble digestion.”
"I have used LACTOPEPTINE both in hospital and
^ private practice, and have found it to answer fully the
purposes for which it is recommended. As an in mediate
’ aid to the digestive function, I know of no remedy which
acts more directly.'1
“ I have made much use of LACTOPEPTINE, and take
great pleasure in stating that it has rarely disappointed
me. I shall, of oourse, continue to preecribe it,”
“ LACTOPEPTINE is an exceedingly valuable rrepara
tion. ai d no one who gives it a fair trial can fail to be
impres ed with its usefulness in dyspepsia.
“ I have used LACTOPEPTINE in a case of Dyspepsia
with satisfaction. I think well of it.”
• 1 1 consi der LAC TOPEPTINE the very best preparation
of the kind which I have ever employed, and for patients
with feeble digestion, I know of nothing which is equal to
it.” _
*■ I find the preparation of LACTOPEPTINE contains
within itself all the principles requited to promote a
healthy digestion.”
PRICE LIST.
4.CTOPEPTINE (in oz. bottles) . . • - per oz. $ 1.00
“ ( “ ) . perdoz. 10.00
“ (in $ lb. “ ) . per lb, 12.00
We also prepare the various Elixirs
and Syrups, in combination with Lacio-
peptine.
THE NEW YORK PHARMA0AL ASSOCIATION,
lO & 12 COLLEGE PLACE, NEW YORK.
O. 1*0 X ir>74.
MEDICAL DEPARTMENT
OP THE
FACULTY.
T. G. RICHARDSON, M.D.,
Professor of General and Clinical Surgery.
SAMUEL M. BEMISS, M.D.,
Professor of the Theory and Practice of
Medicine and Clinical Medicine.
STANFORD E. CHAILLfi, M.D.,
Professor of Physiology and Pathological
Anatomy.
JOSEPH JONES, M.D.,
Professor of Chemistry and Clinical Medi¬
cine.
SAMUEL LOGAN, M.D.,
Professor of Anatomy & Clinical Surgery.
ERNEST S. LEWIS, M.D.,
Professor of General and Clinical Obstet¬
rics and Diseases of Women and Children.
JOHN B. ELLIOTT, M.D.,
Professor of Materia Medica and Thera¬
peutics and Clinical Medicine.
E. HARRISON, M.D.,
Lecturer on Diseases of the Eye.
ALBERT B. MILES, M.D.,
Demonstrator of Anatomy.
The next annual course of instruction in this Department (now in the forty-sixth
year of its exsitence) will commence on Monday, the 20th day of October, 1879, and
terminate ou Saturday the 14th day of March, 1880. The first three weeks of the
term will be devoted exclusively to Clinical Medicine and Surgery at the Charity
Hospital; Practical Chemistry in the Laboratory; and dissections in the spaciaus
and airy Anatomical Rooms of the University.
The means of teaching now at the command of the Faculty are unsurpassed in the
United States. Special attention is called to the opportunities presented for
CLINICAL INSTRUCTION.
The Act establishing the University of Louisiana gives the Professors of the
Medical Department the use of the great Charity Hospital, as a school of practical
instruction.
The Charity Hospital contains nearly 700 beds, and received, during the last year,
nearly six thousand patients. Its advantages for professional study are unsurpased
by any similar institution in this country. The Medical, Surgical an 1 Obitetrical
Wards are visited by the respective Professors in charge daily, from eight ro ten
o’clock A M., at which time all the Students are expected to attend, and familiarize
themselves, at the bedside of the patients, with the diagnosis and treatment of all
forms of injury and disease.
The regular lectures at the hospital, on Clinical Medicine by ^Professors Bemiss,
Elliott and Joseph Jones, Surgery by Professors Richardson and Logan, Diseases of
Women and Children by Professor Lewis, and Special Pathological Anatomy by
Professor Chains, will be delivered in the amphitheater ou Monday, Wednesday,
Thursday and Saturday, from 10 to 12 o’clock, A. M.
The Administrators of the Ho.-pital elect, annually, twelve resident Students, who are
maintained by the Instu'.ion. All vacancies filled by competitive examination.
TERMS :
For the Tickets of all the Professors . $ 140 00
For the Ticket of Practical Anatomy . 10 00
Matriculation Fee . . 5 00
Graduation Fee . 30 00
Candidates for graduation are required to be twenty-one years of age ; to have
studied three years ; to have attended two courses of lectures, and to pass a satis¬
factory examination.*
Graduates of other respectable schools are admitted upon payment of the Matricu¬
lation and half lecture fees. They cannot, however, obtain the Diploma of the Uni-
ven.it y without passing the regular examinations and paying the usual Graduation
Fee.
As the practical advantages hero afforded for a thorough acquaintance with all the
branches of medicine and surgery are quite equal to those possessed by the schools
of New York and Philadelphia, the same fees are charged.
For furthii information, address
T. G. RICHARDSON, M. D. Dean. .
*For further information upon these points see circular.
APRIL, 1880.
The New Orleans
MEDICAL AND SURGICAL
JOURNAL.
EDITED BY
8. M. BEMISS, M. D.,
W. H. WATKINS, M. D. S. S. HERRICK, M. D.
TIeto $eKes— -DJor/IDDi ni $5 pelr ftniwto), k pt)0^r>ce.
Pauliim sepulta i distat inertice celata virtue. — Horace.
TABLE OF CONTENTS :
PAGE.
Original Communications—
By J. H. BEMISS, M. D.,
A Few Cases of Leprosy . . 923
By ROBERT P. HARRIS,
The Caesarean Record of Louisiana —
A Correction . . . 938
By A. C. LOVE, M. D.,
The Hypodermic Administration of Ergot .... 941
By T. S. DABNEY', M. D.,
Reflex Sciatica and Lumbago Cured by Removal
of Cause, Stricture of Urethra . 944
Correspondence . . . 946
Current Medical Literature-
Transfusion of Blood through the Peritoneum.., 949
Relation of Epilepsy to Insanity . 950
The Johns Hopkins University and Higher Edu¬
cation, with a Glance at the Hospital Buildings, 955
Insanity in its Relation to the General Practi¬
tioner of Medicine . . . 961
PAGE.
Foot-bindiDg in China . 968
Tamponing the Vagina for Cystitis . '■ . 970
Czerny 's Operation for the Radical Cure of Her¬
nia . 971
The Rapid Treatment of Club-foot . . . 972
The Hot Springs . 974
Treatment of Chronic Ulcer of the Leg by
Maitin’s Rubber Bandage . 974
(Arson on Inequality in Length of the Lower
Limbs . 975
Tetanus . 976
Tetanus . 977
Cremation in its Medico-Legal Aspects . 977
Editorial Department-
Parish Medical Societies . 980
University of Louisiana — Medical Department. ., 981
Prof. Samvl D. Gross, M. D., D.C.L., Oxon . 982
Photograph ol Prof. S. D. Gross. . . 984
Iberville Medical Association . 984
Necrology . 984
Reviews and Book Notices . . . 985
Books and Pamphlets Received . 1000
Meteorological Table— February, 1880 . 1002
Mortality in New Orleans from February 15th,
to March 21st, inclusive . 1002
NEW ORLE A N S:
L GRAHAM, PRINTER, 127 GRAVIER STREET.
1 8 8 0.
SHARP & DOHME,
Manufacturing Chemists 1 Pharmacists,
BALTIMORE, MD.
We respectfully invite the attention of Physicians and Druggists to the Medicinal
Preparatious of our manufacture, which will be found of superior quality and in
every respect reliable, all possible care being used both in selection of material and
in their manufacture to produce preparations of uniform strength and of the best
quality only.
We prepare all the Officinal and other Standard MEDICINAL SOLID AND FLUID
EXTRACTS, PURE CHEMICALS, and various other Pharmaceutical Preparations, in¬
cluding a full line of SUGAR COATED PILLS AND GRANULES. ELIXIRS,
SYRUPS, SACCHARATED PEPSIN, OLEATE OF MERCURY, ETC., ETC.
Among the late additions to our list of Fluid Extracts we call special atteution to
FLUID EXTRACT MISTLETOE, FLUID EXTRACT JABORANDI, (prompt
diaphoretic and sialagogue,) FLUID EXTRACT DAMIANA (the new aphrodisiac,)
FLUID EXTRACT EUCALYPTUS, FLUID EXTRACT GUARANA. FLUID EX¬
TRACT GRINDELIA ROBUSTA, FLUID EXTRACT BLACK HAW (a new remedy
to prevent threatened miscarriage.)
Catalogues giving composition doses, etc., of all our Preparations mailed to
Physicians by applying either direct to us or to our Wholesale Agent,
X. Xj. LYONS,
Wholesale Druggist and Importer of English and German Chemicals.
42 and 44 Camp St., New Orleans, La.
DR. L. D. McINTOSH’S
ELECTRIC OR GALVANIC BELT
If this new combination could he seen and
tested by the medical profession, few, if any,
words would he needed from us in its favor, for '
it combines^ ility with simplicity in such per¬
fection that seeing it is convincing proof of its
great value. The medical profession to-day
acknowledge, almost universally, Electro-
Therapeutics.
This combination is composed of sixteen cells,
placed in pockets on a belt. Each cell is made
>pper cell, which constitutes the negative plate.
The rubber coating perfectly insulates each cell. The positive plates are of zinc, wrapped
in a porous material to absorb the exciting fluid, and prevent contact with the copper, and
permit the current to pass from the copper to the zinc.
Thus the cells are charged without wetting the belt, and the discomfort following to the
patient. A wire is soldered to each zinc plate, which connects with the copper cell by
entering a tube on its side, thus rendering the belt pliable.
The McIntosh Electric Belt is superior to all others for the following reasons :
It is composed of sixteen cells— thus giving a powerful current. A current selector is
so arranged that one or more cells can be used at pleasure. There Is not anything
Irritating about the Belt, as is the case with all other contrivances where the metal used
is wet with weak acids and placed next to the skin. The electrodes are pieces of metal
covered similar to ordinary battery electrodes, and connected with the cells by connecting
cords. By this arrangement, a current from the Belt can be applied to produce a general
or local effect. •
Many physicians who have used this belt in their practice do not hesitate to recommend
It to the profession.
Our pamphlet on Medical Electricity sent free on application. Address
MclNTOSH GALVANIC BELT AND BATTERY CO.,
192 and 194 Jaokson 8t, CHICAGO, ILL.
)yTfl.ly.
To the Medical Profession.
LACTOPEPTINE
he most important remedial agent ever presented to the Profession for Indigestion,
yspepsia, Vomiting in Pregnancy, Cholera Infantum, Constipation and all Diseases
| rising from imperfect nutrition, containing the five active agents of digestion, viz :
| epsin, Pancreatine, Diastase, or Veg. Ptyalin, Lactic and Hydrochloric Acids, in com-
‘ motion with Sugar of Milk.
FORMULA OF LACTOPEPTINE.
Sugar of Milk . 40 ounces. Veg. Ptyalin or Diastase . 4 drachms.
Pepsin . 8 ounces. , Lactic Acid . 5 fl. drachms.
Pancreatine . 6 ounces. ' Hydrochloric Acid . 5 fl. drachms.
LACTOPEPTINE owes its great success solely to the Medical Profession, and is sold almost entirely by
i hysicians’ Prescriptions. Its almost universal adoption by the profession is the strongest guarantee we can
5 ive that its therapeutic value has been most thoroughly established.
Tlie undersigned Having tested LACTOPEPTINE, recommend it to the profession.
LFRED L. LOOMIS M D ,
Professor of Pathology and Practice of Medicine, Uni
versity of the City of New York.
, iMUEL R. P1RCY, ID,
Prof essor Materia Medica, New York Medical College.
j ,s. Aitkin' Meios, M.D., Philadelphia, Pa. )
■ Prof, of the Institutes of Med. and Med. Juris., >
Jeff. Medical College ; Phy. to Penn. Hos. )
F. LE ROT SATTERLEE, M.D.. Ph. D.,
Professor of Chem., Mat. Med. and Therap. in the
N. Y. College of Dent.; Prof, of Chem. and
Hygiene in the Am. Vet. College, etc., etc.
“ I have used LACTOPEPTINE with very good effect
i a number of case* of Dyspepsia.”
'. W. Dawson, M.D. , Cincinnati, Ohio.
Prof. Prin. and Prac. Surg., Med. Col. of Ohio;
Surgeon to Good Samaritan Hospital.
lbert F. A. Kino, M.D.,
Washington D. C.,
Prof, of Obstetrics, University of Vermont-
) “I have used LACTOPEPTINE with great ad van lage in
/ cases of feeble digestion.”
n. “I have used LACTOPEPTINE both in hospital and
J private practice, and have found it to answer fully the
f purposes for which it is recommended. As an immediate
/ aid to the digestive fanotion, I know of no remedy which
y acts more directly.'’
■. W. Yaniifll. M.D.,
Prof, of the Science and Art of Surg. and Clinical
Surg., University of Louisville , Ky.
) “I have made muoh use of LACTOPEPTINE, and take
> great pleasure in stating that it has rarely disappointed
\ me. I shall, of course, continue to preecribe it,”
P. Yandell. M.D.,
Prof, of Clinical Medicine, Diseases of Children,
and Dermatology, Univer. of Louisville, Ky.
* ‘ 1 LA CTOPEPTINE is an exceedingly valuable r repara
tlon. ai d U“ one who gives it a fair trial can fail to be
irrmres ed with its usefulness in dyspepsia.
tOBT. Battey. M.D.. Rome, Ga.
Emeritus Prof, of Obstetrics, Atlanta Med. Col¬
lege, and Ex-Pres. Med. Associa'mn of Ga.
Jlaude H. Mastix, M.D., LL.D.,
Mobile, Ala.
?rof H. C Bartlett, Ph. D,, F. C. S.,
London, England
!“ I have used LACTOPEPTINE in a case of Dyspepsia
with satisfaction. I think well of it.”
!•* I consider LACTOPEPTINE the very best preparation
of the kind which I have ever employed, and for patients
with feeble digestion, I know of nothing which is equal to
it."
S" I find the preparation of LACTOPEPTINE contains
within itself ftll the principles required to promote a
healthy digestion.”
PRICE LIST.
LACTOPEPTINE (in oz. bottles) . per oz. $ 1.00
“ ( “ “ ) . perdoz. 10.00
“ (in J lb. “ ) . per lb, 12.00
We also prepare the various Elianrs
and Syrups , in combination with Lacto-
peptine.
THE NEW YORK PHARMACAL ASSOCIATION,
lO & 12 COLLEGE PLACE, NEW YORK,
lr». O. BOX 1574,
MEDICAL DEPARTMENT
OF THE
NEW ORLEANS.
FACULTY.
T. G. RICHARDSON, M.D.,
Professor of General and Clinical Surgery.
SAMUEL M. BEMISS, M.D., )
Professor of the Theory and Practice' of
Medicine and Clinical Medicine.
STANFORD E. CHAILLfi, M.D.,
Professor of Physiology and Pathological
Anatomy.
JOSEPH JONES, M.D.,
Professor of Chemistry and Clinical Medi¬
cine.
SAMUEL LOGAN, M.Dq
Professor of Anatomy & Clinical Surgery.
ERNEST S. LEWIS, M.D.,
Professor of General and Clinical Obstet¬
rics and Diseases of Women and Children.
JOHN B. ELLIOTT, M.D.,
Professor of Materia Medica and Thera¬
peutics and Clinical Medicine.
E. HARRISON, M.D.,
Lecturer on Diseases of the Eye.
ALBERT B. MILE3, M.D.,
Demonstrator of Anatomy.
The next annual course of instruction in this Department (now in the forty-sixth
year of its exsitence) will commence on Monday, the 20th day of October, 1879, and
terminate on Saturday the 14th day of March, 1880. The first three weeks of the
term will be devoted exclusively to Clinical Medicine and Surgery at the Charity
Hospital; Practical Chemistry in the Laboratory; and dissections in the spacious
and airy Anatomical Rooms of the University.
The means of teaching now at the command of the Faculty are unsurpassed in the
United States. Special attention is called to the opportunities presented for
CLINICAL INSTRUCTION.
The Act establishing the University of Louisiana gives the Professors of the
Medical Department the use of the great Charity Hospital, as a school of practical
instruction. I
The Charity Hospital contains nearly 700 beds, and received, daring the last year,
nearly six thousand patients. Its advantages for professional study are unsurpased
by any similar institution in this country. The Medical, Surgical and Obstetrical
Wards are visited by the respective Professors in charge daily, from eight to ten
o’clock A. M., at which time all the Students are expected to attend, and familiarize
themselves, at the bedside of the patients, with the diagnosis and treatment of all
forms of injury and disease.
The .regular lectures at the hospital, on Clinical Medicine by Professors Bemiss,
Elliott and Joseph Jones, Surgery by Professors Richardson and Logan, Diseases of
Women and Children by Professor Lewis, and Special Pathological Anatomy by
Professor Chailld, will be delivered in the amphitheater on Monday, Wednesday,
Thursday and Saturday, from 10 to 12 o’clock, A. M.
The Administrators of the Hospital elect, annually, twelve resident Students, who are
maintained by the Instution. All vacancies filled by competitive examination.
TERMS :
For the Tickets of all the Professors . . . $ 140 00
For the Ticket of Practical Anatomy . 10 00
Matriculation Fee . . 5 00
Graduation Fee . . . . . 30 00
Candidates for graduation are required to be twenty-one years of age ; to have
studied three years ; to have attended two courses of lectures, and to pass a satis¬
factory examination.*
Graduates of other respectable schools are admitted upon payment of the Matricu¬
lation and half lecture fees. They»cannot, however, obtain the Diploma of the Uni¬
versity without passing, the regular examinations and paying the usual Graduation
Fee.
As the practical advantages here afforded fer a thorough acquaintance with all the
branches of medicine and surgery are quite equal to those possessed by the schools
of New York and Philadelphia, the same fees are charged.
For further information, address
T. G. RICHARDSON, M. D. Dean.
*For further information upon these points see circular.
Vol. VII.
MAY, 1880.
Xo. 11.
The New Orleans
MEDICAL AND SURGICAL
JOURNAL.
EDITED BY
S. M. BEMISS, M. D.,
W. H. WATKINS, M. D. S. S. HERRICK, M. D.
ffelw Reties— ^i|61isUeO af $5 pel Bwity, i>7 p^b^nce.
Paulum sepultce distat inertia; celata virtm. — Horace.
Original Communications—
By ANDREW W. SMYTII, M. D.,
Interpretations of the Structure and Func¬
tion of the Kidney . 1003
By GEORGE M. STERNBERG, Surgeon, U.S.A.
The Microscopical Investigations of the Havana
Yellow Never Commission . 1017
By GEO. J. FRIEDRICHS, D. I). S.,
Nitrate of Silver in Erosion of the Teeth . 1024
By A. S. GATES, M. D.,
Surgical Notes— Oblique Inguinal Hernia in
J emale — Gunshot Wound of Shoulder Joint 1027
By GEORGE H. ROHE, M. D.,
Recent Progress in Dermatology . 1033
Current Medical Literature—
Excerpta from Dr. Carl Heinemann's ‘‘Contribu¬
tions to the Knowledge of Yellow Fever
(Vomitoofthe Natives; on the Eastern Coast
of Mexico . . 1039
The Sanitary Commissioner of India < n tho Pre¬
vailing Doctrines as to the Causes of Cholera io
their Relation to Sanitary Improvements . 1047
Fissured Nipples . . . 1055
PAGE
Recent Decisions . 1056
Antidote for Carbolic Acid . 1058
Syphilis — A Child Infected through the Utero¬
placental Circulation . 1069
Rectal Feeding in Disease . 1059
Speedy Cura of Nasal Polypi . 1061
Sudden Death from Intra-Uterine Injection of
Water . 1062
On the Treatment of Chorea with Hypodermio
Injections of Arsenic . 1 . 1063
Misuse of the Iron Preparations — Their effect on
the Digestive Process - . 1065
'transmission of Hydrophobia from Man to
Rabbits . ’. . 1066
Editorial Department—
Louisiona State Medical Association . 1067
Louisiana State Board of Health . 1067
The Yellow Fever Canard . 1068
An Omission . . 1068
A Correction . 1068
Hydrate of Chloral . 1069
Erratum . . . 1070
Louisiana State Medieal Society . 1070
Proceedings of the Attakapas Medical Associa¬
tion . 1076
Reviews and Book Notices . 1078
Boobs and Pamphlets Received . 1081
.Meteorological Table— March, 1880 . 1082
Mortality in New Qrleans from March 21st,
to April 17 tii, inclusive . 1082
TABLE OF CONTENTS
PAGE.
NEW ORLEANS:
L. GRAHAM, PRINTER, 127 GRAVIER STREET.
1 8 8 0 .
SHARP & DOHME,
Manufacturing Chemists 1 Pharmacists,
BALTIMORE, MD.
We respectfully invite the attention of Physicians and Druggists to the Medicinal
Preparations of our manufacture, which will he found of superior quality and in
every respect reliable, all possible care being used both in selection of material and
in their manufacture to produce preparations of uniform strength and of the best
quality only.
We prepare all the Officinal and other Standard MEDICINAL SOLID AND FLUID
EXTRACTS, PURE CHEMICALS, and various other Pharmaceutical Preparations , in¬
cluding a full line of SUGAR COATED PILLS AND GRANULES, ELIXIRS,
SYRUPS, SACCHARATEI) PEPSIN, OLEATE OF MERCURY, ETC., ETC.
Among the late additions to our list of Fluid Extracts we call special attention to
FLUID EXTRACT MISTLETOE, FLUID EXTRACT JABORANDI, (prompt
diaphoretic and sialagogue,) FLUID EXTRACT DAMIANA (the new aphrodisiac,)
FLUID EXTRACT EUCALYPTUS, FLUID EXTRACT GUARANA, FLUID EX¬
TRACT GRINDELIA ROBUSTA, FLUID EXTRACT BLACK HAW (a new remedy
to prevent threatened miscarriage.)
Catalogues giving composition doses, etc., of all our Preparations mailed to
Physicians by applying either direct to us or to our Wholesale Agent,
I. L . LYOUS,
WbolesalG DrnMist and Importer of English and Herman Chemicals,
42 and 44 Camp St., New Orleans, La.
DR. L. IJ. MclNTOSH’S
ELECTRIC OR GALVANIC BELT
If this new combination could bo seen and
tested by the medical profession, few, if any,
words would be needed from us in its favor, for
it combines utility with simplicity in such per¬
fection that seeing it is convincing proof of its
great value. The medical profession to-day
acknowledge, almost universally, Electro-
Therapeutics.
This combination is composed of sixteen cells,
_ placed in pockets on a belt. Each cell is made
of hard vulcanized rubber, lined with a copper cell, which constitutes the negative plate.
The rubber coating perfectly insulates each cell. The positive plates are of zinc, w'rapped
in a porous material to absorb the exciting fluid, and prevent contact with the copper, and
permit the current to pass from the copper to the zinc.
Thus the cells are charged without wetting the belt, and the discomfort following to the
patient. A wire is soldered to each zinc plate, which connects with the copper cell by
entering a tube on its side, thus rendering the belt pliable.
The McIntosh Electric Belt is superior to all others for the following reasons :
It is composed of sixteen cells— thus giving a powerful current. A current selector is
so arranged that one or more cells can be used at pleasure. There is not anything
irritating about the Belt, as is the case with all other contrivances where the metal used
is wet with weak acids and placed next to the skin. The electrodes are pieces of metal
covered similar to ordinary battery electrodes, and connected with the cells by connecting
cords. By this arrangement, a current from the Belt can be applied to produce a general
or local effect.
Many physicians who have used this belt in their practice do not hesitate to recommend
it to the profession.
Our pamphlet on Medical Eleotricity sent free on application. Address
WeINTOSH GALVANIC BELT AND BATTERY CO.,
192 and 194 Jaokson St., CHICAGO, ILL.
jy’TO.ly.
To the Medical Profession
I T
rhe most important remedial agent ever presented to the Profession for Indigestion,
Dyspepsia, Vomiting in Pregnancy, Cholera Infantum, Constipation and all Diseases
arising from imperfect nutrition, containing the five active agents of digestion, viz :
Pepsin,. Pancreatine, Diastase, or Veg. Ptyalin, Lactic and Hydrochloric Acids, in com¬
bination -with Sugar of Milk.
FORMULA OF LACTOPEPTINE.
Sugar of Milk..... . 40 ounces.
Pepsin . 8 ounces.
Pancreatine . 6 ounces.
Veg. Ptyalin or Diastase . 4 drachms.
Lactic Acid . . 5 fl. drachms.
Hydrochloric Acid . 5 fl. drachms. '
_ LACTOPEPTINE owes its great success solely to the Medical Profession, and is sold almost entirely by
Physicians’ Prescriptions. Its almost universal adoption by the profession is the strongest guarantee we can
give that its therapeutic value has been most thoroughly established.
The undersigned having tested LACTOPEPTINE, recommend it to the profession.
LERED L. LOOMIS, M.D.,
Professor of Pathology and Practice of Medicine, Uni¬
versity of the City of New York.
AMUEL R. PERCY, M D„
Professor Materia Medica , New York Medical College.
as. Aitkin Meigs, M.D., Philadelphia, Pa. f
Prof, of the Institutes of Med. and Med. Juris.
Jeff. Medical College ; Phy. to Penn. Hos.
. W. Dawson, M.D. , Cincinnati, Ohio.
Prof. Prin. and Prac. Surg., Med. Col. of Ohio ;
Surgeon to Good Samaritan Hospital.
F. LE ROY SATTERLEE, M.D., Ph. D.,
Professor of Chetn., Mat. Med. and Therap. in the
N. Y. College of Dent.; Prof, of Chem. and
Hygiene in the Am. Vet. College , etc., etc.
lbekt F. A. King, M.D.,
Washington D. C.,
Prof, of Obstetrics, University of Vermont.
W. Yandell, M.D.,
Prof, of the Science and Art of Surg. and Clinical
Surg., University of Louisville, Ey.
P. Y anuria.. M.D.,
Prof, of Clinical Medicine, Diseases of Children,
and Dermatology, Univer. of Louisville , Ey.
out. Battey. M.D., Rome, Ga.
Emeritus Prof, of Obstetrics, Atlanta Med. Col¬
lege, and Ex-Pres. Med. Association of Oa.
.At:i>E H. Mastin, M.D., LL.D.,
Mobile, Ala.
■of H 0 Bartlett, Ph. D,, P. C. S.,
London, England
“I have used LACTOPEPTINE with very good effect
in a number of cases of Dyspepsia.”
“ I have used LACTOPEPTINE with great advan tage in
cases of feeble digestion,”
“I have used LACTOPEPTINE both in hospital and
private practice, and have found it to answer fully the
purposes for which it is recommended. As an immediate
aid to tho digestive function, I know of no remedy which
acts more directly.”
• “ I have made much use of LACTOPEPTINE, and take
> great pleasure in stating that it has rarely disappointed
I me. I shall, of course, continue to preecribe it.”
1 “ LACTOPEPTINE is an exceedingly valuable prepara-
- tlon, and no one who gives it a fair trial can fail to be
, impressed with its usefulness in dyspepsia.
“ I have used LACTOPEPTINE in a case of Dyspepsia
with satisfaction. I think well ol' it.”
“ I consider LACTOPEPTINE the very best preparation
of the kind whicli I have ever employed, and tor patients
with feeble digestion, I know of nothing which is equal to
it.”
of LACTOPEPTINE contains
required to promote a
“I find the preparation of L A
within itself All the principles
healthy digestion.”
PRICE LIST.
^.CTOPEPTINE (in oz. bottles) . per oz. $ 1.00
( “ “ ) . perdoz. 10.00
“ (in £ lb. “ ) . per lb, 12.00
We also prepare the various Elixirs
and Syrups, in combination with Lacto-
peptine.
THE NEW YORK PHARMA0AL ASSOCIATION,
lO & 12 COLLEGE PLACE, NEW YORK,
. O. BOX If5r4.
MEDICAL DEPARTMENT
OP TItK
NE W ORLEAN S.
FACULTY.
T. G. RICHARDSON, M.D.,
Professor of General and Clinical Surgery.
SAMUEL M. BEMISS, M.D.,
Professor of the Theory and Practice of
Medicine and Clinical Medicine.
STANFORD E. CHAILLE, M.D.,
Professor of Rhysioiogy and Pathological
Anatomy.
JOSEPH JONES, M.D.,
Professor of Chemistry and Clinical Medi¬
cine.
SAMUEL LOGAN, M.D.,
Professor of Anatomy & Clinical Surgery.
ERNEST S. LEWIS, M.D.,
Professor of General and Clinical Obstet¬
rics and Diseases of Women and Children.
JOHN B. ELLIOTT, M.D.,
Professor of Materia Medica and Thera¬
peutics and Clinical Medicine.
E. HARRISON, M.D.,
Lecturer on Diseases of the Eye.
ALBERT B. MILES, M.D.,
Demonstrator of Anatomy.
The next annual course of instruction in this Department (now in the forty-sixth
year of its exsitence) will commence on Monday, the 20th day of October, 1879, and
terminate on Saturday the 14th day of March, 1880. The first three weeks of the
term will be devoted exclusively to Clinical Medicine and Surgery at the Charity
Hospital ; Practical Chemistry in the Laboratory ; and dissections in the spacious
and airy Anatomical Rooms of the University.
The means of teaching now at the command of the Faculty are unsurpassed in the
United States. Special attention is called to the opportunities presented for
CLINICAL INSTRUCTION.
The Act establishing the University of Louisiana gives the Professors of the
Medical Department the use of the great Charity Hospital, as a school of practical
instruction.
The Charity Hospital contains nearly 700 beds, and received, duriug the last year,
nearly six thousand patients. Its advantages for professional study are unsurpased
by any similar institution in this country. The Medical, Surgical and Obstetrical
Wards are visited by the respective Professors in charge daily, from eight to ten
o’clock A. M., at which time all the Students are expected to attend, and familiarize
themselves, at the bedside of the patients, with the diagnosis and treatment of all
forms of injury and disease.
The regular lectures at the hospital, on Clinical Medicine by Professors Bemiss,
Elliott and Joseph Jones, Surgery by Professors Richardson and Logan, Diseases of
Women and Children by. Professor Lewis, and Special Pathological Anatomy by
Professor Chaill^, will be delivered in the amphitheater on Monday, Wednesday,
Thursday and Saturday, from 10 to 12 o’clock, A. M.
The Administrators of the Hospital elect, annually, twelve resident Students, who are
maintained by the Instution. All vacancies filled by competitive examination.
TERMS :
For the Tickets of all the Professors . $140 00
For the Ticket of Practical Anatomy . .. . 10 00
Matriculation Fee . ' . 5 00
Graduation Fee . . . . 30 00
Candidates for graduation are required to be twenty-one years of age ; to have
studied three years ; to have attended two courses of lectures, and to pass a satis¬
factory examination.*
Graduates of other respectable schools are admitted upon payment of the Matricu¬
lation and half lecture fees. They cannot, however, obtain the Diploma of the Uni¬
versity without passing the regular examinations and paying the usual Graduation
Fet>.
As the practical advantages here afforded for a thorough acquaintance with all the
branches of medicine and surgery are quite equal to those possessed by the schools
of New York and Philadelphia, the same fees are charged.
For further information, address
T. G. RICHARDSON, M. D. Dean.
*For further information upon these points see ciroular.
n
! ti ' . •>
JUNE, 1880. W
No. 12,
nrtt
The New Orleans
w&m
A
MEDICAL AND SURGICAL
JOURNAL.
EDITED BY
S. M. BEMISS, M. I).,
W. H. WATKINS, M.-D. S. S. HERRICK, M. D.
Heto §eh'e$— fn5iisired TjtJooBlly qt $5 pelr ftpilft), it? $db$flpe.
Pauliim nepiiltiK distat inertia) celata virtm. — Horace.
TABLE OF CONTENTS :
PACE.
Original Communications—
By S. LOGAN, M. D. ,
Differential Diagnosis of Tumours in the Scro¬
tum . 1083
By JOHN T. JONES,
The Physiological Action of Atropiaas Demon¬
strated by Experiment . J104
By C. W TRCEH3SART. M. D..
Plaster- Bandage Saw. . . 1121
Current Medical Literature—
The Benzonate of Soda in Phthisis . 1123
Oxalate of Cerium as a Cough Remedy . . 1126
Hypodermic Ether . 1127 j
Burns aud Scalds . ..1128
Notes. . . 1128 :
The Hypodermic Injection of Quinine in Perni¬
cious Malarial Fever . . . . ...1128|
Two Cases of Popliteal Aneuiism Cured by
Ei-march's Bandage . 1123 ;
Treatment of Metronhagia by Infusion of Black
Coffee . H30 |
Nickel Plating without a Batteiy . 1130
>
PAGE.
Experiments upon the Strength of Antiseptics. 1131
Notes on Cystorrhagia from Retention of Urine. 1134
The New Anassthetic — The Bromide of Ethyl. . . 1144
Successful Treatment of Obstinate Ununited
Fractures by Transplantation of Osseous
Tissue - '• . 1147
Antiseptic Treatment of a Bullet Wound Pene¬
trating the Knee-Joint . .; . . .1148
The Bogus Diploma Business . 1148
Hygiene of the School-room in its Relation to
Light . 1149
Cure for Vomiting of Pregnancy . 1150
Meadows' Table for Estimating the probable
Duration of Pregnancy . . 1151
Causes of Fatigue in Reading . 1 152
Editorial Department-
Valedictory . 1152
Obituary — Dr. Sarn'l Choppiu . 1153
Col. T. S. Hardee... . 1154
Reviews and Book Notices . . . 1 155
Books and Pamphlets Received . . . llfiO
M eteorological Table— April , 1 880 . 1162
Mortality in New Orleans from April 17th,
to May 15th. inclusive . 1162
N E W ORLEANS:
L GRAHAM, PRINTER, 127 GRAVTER STREET.
1 8 8 0.
SHARP & DOHME,
Manufacturing Chemists I Pharmacists,
BALTIMORE, MI).
We respectfully invite the attention of Physicians and Druggists to the Medicinal
Preparations of our manufacture, which will be found of superior quality and in
every respect reliable, all possible care being used both in selection of material and
in their manufacture to produce preparations of uniform strength and of the best
quality only.
We prepare all the Officinal and other Standard MEDICINAL SOLID AND FLUID
EXTRACTS, PURE CHEMICALS, and various other Pharmaceutical Preparations , in¬
cluding a full line of SUGAR COATED PILLS AND GRANULES, ELIXIRS,
SYRUPS, SACCHARATED PEPSIN* OLEATE OF MERCURY, ETC., ETC.
Among the late additions to our list of Fluid Extracts we call special attention to
FLUID EXTRACT MISTLETOE, FLUID EXTRACT JABORANDt, (prompt
diaphoretic and sialagogue,) FLUID EXTRACT DAMIANA (the new aphrodisiac,)
FLUID EXTRACT EUCALYPTUS, FLUID EXTRACT GUARANA, FLUID EX¬
TRACT GRINDELIA ROBUSTA, FLUID EXTRACT BLACK HAW (a new remedy
to prevent threatened miscarriage.)
Catalogues giving composition doses, etc., of all our Preparations mailed to
Physicians by applying either direct to us or to our Wholesale Agent,
X. Xj . LYONS,
Wholesale Druggist aM Importer of Euglish an! German Chemicals,
42 and 44 Camp St., New Orleans, La.
DR. L. D. McINTOSH’S
ELECTRIC OR GALVANIC BELT
If this new combination could be seen and
tested by the medical profession, few, if any,
words would be needed from us in its favor, for
it combines utility with simplicity in such per¬
fection that seeiing it is convincing proof of its
great value. The medical profession to-day
acknowledge, almost universally, Electro-
Therapeutics.
This combination is composed of sixteen cells,
_ placed in pockets on a belt. Each cell is made
of hard vulcanized rubber, lined with a oopper cqll, which constitutes the negative plate.
The rubber coating perfectly insulates each cell. The positive plates are of zinc, wrapped
In a porous material to absorb the exciting fluid, and prevent contact with the copper, and
permit the current to pass from the copper to the zinc.
Thus the cells are charged without wetting the belt, and the discomfort following to the
patient. A wire is soldered to each zino plate, which connects with the copper cell by
entering a tube on its side, thus rendering the belt pliable.
The McIntosh Electric Belt is superior to all others for the following reasons :
It is composed of sixteen cells— thus giving a powerful current A current selector is
so arranged that one or more cells can be used at pleasure. There is not anything
irritating about the Belt, as is the case with all other contrivances where the metal used
is wet with weak acids and placed next to the skin. The electrodes are pieces of metal
covered similar to ordinary battery electrodes, and connected with the cells by connecting
cords. By this arrangement, a current from the Belt can be applied to produce a general
or local effect.
Many physicians who have used this belt in their praotioe do not hesitate to recommend
it to the profession.
Our pamphlet on Medical Electricity sent free on application. Address
MclNTOSH GALVANIC BELT AND BATTERY CO.,
192 and 194 Jackson St,, CHICAGO, ILL.
jy’79.1y.
To the Medical Profession.
ALFRED L. LOOMIS, M.D.,
Professor of Pathology and Practice of Medicine, Uni
versity of the City of New York.
SAMUEL R. PERCY, M I).,
Professor Materia Medica, New York Medical College.
I as. Aitkin Meigs, M.D., Philadelphia, Pa. }
Prof, of the Institutes of Med. and Med. Juris.,
Jeff. Medical College ; Phy. to Penn. Hos.
W. W. Dawson, M.D., Cincinnati, Ohio.
Prof. Prin. and Prac. Surg., Med. Col. of Ohio ;
Surgeon to Qood Samaritan Hospital.
I he most important remedial agent ever presented to the Profession for Indigestion,
Dyspepsia, Vomiting in Pregnancy, Cholera Infantum, Constipation and all Diseases
arising from imperfect nutrition, containing the five active agents of digestion, viz :
Pepsin, Pancreatine, Diastase, or leg. Ptyalin, Lactic and Hydrochloric Acids, in com¬
bination with Sugar of Milk.
FORMULA OF LACTOPEPTINE.
Sugar of Milk . 40 ounces. Veg. Ptyalin or Diastase . 4 drachms.
Pepsin . . 8 ounces. . Lactic Acid . 5 fl. drachms.
Pancreatine . Bounces. ! Hydrochloric Acid . 5 fl. drachms.
IAGTQPEPTINE owes its great success solely to the Medical Profession, and is sold almost entirely by
Physicians’ Prescriptions. Its almost universal adoption by the profession is the strongest guarantee we can
give that its therapeutio value has been most thoroughly established.
The undersigned Having tested LACTOPEPTINE, recommend it to the profession.
F. LE ROY SATTERLEE, M.D.. Ph. D„
Professor of Chem., Mat. Med. and Therap. in the
N. Y. College of Dent.; Prof, of Chem. and
Hygiene in the Am. Vet. College, etc., etc.
“ I have used LACTOPljlPTINE with very good effect
in a number of cases of Dyspepsia."
A i.bekt F. A. King, M.D.,
Washington D. C.,
Prof, of Obstetrics , University of Vermont
I). W. Yandbll, M.D.,
Prof, of the Science and Art of Surg. and Clinical
Surg., University of Louisville, Ky.
L. P. Yandkll. M.D.,
Prof of Clinical Medicine, Diseases of Children,
and Dermatology, Univer. of Louisville , Ky
Rout. Battey. M.D., Rome, Ga.
Emeritus Prof, of Obstetrics, Atlanta Med. Col¬
lege, and Ex-Pres. Med. Association of Oa.
Ci.aude H. Mastin, M.D., LL.D.,
. Mobile, Ala.
Prof H 0 Bartlett, Ph. D,, F. C. S.,
London, England
1 “ I have used LACTOPEPTINE with great advantage in
’ oases of feeble digestion.”
“I have used LACTOPEPTINE both in hospital and
I private practice, and have found it to answer fully the
purposes for which it is recommended. As an immediate
’ aid to the digestive function, I know of no remedy which
acts more directly.”
“ I have made much use of LACTOPEPTINE, and take
i great pleasure in stating that It has rarely disappointed
me. I shall, of oourse, continue to preeoribe it.”
“ LACTOPEPTINE is an exceedingly valuable prepara
tion, and no one who gives it a fair trial can fail to be
impressed with its usefulness in dyspepsia.
“ I have used LACTOPEPTINE in a case of Dyspepsia
with satisfaction. I think well of it.”
“ I oonsider LACTOPEPTINE the very best preparation
of the kind which I have ever employed, and for patients
with feeble digestion, I know of nothing which is equal to
it.”
“I find the preparation of LACTOPEPTINE contains
within itself all the principles required to promote a
healthy digestion.**
PRICE LIST.
LACTOPEPTINE (in oz. bottles) . per oz. $ 1.00
( “ “ ) . per doz. 10.00
(in $ lb. " ) . per lb, 12.00
We also prepare the various Elixirs
and Syrups , in combination with Lacto-
peptine.
THE NEW YOEK PHARMAOAL ASSOCIATION,
lO & 12 COLLEGE PLACE, NEW YORK.
P. O. BOX 1574.
MEDICAL DEPARTMENT
OK THE
NEW ORLEANS.
FACULTY.
T. G. RICHARDSON, M.D.,
Professor of General and Clinical Surgery, i
SAMUEL M. BEMISS, M.D., ' I
Professor of the Theory and Practice of |
Medicine and Clinical Medicine. M
STANFORD E. CHAILLE, M.D.,
Professor of Physiology and Pathological
Anatomy.
JOSEPH JONES, M.D.,
Professor of Chemistry and Clinical Medi¬
cine.
SAMUEL LOGAN, M.D.,
Professor of Anatomy & Clinical Surgery.
ERNEST S. LEWIS, M.D.,
Professor of General and Clinical Obstet¬
rics and Diseases of Women and Children.
JOHN B. ELLIOTT, M.D.,
Professor of Materia Medica and Thera¬
peutics and Clinical Medicine.
E. HARRISON, M.D.,
Lecturer on Diseases of the Eye.
ALBERT B. MILES, M.D.,
Demonstrator of Anatomy.
The next annual course of instruction in this Department (now in the forty- seventh
year of its exsiteuce) will commence on Monday, the 18th day of October, 1880, and
terminate on Saturday the 12th day of March, 1881. The tirst three weeks of the
term will be devoted exclusively to Clinical Medicine and Surgery at the Charity
Hospital; Practical Chemistry in the Laboratory; and dissections in the spacious
and airy Anatomical Rooms of the University.
The means of teaching now at the command of the Faculty are unsurpassed in the
United States. Special attention is called to the opportunities presented for
CLINICAL INSTRUCTION.
The Act establishing the University of Louisiana gives the Professors of the
Medical Department the use of the great Charity Hospital, as a school of practical
instruction.
The Charity Hospital contains nearly 700 beds, and received, during the last year,
nearly six thousand patients. Its advantages for professional study are unsurpased
by any similar institution in this country. The Medical, Surgical and Obstetrical
Wards are visited by the respective Professors in charge daily, from eight to ten
o’clock A. M., at which time all the Students are expected to attend, and familiarize
themselves, at the bedside of the patients, with the diagnosis and treatment of all
forms of injury and disease.
The regular lectures, at the hospital, on Clinical Medicine by Professors Bemiss,
Elliott and Joseph Jones, Surgery by Professors Richardson and Logan, Diseases of
Women and Children by Professor Lewis, and Special Pathological Anatomy by
Professor C hail 16, will be delivered in the amphitheater on Monday, Wednesday,
Thursday and Saturday, from 10 to 12 o’clock, A. M.
The Administrators of the Hospital elect, anmially, twelve resident Students, who are
maintained by the Instution. All vacancies filled by competitive examination.
TERMS :
For the Tickets of all the Professors . ’ . $140 00
For the Ticket of Practical Anatomy . . 10 00
Matriculation Fee . . . .'. . . . . . . . . . . . 5 00
Graduation Fee . . . . . . 30 00
Candidates for graduation are required to be twenty-one years of age ; to have
studied three years; to have attended two courses of lectures, and to pass a satis¬
factory examination.*
Graduates of other respectable schools are admitted upon payment of the Matricu¬
lation and half lecture fees. They cannot, however, obtain the Diploma of the Uni¬
versity without passing the regular examinations and paying the usual Graduation
Fee.
As tht practical advantages here afforded for a thorough acquaintance with all the
branches of medicine and surgery are quite equal to those possessed by the schools
of New York and Philadelphia, the same fees are charged.
For further information, address
T. G. RICHARDSON, M. D. Dean.
'For further information upon these points see circular.
i
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