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CANADA  MEDICAL  RECORD: 


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EDITOR: 

FRANCIS   WAYLAND   CAMPBELL,    A.M.,    M.D.,    L.KC.P,,    LONDON, 

PJiijsicia7i  to  the  Women's  Hospital.  Consulting  Physician  to  the'Jilontreal  Dispensary. 


ASSISTANT     EDITORS: 

JAMES  PERRIGO,  M.D.,  M.R.C.S.,  Eng.  |  ElCHAED>rKENNEDY,  M.D. 

Physicians  to  the  Woimn's  Hospital. 


VOLUME    IX. 
OCTOBER,    1880,   to   SEPTEMBER,   1881. 


ARMSTRONG,  Geo.  E.,  M.D. 
Bessey,  W.  E.,  M.D. 
BOTSFOKD,  J.  Le  B.,  M.D. 
BBtTNTON,  "W.  Y.,  M.D. 

Cameron,  J.  C,  M.D.,  M.R.C.P.I 


CONTRIBUTORS 

Cassell; 
Howard, 
LiTTEK,  L.,  M.D. 
Nelson,  C.  E.,  M.D 
Wood,  C.  A.,  M.D. 


MONTREAL : 

PRINTED    BY    JOHN    LOVELL   &   SON- 

1881. 


CONTENTS. 


OniOINAL  COMMUNICATIONS. 

Armstrong,  Dr.  George  E.,  Case  of  Perityphlitis 217 

BeMj,  Dr.,  VacciDation  in  Chronic  Skin  Diseases 25 

Botsford,  Dr.,  Report  on  Srtnitary  Science 1 

Brunton,  Dr.  W.  Y.,  Inflammation:  its  Chemical  Cause 

and  Cure 60 

Cameron,  Dr.  J.iraes  C,  Valedictory  Address  to  the 
Graduating  Class,  Medical  Faculty  of  Bishop's  Col- 
lege    169 

Cameron,  Dr.  James  C,  Case  of  Chronic  Bright's  Dis- 
ease treated  by  Nitro-GIycerine 241 

Cassels,  Dr.,   On  the  Treatment  of  Tape-worm  (taenia 

solum) 172 

HowarJ,  Dr.  Henry,  Man's  Two  Natures 97 

Howard,  Dr.  Henry,  Some  Remarks  on  "  Haeckel  on  the 
Evolution  of  Man,"  and  on  so  called  Blood-poisoning  145 

Litten,  Dr.,  On  Septicaemia  and  its  Effects 61 

Nelson,  Dr.  C.  E.,  The  After-treatment  of  Operations 
as  regards   the  Application  of  Carbolic  Acid  to  the 

Wound 6 

Nelson,  Dr.  C.  E.,  A  Surgical  Case,  of  severity,  treated 

without  the  intervention  of  Carbolic  Acid 7 

Nelson,  Dr.  C.  E.,  On  the  local  After-treatment  of  Oper- 
ations      30 

Nelson,  Dr.  C.  E.,  Fracture  of  the  Cervix  Femoris,  exter- 
nal to  the  joint,  in  a  lady  71  years  old,  weighing  over 

200  pounds  ;  Cure,  by  bony  union 32 

Nelson,  Dr.  C.  E.,  On  the  True  Position  of  the  Bladder 
in  the  Male,  and  a  FewThoughts  on  Passing  the  Cathe- 
ter, both  as  regards  Drawing  of  Urine,  and  as  regards 

"Sounding"  for  Stone 103 

Nelson,   Dr.  C.  E  ,  On  Some  Points  of  Contemporary 

Interest 173 

Nelson,  Dr.   C.   E ,   Dangerous  Inhalation   of  Nitrous 

Oxide  Gas 193 

Nelson,  Dr,  C.  E.  Noeggerath's  Operation 219 

The  Canada  Medical  Association 265 

Wood,  Dr.  Casey  A.,  The  Qiiestion  of  Prostitution,  and 

its  Relations  to  the  Public  Health 49 

PR0ORE8S  OF  MEDICAL  SCIENCE, 

Abnormally  High  Temperature,  Cases  of 133 

Abscesses,  .Management  of  D.-ep 131 

Abscesses,  New  Treatment  of. 260 

Aching  Kidney,  i)y  J.  JJ-  Duncan,  M.D 124 

Acute  RliPMMiatism 197 

Acute  Rheumatism,  Benzoate  of  Sodium  in  the  Treat- 
ment of 26^ 

Acute  lUieumaiisra,  Treatment  of 132 

Adlvtrcfit  Placenta,  Diagnosis  of 233 

An-itvoniK,  Sulphate  of  Copper  in  Tic  Douloureux 2156 

Amvnorrlioea 303,305 

An  Opinion  as  to  Quinine  i^  Pneumonia 296 

Anfi-Piiritic  Roinpdies.,... i 281 

Arsenic  as  a  Bkiofi  and  'Cardiac  Tonic,  On  the  Use  of..    33 
Bad      Odor    somftiims    Associated    with     Excessive 
Sweating  of  the  Feet,  On  the  Cause  and  Treatment 

of 258 

Beef  Suppositories 307 


PAGE 

Benzoate  of  Soda  in  Whooping  Cough 296 

Bilious  Head-aches, 140 

Bismuth  Ointment 185 

Blood-Letting,  An  Opinion  on 258 

Bright's  Disease,  The  Treatment  of 286 

Bromide  of  Ethyl  as  an  Anaesthetic 182 

Bromide  of  Elliyl,  Death  from 174 

Cancer,  Chian  Turpentine  in  the  Treatment  of 181 

Carbuncles,  Carbolic  Acid  for 285 

Cardiac  Dyspnoea,  Iodide  of  Potassium  in 280 

Chilblains •. 208 

Chloride  of  Barium  in  Internal   Aneurism,   Probable 

value  of 124 

Chorea,  Treatment  in 133 

Chronic  Eczema,  The  Treatment  of 16 

Clinical  Lecture  on  Burns,  by  R.  J.  Lewis,  M.D 34 

Cod-Liver  Oil  in  Phthisis  and  Bronchitis 209 

Cod  Liver  Oil  in  Epilepsy 307 

Collodion  Bandage  in  the  Treatment  of  Umbilical  Her- 
nia,      40 

Compulsory  Vaccination  in  France 261 

Constipation,  The  Treatment  of 15 

Consumption,  The  Treatment  of 257 

Cough  in  Bronchitis  and  Phthisis,  Treatment  of. 208 

Cough  Produced  by  Accumulations  in  the  Ear 40 

Croton  oil  Treatment  of  Ringworm,  Notes  on  the 63 

Cystitis 208 

Cystitis,  Treatment  of 284 

Diabetes  Insipidus  treated  with  Ergot 118 

Diseases  of  Childhood,  The  Advantages  of  Calomel  in 

the 247 

Diseases  of  Children,  Recent  Progress  in  the  Treatment 

of 224 

Disea>es  of  Women,  Aids  to  127,  153 

Displacements  of  the  Uterus  in  General,  Causes  of 281 

Double  Pneumonia  and  Abortion 184 

Dropsy  and  Unemic  Convulsions  during   Pregnancy, 

The  Treatment  of.  222 

Ear-ache  and  Chloroform  Vapor 41 

Eczema,  The  Treatment  of 221 

Effectat  a  Distance 9 

Elixir  Chloroformi  Compositus 283 

Epilepsy,  Prof.  Ball's  Prescription 18^ 

Epilepsy,  The  Treatment  of 194 

Kpilepsy,  Treatment  of 126 

Epistvxis,  Surgical  Treatment   of 119 

Epislaxis  cured  by  Blisters 307 

Ergot  iu  Neuralgia 306 

Ergotin  as  a  Cough-Sedative,  Hypodermic  Injection  of  285 

Erysipelas,  The  Abortive  Treatment  of. 231 

Excessive  Lochial  Discharges,  Treatment  in  Oases  of...   132 

Fishbones,  To  Remove 261 

Fissure  of  the  Anus,  Treatment  of 284 

Fissueoflhe  Rectum  with  Constipation 229 

Flatulence,    Acidity,  and   Pyrosis,    Glycerine   in   the 

Treatment  of. 233 

For  Fresh  Cold  in  the  Head ..  296 

Functional  Cardiac  Disturbances,  On  Various  Forms  of  122 


CONTENTS. 


111. 


PAGE 

Functional  Cardiac  Disturbances,  On  Various  Forms  of, 

by  Beverley  Robinson 114 

Gastric  Ulcer,  by  Herbert  W.  Little,  M.D 141 

■Glandular  Sore  Throat,  Treatment  of 165 

Glycerin  in  Flatulence,  Acidity  and  Pyrosis,  On 131 

Gonorrhoea,  Formula  in 41 

Gonorrhoea,  On  a  New  Method  of  Arresting 277 

Gonorrhcea,  Rules  for  Injection  in 133 

GonoiThoea,  Treatment 9 

Haemorrhagic  Diathesis,  Chlorate  of  Potash  in  the 252 

Headache,  and  the  Remedies  proposed 273 

Headache,  Remedies  for 256 

Hemoptysis 232 

Housemaid's  Knee,  Treatment  of 64 

Impacted   Cerumen,  On  the   Cerebral  Symptoms  Pro- 
duced by 10 

Improvement  of  Sayre"s  Treatment  for  Spinal  Curva- 
ture   306 

Incontinence  of  Urine  in  Boys 250 

Indigestion  and  Heartburn,  Treatment  of 259 

Inunction  of  Castor  Oil  as  a  Purgative,  The  276 

Inveterate  Epilepsy  Successfully  Treated  by  Ergot  and 

Bromide  of  Sodium,  by  J.  R.  Boaudry,  M  D 37 

Iodoform  and  Goitre 183 

Iodoform  in  Chancroid,  How  to  Use 182 

Iodoform,  Cure  of  Ozoena  by 286 

Iodoform,  To  Mask  the  Odor  of 16 

Itch,  Ointment  for 64 

Lacerated  Perineum,  Prevention  of. 280 

London  Letter 12 

Mammary  Abscess,  Treatment  of 232 

Management  of  the  third  Stage  of  Labor 29G 

Maternal  Impressions 307 

Measles,  Lecture  on 177 

Measles,  The  Cool  Air  and  Water  Treatment  of  185 

Menorrhagia  and  Metrorrhagia,  Treatment  of. 234 

Midwifery  and  Gynaecology.  The  Prevention  and  Treat- 
ment of  Post  Partum  Hemorrhage Ill 

Morphine  on  Puerperal  Eclampsia 306 

Nervous  Dyspepsia 201 

Nocturnal  Incontinence   of  Urine,  Treatment,  by    Dr. 

Kelp 64 

Official  Account  of  Typhoid  Outbreaks  at  Lennoxville...   134 

Ophthalmia  Neonatorum 279 

Opium  Habit, — a  Possible  Antidote,  The 180 

Ovarian  Dyspepsia    129 

Oxalate  of  Cerium  as  a  Cough  Remedy 141 

Peritonitis,  A  Lecture  on 175 

Pharmacy,  Explosive  Combinations  in 121 

Post-Nasal  Catarrh,  Tne  Treatment  of 161 

Post  Partum  Hemorrhage,  Hot  Water  Injections  for...  257 

Post-Partum  Hemorrhage,  Treatment  of ...  279 

Pruritus  Vulvae 285 

Pulse,  The 201 

Quinia  in  Obstetrics 10 

Ranula,  The  Treatment  of. 165 

Rest  after  Delivery 301 

Ringworm  of  the  Scalp 183 

Salicylic  Acid,  A  Menstruum  for 280 

Scarlatina  in  Children,  Treatment  of 164 

Scour  Weed 285 

Sea-bathing,  Hints  on 139 

-Seminal  Emissions,  Treatment  of. 154 

Sick-room,  Heat  and  Light  in  the 39 


PAOg 

Sore  Nose,  Liniment  for 40 

Sprains,  Treatment  of 254,  280 

Sterility,  Treatment  of 129 

Stigmata  of  Maize 300 

Strongest  Man  in  the  WorM,  The 183 

Strong  Odors  from  the  Hands,  Removal  of 185 

Sulphur  for  Pimples  on  the  Face 306 

Suberine  in  Excoriated  Nipples K3 

Sulphide  of  Calcium  in  the  Treatment  of  Suppurating 

Buboes 130 

Summer  Diarrhoe.a,  The  Treatment  of 184 

Summer  Diarrhoea  of  Children 204 

Syphilis  in  Married  Life 298 

Telephony,  The  Wonders  of 286 

Tetanus  :  Study  of  Four  Hundred  and  Fifteen  Cases....  123 

Tetanus,  The  Origin  of 140 

The  Cause  of  Death  at  the  Several  Epochs 16 

Therapeutical  Employment  of  Iodoform 306 

Throat  and  Lungs,  For  Treatment  of  Diseases  of  the....  208 

Tincture  of  Iron,  To  Disguise  the  Taste  of. 278 

Tobacco,  Therapeutic  Uses  of 259 

Tooth-caries  of  Pregnancy 163 

Tubercular  Consumption,  On  the  Treatment  of 155 

Treatment  of  Leucorrhoei  in  Children 296 

Treatment  of  Diabetes  Mellitus 297 

Treatment  of  Pneumonic  Fever,  by  the  Wet  Sheet 303 

Treatment  of  Chronic  Prostatic  Enlargement 304 

Tuberculosis  and  Pregnancy 284 

Typhoid  Fever,  Ice  to  the  Abdomen 143 

Typhoid  Fever,  Remarks  on  some  points  in  the  Treat- 
ment of 243 

Ulcers,  Treatment  of 281 

Urine  in  Children,  Incontinence  of 62 

Uterus  with  Carbolic  Lotion  after  Delivery,  The   Pro- 
phylactic Washing  out  of  the 10 

Vaginitis,  Dr.  J.  M.  Duncan 38 

Varicocele  and  its  Treatment 284 

Weak  Spines  in  Young  Girls  and  their  Treatment 227 

Why  we  eat  Oysters  raw 142 

EDITORIAL. 

Administration  of  Ergot  in  Labor 144 

A  New  Gold  Medal 18 

Animal  Vaccine,  how  it  is  Propagated 65 

An  Omission 69 

Another  Dodge 210 

A  Novel  Prescription 167 

A  Proposed  New  Plan  to  Disinfect  Sewers 211 

Bishop's  College  School,  Lennoxville 235 

Canada  Medical  Association 24,211,234 

Cascara  Sagrada 240 

College  of  Physicians  and  Surgeons,  Province  of  Que- 
bec  ." 22,  69,  167,  236,  287 

Correction 211 

Correspondence 8,  110,  271,  273 

Death  of   Mr.  Stephen  S.  Alford,    F.R.C.S.,   London, 

England 263 

Decision  Respecting  the  Rights  of  Qualified   Ontario 

Druggists  Practising  in  the  Province  of  Quebec 186 

Dr.  Robert  Nelson 63 

Electricity  in  the  Treatment  of  Exophthalmic  Goitre...  234 

Elixir  Ferri  et  Calcis  Phosph.  Co 213 

Ergotine:  Its  Inconveniences  and  Dangers 211 

Gymnastics  as  a  Cure  of  Disease 21- 


\S).r^n^ 


iv. 


CONTENTS. 


PAOB 

How  to  Restore  the  Scale  of  Thermometers 211 

Important  Question 261 

Iodide  of  Ethyl  in  Asthma 235 

Lactopeptine 239 

Laval  Mrdicnl  Faculty 41 

Lawlon's  Absorbent  Cotton H'-' 

Literary  Note  from  the  Century  Co.,  N.Y 287 

London  Correspondence 119 

McGill  University,  Meeting  of  Convocation 191 

Medical  Schools 19 

Medico-Chirnrgical  Society  of  Montreal 47,  72 

Nana's  Daughter 208,  239 

Xew  York  Sanitary  Engineer 239 

Obituaries 43,  44,  144 

Paris  Green 19 

Persona! 20,  43,  216,  236 

Practical  Physiology 18 

Preliminary  Examination  College  Physicians  and  Sur- 
geons, P.Q 107 

Proposed  Protestant  Lunatic  Asylum 166 

Saccharated  Pepsin 308 

Tenth  Convocation  of  the  Medical  Faculty  of  Bishop's 

College 1^7 

The  Bogus  Dii)loma  Business  in  Philadelphia 210 

The  Bridal  Eve 287 

The  Case  of  Psoriasis  Lepraformis 67 

The  Issue  of  the  August  Number 287 

The  Mackinnon  Pen  or  Fluid  Pencil 239 

The  Montreal  General  Hospital 209 

The  Popular.Science  Monthly 212 

The  Popular  Science  Monthly  for  August,  1881 263 

To  our  Subscribers 63,  233,  308 

To  Preserve  the  Brain 213 

To  Test  House  Drains 235 

Trommer's  Extract  of  Malt 43 

Typhoid  Fever  at  Bishop's  College  School,  Lennoxville    67 

University  of  Bishops  College 262 

Woods'  Library  of  Standard  Medical  Authors  for  1881  192 

Woman's  Hospital 17 

Woman's  Hospital,  Annual  Report 107 

Wyeth's  Dialised  Iron 203 

Wyeth's  Elixir  of  Gentian  with  Tincture  of  Chloride  of 

Iron 288 

Wyeth's  Elixir  of  Phosphorous 212 

Wyeth's  Fluid  Extract  of  Ergot 167 

Wyeth's  Peptonic  Pills 187 

Wyeth's  Vinum  Cibi 239 

REVIEWS. 

A  Manual  of  Minor  Surgery  and  Bandaging,  by  Chris- 
topher Heath 71 

American  Newspaper  Directory  for  1880,  by  Geo.  P. 
Rowell  &  Co 45 

Aphorisms  in  Fractures,  by  R.  0.  Cowling,  M.D 210 


45 
4S 

47 

09 
4d 
46 


PiGB 

A  Treatise  on  Bright's  Disease  and  Diabetes,  with  Espe- 
cial Reference  to  Pathology  and  Therapeutics,  by 
James  Tyson,  M.D 264 

A  Treatise  on  Common  Forms  of  Functional  Nervous 
Disease,  by  L.  Put/el,  M.D 21 

A  Treatise  on  Diphtheria,  by  A.  Jacobi,  M.D 70 

A  Treatise  on  the  Practice  of  Medicine  for  the  use  of 
Students  and  Practitioners,  by  Robert  Bartholow, 
M.D 71 

Cutaneous  and  Venereal  Memoranda,  by  Henry  G. 
Piffard,  M.D 

Diseases  of  the  BIa<lder  and  Urethra  in  Women,  by 
Alexander  J.  C.  Skene,  M.D 

Eyesight,  Good  and  Bad  :  a  Treatise  on  the  Exercise 
and  Preservation  of  Vision,  by  Robt.  Brudenell 
Carter 

How  Persons  Afflicted  with  Bright's  Disease  ought  to 
live,  by  Joseph  F.  Edwards,  M.D 

Lessons  in  Gynecology,  by  Wm.  Goodell,  M.D  

Lindsay  &  Blakiston's  Visiting  List 

Medical  Heresies,  historically  considered  :  a  series  of 
critical  essays  on  the  origin  and  evolution  of  Secta- 
rian Medicine,  embracing  a  special  sketch  and  review 
of  Ilomocopatliy  past  and  present,  by  Gonzalvo  C. 
Smythe,  M.D 

On  the  Construction,  Organization  and  General  Ar- 
rangements of  Hospitals  for  the  Insane,  with  some 
Remarks  on  Insanity  and  its  Treatment,  by  Thomas 
S.  Kirkbride,  M-D 

Ophthalmic  and  Otic  Memoranda,  by  D.  B.  St.  John 
Rosa,  M.D 

The  Bacteria,  by  Dr.  Autoine  Magnin 

The  Compend  of  Anatomy,  by  John  B.  Roberts,  M.D.... 

The  Druggist's  Hand  Book  of  Private  Formulas,  by 
John  H.  Nelson 

The  Hygiene  and  Treatment  of  Catarrh,  by  Thos.  F. 
Rumbold,  M.D 

The  Hygiene  of  Catarrh,  by  Thomas  F.  Rumbold,  M.D.. 

The  Micro£copist:.a  Manual  of  Microscopy  and  Com- 
pendium of  the  Microscopic  Sciences  :  Micro-Minera- 
logy, Micro-Chemistry,  Biology,  Histology,  and 
Practical  Medicine,  by  J.  H.  Wythe,  M.D 

The  Practitioner's  Reference  Book,  by  Richard  J. 
Dunglison,  M.D 

Therapeutics  of  Gynecology  and  Obstetrics,  by  Wm.  B. 
Atkinson,  M.D  

The  Transactions  of  the  American  Medical  Association. 

"  The  Trials  of  Raissa  : "  a  Russian  Love  Story,  by 
Henry  Greville 

Transactions  of  the  American  Gynoecological  Society, 
Houghton,  Mifflin  &  Co 

Births 

.Marriages 24 

Deaths 144,  168 


45- 


214 

45 

288 

47 

70 

263 

0  0 


70 

70 

46 
47 

70 

20 

288 


THE  CANADA  MEDICAL  RECORD 


Vol.  IX. 


MONTREAL,  OCTOBER,   1880 


No.   I 


O  OIsTTElsTTS. 


ORIGINAL  COMMUNICATIONS. 


Pagb 

Repoit  on  Sanitary  Science,  by  Dr. 
Botsford,  of  at.  John,  N.B.,  1— The 
After-Treatment  of  Operations,  as 
regards  the  application  of  Carbolic 
Acid  to  the  Wound,  by  Dr.  C.  E. 
Nelson  of  Xew  York,  6 — A  Surgi- 
cal case  of  Severity,  treated  with- 
out the  intervention  of  Carbolic 
Acid,  by  C.  E.  Nelson,  N.Y.,  7— 
Correspondence,  8 — Antiseptic 
Surgery  vs.  Listerism 9 


PROGRESS  OF  MEDICAL  SCIENCE 

Paob 

Treatment  of  Gonorrhoea,  9 — Effect 
at  a  distance,  9 — The  Prophylactic 
Washing  out  of  the  Uterus  with 
Carbolic  Lotion  after  Delivery,  10 
— Quinia  in  Obstetrics,  10 — On  the 
Cerebral  Symptoms  produced  by 
Impacted  Cerumen,  10 — London 
Letter,  12— The  Treatment  of  Con- 
stipation, 15— The  Cause  of  Death 
at  the  several  Epochs,  16 — To 
Mask  the  Odor  of  Iodoform,  16 — 
The  Treatment  of  Chronic  Eczema.l7 


EDITORIAL. 


Paoi 

Vol.  IX.,  17— Woman's  Hospital,  17 
— Practical  Physiology,  18 — A  new- 
Gold  MedalL  18— Medical  Schools, 
19— Paris  Gfreen,  19— Personal,  20 
— Pamphlets,  &c.,  Received,  20 — 
Books  held  over  for  Review,  20— 
Reviews,  20— Report  of  the  Semi- 
Annual  Meeting  of  the  College  of 
Physicians  and  Surgeons  of  Que- 
bec, 22 — Canada  Medical  Associa- 
tion— Report  of  the  Committee  on 
Necrology,  24 — Married 24 


0F4§inai  Bammunkaitoft^ . 

REPORT  ON   SANITARY  SCIENCE. 

By  Dr.  Botsford,  of  St.  John,  N.B.  Read  before  the 
Canada  Medical  Association  at  its  Meeting  in  Ottawa, 
September  ist,  i88o. 

In  accordance  with  the  request  of  the  Associa- 
tion at  its  last  meeting,  I  have  the  honor  to  submit 
a  few  remarks  upon  the  subject  of  Sanitary  Science, 
and  in  doing  this  will  confine  myself  to  the 
relationship  of  State  legislation  to  hygiene,  ad- 
ducing a  few  facts  to  shew  the  result  of  wise  inter- 
ference. 

Hygiene,  as  its  derivation  denotes,  touches 
upon  the  health  and  soundness  of  the  body,  and 
it  embraces  in  its  consideration  all  the  rules  and 
conditions  which  tend  to  the  well-being  of  men, 
whether  these  relate  to  the  individual,  to  commu- 
nities, or  to  a  nation  at  large. 

Hygiene  refers  rather  to  the  physical  conditions, 
and  though  these  may  be  much  influenced  by  the 
moral  surroundings,  and  act  and  re-act  upon 
them,  yet  the  moral  phase  comes  more  under  the 
consideration  of  another  department,  that  of 
Social  Science. 

It  is  somewhat  remarkable  that  man  should  have 
devoted  so  much  energy  to  fathom  the  unseen  and 
the  spiritual,  and  yet  only  of  late  has  directed  his 
attention  to  the  physical  laws  which  minister  to 
his  health  and  happiness,  or  which  undermine  his 


vitality  and  usefulness.  With  a  strange  fascination 
he  endeavors  to  soar  into  the  regions  of  the  mys- 
terious and  leave  unconsidered  the  tangible,  which 
has  so  much  to  do  with  his  daily  life. 

Many  of  us  can  remember  how  much  time  was 
devoted  to  the  languages,  ancient  and  modem,  how 
much  to  mathematics,  to  natural  philosophy,  and 
how  the  relation  of  the  body  to  what  was  touching 
it  on  every  side  formed  no  part  of  education  :  and 
even  now  our  educational  systems  and  institutions 
of  learning  are  greatly  deficient  in  teaching  the 
hygienic  conditions  which  envelope  us.* 


Subject  of  Question. 


Public  Hygiene 

State  Preventive  Medicine. 

Private  Hygiene 

Special  Inst'ns  in  Hygiene 
Full  Course  Hygiene 


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4 

39 

23 

25 

5 

34 

3 

13 

o 


Per  Centages 
of 


o     • 
-a  t; 

c 


c 


16 

19 

14 

23 
46 


17-74 
6.45 

3709 
8.06 
4.84 


.c  o 

°  2 

o 

■o 


82.21 

93-55 
62.91 

91.92 
9514 


Centennial,  Bowditch,  p.  285. 
23  Medical  Colleges. 


Public  Hygiene 

State  Preventive  Medicine. 

Private  Hygiene 

Special  Professorships . 

Full  Course 

Subsidiary  Course  .... 


9 

10 

4 

39 

7 

12 

4 

36 

9 

10 

4 

39 

5 

18 

21 

5 

'7 

I 

21 

II 

II 

I 

47 

60 

69 

60 

78 
78 

52 


Results  from  62  Colleges  exclusive  of  Medical  Colleges. 


THE   CANADA    MEDICAL    RECORD. 


The  cultivation  of  the  laws  of  personal  hygiene 
may  well  be  left  to  the  individual  ;  they  will  force 
themselves  upon  the  notice  of  men  as  the  progress 
of  civilization  gives  clearer  views  of  the  require- 
ments of  life,  and  as  a  rule  the  individual  will  con- 
form to  the  demands  of  what  is  expedient 
though  this  is  often  too  woefully  neglected.  But 
whilst  with  the  individual  the  general  education 
may  suffice  to  produce  good  results,  it  is  otherwise 
with  communities.  We  enter,  in  their  case,  upon  a 
more  complicated  state.  We  have  superinduced 
upon  the  personal  rights  the  rights  of  property,  and 
the  rights  and  liberties  of  our  fellow  citizens.  These 
must  be  consulted,  ai^  to  accomplish  an  interference 
with  private  rights  we  must  send  for  aid  from  the 
ftowers  which  make  the  laws  for  the  general  good- 
Our  first  knowledge  of  what  may  be  beneficia^ 
or  what  may  be  injurious  will  largely  depend  upon 
personal  experience,and  this  gradually  accumulating 
will  form  the  basis  of  commercial  action.  Bit  to 
enable  a  community  to  act  and  to  avail  itself  of 
knowledge  thus  accumulated  there  must  be  power 
derived  from  and  delegated  by  the  general  govern- 
ment.* 

This  delegated  or  compulsory  power  which  is 
to  be  sought  from  the  Legislature  of  a  country 
will  be  granted  in  proportion  to  the  hygienic 
knowledge  attained  by  the  members  composing 
the  body  which  makes  our  laws.  And  as  we 
cannot  expect  a  stream  to  rise  above  its  source,  so 
if  among  our  legislators  there  is  an  ignorance  of 
the  conditions  conducive  to  wealth,  just  in  tha^ 
proportion  will  they  fail  in  their  duty  to  their 
country.  Looking  at  our  law-makers  we  at  once 
recognize  them  as  persons  who  in  their  education 
were  not  thrown  into  contact  with  hygienic 
teaching.  It  did  not  form  a  part  of  the  genera] 
education  of  their  times,  and  however  well  in- 
formed in  other  respects,  and  however  some  few 
may  and  do  keep  abreast  of  the  times  in  general 
matters,  yet  in  the  direction  of  hygiene  there  is 
much  ignorance  which  shuts  out  a  due  considera- 
tion of  its  demands. 

It  is  being  too  wise  to  be  so  far  ahead  of  the 
times  as  to  attempt  to  prematurely  force  upon  a 
people  things  which  under  certain  conditions  may 
be  right  if  not  expedient.     It  is,  however,  far  from 


•  r.ut  after  a  state  has  been  formed  it  would  seem  to  be 
one  of  its  first  duties,  as  the  sovereign  guardian  of  the  lives 
and  health  of  the  people,  to  look  into  all  the  influences,  good 
and  bad  bearing  upon  health.— Bowditch,  Centennial  Ad- 
dress, p.  641. 


being  wise  to  lag  behind  in  the  progress  of 
civilization,  and  to  allow  communities  and  nations 
to  endure  loss  of  life,  loss  of  property  and  loss  of 
morality  by  ignoring  the  plain  demands  of  duty. 

It  is  not  necessary  to  enter  into  numerous  de- 
tails to  show  the  importance  of  the  results  involved 
in  the  adoption  of  sanitary  legislation,  but  I  wil^ 
content  myself  with  a  few  prominent  facts  in  con- 
nection with  it. 

The  following  are  taken  from  the  37th  Report 
of  the  Registrar  General  of  England,  and  are  the 
results  of  accurate  observation  extending  through 
a  number  of  years,  and  cannot  be  looked  upon  as 
the  guess-work  of  theorists.*     The    observations 


*  Thirteen  districts  of  England  and  Wales,  shewing 
some  improvement  in  the  annual  rate  of  mortal- 
ity in  the  three  decades  1841-50,  1851-60,  and 
1861-70. 


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Much  good  may  be  derived  from  a  study  of  the  stalls- 


THE    CANADA   MEDICAL    RECORD. 


-embrace  13  districts  in  different  counties  of 
England  and  Wales,  extend  over  three  decades 
from  1840-187 1,  and  concern  about  600,000 
people.  They  show  the  improvement  in  the 
annual  rate  of  mortality  during  the  thirty  years. 
The  first  decade,  1841-50,  the  rate  per  1000 
averaged  26.54.  The  second  decade,  1851-60,  it  fell 
to  24.75,  and  in  the  third  it  fell  to  21.76,  or  nearly 
5  per  1000  less,  or  an  annual  saving  of  3000  lives. 

The  report  says:  "The  district  of  North 
Witchford  (Cambridge)  affords  a  striking  instance 
•of  the  important  results  that  can  be  attained 
through  health  administration.  The  average 
annual  mortality  fell  from  27  per  thousand  in 
1841-50  to  21  in  1851-60,  and  to  20  in  1861-70. 
In  the  four  years  187 1-4  the  results  are  still  more 
remarkable,  the  mortaHty  being  reduced  to  17  per 
thousand" — a  saving  of  150  lives  each  year  in  a 
population  of  15,000. 

"  In  Whittlesey  (same  county)  a  steady  improve- 
ment in  the  mortality  is  also  discernible,  from" 2  5 
per  thousand  in  1841-50,  to  19  per  thousand  for 
4  years,  187 1-4." 

"In  Wlsbeck  (Cambridge),  in  1866,  the  town 
was  supplied  ^ath  pure  water,  and  extensive 
sewerage  works  are  now  completed.  The  annual 
■death-rate  of  this  district  has  been  reduced  from 
25  per  thousand  to  19  per  1000  in  187 1-4.  The 
gieat  land  drainage  works  have  had  great  influence 
in  improving  the  health  of  the  inhabitants  of  the 
city."  In  the  death  rate  from  phthisis  the  average 
annual  mortality  per  thousand  in  the  decade 
1851-60  being  2,  whereas  in  the  ten  years  1861- 
70  it  was  reduced  to  1.6,  nearly  25  per  cent. 


upon  the  causes  of  the  difference,  whether  it  comes  from  race, 
climate,  food,  clothing  or  social  habits. 

Richardson  quotes  statistics  taken  from  a  work  titled 
*' Effective  Population  of  the  World  :  " 

"  Of  10,000  children  bom  in  Norway  7,415  live  to  be  20 
years  of  age.  In  England,  6,627.  In  United  States  boys 
have  nearly  as  good  a  chance  as  in  England,  girls  have  not. 
In  France  5,022.  In  Ireland  4,855,  or  less  than  one  out 
of  two  attain  that  age."  Out  of  the  same  10,000  in  Norway 
more  than  i  out  of  3  reach  70.  In  England  i  out  of  4. 
In  France  I  out  o'  S}4.     In  Ireland  i  out  of  11)4. 

"  Ib  Norway  a  larger  proportion  of  infants  survive  than 
in  any  other  country,  and  when  grown  up  display  the 
greatest  power  of  endurance." 

A  1000  years  spent  in  the  growing  period  produce  63  per 
cent,  more  of  working  life  among  the  Norwegians  than 
among  the  Irish,  and  13  per  cent,  more  than  among 
American  men. 

— Richardson,  Ministry  of  Health. 


"  In  Orsetts  (Essex)  the  remarkable  reduction 
in  the  death-rate  during  the  thirty  years"  1841-70 
is  partly  due  to  sanitary  improvements,  but 
mainly  to  the  drainage  of  the  land  and  consequent 
tics  of  different  nations,  and  when  these  statistics  differ  an 
examination  of  the  different  conditions  might  throw  light 
dryness  of  the  soil.  *  In  the  4  years  187 1-4  the 
mortality  was  only  1 7  per  thousand,  and  phthisis 

decreased  from  2.8  to  1.9  in  1861-70. 

"  In  the  district  of  Salisbury  (Wilts)  before  any 
improvements  were  made  the  annual  death-rate  in 
1841-50  was  28  per  thousand.  In  1855  an  excel- 
lent system  of  drainage  was  in  operation,  and  the 
district  supplied  with  pure  water,  so  the  annual 
rate  was  reduced  in  1851-60  to  24  per  thousand, 
and  in  the  following  decade  to  20  per  1000. 

"  In  Wolverhampton  the  annual  mortality  has 
fallen  from  28  in  the  ten  years  1851-60  to  24  in 
the  four  years  187 1-4.  In  1865  the  town  was 
entirely  resewered,  and  a  more  wholesome  water- 
supply  obtained,  but  much  remains  to  be  done  to 
put  Wolverhampton  in  a  good  hygienic  state. 

"  Kingston-upon-Hull  presents  another  exam- 
ple of  the  good  effect  of  sanitary  measures.  The 
annual  rate  of  mortaHty  in  the  ten  years  1841-50 
was  81  per  1000." 

An  investigation  shewed  that  the  drainage  was 
bad,  and  the  water,  derived  from  the  river  Hull, 
received  the  sewage  of  such  places  as  Driffield  and 
Beverly. 

The  local  board  incorporated  in  1851  began 
sanitary  improvements.  From  1851-60  the  mor- 
tality was  reduced  to  25.  In  1864  the  river  water 
was  abandoned  and  water  from  the  springs  of  the 
Chalk-wolds  introduced.  The  mortality  from  187 1- 
74  was  25  per  thousand. 

In  the  parish  of  Merthyr  Tydfil,  in  South  Wales, 
the  results  of  sanitary  works  are  thus  recorded  by 

Mr.  Dyke  : 

I  St.  Before  the  works  were  "|  33 

begun,    eleven    years,    1845-  r  P^"" 


55- 


1000 


*  Drainage,  Moisture  and  Phthisis. 

Three-quarters  of  all  these  (his  own)  patients  have 
resided  where  dampness  of  the  soil  is  a  prominent  charac- 
teristic. Somewhat  less  than  one-quarter  have  resided  in 
dry  places.     Cent.  p.  458. 

Moisture  of  the  soil  is  the  only  known  characteristic 
which,  as  far  as  our  investigations  have  gone,  is  connected 
with  the  consumptive  breeding  districts,  p.  460. 

The  same  conclusion  was  arrived  at  by  Dr.  Buchanan  in 
England,  who  suggested  that  dampness  of  soil  is  an 
important  cause  of  phthisis  to  the  population  living  upon 
the  soil. 


TllK    CANADA    MEDICAL   RECORD. 


2nd.  During  paving  inspec- ")  28 

tion    and   nuisance    removal,  >-  per 

1856-61.                                      )  1000 

3rd.  After  the    addition   of  )  26 

water  supply  and  during  main  >•  per 

drainage,  1862-65.                      )  1000 

4th.  While       drainage      of^  25 

houses   was  being  effected,  7  >•  per 

years,  1866-72.                           )  1000 

Owing  to  epidemics  of  small-pox  in  '72,  enteric 
fever  '73,  and  contagious  fevers  '74,  it  rose  to  27 
l)er  thousand. 

It  must  be  observed  that,  though  these  epidemics 
prevailed,  the  death  rate  was  6  per  thousand  less 
under  such  unfavorable  circumstances,  being  a 
saving  of  600  people  annually  in  a  population  of 
100,000. 

The  report  further  shews  what  under  favorable 
conditions  was  the  death-rate  of  two  districts, 
Glendale  and  Rothbury,  in  which  for  30  years, 
from  1840-71,  the  annual  mortality  was  at  the  low 
average  of  15  per  thousand.  In  Rothbury  a  third  of 
the  population  is  employed  in  healthy  occupations 
connected  with  agriculture.  The  district  of  Roth 
bury  contains  several  large  parishes.  That  of  Al- 
vinton,  with  a  population  of  1,200,  had  a  death-rate 
of  7.5  per  thousand,  and  in  1874  only  six  deaths 
were  registered,  or  a  rate  of  only  5  per  1,000.  In 
187I;  the  birth-rate  was  32.4,  and  only  two  deaths 
under  one  year  occurred.  True,  these  are  very 
exceptional  cases,  and  it  may  not  be  within  the 
bounds  of  possibility  to  effect  the  same  results, 
generally  ;  they,  however,  demonstrate  that  these 
are  disturbing  elements  which  should  be  more  or 
less  eliminated  by  wise  regulations. 

We  will  bring  to  your  notice  one  more  fact,  and 
that  connected  with  Montreal,  the  largest  city  in 
our  Dominion.  According  to  the  returns  made  in 
his  excellent  report  by  Dr.  Larocque,  the  death- 
rate  of  that  city  during  7  years,  1872-8,  averaged 
34  per  one  thousand.  And  if  there  is  no  reason 
why  Montreal  should  necessarily  have  a  death-rate 
so  much  above  other  cities,  then  we  must  conclude 
that  1300  lives  are  annually  sacrificed  to  ignorance 
and  indifference  on  the  part  of  some  one.* 


*  The  number  of  deaths  in  Montreal  has  been  and  still  is 
large,  and  commented  uj)on  by  Dr.  Larocque,  whose  exper- 
ience is  similar  to  that  quoted  from  Bowditch. 

"A  former  physician  of  Boston  used  to  say  that  Boston 
could  be  kept  free  from  small-pox.  if  it  were  not  for  Maine 
immigmnjs.  This  assertion,  though  not  strictly  true,  illus- 
trates the  utter  inability  of  a  State  to  defend  itself  in  case 
one  adjacent  to  it  fails  of  its  duty  in  regard  to  vaccination. 


It  is  not  necessary  to  accumulate  facts  for  the 
information  of  this  Association.  Its  members  are 
sufficiently  acquainted  with  the  details  of  this  sub- 
ject. It  is  sufficient  to  say  that  the  number  of 
deaths  which  arise  from  imperfect  knowledge  of 
hygiene  or  a  violation  of  its  teachings,  and  which 
might  be  prevented  by  the  introduction  of  wise  and 
suitable  laws,  cannot  be  less  than  10,000  annually, 
and  I  consider  this  to  be  a  low  estimate. 

This  undue  mortality  does  notarise  in  our  cities 
only,,  where  people  are  crowded,  and  the  causes  of 
disease  intensified,  but  will  be  found  to  exist  in 
the  country  districts.  Any  one  conversant  with 
the  habits  and  mode  of  life  of  our  rural  population,, 
and  the  disregard  of  the  conditions  of  health,  will 
readily  acknowledge  this. 

We  would  consider  a  drain  of  10,000,  from  our 
country  to  swell  the  productive  forces  of  another 
people  as  something  to  be  deplored,  something  to 
be  strongly  commented  upon  by  our  guardians  of 
the  press  or  in  politics,  and  yet  there  is  little  heed 
given  to  the  fact  that  this  number  annually  die  in 
our  midst  unnecessarily,  and  to  our  public  detri- 
ment;  nor  is  this  all  :  we  must  add  to  the  loss  from 
diminished  numbers  that  which  arises  from  a 
large  amount  of  disease  which  should  not  exist, 
were  it  not  for  the  depressing  agencies  at  work. 

The  study  of  hygiene  is  not  and  should  not  be 
confined  to  one  profession,  though  we  are  supposed 
to  be,  par  excellence,  the  guardians  of  the  public 
health,  but  should  form  a  part  of  the  general  edu- 
cation of  the  people  ;  and,  as  the  regulations  neces- 
sary to  ensure  hygienic  conditions  must  proceed 
from  the  body  politic,  ignorance  there  will  defeat 
any  attempt  to  introduce  compulsory  rules,  and 
we  must  first  educate  our  law-makers  to  secure  a 
thorough  foundation  for  the  general  good. 

When  we  take  into  consideration  the  subjects 
discussed  in  our  Legislatures,  the  time  devoted 
to  maintain  the  rights  of  citizens  in  the  smallest 
matters ;  when  we  calculate  the  relative  cost  and 
value  of  such   debates  (and  we  do   not  condemn 


I  see  no  remedy  for  this,  save  a  National  .\ct  for  compulsory 
vaccination."     Cent.  Add.  p.  73. 

"  Of  small-pox, which  in  the  commencement  of  the  centen- 
nial period  (1776)  spread  like  wildfire,  carrying  panic  intol- 
erable with  it,  we  may  say  that  only  the  folly  of  individual 
men,  and  utter  neglect  on  the  part  of  the  State,  or,  as  in 
Canada  at  the  present  time,  the  frenzy  of  bigotry  and  of  baes 
ignorance  alone  prevent  us  from  extirpating  tlie  disgusting, 
disease  from  the  face  of  our  portion  of  the  earth." — Centen- 
nial Address,  p.  93. 


THE    CANADA    MEDICAL    RECORD. 


nor  despise  the  watchful  care  of  our  representa- 
tives in  such  minor  points.)  ;  when,  I  say,  we  con- 
sider the  importance  attached  to  these,  or  it  may 
be,  the  time  annually  spent  on  the  onslaught  of  the 
outs  upon  the  ins,  the  defence  of  the  respective 
parties  in  every  Legislature  throughout  the  Domin- 
ion,— it  is  truly  marvellous  that  hygiene  should 
receive  so  little  consideration.  And,  moreover, 
when  we  look  at  what  has  been,  and  is  now,  doing 
in  the  old  country,  it  is  strange,  it  is  passing 
strange,  that  in  this  new  country  we  should  shut 
our  eyes  to  the  necessities  of  the  times,  and  ignore, 
nay,  reject,  the  experience  of  the  Old  World. 

In  accordance  with  a  recommendation  of  the 
Association,  a  committee  drew  up  a  scheme  for 
the  registration  of  health. 

1st.  Shewing  the  information  which  it  was  pro- 
posed to  obtain.  2nd.  The  method  by  which  it 
was  to  be  obtained.  3rd.  How  it  might  be  utilized. 
4th.  The  benefits  which  would  be  derived  from  it. 
5th.  And  that  the  cost  would  not  exceed  $5000. 
I  wrote  to  a  Senator  requesting  his  support  to  this 
scheme  if  it  should  be  brought  before  the  Legisla- 
ture. His  reply  was  most  favorable  as  far  as  he 
was  personally  concerned,  but  stated  that,  though 
the  subject  was  "  of  great  importance  "  "  some  of 
its  members  think  there  is  too  much  legislation." 

Why,  Mr.  President  and  Gentlemen,  the  State  of 
Michigan  puts  to  shame  the  apathy  of  our  Domin- 
ion. In  that  State,  with  a  population  of  1,200,000  in 
1870  they  are  carrying  out  a  system  of  returns 
which  will  enable  them  to  solve  many  of  the  ques- 
tions connected  with  the  vital  problems  of  the 
country.  Not  merely  is  the  profession  engaged 
in  it,  but  hygiene  has  become  a  State  movement, 
and  I  hold  in  my  hand  a  report,  the  seventh  issued 
by  the  "  State  Board  of  Health."  *  And  yet  in  our 
Dominion,  with  a  population  of  4,000,000,  there, 
has  been  no  general  action  taken. 

It  is  true  that  Quarantine  has  been  recognized. 
Even  in  the  Province  of  New  Brunswick,  ninety 
years  ago,  laws  respecting  infectious  diseases  were 
enacted,  boards  of  health  were  provided  to  enforce 
quarantine.  Houses  could  be  entered,  and  people 
removed  to  hospitals,  vessels  placed  in  quarantine 
and  funds  provided  when  necessary.  All  this  was 
done  in  the  case  of  infectious  diseases,  which,  being 


*The  State  Board  of  Health  "  shall  from  time  to  time  re- 
commend standard  works  on  the  subject  of  hygiene  for  the 
use  of  schools  of  the  State,"  by  Act  of  1873.  Mich. — State 
Board  of  health.  P.  5  and  6 


palpable  and  visible  in  their  results,  made  men 
anxious  to  stamp  them  out.  They  acted  up  to 
their  knowledge.  And  yet  there  are  the  unseen 
agencies  at  work  which  are  destroying  yearly,  nay 
monthly,  more  of  our  people  than  any  open  plague 
wasting  at  noon-day,  and  it  is  because  men  are 
unconscious  of  the  pestilence  that  walketh  in  dark- 
ness that  no  efforts  are  made  to  combat  with  the 
insidious  enemy. 

In  New  Brunswick  we  have  a  residence  for  our 
Governors,  built  at  a  cost  of  about  $100,000,  and 
with  annual  expenses  of  from  S5000  to  $8000.  Last 
year  one  Governor  died  unexpectedly,  and  other 
members  of  his  family  suffered  from  sickness. 
This  year  our  present  Governor  barely  escaped 
with  his  hfe.  The  cause  was  very  evident :  the 
building  was  foul  with  sewage-gas,  and,  though 
there  were  drains  originally,  they  were  choked  and 
never  had  been  protected  by  traps  against  the 
return  of  gas. 

As  a  profession  we  have  clearly  and  frequently 
brought  this  subject  of  vital  statistics  before  the 
country,  and  no  blame  can  attach  to  us  if  efforts 
are  not  being  made  to  do  away  with  the  annual 
loss  of  10,000  lives.  Yet  as  citizens  we  have  to 
blush  for  our  Dominion,  which  either  from  ignor- 
ance or  wilfulness  neglects  to  grapple  with  this 
momentous  question. 

A  system  of  vital  statistics  is  necessary  to  enable 
us  to  ascertain  the  death-rate  of  a  people.*  It 
enables  us  to  ascertain  the  localities  where  it  is  in 
excess,  it  enables  us  to  ascertain  the  causes  which 
lead  to  that  excess,  and  it  enables  us  to  apply  such 
remedies  as  will  do  away  with  noxious  elements. 
Such  a  system  involves  no  violation  of  private 
rights  but  such  as  the  individual  should  cheerfully 
surrender.  It  trenches  upon  none  of  any  section 
of  society  but  which  should  yield  to  the  public 
good.  It  does  not  interfere  with  the  moral,  the 
spiritual  or  ecclesiastical  regulations  of  any  body 
of  men.  It  asks  for  data  respecting  marriages, 
births,  deaths  and  the  causes  of  death,  and  left 
undone  throws  the  responsibility  of  the  unnecessary 
sacrifice  of  10,000  hves  upon  those  who  oppose 
and  those  who  refuse  the  necessary  legislation. 

I  repeat  that  as  a  profession  our  gamients  are 
clear,  but  as  members  of  a  general  self-governing 


*  "  Until  accurate  registration  of  vital  statistics  is  thor- 
oughly carried  out,  it  obviously  will  be  impossible  to  have 
an  efficient  system  of  State  preventive  medicine." — Centen- 
nial Address,  p.  67. 


THE   CANADA   MEDICAL   RECORD. 


people  the  blood  of  10,000  human  beings  lies  at 
our  door. 

In  conclusion,  I  would  direct  the  attention  of 
the  younger  members  of  the  profession  to  the 
splendid  field  which  is  now  open  to  some  one  of 
them.  I  know  of  no  otlier  in  which  a  man  may 
attain  a  similar  prominence.  The  subject  of  pre- 
ventive medicine,  inasmuch  as  it  strikes  at  the  very 
roots  of  disease,  must  in  the  future  be  associated 
(in  this  Dominion  at  least)  with  any  man  who 
brings  to  a  successful  issue  the  principles  involved 
in  it.  To  a  general  culture  he  must  add  large  pro* 
fessional  attainments,  and  then  be  content  with  a 
life  of  hard  work,  little  remuneration  and  much 
obloquy.  But  if  he  has  the  strong  will  to  sacrifice 
self  and  present  prospects  he  may  attain  to  pro- 
minence among  his  fellows.  Most  certainly  will  his 
memory  be  associated  with  his  work  after  genera- 
tions have  passed  away,  and  he  will  be  remem- 
bered by  his  country  when  there  will  be  none  so 
interested  a ;  to  brush  the  dust  from  the  inscriptions 
which  record  the  birth  and  death  of  the  most  pro- 
minent among  us. 


THE  AFTER-TREATMENT  OF  OPERA- 
TIONS, AS  REGARDS  THE  APPLICA- 
TION OF  CARBOLIC  ACID  TO  THE 
WOUND. 

By  Dr.  C,  E.  Nelso.n  of  New  York. 

I  believe  it  is  generally  conceded  that  when  any 
new  modus  operandi  is  floated  in  the  medical 
world,  members  of  the  profession  are  permitted 
to  relate  their  experience  of  and  views  concerning 
it  in  the  journals  that  are  set  apart  for  the  use 
of  the  profession.  Being  a  private  practitioner, 
I  have  not  the  field  to  investigate  in  that  is  afford- 
ed in  a  hospital,  still,  having  seen  and  practised 
surgery  more  or  less  for  seventeen  years,  I  would 
like  to  offer  my  quota  (such  as  it  is)  on  the  use  of 
carbolized  applications  to  surgical  wounds. 

Before  starting  out  on  this  paper,  I  would  like 
to  premise  (especially  for  the  younger  readers), 
that  when  a  new  treatment  has  been  supposed(or 
even  shown)  to  be  generally  successful — the  idea 
is  no  other  treatment  can  possibly  succeed  in  the 
same  class  of  cases — such  is  the  opinion  of  a  large 
number  of  medical  men ;  and  this  has  never  been 
so  much  exemplified  (in  all  medical  history)  as  in 
this  present  instance  of  the  use  of  carbolic  acid. 

That  thousands  of  wounds  have  done  well,  and 
healed   quickly    without    the   use    of  carbolized 


applications  nobody  will  deny  ;  this  has  been  at- 
tested down  through  all  the  ages,  as  any  person 
can  see  for  himself  if  he  consult  the  celebrated 
authors  of  those  times.  In  our  own  time,  and  in  all 
countries,  surgical  practitioners  can  recall  many 
(dozens)  of  their  own  cases  that  have  healed 
quickly  and^done  well  (no  pyaemia,  or  other  com- 
plications occurring)  without  the  use  of  carbolic 
acid. 

The  "  points  "  of  carbolic  acid,  according  to 
those  who  favor  its  use,  are  (I)  that  one  can  almost 
surely  count  upon  terribly  bad  wounds  getting 
rapidly  well,  in  almost  the  same  time  as  simple 
wounds  under  ordinary  and  previous  treatments  ; 
(II)  that  wounds  and  compound  fractures  which 
might  frighten  a  surgeon,  in  regard  to  prognosis, 
are  simplified  and  rendered  easy  of  treatment  by 
the  above-mentioned  agency.  As  a  deduction  from 
this  latter,  or  rendered  in  a  sub-paragraph,  (III) 
that  there  is  little  or  no  danger  of  pyo-hoemia 
being  apprehended  then.  (IV)  That  then  there 
would  be  no  danger  of  other  patients'  wounds  in 
the  same  ward  being  infected.  (V)  That  this  is  a 
short,  easy  and  royal  road  to  preventing  and  putting 
a  stop  to  erysipelas,  erythema,  and  other  cognate 
blood  diseases  ;  and  that  lastly  (VI)  the  time  of 
healing  surgical  wounds  is  thereby  materially,  if 
not  vastly,  shortened. 

I  think  I  have  placed  these  "  reasons  "  in  the 
order  of  their  importance  to  the  surgeon  and  the 
patient.  Let  us  now  dispassionately  view  the 
field,  and  see  how  many  of  our  forces  (our  six 
regiments  I  may  say)  we  can  count  upon. 

(I) 

This  first  section  treats  of  a  very  wide  fields 
almost  appalling  in  its  vastness — and  what  young 
fledged  beginners  shall  say,  that  he  knows,  not,  as 
much,  but  more,  than  the  celebrated  men  who  have 
gone  before,  and  who  are  even  his  contemporaries  ? 

Instead  of  wearying  the  reader's  patience  with 
writing  pages  on  this  section,  I  will  proceed  to  the 

(11) 

The  ideas  and  facts  comprised  in  this  section, 
also  comprise  a  large  intellectual  field  ;  here,  I  am 
sorry  to  say,  I  shall  be  obliged  to  dwell  a  little. 

Take,  first  of  all,  the  compound  fractures,  which 
fifty  years  since  would  have  been  adjudicated 
upon  as  proper  subjects  of  amputation  [let  me 
admit,  please,  in  the  premises,  that  carbolized 
appliances  answer  as  well  as  anything  hitherto  has, 
or,  perhaps,  even  better] ;  supposing  there  were  na 


THE   CANADA   MEDICAL    RECORD. 


carbolic  acid  what  would  we  do.  After  putting  up 
the  limb,  secundum  artem,  extracting  foreign  bodies 
if  we  thought  the  arterial  circulation  were  not  too 
far  damaged,  we  might  follow  one  of  two  practices  : 
(A)  seal  up  the  wound,  from  the  outside  air,  or 
adopt  certain  devices,  to  keep  the  wound  in  (what 
wedoctors  call)  a  "  healthy  condition." 

A 

Sealing  up  the  wound. — This  manner  has  been 
known  and  practised  from  time  immemorial ;  there 
are  very  many  ways  of  doing  it  ;  by  pouring  in  bal- 
samic preparations  ;  preparations  of  white  of  tgg  ; 
washing  with  wine,  etc.  This  is  old-fashioned,  but 
recently,  a  Scotch  doctor  made  up  a  compound, 
poured  it  into  his  compound-comminuted  frac- 
tures, and  declared  it  acted  marvelously  ;  Richard- 
son, of  London,  says  he  can  do  as  much  with  his 
styptic  colloid  (this  controversy  occupied  the 
London  journals  for  a  long  time).  Many  of  us  know 
that  collodion,  poured  upon  a  wound,  as  well  as  a 
cut,  will  ensure,  in  many  instances,  a  complete 
•cure  ;  a  rag  or  piece  of  lint  dipped  in  blood  often 
acts  in  a  very  satisfactory  manner  ;  and  to  this 
end  all  the  old-time  compress  and  bandage  treat- 
ment. 

(B) 

Other  means,  practised  formerly  in  hospitals, 
as  well  as  in  private. — A  very  important  point  is 
what  is  termed  cleanliness,"  /.  e.,  not  allowing  pus 
and  other  secretions  to  collect  to  too  great  an 
extent  on  a  woundj  to  this  effect  were  devised 
frequent  changing  of  wraps,  frequent  wetting  with 
water,  or  medicated  lotions ;  changing  often  the 
rags  ;  substituting  French  charpie  for  English  lint ; 
using  tow  to  absorb  the  pus  ;  irrigating  the  wound 
from  a  height  by  a  wet  strip  of  rag,  from  a 
pitcher,  as  I  have  seen,  etc. — Thus,  have  many 
brilliant  cases  been  secured,  without  the  use  of 
carbolic  acid. 

(Ill) 

As  regards  pyoemia,  this  might  be  regarded  as  a 
corollary  from  the  preceding  paragraph ;  but,  in 
my  opinion,  "pyoemia"  depends  very  much  on  the 
surgeon  who  conducts  the  case. 

(IV) 
Danger  of  infection. — If  carbolic  acid  acts  as 
a   useful  disinfectant  it  certainly  should  be  used. 

(V) 
Cuts   short   all  blood-infecting  diseases. — This 
remains  to  be  seen  ;  a  good  deal  can  be  done  in 
this  way,  by  isolating  the   cases  ;  but  still,   in  a 


hospital,  where  time  and  trouble  are  important 
factors,  it  would  be  well  to  try  it — although  I 
think  that  a  good,  smart  doctor  might  steer  his 
patients  through,  without  any  blood  complications. 

(VI) 

Time  of  healing. — This,  I  certainly  and  most 
emphathically  deny.  I  could  cite  (like  many 
others)  any  number  of  cases  that  have  been 
healed  in  as  short  (or  shorter)  time  than  was  eveJ 
seen  under  carbolic  acid. 

I  don't  like  speaking  about  myself,  but,  by  way 
of  illustration,  to-day  I  removed  the  wraps  (dress- 
ings) for  the  first  time,  of  a  case  of  cancer 
mammae,  which  was  removed  six  days  ago :  at 
time  of  excision  no  ligatures  of  vessels,  no  sutures, 
and  no  sponging  were  employed  ;  to-day,  when  I 
turned  back  the  wraps,  not  a  sign  of  redness  of  flaps, 
or  surrounding  parts  ;  no  ecchymosis  ;  there  had 
not  been  a  drop  of  secondary  hemorrhage,  or 
even  venous  oozing;  and,  on  pressing  point  of 
finger,  centripetally,  from  three  inches  from 
incision  towards  incision  itself,  not  one  drop  of 
pus  could  be  made  to  exude  :  all  this  in  six  days ; 
and  the  line  of  incision  seemed  (by  the  "  pulling  " 
test  that  I  employ)  to  be  perfectly  healed  ;  how- 
ever, for  the  surety,  the  plaster-strips,  compress 
and  bandage  (no  water  or  carbolic  acid)  were  left 
on  for  two  or  three  days  longer,  when  I  expect 
a  complete  cure  by  agglutination,  without  any 
external  devices.  [I  might  diverge  here  into  (i) 
the  employment  of  sutures,  (2)  sponging,  etc., 
but  refrain.] 

I  may,  parenthetically,  remark,  that  no  drainage 
tubes,  horsehairs,  syringing  daily  with  carbolic 
acid  solutions,  counter-openings,  were  made  use 
of. 


A  SURGICAL  CASE,  OF  SEVERITY, 
TREATED  WITHOUT  THE  INTER- 
VENTION OF  CARBOLIC  ACID. 

By  C.  E.  Nelson,  New  York,  Oct.  3,  1880. 

I  timidly  venture  to  send  the  following  case  to 
the  journals,  interesting  to  a  certain  extent,  in  two 
ways,  (i)  showing  the  recuperative  power  in  a 
patient's  own  self  (or  in  other  words  "  conservative 
surgery  " — another  phrase  for  letting  things  alone), 
and  (2)  that  a  severe  surgical  case,  where  death 
was  expected  in  a  few  days,  can  be  cured  without 
the  intervention  of  carbolic  acid. 

Miss  George,  a  rather  portly  lady,  75  years  old, 


8 


THE   CANADA    MEDICAL   RECORD. 


while  closing  an  outside  shutter  (blind)  one  windy 
night,  had  it  catch  her  on  the  back  of  her  hand. 
Thinking  it  a  small  matter,  she  applied  simple 
things,  but,  in  a  fortnight's  time,  the  hand  was  in 
such  a  serious  condition  that  a  doctor  (namely, 
myself)  was  sent  for  ;  the  condition  was  as  follows 
(July,  1880):  erysipelas  (intensely  deep  red  color) 
of  hand  and  forearm,  almost  up  to  elbow ;  swell- 
ing of  hand,  semi-oedematous,  more  on  the  back 
than  in  the  palm ;  had  had  shivering,  previously  ; 
now  a  slight  fever,  great  weakness  ;  mind  tranquil, 
but  e\idently  averse  to  any  exertion  that  was  not 
strictly  necessary  ;  a  good  deal  of  pain,  but,  as  she 
bore  pain  well,  bystanders  did  not  think  she  suf- 
fered as  much  as  was  really  the  case. 

The  case  was  one  evidently  of  phlegmonous 
erysipelas  ;  I  told  her  I  thought  the  only  thing  to 
be  done  was  to  make  good  incisions.  The  night 
(10  p.m.)  of  that  same  day,  I  took  up  my  old  friend 
Dr.  Sheppard  (of  thirty  years'  large  practice,  both 
surgical  and  medical),  who  gave  chloroform,  while 
I  made  one  incision  on  dorsum  which,  according 
to  him  would  empty  out  the  whole  thing  ;  but  my 
opinion  was  that  three  or  four  incisions  would  be 
necessary.  We  left  her,  he  telling  me  that  she  would 
not  live  more  than  four  days  ;  it  certainly  looked  bad. 
In  about  three  days  as  that  incision  had  done 
no  good,  no  pus  having  come  out,  I  took  him  there 
again,  patient  anaesthetized  a  second  time,  and  I 
effected  four  good  (/.  e.  very  deep  and  long)  incisions 
over  the  metacarpals,  merely  on  the  dorsum  ;  then 
applied  a  common  poultice  (although  I  do  not  like 
poulticing  as  a  general  rule),  telling  her  at  the 
time  her  life  was  hanging  by  a  thread  ;  after 
this,  pus  exuded  in  abundance,  but  did  not  seem 
to  relieve  her  condition  ;  some  nights  she  was 
flighty.  I  then  intimated  to  her  that,  although  she 
might  get  well,  the  chances  were  against  her,  and 
that  I  should  consequently  advise  amputation  of 
forearm  (as  I  did  not  wish  to  get  blamed,  although 
I  had  a  little  inkling  in  my  own  mind  that  she 
might  possibly  pull  through) :  to  this  she  would  not 
consent,  preferring  death  unmaimed  ;  I  answered 
"  very  well,  you  will  have  to  die."  Now  for  the  treat- 
ment and  the  anatomical  condition  of  the  hand.  In 
about  ten  days  or  so,  I  le't  off  poulticing  (as  I  am 
not  in  favor  of  that  mode  of  treatment  if  one  can 
possibly  do  without),  and  kept  hand  wet  with 
double  rag,  dij^ped  in  dilute  nitric  acid  lotion 
(hospital  strength,  of  old  fashioned  times — 20  years 
ago)  every  hour,  as  it  was  intensely  hot  weather, 
and  the  wraps  soon  dried— temperature  of  circum- 


ambient air  was  between  90°  and  100°.  The  poulti- 
cing had  the  effect  of  causing  the  whole  top  (dor- 
sum) of  the  hand  to  slough  off,  nothing  to  be  seen 
but  the  tendons  (of  the  extensors).  For  the  first 
few  days,  dorsal  veins  of  hand  (venous  arch)  were 
still  discernible  ;  they  then  shrivelled,  and  finally 
sloughed  away,  like  the  other  tissues.  Now,  here 
was  a  practical  question  :  if  she  got  well,  what  use 
could  she  expect  of  her  hand  ;  and,  another,  where 
was  the  skin  to  come  from  with  which  to  cover  the 
same  ? 

I  was  then  taken  sick  myself,  and  did  not  .see 
her  for  some  weeks  afterwards,  when  I  found  that 
the  natural  .skin  had  stretched  (or  relaxed)  over 
back  of  hand,  and  in  centre  was  a  longish  red 
cross  (cicatricial  tissue)  which  will  very  likely 
soften,  and  get  paler,  inside  of  a  year. 

Her  arm  and  her  life  were  saved  ;  and  I  should 
suppose  if  there  ever  were  a  case  where  carbolic 
acid  would  be  tried,  this  would  be  one  of  them. 

The  motions  of  her  fingers  are  still  limited,  but 
will  doubtless  improve  in  time.  During  my  atten- 
dance, the  smell  from  the  hand  was  perfectly  ter- 
rible— yet  even  so,  I  did  without  the  carbolic 
acid. 


'/ei 


To  the  Editor  of  Canada  Medical  Record. 

Sir, — In  reading  the  Star  the  other  evening,  I 
noticed  a  paragraph  describing  an  operation  per- 
formed by  a  surgeon  of  this  city.  The  operation 
was  so  described,  and  the  description  given  of  the 
tumour  so  minute,  that,  were  it  not  for  the  well 
known  aversion  of  the  operator  in  question  to 
public  puffing,  one  would  have  supposed  he  had 
given  the  details  to  the  reporter. 

This,  following  .so  shortly  after  a  similar  puff  of 
an  operation  performed  in  one  of  our  hotels,  makes 
one  think  that  the  practice  is  in  quite  accordance 
with  the  rules  of  Medical  etiquette. 

Perhaps  these  rules  are  meant  only  to  be  applied 
when  the  older  men  are  giving  wise  lectures  to  the 
younger  fry  in  what  they  should  or  should  not  do ; 
much  in  the  same  way  that  some  parsons  tell  their 
parishioners,  "  don't  do  as  I  do,  but  do  as  I  tell 
you."  In  a  good  many  instances,  this  appears  to 
have  been  the  custom  in  this  city. 

If  a  younger  practitioner  should  be  guilty  of 
allowing  his  name  to  appear  in  connection  with 


THE   CANADA    MEDICAL    RECORD. 


9 


an  operation,  he  would  be  condemned  as  unprofes- 
sional, but  those  who  should  set  the  example 
appear  to  enjoy  an  immunity  from  blame. 

It  would  be  well,  and  at  the  same  time  it  would 
avert  suspicion,  if  any  surgeon,  under  the  same 
circumstances,  would  caution  his  friends  and  ad- 
mirers, that  such  puffing  is  excessively  annoying, 
and  partakes  of  quackery.  Not  only  does  it  give 
a  bad  example  to  younger  men,  but  the  public 
also  have  a  vague  suspicion  that  self-advertising 
lurks  somewhere  beneath  the  surface. 


Yours  truly, 


Critic. 


ANTISEPTIC  SURGERY  vs.  LISTERISM. 
To  the  Editor  of  the  Canada  Medical  Record. 

Dear  Sir, — In  your  excellent  report  of  the 
discussion  which  followed  the  reading  of  Dr. 
Kingston's  paper  on  the  "  Treatment  of  Surgical 
Wounds,"  at  the  meeting  of  the  Canada  Medical 
Association,  I  am  reported  as  saying,  that  I  "  had 
confidence  in  antiseptic  surgery."  This  is  quite 
true ;  but  to  the  casual  reader  it  might  be  regarded 
as  endorsing  Listerism.  Nothing  could  be  more 
opposite  to  my  conviction  and  belief,  in  fact,  my 
knowledge.  On  this  point,  as  on  almost  every 
other.  Dr.  Kingston  in  his  most  admirable  essay 
exactly  expresses  my  views.  To  carry  out  Dr. 
Kingston's  principles  is  to  practice  antiseptic 
surgery  on  correct  physiological  grounds,  and 
not  on  visionary  theories  of  germ  putrifaction.  In 
fact  I  have  little  patience  with  those  who,  availing 
themselves  of  the  teaching  of  Hilton,  Poget,  and 
I  may  add  of  Gamgre  and  others,  and  by  securing 
the  requirements,  by  a  hocus  poais  proceeding 
necessary  to  allow  nature  to  do  his  work  of  heal- 
ing and  restoration  of  tissue,  endeavor  to  make  it 
appear  that  it  is  by  the  use  of  germicides  and  the 
exclusion  of  gernis  that  success  is  secured. 
Listerism  disports  itself  in  the  robes  of  anti- 
septicism  ;  but  the  latter  is  founded  on  physiological 
and  pathological  grounds,  while  the  former  is  a 
passing  fashion  in  the  practice  of  our  profession, 
meanwhile  beneficial  to  the  inventor  and  retailers, 
but  only  ephemeral,  like  all  fashions. 

In  respect  to  the  organization  of  a  blood  clot 
which  it  is  claimed  Listerism  will  secure,  I 
remarked  that  when  a  clot  did  become  organized, 
it  was  not  blood  but  fibrin  colored  by  haematine. 
This   I  have   often   seen    take   place  under    the 


antiseptic  treatment  of  rest.,  ventilation  and  clean- 
liness. 

Yours  very  truly, 

Wm.  Canniff,  M.D.,  M.R.C.S. 
Toronto,  Oct.,  1880. 

J^PO^r-d'S  O'fJiiedkai  Scieme, 

TREATMENT  OF  GONORRHCKA, 

Dr.  Law,  of  Greeley,  Colorado,  recently  re- 
commends the  following: 

I^     Tannici  acidi 1  ounce. 

Aquae  purae 6  ounces. 

Mix.     Sig.     Inject  as  specified. 

Introduce  a  number  six  or  seven  catheter 
beyond  the  point  of  soreness  in  the  urethra, 
having  had  the  patient  urinate  first,  for  the 
purpose  of  washing  out  the  accumulated  mat- 
ter; direct  him  to  make  firm  pressure  on  the 
tract  of  the  urethra  beyond  the  point  of  the 
instrument.  Now  take  a  common  rubber  bulb 
syrirge,  and  by  means  of  a  bit  of  elastic  rubber 
tubing,  connect  the  catheter  and  syringe,  and 
wash  out  the  urethra  with  cold  water,  in  a 
thorough  manner.  Press  the  syringe  bulb  with 
force,  80  that  the  return  cui*rent  of  water  will 
flow  out  at  the  meatus,  around  the  catheter, 
with  considerable  force.  Finally  inject  the 
tannin  solution  in  the  same  way.  Eepeat  twice  u 
day,  gradually  weakening  the  solution  of  tannin 

With  this  plan  faithfully  carried  out,  the 
doctor  claims  that  the  disease  rarely,  if  evei. 
passes  beyond  the  original  site  of  the  fossa 
navicularis — may  sometimes  be  actually  cured 
in  three  days.  Stricture  in  the  niembranouE 
portion  of  the  urethra  is  thus  avoided,  because 
the  disease  is  not  allowed  to  invade  it.  If  the 
urine. is  acid  and  irritating,  he  ordei'S  alkalies, 
as  bicarbonate  potassium,  etc. — Philadelphia 
Medical  Reporter. 


EFFECT  AT  A  DISTANCE. 
A  correspondent  writes  to  the  British  Medicdl 
Journal,  relating  the  case  of  a  female  patient 
who  "  was  never  troubled  with  after-pains." 
When  asked  how  she  prevented  their  occurrence, 
she  said  that,  in  accordance  with  the  advice  of 
a  "  woman  from  America,'  she  had,  during  her 
last  two  labors,  put  some  steel,  in  the  shape  of 
carpenter's  tools,  under  her  bed,  and  had  had  no 
after  pains,  thouirh  formerl}'  she  had  suffered 
very  much.  The  correspondent  relates  a  parallel 
case,  that  of  an  old  lad}^  subject  to  cramps  in 
the  extremities  at  night,  which  she  prevents  by 
having  a  piece  of  rock-sulphur  placed  in  her  bed. 
If  this  is  removed,  even  unknown  to  hei',  she 
is  sure  to  suffer.  "  So  much  is  now  written 
about  metal lo- therapy,"  says  the  correspondent, 
"  that  if  any  of  your  readers  can  give  an  ex^>l6- 
nation  of  the  above  cases  they  will  oblige." 


10 


THE    CANADA    MEDICAL    RECORD. 


THE  PROPIIYLACTrC  WASTIIXG  OUT  OF 
THE  UTERUS  WITH  CARBOLIC  LOTION 
AFTER  DELIVERY. 

Professor  Stiidfoldt,  of  Coponha^en,  contri- 
Lutcs  a  paper  on  this  Rulijeot  to  No.  7  of  the 
Ceniralhhttt  fur  Gynakologie,  1880.  He  states 
that  the  previous  communication  in  No.  5  of  the 
Cnifrall'ldtt  (reported  bjunin  the  Medical  News 
ami  Abstract  for  May,  1H80,  p.  302)  led  him  to 
communicate  some  observations  on  the  applica- 
tion of  an  antiseptic  treatment  modified  to  suit 
lying-in  women.  The  author  has  employed  this 
method  since  1870  with  ever-increasing  energ}-, 
and  communicated  a  paper  on  "  Maternities, 
their  Organization  and  Administration,"  to  the 
Brussels  Congress,  in  which  he  publishes  his 
experiences.  In  that  communication  the  author 
was  able  to  state,  that  in  the  quinquennium 
1870-74  the  mortality  in  the  Copenhagen  Uni- 
Tersity  lying-in  institution  had  been  reduced  to 
1  in  87,  whilst  the  majority  during  the  three 
previous  quinquennia  varied  from  1  in  37  to  1 
in  14,  and  had  at  no  single  quinquennium  during 
the  long  existence  of  the  institution  been  nearly 
so  low.  The  relation  is  still  more  favorable  in 
the  last  quinquennium  1875-79,  since  of  5098 
lying-in  women  only  44  died  of  puerperal  fever, 
i.  e.  1  in  116.  This  result  the  author  considers 
more  favoraltle  than  can  be  presented  by  any 
similar  lying-in  institution  wlaich  receives  pa- 
tients from  all  the  hospital  quarters  of  a  town, 
as  well  as  from  the  workhou.ses,  in  which  pri- 
mi])ar8e  are  decidedly  in  the  majorit}-.  The 
author  contends,  that  not  only  the  mortality 
but  the  morbility  of  the  patients  is  diminished 
by  the  antiseptic  precautions.  The  method 
adopted  by  the  author  is  methodical  washing 
out  of  the  vagina  before  delivery,  the  applica- 
tion of  carbolic  vapor  spray  during  the  delivery, 
and  intra-uterine  injections  with  carbolic  lotion 
after  deliveiy.  The  author  expresses  his  aston- 
ishment that  the  application  of  carbolic  spray 
has  found  so  little  acceptance  inl3Mng-in  institu- 
tions, Htatiiig  that  in  the  Copenhagen  Maternity 
it  has  been  four  years  in  use  for  every  labor, 
without  having  caused  any  injurious  results  to 
mother  or  child.  He  states,  also,  that  its  appli- 
eation  causes  so  little  trouble  that  he  cannot  see 
■why  a  mcthed  so  reasonable  for  a  lying-in  insti- 
tution should  be  summarily  pushed  aside.  The 
spray,  must  be  commenced  from  the  moment 
when  the  parts  of  the  child  begin  to  show  them- 
selves at  the  vulva  until  any  tears  which  may 
have  occurred  during  the  delivery  in  the  vulva 
are  united  by  suture,  and  the  genital  opening  is 
covered  with  a  layer  of  prepared  jute.  The 
intra-uterine  washings  after  deliver}-  have  been 
found  specially  berieticial  under  certain  condi- 
tions, although  he  has  only  used  three  p.  c.  so- 
lution, but  in  large  quantity.  He  has  never  ob- 
served any  evil  results  from  these  injections  in 
liundredw  of  cases.     He    does  not  recommend 


such  injections  in  every  case,  however,  but  only 
when  the  hand  or  instruments  have  been  intro- 
duced into  the  pa.ssages,  or  when  remains  of 
membranes  have  been  retained  in  the  uterus.  A 
brief  account  of  twelve  cases  is  given  in  sup- 
port of  the  advantage  derivable  from  the  use  of 
intra-ulerine  injections. — Edinburjh  Med.  Jour- 
nal, June,  1880. 


QUINIA  IN  OBSTETRICS. 

A  correspondent  of  the  Louisville  Medical 
News  says  that,  in  his  experience,  puerperal 
fever,  abscess  of  the  breast,  phlegmasia  dolens, 
and  the  like,  may  be  prevented  with  almost 
absolute  certainty  by  the  administration  of 
quinia  prior  and  subsequently  to  childbirth. 
Iron  is  often  a  valuable  ally  of  quinia,  and 
should  be  used  freely. 


ON  THE  CEREBRAL  SYMPTOMS  PRO- 
DUCED BY  IMPACTED  CERUMEN. 

Bj  William  A.  Hammonp,  M.D.,  Professor  of  Diseases  of  the 
Mind  and  Nervous  System  in  the  University  of  the  City 
of  New  York.  (Reai  before  the  New  York  Neurological 
Society,  November  4th,  1878.) 

There  is  nothing  new  in  the  fact  that  impacted 
cerumen  in  one  or  both  ears  is  capable  of  giving 
rise  to  notable  disturbances  of  cerebral  and 
nervous  action,  but  the  circumstance  does  not 
seem  to  have  attracted  the  attention  it  deserves, 
except  perhaps  so  far  only  as  the  sense  of  hear- 
ing is  concerned.  Kramer*  does  not  even  men- 
tion the  existence  of  any  brain  symptoms  in 
connection  with  the  disorder  in  question,  though 
specially  detailing  those  exhibited  as  the  result 
of  noises  in  the  ear. 

To3-ubeet,    however,     is   more    explicit — he 
says : 

The  sj'mptoms  of  a  collection  of  cerumen  in 
the  meatus  vary  according  to  the  nature  and 
position  of  the  mass.  Sometimes  the  whole  of 
the  meatus  is  distended  by  cerumen,  the  inner 
end  of  which  lies  in  contact  with  the  outer  sur- 
face of  the  membrana  tympani  of  which  it  forms 
a  cast.  In  these  cases  there  is  often  giddiness, 
from  the  pressure  on  the  chain  of  ossicles.  The 
symptoms  of  pressure  on  the  brair  are  familiar 
to  most  surgeons,  but  it  is  not  generally  known 
that  pressure  on  the  contents  of  the  labyrinth 
produces  somewhat  analogous  symptoms.  A 
mass  of  cerumen  may  force  inwards  the  mem- 
brana tympani  and  the  chain  of  bones  until 
the  base  of  the  stapes  is  pressed  against  the  con- 
tents of  the  vestibule.     In  some  cases  of  this 


*  The  Aural  Surgery  of  the  PresentDay  ;  New  Sydenham 
Society  Publication,  1863. 

t  The  Diseases  of  the  Ear,  their  Nature,  Diagnosis  and 
Treatment.    American  Edition,  I860,  p.  80. 


THE   CANADA   MEDICAL    RECORD. 


11 


nature,  constant  attacks  of  giddiness  occur  ;  in 
others  there  is  a  confusion  of  ideas  and  an 
inability  to  walk  straight,  and  in  a  third  class 
there  is  a  feeling  of  weight  and  pressure  on  the 
head.  These  symptoms  are  often  com  batted 
by  the  use  of  counter  irritants  and  depletion  ; 
but  the  only  proper  remedy  is  the  removal  of 
the  accumulation. 

The  author  then  cites  several  cases  in  which 
cerumen  had  accumulated  in  one  or  both  ears,  in 
only  two  of  which,  however,  were  there  any 
cerebral  symptoms. 

Eoosa*  states  the  prominent  symptoms  of 
inspissated  cerumen  in  the  ears  to  be  sudden 
impairment  of  hearing,  tinnitus  aurium,  vertigo 
and  pain  in  the  ear,  subsequently  he  says  on 
the  authority  of  Prof  Mayer,  that  mental  hal- 
lucinations have  in  rare  instances  been  relieved 
by  the  removal  of  inspissated  cerumen,  and  then 
makes  the  following  interesting  statement :  "  I 
once  saw  a  lady  who,  though  not  regarded  as  a 
person  of  unsound  mind,  seemed  to  be  such,  and 
who  complained  greatly  of  tinnitus  aurium  in 
all  its  varities.  I  found  the  ears  fall  of  impacted 
cerumen  ;  but  she  utterly  refused  to  allow  me 
to  remove  it  and  I  never  saw  her  but  once.  It 
would  have  been  very  interesting  to  show  the 
eifect  of  the  relief  of  the  tinnitus  upon  the 
mental  hallucinations  of  which  she  seemed  to  be 
a  victim." 

With  this  very  brief  reference  to  aural 
authorities,  I  pass  to  the  consideration  of  several 
cases  in  which  notable  cerebral  symptoms  were 
the  immediate  result  of  impacted  cerumen. 

Case  I. — Miss  C,  age  twenty-seven,  consulted 
nie  Sept.  11th,  1866.  I  found  her  suffering 
from  vertigo,  pain  in  the  posterior  region  of  the 
head,  insomnia,  profound  melancholy,  and  hallu- 
cinations of  hearing.  These  latter  were  of  a 
marked  character  and  were  scarcely  ever  absent 
during  the  time  she  was  awake.  They  con- 
sisted of  voices  which  whispered  to  her  words 
of  an  exceedingly  terrible  import,  such  as  "  You 
have  lost  your  soul.  You  have  committed  the 
unpardonable  sin.  You  are  to  vile  to  live.  Go 
and  kill  yourself,"  etc.,  etc.  Sometimes  the 
sentences  were  much  longer,  and  occasionally 
long  speeches  were  apparently  made  to  her. 
More  frequently,  however,  there  was  for  hours 
the  repetition  of  some  one  assertion  of  her  total 
depravity  or  an  order  to  destroy  herself. 

Though  at  first  recognizing  the  hallucinatory 
character  of  these  words,  the  idea  of  their 
reality  was  gradually  forced  upon  her,  and  they 
therefore  became  true  delusions.  She  began 
accordingly  to  conceive  it  to  be  her  duty  to  act 
in  accordance  with  the  advice  she  believed  her- 
self to  be  constantly  receiving,  and  hence  she 
made  a  determined  effort  at  suicide  by  plung- 
ing a  pair  of   scissors  into    her  neck.     Fortu- 


t  A  Practical  Treatise  on  the  Diseases  of  the  Ear,  etc. 
New  Fork,  1873,  p.  147. 


nately  no  serious  organ  was  injured,  and  vigilant 
watching  prevented  a  repetition  of  the  attempt. 
Previous  to  her  coming  under  my  notice  she 
had  been  subjected  to  vigoi-ous  medical  treat- 
ment, consisting  in  the  main  of  cupping  and 
leeching,  blistering,  purging  and  the  adminis- 
tration of  bromide  of  potassium  in  large  doses. 
None  of  these  measures  were  of  any  avail. 
Under  the  idea  that  there  was  uterine  trouble, 
and  that  the  cerebral  symptoms  were  of  reflex 
character,  she  was  sent  to  an  eminent  gynaeco- 
logist, who,  however,  declared  her  generative 
system  to  be  in  good  condition. 

My  attention  was  at  once  attracted  to   the 
ears  by  the  statement  made  by   her  mother, 
that  at  first  there  had  been  some  difficulty  in 
hearing,  though  after  a  little  while  this  had  dis- 
appeared.    I  therefore,  began  my  examination 
of  the  ears,  and  at  once  found  that  both  meati 
were  obstructed  by  large  plugs  of  inspissated 
cerumen.     These  I  softened  by  the  introduction 
of  a  few  drops  of  a  solution  of  bicarbonate  of 
soda  in  glycerine,  and  the  next  daj'  by  injections 
removed  from  the  ears  masses  of  cerumen  as 
large  each  as  a  marble.  The  patient  was  then  kept 
quiet  for  the  remainder  of  the  day,  and  at  bed- 
time  the  sixth  of  a    grain  of  morphine  was 
administered  hypodermically  so  as  to  insure  a 
good   night's    rest.      On  awakening  the    next 
morning  she  announced  an  entii-e  freedom  from, 
dizziness,  and  that  the  voices  whispering  to  her 
were  at  a  greater  distance  than  they  had  been. 
The  delusions,  as  to  their  reality  still,  however, 
continued.     During  the   day  the   pain   in   the 
head  disappeared,  as  did  also  the  voices.     Little 
by   little   the  force   of  the   false    beliefs   w;« 
lessened,  and  after  a   few  days  there  were  no 
further  abnormal,    mental  or   physical  syoip 
toms. 

Case  II. — I.  K.,  a  young  man,  twenty-two  yean 
of  age,  came  under  my  observation  January  20' 
1870,  suffering  from  severe  vertigo,  noises  ia 
the  ears,  deafness,  and  intense  mental  depres- 
sion. These  symptoms  had  come  on  suddenly 
six  days  before,  shortly  after  a  cold  bath  it 
which  the  water  had  entered  the  ears.  Hie 
expression  was  one  of  great  anxiety  ;  there  wae 
an  apprehension  of  impending  evil,  and  he 
walked  the  floor  of  my  consulting  room  with  a 
staggering  gait,  his  hands  pressed  to  his  head, 
and  tears  running  down  his  face. 

On  examining  his  ears,  which  I  was  induced 
to  do  mainly  from  the  facts  that  there  were 
pain,  tinnitus,  and  vocal  resonance  in  addition 
to  the  special  cerebi-al  symptoms,  I  discovered 
that  both  auditory  canals  were  obstructed  with, 
cerumen.  A  few  syringes  of  warm  water 
removed  this,  and  the  symptoms  almost  imme- 
diately disappeared. 

Mr.  X,  a  lawyer  of  Brooklyn,  consulted  me 
about  three  years  since  for  hallucinations  of 
hearing,  together  with  vertigo,  pain  in  ^tbe 
head,  confusion  of  ideas,  insomnia,  and  frequetrit 


12 


THE    CANADA    MEDICAL    RECORD. 


flushings  of  the  fiicc  from  which  he  had  sufTerorl 
for  several  wc(^ivs.  r)n  hi'*  way  to  my  hoiiso  ho 
beard  voices  apparently  savin;'  to  him  "  VVhat 
»  the  use  of  your  ^'oing  tea  |)hycician  ?  You 
arc  of  no  n-o  in  the  wo:Id.  Go  and  jump  into 
liho  river.  Jump  off  ihe  ferryboat;  junij),  jinnp, 
wow;  at  this  very  instant,"  atid  so  on.  Jlo 
>*tHte«l  that  it  was  impiwsiblo  for  him  to  follow 
hi^  profession,  for  that  the  voices  interferred  to 
the  extent  of  piwenting  his  (dearly  distini^uish- 
iug  what  was  beinj^saidin  his  presence.  Kven 
as  he  was  talking  to  me  the  hallucinations  of 
hearing  were  pro-ent  in  full  forct*. 

These  voices  did  not  actually  impose  upon 
ills  intellect,  but  he  stated  that  he  was  conscious 
ef  a  gradually  increasing  inability  to  resist 
accepting  them  as  realities. 

Although  there  were  many  of  the  symptoms 
of  cerebral  liyponfmia  present,  I  was  imluced 
from  the  fact  that  the  disorder  had  come  on 
immediately  after  bathing  in  the  ocean,  during 
which  water  had  entered  the  ears,  to  examine 
these  organs  in  the  very  beginning  of  my  inter- 
view. Both  ears  wore  found  full  of  inspissated 
cerumen.  This  was  thoroughly  softejied  by  the 
solution  of  soda  in  glj'cerine,  and  removed  by 
syringing  with  warm  water.  On  the  instant 
the  voices  ceased  and  the  patient  left,  feeling  as 
he  said  entire  relief  from  his  annoying  symp- 
toms. 

I  heard  no  iiaore  of  this  patient  till  about 
fewo  months  afterwards,  I  read  in  the  news- 
papers of  the  day  that  he  had  been  violently 
abusive  in  court  of  the  judge  on  the  bench,  and 
/lad  been  punished  by  fine  and  imprisonment  for 
contempt,  and  soon  afterward  his  wife  called 
to  tell  me  of  the  trouble  into  which  her  husband 
bad  gotten.  As  she  explained  it  to  me  he  had 
imagined  that  the  judge  was  calling  him  names 
and  cursing  him,  and  had  replied  in  like  manner. 
I  had  no  doubt  that  there  was  an  accumulation 
of  cerumen,  and  that  the  hallucinations  of  hear- 
ing had  returned  in  so  aggravated  a  form  as  to 
convince  the  intellect  of  their  reality.  A  letter 
from  me  to  the  judge  secured  his  release,  and  on 
his  visiting  me  1  found  my  suspicions  confirmed. 
The  impacted  cerumen  was  removed,  and  so  far 
as  1  know  there  has  been  no  recurrence  of  the 
disorder. 

These  aiconl}'  a  part  of  the  instances  in  which 
impacted  cerumen  has  caused  cerebral  symp- 
toms that  have  fallen  under  my  notice,  but  they 
are  t^-pical,  and  nothing  would  be  gained  by 
detailing  the  others. 

Aw  reganls  the  cause  of  noises  in  the  cars  I 
have  no  information  to  offer  except  to  state 
thai  it  is  not  the  mere  stoppage  of  the  external 
meatus  by  impacted  cerumen,  for  such  closure 
does  not  give  rise  to  any  subjective  sensation. 
It  is  true  that  if  the  canal  be  stopped  by  the  fin- 
ger a  .sound  is  heard,  but  this  is  derived  entirely 
from  the  body,  and  is  probably  from  the  action 
«>f  the  heart,  the  circulation  of  the  blood  through 


the  tissues,  muscular  contraction,  etc.  A  cork 
or  other  siibstance  put  into  the  e;ir  so  as  to 
(dose  the  canal  and  left  there  without  being 
held  by  the  hand  doe-i  not  give  rise  to  any 
sound.  If,  however,  the  firiirers  hold  it  in  plac*', 
it  transmits  the  sfmnd  from  tlicrn  as  would  any 
other  solid  substance. — 1\.   Y.  Ifosp.  Gazette. 


LONDON  LETTER. 

Porhajys  Ihe  m'^st  interesting  communication 
made   to  any  of  our  societies   lately  is   that  of 
Dr.  Matthews   Duncan  to  the  Medical  Society, 
on  Anfisr.pfir  Midu-lfery.     So  important  was  it, 
and  listened  to  with  eveiy  attention  by  a  dis- 
tinguished audience,  that  an  abstract  of  it  may 
be  acceptable  to  your  readers.     Being  a  great 
])er.sonal   friend  of    Prof   Lister's,    having   left 
the   northern   metropolis   at  nearly   the  exact 
time  Prof.  Lister  turned  his  stops  south  ward,  it 
might  a  ■priori  bo  sui-miscd  that  Dr.   Duncan 
would  bo  an  advocate  of  the  antise])lic  plan  of 
treatment.      Consequently  a  large   number  of 
practitioners  came   to  hear,  and  also  to  learn 
how  antiseptics  are  applied  to  every-day  mid- 
wifery.     Dr.    Duncan    commenced    by   saying 
that  there   is  no    subject  which  excites   more 
professional   interest  or  more   interest  among 
the    general    public    than    that   of    puerperal 
deaths.     A  wife,  the  mistress  of  a  household, 
the  solace  of  her  husband,  the  proud  mother  of 
a    number    of    happy    children,    is    suddenly 
snatched    away    after     an     auspicious    event. 
There  is  something  so  sad  about  such  deaths 
that  all  would  welcome  with  heartfelt  ]oy  any 
plan  which  promises  to   lessen  such  disastrous 
events.     Puerperal  deaths  own  various  causes, 
but  by  far  the  most   frequent    and   prevalent 
causes  are  septicaemia  and  pyaemia.    Both  these 
disea.ses  involve   or   imply   inflammatory  pro- 
ce.sses,  and  both  are  essentially  septic.     It  is 
against  them  that  antiseptic  midwifery  wages 
war,   and    in    which,   he  said,   it   had    already 
achieved    great    success.     The    object   of   the 
paper  was  to  spread  and  diffuse  further  know- 
ledge on  this  important  matter,  and  to  stimulate 
further  inquiry  into  it,  with  a  view  to  the  more 
general  adoption  of  the   beneficent  antiseptic 
methods.      Already,    said    Dr.    Duncan,    more 
pain  is  prevented,  more  life  saved  b}-  antiseptic 
methods  than  by  all   the  recent  improvements 
of  modern   midwifery  combined  ;   and  there  is 
no  prospect  half  so  bright  and  encouraging  as 
that  held  out  by  the  general  adoption  of  the 
antiseptic  treatment  of  tlie  parturient  condition. 
And,  it  is  certain,  all  fervently'  wish   that  these 
high  hoj)os  may  be  realized,    lie  would  not,  he 
said,   proceed   to  discuss    that  division  of  the 
subject,  the   treatment  of  the   blood    by  which 
the  fermentation  or  sepsis  is  carried  throughout 
the  organism,  as  by  the   use  of  hyposulphites, 
intrcduccl    by    Polli,    of   Milan.      IIo    would 


THE    CANADA    MEDICAL    RECORD. 


13 


confine  himself  to  the  consideration  of  the  local 
use  of  antiseptics.  He  pointed  out  that  the 
iiealthy  lochia!  discharge  of  some  women 
approached  in  smell  and  odor  putrefactive 
discharges,  so  that  it  was  not  alwa^'s  possible 
to  discriminate  them  ;  but  in  all  doubtful  cases 
it  was  well  to  treat  them  as  if  putrefactive. 
The  putrefying  loch'al  discharge  may  find  its 
way  directly  into  the  blood  by  the  uterine 
sinuses,  or  be  taken  up  bj' the  lymphatics:  in 
either  case  a  state  of  blood-poisoning,  or  sep- 
ticaemia, is  set  up.  The  removal  of  all  putrefy- 
ing material  is  essential  to  the  arrest  of  this 
blood-condition.  The  antiseptic  measures  to 
be  adopted  consist  of  the  removal  of  the 
offending  material  by  the  obstetrician's  finger, 
or  a  pair  of  forcop.s,  previousl}^  covered  with 
an  antiseptic.  In  some  cases  it  becomes 
necessary  to  introduce  the  hand,  which  should 
previously  be  carbolizod,  by  being  smeared 
with  the  ordinary  carbolic  acid  and  oil  mixture. 
By  such  treatment  of  the  hand  preparatory  to 
its  introduction  into  the  female  passages,  two 
ends  are  attained.  If  there  be  no  great  amount 
of  putrefaction  present,  the  hand  thus  treated 
carries  with  it  no  danger  of  leaving  putrefying 
matters,  or  germs,  on  the  bared  surface  ;  while 
on  the  other  hand  it  is  a  means  of  applying  an 
antiseptic  to  a  surface  on  which  a  putrefactive 
process  may  be  activel}'  progressing.  Then  as 
to  injections  into  the  uterus,  he  advocated 
carbolized  water  and  the  gentlest  possible  force 
sufficient  to  throw  the  fluid  into  the  uterine 
cavity.  Neglect  of  these  precautions  might 
lead  to  the  introduction  of  air  or  fluid  into  the 
uterine  sinuses,  and  produce  baneful  results. 
To  secure  gentleness  of  pressure,  it  was  of  the 
first  importance  to  have  free  and  sufficient  exit 
for  the  fluid  injected,  and  often  it  became 
necessary  to  use  a  double  canula.  The  running 
out  should  be  carefully  watched,  and  the 
mom.ent  the  outflow  ceases  the  injection  should 
be  stopped.  He  did  not  agree  with  those  who 
advocated  the  leaving  of  the  inti'a-uterine  tube 
in  utero  to  act  as  a  drainage-tube.  If  antisep- 
tically  plugged,  it  no  longer  acted  as  a  drainage- 
tube,  and  not  so  plugged  it  was  a  source  of 
danger  in  itself  To  secure  gentle  pressure  it 
was  well  to  have  a  long  tube,  so  that  the  fluid 
could  be  held  above  the  patient ;  but  it  should 
not  be  raised  to  an  undue  height.  A  warm 
carbolic  lotion  of  the  strength  of  one  in  fifty 
was  useful.  About  half  a  pint  or  a  pint  should 
be  injected  at  once,  and  the  uterine  cavity 
should  be  washed  until  the  fluid  returns  clean. 
It  is  not  desirable  to  have  too  frequent  daily 
injections.  Such  irrigation  might  be  desirable 
in  some  cases  even  when  no  putrefaction  was 
present.  I  am  not  now  engaged  in  midwifery 
practice,  and  never  losta  patient  in  the'  partu- 
rient or  post-parturient  state,  but  I  can 
remember  a  number  of  cases  where  the  lochia 
became  off'eusive,  where  such  irrigation  would 


probably  have  given  much  comfort  to  the 
patient  and  those  in  attendance  upon  her 
There  was  a  certain  risk  of  the  carbolic  acid 
producing  poisoninfr  of  its  own  in  certain  case**, 
but  Dr.  Duncan  said  that  the  production  of 
dark-colored  urine  merely  was  quite  unim- 
portant. At  times  more  serious  symptoms 
were  produced,  as  .-shivering,  cyanosis,  and  a 
weak  and  fast  pulse.  So  far  as  he  knew,  no 
fatal  case  had  yet  occurrel. 

The  great  modern  improvement  in  antiseptic 
midwifery  was  the  prophylaxis  of  puerperal 
septicaemia  or  pyaemia.  This  subject  could  be 
divided  into  the  prevention  of  danger  from 
within  and  of  danger  from  without.  In  addition 
to  the  most  scrupulous  carefulness  as  to  perfect 
cleanliness  about  the  parturient  woman,  in 
different  Continental  schools,  they  had  adopted 
the  plan  of  using  carbolized  ointment  for 
smearing  the  finger  previous  to  its  introduction 
into  the  vagina,  and  systematic  carbolized 
irrigation  of  the  uterus  after  parturition,  with 
most  excellent  results.  As  to  the  use  of  the 
spray  in  labor,  at  the  moment  of  the  birth  of 
the  child,  it  had  been  attempted,  but  was  found 
to  be  very  troublesome.  The  spray  had  been 
tried  in  the  performance  of  Caesarean  section, 
as  it  had  in  the  operation  of  ovariotomy,  with 
good  results.  It  certainly  seemed  very  desirable 
that  the  spray  should  be  used  for  the  treatment 
of  the  abdominal  as  well  as  the  uterine  incision  ; 
but  the  drawback  here  was  that,  in  spite  of  all 
care  on  the  part  of  the  operator,  septic  material 
might  find  its  way  into  the  uterus  through  the 
natural  passages.  Returning  to  the  subject  of 
antiseptic  midwifery,  he  said  that  now  it  was 
comparatively  easy  for  physicians  and  nurses 
to  keep  themselves  medically  clean,  and  that 
the  danger  of  puerperal  septicaemia  being 
carried  by  the  medical  man,  and  nurse,  from 
one  patient  to  another  was  much  diminished, — 
an  expression  of  opinion  which  elicited  some 
adverse  comment  from  Professor  Playfair,  who 
advocated  the  old  plan  of  refraining  fi-om 
midwifery  for  a  time,  when  it  was  found  that 
one  case  of  puerperal  fever  followed  after 
another.  Dr.  Duncan  pointed  out  that  if  this 
principle  was  carried  out  to  its  logical  conclu- 
sion the  general  practitioner  would  have  to 
abandon  all  his  other  practice  if  he,  by  anj 
oversight,  saw  a  case  of  scarlatina. 

If  a  piece  of  membrane  or  placenta  was 
retained  in  the  uterus,  it  was  well  to  use  a  three 
per  cent,  solution  of  carbolic  acid  for  at  least 
twelve  days  after  the  accouchement,  as  pro- 
phylaxis against  danger  arising  from  within. 
Others  advocated  a  solution  of  the  subsulphato 
of  iron  with  glycerin  under  these  circumstances. 
But  poisoning  from  within  was  not  so  common 
a  cause  of  septicaemia  aa  poisoning  f^6m'  with- 
out ;  and  care  on  the  part  of  the  obstetriciaa 
would  be  found  the  great  means  of  obviating 
puerperal  septicaemia.     It  was   by  avoidanca 


u 


THE    CANADA    MEDICAL    RECOBD. 


that  puerperal  mortality  was  to  be  reduced  in 
amount.     When    septicemia    had    once     lecn 
started,  then   tho  treatment  was  no  lonfjer  that 
of  prevention,  but  that  of  cure.     Dr.  JDuncan, 
as  ho  announced  at  the  commencement  of  his 
lecture,  did   not  go  into  tho  treatment  of  the 
blood    in   puerperal    septicnemia,   but    perhaps 
your   readers   will    not   feel    aggrieved    if   his 
remarks  are  supplemented   by  some  others  on 
the    management    of   the    general    condition. 
When  8ym})tom8  of  sejitica^mia  set  in,  not  only 
should  the  irrigation  of  the  uterus  several  times 
a  day  be  a.-^siduously  carried  out,  but  antiseptics 
^hould  be  administered  internall}-.    Chlorate  of 
j'Otash  and  the  sulphites  and  hyposulphite  of 
soda,  together  or  singly,  should  be  given  freely 
by  the   mouth.     In    one   case   in    my   by-past 
general  practice,  a  delicate  woman  was  confined 
of  a  dead  putrid  child  :  on  vaginal  examination 
the  head  felt  like  a  leather  bag  with  a  lot  of 
])ieces  of  broken  pot  in   it,  the  cranial  bones 
being  all  loose  and  out  of  place,  and  the  foetus 
discolored  and  fiar  advanced  in  putrefaction.    In 
this  case  the  lochia   became  very  putrid   and 
^tlnk,    and    there    were    evidences   of    blood 
poisoning    on    the   part   of   the   mother.     By 
means  of  vaginal  injections  of  a  solution  of  the 
sulphites  and    the   internal   administration   of 
chlorate  of  potash  and  sulphite  of  soda,   the 
ominous    symptoms     passed    away,    and    the 
woman  made  an  excellent  recover^-.    Such  was 
a  successful  case  treated  antiseptically,  but  in  a 
very  primitive  way.     Now  the  management  of 
the  case  would  be  considerably  more  advanced 
and  scientific.    In  addition  to  the  injections  and 
the  internal  administration  of  the  various  anti- 
septics, it  would  be  well  to  influence  tho  air 
respired   by   the  patient,  and   to  place  in  the 
sick-room  some  disinfectant;   the  drawback  to 
this  being  the  objectionable  smell  of  most  of 
these  potent  agents.     Sanitas  is  odorless,  and 
solutions  of  thymol  are  not  offensive  certainly, 
if  they  do  not  form  a  very  agreeable  scent,  and 
such  should  be  used  freely,  being  sprinkled  over 
the  floor,  and,  better  still,  being  well  sprayed 
about    the   room    at  frequent   intervals.     This 
should  be  continued  as   long  as  any  signs  or 
symptoms  of  septicemia  remain.     That  such 
should  be  the  line  of  treatment  to  be  pursued 
in  all  cases,  either  of  established  septicemia  or 
where  it  is  threatening,  there  can  be  no  doubt 
remaining.     The  question  then  arises,  "Shall 
antiseptic  precautions   be  taken  in  all  cases  of 
j)arluiition  ?  "  As  regards  my  personal  opinion, 
it  is  affirmative  of  this  proposition.    Antiseptic 
precautions,  in  the  first  place,  are  not  expensive. 
They  would  form  a  species  of  cheap  insurance. 
In  the  next  place,  they  are  free  from  danger  if 
used  carefully.     Dr.  Duncan  pointed  out  that 
careless  irrigation  of  the  uterus  might  lead  to 
serious   consequences,   air   or   fluid   might    bo 
forced  into  the  uterine  sinuses  ;  but  against  this 
may  be  set  the  presumption  that  the  man  who 


is  careful  enough  to  adopt  antiseptic  obstetric 
precautions  would  be  careful  enough  to  see  the 
antiseptic  method   carried  out  properly  in  the 
one  single  source  of  po.ssible  danger,  the  irriga- 
tion of  the  uterus.     As  to  the  argument  which 
might  be  raised  that  this  involves  unnecessary 
fuss  and  tiouble,  the  answer  must  be  returned 
that   after   certain    unpleasant   incidents   it  is 
commonly  found  that  a  very  little  care  and 
foresight  would  have  prevented  the  disasters. 
All  preventive  medicine  has  this  for  its  raison- 
d'ctre,  and  many,  if  not  most,  practitioners  will 
probabl}^  soon  adopt  antiseptic  midwifery;  and 
as  to  those  who  do  not,  it  is  probable  that  when 
they  do  have   cases  of  puerperal   septicffimia 
they  will  find  their  conduct  and  management 
of  their  cases   sharply  criticised.     The   obste- 
trician  would  carry  with   him,  as  part  of  his 
armamentarium,  a  bottle  of  carbolized  oil  with 
which   to    anoint    the  finger  at   each  vaginal 
examination  and  to  anoint  the  dorsal  surface  of 
the  hand  and  arm  in  turning.     Also  the  instru- 
ment might  be  smeared  with  this   antiseptic 
before  being  applied,  in  the  cases  which  require 
them.   This  would  involve  their  being  thorough- 
ly cleaned  ;   and  then  it  is  to  be  hoped  we  will 
hear  no  more  of  such  sad  cases  as  that  reported 
in  a  recent  number  of  the  "  Confessional  "  com- 
menced  in    the   British   Medical  Journal  quite 
lately,  where  a  medical  man  owned  that  after 
delivering  a  woman  with  his  forceps  he  forgot 
to  clean  them,  and  the  next  woman  delivered 
with    the   forceps   died   of    septicaemia.     This 
matter   cropped  up  in  the  discussion   on    Dr. 
Duncan's  paper,  and  Dr.  John  Brunton  pointed 
out  how  the  wood  of  the  handles  of  midwifery 
forceps   often    shrank   from    the    metal,    thus 
leaving  a  crevice  in  which  putrefiactive  material 
might  lodge.     He   exhibited  his  own   forceps 
which  he  had  had  for  years  in  constant  use; 
the}'  consisted  entirely  of  metal,  nickcl-])lated, 
and  their  condition  was  admirable.    In  addition 
to  the  above,  a  little  carbolic  acid  might  be 
carried,  in  case  it  turned  out  that  the  child  was 
dead,  and  it  might  be  well  to  irrigate  the  uterus 
in  a  few  hours,,   so  as  to  prevent  any  putre- 
factive  change   with   its   consequent  dangers. 
An  irrigation  of  the  uterus  once  a  day,  in  all 
cases,  with  carbolized  water,  would  be  a  cleanly 
practice,  as  well  as  a  sanitary  precaution,  in 
midwifery    practice,   and    might    be    adoj^ted 
generally  with  advantage. 

How  far  the  use  of  carbolized  oil  on  tho 
obstetrician's  finger  would  tend  to  pi-event  that 
sad  accident,  syphilitic  poisoning,  it  is  difficult 
to  say.  An  answer  only  could  be  given  after  a 
considerable  experience  b}'  many  and  numerous 
individuals.  But  antiseptic  midwifery  must  no 
be  looked  at  from  tho  point  of  view  of  the 
safety  of  the  accoucheur,  but  from  that  of  the 
safety  of  the  patient.  Where  operative 
measures  are  anticipated,  I  venture  to  think 
that    antiseptic    precautions    will    always    be 


THE    CANADA   MEDICAL    RECOED. 


15 


taken,   after   the    evidence   wc    have    already 
before  us. 

And,  lastly,  comes  the  cause  of  all  this,  the 
thing  born, — the  infant  itself  Dr.  Duncan  said 
that  3'oung  organisms  are  readil_7  poisoned 
septicamiically.  It  appears  that  ulceration  of 
the  stump  of  the  umbilical  cord  has  been 
followed  by  blood-poisoning  in  some  cases,  and 
that  pus  has  found  its  way  into  the  umbilical 
vessels.  It  is  well  then  to  dress  the  stump 
antiseptically,  by  enclosing  it  in  a  piece  of  lint 
treated  previously  to  an  application  of  carbolic 
acid  and  oil.  An  animated  discussion  followed 
Dr.  Duncan's  paper. 

A  ease  of  opium-poisoning  treated  successfully 
by  the  subcutaneous  injection  of  atropine  has 
just  occurred  in  the  practice  of  an  ex-house- 
snrgeon  of  the  West  London  Hospital.  On  the 
llth  of  February,  1878,  I  had  one  grain  of 
sulphate  of  atropia  injected  subcutaneously  into 
a  woman  dying  of  opium-poisoning.  On  the 
13th  of  February,  1879,  a  case  was  admitted 
into  the  Leeds  Infirmary.  In  the  absence  of 
the  house-physician,  the  house-surgeon  took 
charge  of  the  patient.  He  has  forwarded  me 
the  following  notes :  A  man  aged  35  was 
admitted  at  9  P.  M.,  who  was  said  to  have  taken 
3  vi  of  laudanum  one  hour  previously.  He 
was  able  to  answer  questions,  his  pupils  were 
contracted,  he  was  irritable  and  somewhat 
excited,  saying  he  wished  he  had  taken  twice 
as  much.  He  refused  to  have  the  stomach- 
pump  applied.  A  scruple  of  sulphate  of  zinc 
was  given.  At  9.40  there  was  no  vomiting,  and 
the  patient  was  getting  worse ;  the  stomach 
pump  was  resorted  to,  and  about  twelve  ouncse 
of  brownish-colored  fluid,  smelling  of  opium, 
was  withdrawn,  and  a  pint  of  strong  coffee 
injected.  At  11.20  the  patient  was  worse,  and 
could  be  roused  only  with  great  difficulty. 
Pulse  120  ;  respirations  15  per  minute.  The 
pupils  were  reduced  to  a  pin's  point ;  the 
patient  had  been  walked  about  continuously. 
One-tenth  of  a  grain  of  atropia  was  then 
administered  subcutaneously ;  condition  slightly 
improved  till  12.20  A.  M.,  when  he  became 
utterly  unconscious  and  incapable  of  being 
roused  by  the  most  violent  means,  including 
faradaism,  etc.,  etc. ;  pupils  firmly  contracted  ; 
pulse  feeble  and  rapid  ;  respiration  down  to  12. 
A  quarter  of  a  grain  of  atropia  was  then 
injected  subcutaneously.  At  12.40  A.  M.  the 
patient  was  somewhat  better;  respiration  18; 
pulse  firmer  and  120  per  minute.  The  pupils 
were  dilated  ;  there  was  no  retui-n  of  conscious- 
ness, the  extremities  were  cold,  but  the  sleep 
was  more  natural.  At  1.10  A.  M.  the  respira- 
tions suddenly  sank  to  12,  but  rose  again  to  20 
after  artificial  respiration  had  been  carried  on 
for  ten  minutes ;  pulse  good ;  the  patient  con- 
tinued to  sleep  till  8  A.  M.  when  he  awoke,  was 
able  to  answer  questions  and  to  take  food,  and 
to  the  present  time  (16th,  6  P.  M.)  has  con- 


tinued to  improve.  This  case  illustrates  the 
toxic  effect  of  opium  upon  the  respiratory 
centres,  r.nd  also  how  the  paralysis  so  induced 
can  be  met  and  antagonized  by  the  use  d 
atropine.  The  only  criticism  I  have  to  make 
is  that  if  a  quarter  of  a  grain  of  atropia  had 
been  injected  at  the  very  first,  the  serious 
symptoms  which  appeared  might  have  been 
kept  off.  The  case  is  very  encouraging  as  to 
the  future  treatment  of  o]yium-poisoning  by  the 
subcutaneous  injection  of  atropine.  Fhiladel. 
Med.  Times. 

J.    MiLNER   FOTHERQILL. 


THE   TEEATMENT    OF    CONSTIPATION. 

Dr.  Eobort  Smith  recommends  that  in  cases 
of  constipation  the  individual  should  daily  at 
the  same  hour  make  powerful  defsecatory  efforts. 
Should  these  efforts  be  unsuccessful,  he  must 
still  be  urged  to  persevere.  This  daily  repeti- 
tion of  the  attempt  to  defaecate  usually  ends  by 
a  daily  need  for  the  relief  of  the  bowel  at  that 
hour.  During  the  treatment  it  is  sometimes 
necessary  to  procure  an  evacuation.  An  enema 
of  tepid  water,  followed  by  one  of  cold,  will 
generally  be  sufiieient  for  this  purpose  ;  a  sup- 
pository of  belladonna,  or  one  of  ordinary  yel- 
low soap,  or  of  honey  hardened  by  heat,  is 
equally  efficient.  Purgatives  are  not  to  be  used 
except  under  the  greatest  necessity,  and  then  a 
pill  of  colocynth  with  hyoscyamus  is  sufficient. 
Mineral  waters  are  frequently  of  great  service, 
particularly  those  of  Carlsbad  and  Cheltenham, 
a  tumblerful  taken  warm  before  breakfast  being 
often  found  to  act  effectually  in  keeping  the 
bowels  in  healthy  action.  Belladonna  in  a  sin- 
gle dose  of  one-sixth  to  one-fourth  of  a  grain  of 
the  extract  taken  fasting  by  preference  in  the 
early  morning  has  also  been  used  with  success. 
Excellent  results  have  also  been  obtained  from 
the  use  of  sulphate  of  zine  and  strychnia.  Much 
of  the  success  of  the  treatment  will,  however, 
depend  upon  the  directions  as  to  habit  and 
diet.  The  tablespoonful  of  cold  water  at  night, 
the  cold  bath  and  cold  compresses  to  the  abdo- 
men in  the  morning,  the  taking  of  large  quan- 
tities of  fruit,  the  use  of  oatmeal  porridge  and 
of  bran  bread,  the  cigar  after  breakfast,  the 
daily  walk,  have  all  their  influence  in  bringing 
about  the  desired  end.  For  infants,  the  use  of 
oatmeal  boiled  in  milk,  an  occasional  soap  sup- 
pository, abdominal  friction  with  the  warm 
hand,  combined  with  small  doses  internally  of 
codliver  oil,  have  never  been  found  to  fail.  In 
all  cases  of  constipation,  however,  it  is  abso- 
lutely necessary  to  obtain  the  confidence  of  the 
patients.— TAe  Lancet. 


16 


THE   CANADA    MEDICAL    RECORD. 


THE  CAUSE    OF    DEATH    AT   THE  SEV- 
ERAL EPOCHS. 

In  infancy,  diRonRcs  of  the  brain  and  nervous 
Rystem — notahly  convulsions— rank  first  anion^ 
the  causes  of  death  ;  dit^ensos  of  Iho  luiiffs  have 
the  second  place,and  diarrheal  diseases  the  third. 
From  tlie  end  of  the  fir^t  year  of  life  to  the 
end  of  the  fifth — that  is  to  sa}',  in  early  child- 
liood — the  infectiouH  diseases,  especially  scarlet 
fever  and  hooping-cough,  give  rise  to  the  greatest 
mortality  ;  then,  as  in  infancy,  next  in  order  of 
mortality  at  this  period  of  life  come  lung- 
diseases;  and  third,  the  diarrheal  diseases. 

In  childhood  and  earl}'  youth  (five  to  fifteen 
3'ears~)  the  infectious  diseases  are  the  chief 
causes  of  mortality,  principally  scarlet  fever 
and  continued  fevers. 

From  youth  to  manhood  (fifteen  to  twenty- 
five  years)  phthisis  is  the  most  important  cause 
of  death,  and  the  infectious  diseases  sink  to  the 
second  place. 

In  early  manhood  (twenty-five  to  thirty-five 
years)  phthisis  still  maintains  the  first  rank 
among  the  causes  of  death;  but  a  marked  in- 
crease of  mortality  is  now  observed  from  other 
diseases  of  the  lungs.  The  infectious  diseases 
continue  to  hold  the  second  rank  among  the 
causes  of  death  at  this  period  of  life. 

In  manhood  and  maturity  (thirty-five  to  fifty- 
five  years)  phthisis  maintains  its  predominance 
among  the  causes  of  death,  but  now  the  mortal- 
ity from  other  diseases  of  the  lungs  becomes 
largely  augmented.  The  second  place  in  the 
order  of  causes  of  death  at  this  jieriod  of  life  is 
taken  by  diseases  of  local  origin,  especially  local 
affections  of  the  brain  and  nervous  system,  of 
the  heart  and  blood-vessels,  and  of  the  digestive 
organs.  Cancer  now  becomes  an  important 
source  of  mortality,  but  the  infectious  diseases 
sink  to  a  comparatively  low  place  among  the 
causes  of  death. 

In  the  decline  of  life  (fifty-five  to  seventy-five 
years)  the  diseases  of  local  origin,  including  dis- 
eases of  the  lungs,  are  the  chief  causes  of  death  ; 
jththisis,  the  infectious  diseases,  and  general  dis- 
eases, as  a  rule,  except  cancer,  becoming  rela- 
tively less  predominant.  At  this  period  of  life, 
indeed,  the  causes  of  death  foreshadow  the  more 
general  decay  of  old  age  (seventy-five  and  up- 
ward), whore  death,  if  it  does  not  arise  from 
the  natural  inability  of  the  several  organs,  in 
the  progress  of  decay,  to  continue  their  func- 
tions, unafl'ected  by  exterior  circumstances,  is 
mainly  brought  about  by  local  accidents  of  the 
brain  and  nervous  system,  the  heart  and  blood- 
vessels, irredeemably  damaged  in  the  course  of 
the  decay. 

The  progress  of  fatal  disease  through  the  sev- 
eral periods  of  life  has,  in  fact,  characteristic 
relations  with  the  natural  conditions  of  the  body 
fit  the  different  periods.  'J'he  fatal  diseases  of 
inluncy  are  pigniticant  of  the  immaturity  and 


mobility  of  the   infants'   organs  and  functions. 
The  fatal   diseases  of  childhood   relate,   not  so 
much   to    states  of  the  system   then   in  fullest 
vigor  of  vital  re-action  (to  inherent  conditions 
of  the  body,  so  to  speak),  and  to  the  influence  of 
the  media  in  which  wo  live,  as  to  the  accidental 
liability  of  exposure  to  morbific  agencies  current 
among  populations,  such  as  the  contagions  of 
the  catching  diseases;  as,  for  example,  scarlet 
fever,  small-pox,  measles,  t3'phus,  etc.      With 
the  completion  of  manhood,  diseases  indicative  of 
local  degenerations  of  tissue  begin  to  be  predo- 
minant, and  with  each  successive  stage  of  life 
this  predominance  becomes  more  marked.     In 
old  age  the  do<ienorative  changes,  which  at  ear- 
lier periods  of  life  are  regarded  as  the  signs  of 
disease,  now  appear  as  the  natural  consequences 
of  decay;  and  death  becomes    a   physiological 
not  a  pathological  fact — as  the  determination  of 
a  natural  life,  not  as  the   premature   close  of  a 
life  cut  short  by  disease — Ext.  from  Health  Pri- 
mer— Premature  Death. 


TO  MASK  THE  ODOR  OF  IODOFORM. 

Tannin,  which  was  recommended  by  Moles- 
chott  as  a  means  of  hiding  the  unpleasant 
smell  of  iodoform,  has  not  been  wholly  suc- 
cessful ;  ether,  which  conceals  the  odor,  on 
account  of  its  great  volatility  is  only  useful  for 
a  short  time  ;  while  oil  of  peppermint  has  not 
answered  to  its  expectations.  Dr.  Lindcmann, 
of  Munster,  contributes  to  the  AUg.  Med.  Cen- 
tral Zeitumj  an  account  of  experiments  which  he 
has  made  with  several  preparations  in  regard 
to  this  subject.  The  conclusion  at  which  he  has 
arrived  is  that  the  balsam  of  Peru  completely 
masks  the  smell  of  iodoform,  and  renders  it  im- 
perceptible to  the  most  delicately  organized.  He 
mixes  two  parts  of  the  balsam  with  one  part  of 
iodoform,  and  recommends  vaselin  as  being  the 
best  medium  for  ananguent;  it  may  also  be 
employed  in  an  aqueous  solution.  The  following 
useful  formulro  are  subjoined  : 

I^    Iodoform., 1  gram  ; 

Bals.  peruv., 2  grams  ; 

Vaselin, 8  grams; 

M.  f.  ungt. 

I^   lodorform., 1  gram  ; 

Bals.  peruv., 3  grams  ; 

Spir.  vin.rectif.  or  glycerin.,..  12  grams. 

In  regard  to  the  preparation  of  these  prescrip- 
tions, the  author  recommends  that  the  iodoform 
should  first  be  mixed  with  the  balsam,  and  that 
the  vehicle  should  afterward  be  added. 


THE  TREATMENT   OF   CHRONIC    EC- 
ZEMA. 


Avoid    the    use  of  soap,  as    this  is    irritatmg. 
Twice  a  day,  bathe  the  part  in  an  aqueous  solution 


THE   CANADA    MEDICAL    RECORD. 


IT 


of  borax,  one  ounce  to  the  pint.  Dry  without 
friction,  and  freely  apply  the  benzoatic  oxide  of 
zinc  ointment,  then  bandage  the  part  firmly  with 
old  dry  muslin  which  has  been  previously  wet  with 
a  saturated  aqueous  solution  of  borax.  Over  this 
apply  a  bandage  of  oiled  silk,  in  such  a  manner  as 
to  exclude  the  air  perfectly.  Let  the  bowels  be 
kept  regular.  In  the  majority  of  cases  eczema 
may  be  promptly  cured  by  the  simple  ex- 
clusion of  the  air.  Eczema  of  the  fingers  will  gen- 
erally yield  in  a  few  days  if  the  air  be  excluded  by 
the  ordinary  rubber  cot. — Med.  Review. 


The  Canada  Medical  Record, 

SI  iaontj^In  Sournal  of  iSclJicinc  aitU  ^fjarmacfi. 

EDITOR,  : 
FRANCIS  W.CAMPBELL,  MA.,  M.D.,L.K. C.F.,LOND. 

ASSISTANT  EDIT0E6  : 

B.  A.  KENNEDY,  M.A.,  M.D. 

JAMES  FERRIGO,  M.D.,  M.B.C.S.  Eng. 

SDITOB  OF  PHABMACKDTICAL   DKPARTMEWT  : 

ALEX.  H.  KOLLMYER,  M.A.,  M.D- 

SUBSCRIPTION  TWO  DOLLARS  PBR  ANNUM  . 


All  communication  f.  and  Kocchanges  mvst  he  addrestedio 
the  Editor^  Drawer  ^bQ,  Post  Office,  Montreal. 


MONTREAL.  OCTOBER,  1880. 


VOL.   IX. 

With  this  number  we  commence  our  ninth 
volume.  Very  few  of  our  subscribers  have  seen  fit 
to  discontinue,  and  these  few  are  compensated 
for  by  more  than  double  the  number  of  new 
names.  The  fact  is,  few  men  in  practice  now-a- 
days  can  afford  to  be  without  a  medical  journal, 
so  as  to  keep  abreast  of  the  times,  and  this  one 
is  furnished  at  so  cheap  a  rate  as  to  be  within 
the  reach  of  all.  That  the  Record  is  appre- 
ciated, letters  from  readers  attest,  and  not  the  least 
portion  acceptable  is  the  selected  matter  which 
has  been  found  of  considerable  value  by  many 
Every  physician  should  keep  himself  informed  of 
matters  relating  to  the  profession  especially  in  his 
own  country,  and  this  we  endeavor  to  render  avail- 
able by  acquiring  information  from  every  possible 
source.  Subscriptions  are  acknowledged  in  the 
usual  manner  by  the  date  placed  on  the  label  after 
the  address,  which  indicates  the  year  up  to  which 
the  Record  has  been  paid  for.  Those  in  arrears 
will  please  consult  the  same  for  the  amount  due 


us,  and  if  they  will  kindly  take  the  hint  and  remit, 
we  certainly  will  not  feel  very  much  hurt.  A  word 
to  the  wise  is  suflFicient,  and  therefore  we  expect 
the  remittances  to  roll  in. 

INDEX  OF  VOL.  VIII. 

Owing  to  the  absence  of  the  editor  in  chief,  who 
managed  the  details  of  the  Record,  we  had  the  mis- 
fortune to  overlook  the  index  for  vol.  viii.,  which 
should  have  accompanied  the  last  number.  It 
will  be  sent  with  this,  and  therefore  the  omission 
will  be  remedied. 


WOMAN'S  HOSPITAL. 

It  was  announced  some  time  ago  in  these 
columns  that  the  Woman's  Hospital  had  been  re- 
moved to  the  large  and  commodious  building 
known  as  the  Western  Hospital.  Formerly  the 
Hospital  was  almost  entirely  conducted  as  a 
Lying-in,  and  was  managed  solely  by  its  Medical 
Board.  Since  its  removal,  however,  advantage  has 
been  taken  of  the  provisions  of  the  charter  so  as 
to  include  a  Board  of  lay  gentlemen  as  Governors, 
and  this  has  been  followed  by  the  very  best  of 
results.  It  is  seldom  that  any  institution  acquires 
such  an  energetic  Committee  of  Management ;  aU. 
its  members  have  worked  with  a  will  to  place  the 
Hospital  in  effective  working  order.  The  result* 
are  shown  in  the  funds  collected  and  the  dona 
tions  in  kind  received,  a  fact  which  also  shows  that 
the  objects  of  the  Hospital  are  generally  appre- 
ciated by  the  public,  and  that  it  was  really  re- 
quired. Though  much  has  been  done,  yet  it  is  not 
as  fully  equipped  as  desired,  but  this  will  only  be 
a  matter  of  time.  In  the  meantime  the  depart- 
ments are  fully  organized  :  one  flat  being  devoted 
to  obstetric  cases,  having  twelve  beds;  another 
flat  to  special  diseases  of  women,  having  eight 
beds.  There  are  also  eight  private  wards  and 
an  out-door  service.  Medical  attendance  on  the 
public  wards  is  provided  for  by  a  staff  of  attending 
physicians.  The  Committee  of  Management  by  a 
wise  liberality  permit  any  properly  qualified 
physician  to  attend  their  patients  in  the  private 
wards,  being  the  only  public  Institution  which 
allows  of  this  privilege  with  the  exception  of  the 
New  Hospital  of  Notre  Dame,  which,  as  we  are 
informed,  has  lately  extended  the  same  to  all 
practitioners.  Fears  were  at  first  entertained  that 
this  Institution  would  be  found  too  far  away  from 
the  centre  of  the  city,  but  experience  proves  the 


18 


THE    CANADA    MEDICAL    RECORD. 


contrary.  Already  a  large  number  of  patients 
have  been  admitted,  and  many  more  apply  but 
cannot  be  received  owing  to  the  Committee  having 
for  the  present  set  a  limit  to  the  number  of 
available  beds.  The  prospects  are,  however,  that 
by  another  year  double  the  number  will  be 
accommodated.  The  out-door  department,  which 
at  first  fell  off  in  the  number  of  patients  attending, 
is  now  gradually  on  the  increase.  Altogether  those 
who  have  been  instrumental  in  accomplishing  the 
extension  and  increased  usefulness  of  the  Woman's 
Hospital  have  every  reason  to  congratulate  them- 
selves on  the  result. 

We  have  been  surprised  to  learn  that  a  report 
has  been  circulated,  that  the  Hospital  is  badly 
drained,  and  its  sanitary  condition  defective. 
We  can  speak  with  certainty  that  its  hygienic  con- 
dition could  not  be  bettered,  and  that  there  is  not 
a  particle  of  infection  which  could  endanger  the 
life  of  any  parturient  woman.  Indeed  all  antisep- 
tic precautions  are  observed,  and  the  result  is 
shown  in  the  rapid  recovery  after  child-birth. 
Cases  of  auto-infection  will  occur  in  any  institution 
no  matter  how  well  conducted,  and  such  have 
occurred,  but  we  are  happy  to  state  that  there 
have  been  none  such  for  some  time.  At 
present  the  Hospital  is  in  an  exceptionally 
healthy  condition,  and  the  authorities  invite  in- 
spection from  any  medical  practitioner  who  may 
wish  to  visit  the  Institution,  and  if  there  are  any 
that  think  the  sanitary  arrangements  defective,  we 
are  sure  that  a  personal  visit  will  soon  remove 
that  idea  from  their  minds. 


PRACTICAL  PHYSIOLOGY. 

Five  years  ago  the  Medical  Faculty  of  Bishop's 
College,  through  the  energy  of  one  of  its  Profes- 
sors, opened  a  Laboratory  of  Practical  Physiology. 
This  year  a  second  one  has  been  established  in 
this  city,  but  this  time  in  connection  with  the  Uni- 
versity of  McGill.  This  latter  was  opened  on  the 
second  instant,  for  the  inspection  of  those  present 
who  came  to  listen  to  the  introductory  lecture  of 
the  Medical  Session  of  1880.  The  lecture  was 
delivered  by  the  Professor  of  Physiology,  Dr. 
Osier,  and,  as  would  be  expected  from  the  well- 
known  ability  of  the  lecturer,  was  not  only  an  able 
but  also  an  interesting  discourse,  the  advances  in 
Physiology  being  fully  dwelt  upon.  Unfortu- 
nately unavoidable   circumstances   prevented   us 


from  attending,  but  we  are  informed  that  the 
laboratory  is  fitted  up  with  nearly  all  the  modern 
requirements  of  Physiological  research.  The 
apparatus  is  of  the  most  improved  make,  and  we 
are  sure  that,  under  the  able  management  of  Pro- 
fessor Osier,  it  will  be  a  good  acquisition  to  the 
teaching  facilities  of  McGill.  It  certainly  speaks 
well  of  Montreal,  as  a  centre  of  Medical  Fducation, 
that  it  should  contain  two  such  thoroughly  equip- 
ped Physiological  Laboratories  that  of  Bishop's  as 
well  as  the  one  now  opened  in  McGill,  these  being 
the  only  two  in  Canada  which  can  justly  be  so 
styled.  Having  frequently  witnessed  many  inter- 
esting and  instructive  Physiological  demonstrations 
at  Bishop's  we  feel  convinced  that  an  immense 
advantage  is  to  be  derived  from  this  sort  of  prac- 
tical training,  and  it  is  surprising  that  such  demon- 
strations are  not  more  universally  attempted.  The 
establishment  of  such  a  course  will  well  repay  any 
school  that  may  adopt  it. 

The  cost  of  fitting  up  a  Laboratory  equal  to 
either  of  these  just  mentioned  would,  so  we  are 
told,  be  about  two  thousand  dollars,  and  an  extra 
yearly  outlay  of  from  one  hundred  and  fifty  to  two 
hundred  dollars  would  be  required  for  the  purpose 
of  providing  the  necessary  material,  improvements, 
repairs  to  apparatus,  &c. 

There  can  be  no  doubt  that  a  more  lasting  im- 
pression will  be  made  on  the  minds  of  students  by 
demonstrations  such  as  reflex  action,  as  seen  in  the 
frog,  on  the  calling  into  play  the  functions  of 
various  important  nerves  as  shown  in  numerous 
experiments  on  animals,  and  the  process  by  which 
food  is  digested  as  exhibited  in  test  tubes.  These 
appeal  directly  to  the  senses  of  the  most  careless 
student,  and  from  being  much  more  quickly  and 
easily  understood  give  more  information  than  can  be 
acquired  through  the  diligent  study  of  the  same 
matters  presented  in  a  less  interesting  manner. 


A  NEW  GOLD  MEDAL. 

It  is  with  pleasure  that  we  announce  the 
acquisition  of  a  second  gold  medal  by  the  Medical 
Faculty  of  Bishop's  College.  Many  will  remember 
the  late  Dr.  Robt.  Nelson,  who  was  distinguished 
as  a  surgeon,  having  made  for  himself  a  name  in 
this  city  prior  to  1837.  Unfortunately,  from  tak- 
ing part  in  the  troubled  politics  of  that  period,  cir- 
cumstances compelled  him  to  leave  Canada  for  the 
United  States,  where  he  resided  for  the  balance  of 


THE    CANADA    MEDICAL   RECORD. 


19 


his  life,  continuing  to  attain  fame  as  a  surgeon  and 
realizing  a  considerable  fortune. 

In  order  to  perpetuate  his  name  in  this  his  native 
city,  his  son,  Dr.  C.  E.  Nelson,  of  New  York,  has 
founded  a  gold  medal  of  the  annual  value  of  fifty- 
dollars,  to  be  competed  for  by  the  medical  classes 
of  Bishop's  College.  The  subjects  for  competition 
are  not  yet  fully  decided  on,  but  it  is  expected  will 
soon  be  finally  arranged.  In  our  next  issue  we 
trust  to  be  able  to  give  more  particulars. 


MEDICAL  SCHOOLS. 

The  medical  schools  in  Montreal  are  now  in 
full  operation,  and  there  appears  to  be  an  increase 
in  the  number  of  students  entering  upon  the  study 
of  medicine.  At  the  last  matriculation  examination 
held  in  Quebec,  nearly  one  half  of  the  candidates 
were  rejected,  which  either  implies  that  the  exam- 
nations  are  unnecessarily  severe,  or  that  something 
s  wrong  in  the  education  which  young  men  obtain 
in  this  Province.  Probably  a  little  of  both.  The 
introductory  lecture  at  McGill  was  delivered  by 
Prof.  Osier  on  the  evening  of  the  2nd,  after  which 
there  was  an  exhibition  of  new  Physiological 
apparatus. 

In  Bishop's,  Prof.  Armstrong  welcomed  the 
students  on  the  4th  at  three  in  the  afternoon,  giv- 
ing the  class  some  good  practical  advice  in  regard 
to  their  studies  and  future  calling. 

Laval  inaugurated  her  Third  Medical  Session  on 
Tuesday  evening,  the  5th  inst.,  the  Rev.  Mr.  Beau- 
det,  the  vice  rector,  addressing  the  meeting.  His 
Lordship  the  R.  C.  Bishop  of  Montreal,  the 
professors  in  the  different  Faculties  and  several 
distinguished  visitors  being  also  present. 

The  opening  address  in  the  French  School  of 
Medicine  in  connection  with  the  University  of 
Victoria  was  delivered  by  Prof.  Durocher,  on 
Friday,  ist  October,  at  3  p.  m. 


PARIS  GREEN. 

When  we  wrote  last  month  on  the  danger  attend- 
ing the  indiscriminate  sale  of  Paris  green,  and 
the  necessity  for  putting  in  force  existing  legislation 
regulating  its  sale,  we  scarcely  expected  that  two 
more  cases  of  poisoning  by  this  substance  would 
occur  in  this  city  before  the  article  itself  had 
reached  our  readers.  One  case  was  fatal,  and  the 
particulars  have  appeared  in  the  daily  press.  The 
other  was  in  our  own  practice.     Vomiting  having 


set  in  prior  to  our  arrival,  the  woman's  life  was 
happily  saved. 

We  should  like  to  know  whether  the  Paris  green 
taken  in  these  cases  was  purchased  from  a  licensed 
pharmacist,  and  if  so  whether  the  sales  were  re- 
gistered in  the  poison  book  according  to  law? 
Surely  there  is  some  official  whose  duty  it  is  to 
see  that  the  law  regulating  the  sale  of  deadly 
poisons  is  properly  carried  out. 

Let  us  suppose  that  a  person  wishes  to  poison 
himself  He  is  very  unlikely  to  use  a  poison 
which  is  comparatively  unknown  to  the  general 
public.  In  nine  cases  out  of  every  ten  either 
arsenic,  Paris  green,  prussic  acid,  morphine  or 
strychnine  is  employed.  Having  decided  in  his 
own  mind  which  poison  he  will  use,  the  would-be 
suicide  sets  forth  to  obtain  it,  and  in  order  to  do 
this  he  must  apply  to  a  licensed  vendor  of  poison, 
who,  under  the  Act,  cannot  sell  it  unless  he  knows 
the  person  applying  for  it  personally,  or  receives 
an  introduction  to  him  from  some  one  known  to 
both.  This  diflaculty  of  obtaining  deadly  poison 
is  a  wise  provision,  as  it  is  evident  that  any  res- 
pectable pharmacist,  in  order  to  prevent  his  estab- 
Hshment  from  being  mixed  up  in  a  poisoning  case, 
will  take  every  precaution  as  to  whom  he  sells 
such  things  as  laudanum,  arsenic  or  Paris  green,  and 
it  is  quite  possible  that  many  embryo  murderers 
and  suicides  would  be  altogether  deterred  from 
accomplishing  their  design  by  the  very  salutary 
regulations  laid  down  in  the  Pharmacy  Act,  tuere 
they  tnore  generally  enforced. 

The  Druggists'  poison  register  might  and  has  fre- 
quently been  a  source  of  valuable  information  to 
detectives  in  cases  where  cattle,  as  well  as  human 
beings,  have  been  destroyed.  By  all  means,  gentle- 
men of  the  Council  of  the  Pharmaceutical  Associa- 
tion, let  us  have  the  law  rigidly  enforced,  espe- 
cially the  registration  of  all  sales  of  Paris  green. 


We  have  received  the  first  number  of  the  Rocky 
Mountain  Medical  Review,  a  monthly  journal  of 
Scientific  Medicine  and  General  Science,  publish- 
ed at  Colorado  Springs,  Colorado,  at  a  subscription 
price  of  $5.00  per  annum.  This  journal  promises 
to  be  a  valuable  addition  to  the  many  able  Medical 
journals  of  the  United  States.  Its  Editors,  six  in 
number,  are  among  the  leading  physicians  of  Den- 
ver and  the  Springs,  and  if  they  will  only  work  up 
the  material  at  their  command  their  venture  must 
be  successful.  Much  can  can  be  said  of  the  benefit 
derived   by   a  residence  in   Colorado  of  persons 


20 


THE    CANADA    MEDICAL    RECORD. 


suffering  from  "ing  disorders,  and  if  facts  are  elimi- 
nated, deductions  may  be  drawn  which  will  afford 
])hysicians  a  guide  as  to  the  proper  cases  to  send 
and  likely  to  be  benefited.  We  will  gladly  ex- 
change with  our  new  contemporary. 


PERSONAL. 

The  friends  of  Dr.  Wolfred  Nelson  will  be 
interested  to  hear  of  him.  From  information  he 
appears  to  have  ranged  over  quite  an  extensive 
territory  as  a  special  correspondent.  Nothing 
being  said  about  his  physical  condition,  the  infer" 
ence  may  be  drawn  that  he  is  much  better  than 
when  he  left  Montreal  is  search  of  an  El  Dorado. 
His  perigrinations  have  led  him  from  the  sunny 
isles  of  the  South  across  the  continent  to  the 
Golden  Gate.  Vancouver's  Island,  British  Colum- 
bia, Washington  Territory,  and  Oregon  have  each 
furnished  material  for  his  pen,  and  he  was  last  heard 
of  as  sitting  on  a  fallen  monarch  among  the  big 
trees  of  California.  He  has  been  well  received 
as  a  journalist,  and  we  wish  him  a  continuance  of 
pleasant  voyages. 

Dr.  G.  F.__^Slack,  formerly  of  this  city,  has  re- 
moved to  West  Farnham,  P.Q. 

Dr.  Robt.  Costigan  (Bishop's,  1874),  late  of 
Indianapolis,  is  now  practicing  in  Los  Lunas,  New 
Mexico,  and  for  the  short  time  he  has  been  there 
has  met  with  considerable  success. 

Dr.  F.  W.  Campbell  writes  us  that  he  has  had 
a  very  enjoyable  and  profitable  trip,  having  visited 
nearly  all  the  continental  cities.  He  expects  to 
sail  for  Canada  on  the  28th  of  this  month,  so  that 
his  return  may  be  looked  for  about  the  eighth  of 
November  next. 


PAMPHLETS,  &c.,  RECEIVED. 

The  Vinum  Nutrio  Phosphaticum.  Orthozoic 
Chemical  Association,  1200  Broadway,  New  York. 

Lacerations  of  the  Neck  of  the  Uterus.  By  A. 
Reeves  Jackson,  A.M.,  M.D.  Read  before  the 
Tippecanoe  County  Medical  Society  at  Lafayette, 
Jnd.,  May  6,  1880.  Reprinted  from  the  "  American 
Practitioner.  " 

Diagnosis  of  Malignant  Tumors  of  the  Upper  Jaw 
in  Youth,  by  L.  McLane  Tiffany,  M.D.,  Reprint 
from  Transactions  of  the  Medical  Faculty  of  Mary- 
land, 1880. 

Annual  Calendar  of  the   University  of  Laval, 

J  >   —  i  I 


An  Historical  Sketch  of  the  Redwood  Library 
and  Athencxum  in  Newport,  Rhode  Island.  By  D. 
King,  M.D. 

Anaesthesia  by  Ethyl  Bromide.  By  H.  A.  Wil- 
son, M.D.  Reprinted  from  the  "  Medical  and  Surgi- 
cal Reporter."     August  7th,   1880. 

Seventeenth  Annual  Report  of  the  New  York 
Society  for  the  Relief  of  the  Ruptured  and  Crippled. 
May,   1880. 

The  Rise  of  American  Dermatology.  By  Louis 
A,  Duering,  M.D.  Being  the  President's  address, 
American  Dermatological  Association,   1879. 


BOOKS  HELD  OVER  FOR  REVIEW. 

Index  Catalogues  of  the  Library  of  the  Surgeon 
General's  oflSce,  Washington,  1880.     Vol.  i. 

The  Art  of  Prolonging  Life.  By  Erasmus 
Wilson,  M.D.  Transactions  of  the  American 
Medical  Association.  Vol.  30,  1879. 

American  Newspaper  Directory,  1880. 

A   Practical  Treatise    on    Nasal  Catarrh.     By 
Beverley  Robinson,  M.D. 

Practice  of  Medicine.     By  Dr.  Bartholow, 


REVIEWS. 

Transactions  of  the  American  GyncBcological 
Society.  Vol.  4  for  the  year  1879.  Boston, 
Houghton,  Mifflin  &  Co.,  1880.  Montreal, 
Dawson  Bros. 

The  printing,  binding,  etc.,  of  this  volume  is  in 
keeping  with  the  excellent  character  of  its  pre- 
decessors, and  forms  a  large  work  of  over  500 
pages.  To  give  a  thorough  review  of  this  work 
would  take  a  much  larger  space  than  is  at  our 
command,  therefore  the  mere  mention  of  some  of 
the  papers  will  be  given.  The  President  in  his 
address  deplored  the  need  of  "  proper  reviewing 
of  books  ;  "  that  "  rose-colored  book  notices  "  too 
often  replace  "  honest  criticism."  This  may  be 
true,  and  some  of  our  readers  may  think  that  here 
we  are  guilty,  but  we  trust  that  such  will  believe 
in  our  "  sincerity,"  and,  if  not,  let  them  get  the 
work  for  themselves  and  prove  our  recommenda- 
tion. The  Gynecological  Society  only  admits  to 
its  fellowship  men  who  have  already  attained  a 
name,  and  are  therefore  experienced  in  the  subjects 
discussed,  so  that  it  is  no  wonder  that  this  volume 
and  its  preceding  companions  should  occupy  a 
place  in  gynaecological  literature  amongst  the  ablest 


THE    CANADA    MEDICAL    RECORD. 


21 


productions.  Therefore  we  deem  the  library  of 
the  gynaecologist  especially,  and  that  of  the  gen- 
eral practitioner,  incomplete  without  them.  Papers, 
ably  and  carefully  prepared,  discussed  freely 
by  those  who  possess  extensive  practical  know- 
ledge of  their  subjects,  brought  together  in  this 
form,  must  necessarily  be  of  great  value.  Syste- 
matic works  treat  of  the  diseases  of  women  gener- 
ally, but  in  this  we  have  complete  essays  on 
special  conditions,  followed  by  a  better  criticism 
than  we  can  pretend  to  give.  Organized  but  five 
years  ago  the  Society  has  attained  the  highest 
rank,  and  its  publications  partake  of  the  same 
character,  and  this  volume  records  the  transac- 
*tions  of  the  fourth  annual  meeting  held  at  Balti- 
more last  year. 

The  table  of  contents.     List  of  Fellows,  49  in 
number,  and  minutes  of  proceedings  occupy  the 
first  25  pages.     The  papers  next  follow  :  first  the 
annual  address  by  the  President,  Dr.  Thomas,  who 
briefly  reviews  the  history  of  Gynaecology,  deplores 
the   dogmatism  of  some    of  its  followers  in  this 
comparatively    new    field     of    knowledge,     and 
cautions  the  unwary  not  to  be  misled  into  follow- 
ing a  popular  fashion  in  treatment  which  prescribes 
for  the  time  one  remedy  for   all  conceivable  dis- 
orders.    Sponge  tents,  cervical  section,  trachelor- 
rhaphy with  its  stitch  as  a  relief  to  all  a  woman's  ills, 
were  each  in  turn  held  up  to  view,  and  to  this  list 
might  have  been  added  the  use  of  strong  caustics 
for  the  same.  In  deploring  j  ust  reviews  a  standing 
committee  is  suggested  whose  duty  it  would  be  to 
"  pronounce  judgment  upon  the  current  literature  " 
of  gynaecology  as  a  guidance  to  the  practitioner  in 
the  purchase  of  books.     Such  a  committee  would 
have  to  be,  like  Cesar's  wife,  above  suspicion,  and 
authors   would  necessarily    be      excluded    from 
appointment.     As  everybody   now  is    aiming   at 
becoming   eminent    gynaecologists   we  fear  there 
would  be  none  to  act,  and,  like  the  jurors  in  our 
law  courts,    the    intelligent    reviewer    would    be 
debarred,    otherwise  he   would   be    suspected  or 
even  accused  of  being  prejudiced.     The  future  of 
gynaecology  was  next  dwelt  upon  at  some  length 
in  a  very  interesting  manner. 

The  papers  then  follow  in  order.  Dr.  White 
and  Dr.  Battey's  on  Intra-Uterine  Medication. 
A  long  discussion  on  both  followed,  speakers  not 
fiilly  endorsing  such  treatment.  Intra-Uterine  In- 
jections in  Puerperal  Septicemia ;  Dr.  Jenks 
Sporadic  Septicaemia  in  Gynaecological  Practice  by 
James  R.    Chadwick,    M.D. ;  A   Contribution  to 


the  Pathology  of  the  Cicatrices  of  Pregnancy,  by 
Samuel  C.  Busey,  M.D.  ;  Prolapse  of  the  Ovaries, 
by  Paul  E.  Munde,  M.D. ;  Case  of  Removal  of 
both  Ovaries  for  Dysmenorrhoea,  by  T.  Spencer 
Wells,  F.R.C.S.  ;  Kolpo-Cystotomy  by  Galvano 
Cautery,  by  John  Byrne,  M.D. ;  Measurements  of 
the  Uterine  Cavity  in  Childbed,  by  A.  D.  Sinclair,. 
M.D. ;  The  Early  Application  of  the  Forceps  in 
the  First  Stage  of  Natural  Labor,  by  Isaac  E. 
Taylor,  M.D. ;  Elongations  of  the  Cervix  Uteri, 
by  William  Goodell,  M.D.  ;  Mismanaged  Labor, 
the  cause  of  much  of  the  Gynaecological  Practice 
of  the  Present  Day,  by  J.  Taber  Johnson,  M.D.  ; 
A  Case  of  Extra  Uterine  Pregnancy  with  Suc",ess- 
ful  application  of  Electricity,  by  J.  C.  Reeve, 
M.D. ;  The  Relation  of  Symptoms  to  Versions  and 
Flexions  of  the  Uterus,  by  Ely  Van  de  Warker, 
M.D.  ;  Chronic  Inversion  of  the  Uterus,  by  Wm. 
H.  Byford,  M.D. ;  The  Justo-Minor  Pelvis,  by 
Wm.  T.  Lusk,  M.D. ;  Kolpoecpetasis  versus  Par- 
tial Kolpokleisis,  by  Nathan  Bozeman,  M.D. ;  A 
new  method  of  Performing  Decapitation,  by  Wm. 
L.  Richardson,  M.D. ;  Atresia  of  the  Vagina  in 
the  Pregnant  or  Non-Pregnant  Female,  by  Isaac 
E.  Taylor,  M.D.  ;  Premature  Senile  Obliteration 
of  the  Uterine  Cervical  Canal,  by  Henry  F. 
Campbell. 

A  full  report  of  discussions  which  took  place 
follows  each  paper,  and  in  these  the  great  value  of 
the  book  is  shown. 

In  memoriam  M.  B.  Wright,   with  portrait  by 
Dr.  Parvin.     The  volume  closes  with  a  complete 
index  of  Gynaecological  literature  of  all  countries 
for  187S,  covering  fifty-three  pages. 
A  Treatise  on  Common  Forms  of  Functional  Ner- 
vous Disease.  By  L.  Putzel,  M.D.   New  York, 
William  Wood  &  Co.,  1880. 
This  is  the  eighth  volume  of  the  series  of  1880 
of  Woods  Library  of  Standard  Medical  Authors. 
It  may  be  questioned  whether  the  work  can  really 
be   classed   with  those   usually  termed   standard 
authorities,  but,  as  it  presents  the  latest  scientific 
views  of  the  subjects  treated,  and  being  well  and 
ably  written,  it  fully  maintains  its  place  and  value 
among    its    companion    volumes  of    the   series. 
Chorea,  epilepsy,  the  various  forms  of  neuralgia 
and  peripheral   paralysis   are  the    subjects  upon 
which  the  author  dwells.     Tfie  last  subject  forms 
a  large  portion  of  the  work,  and  by  no  means  the 
least   valuable  part,  but,  as  it  includes  para'ysis 
from  acute  and  chronic  neuritis  and  surgical  inju- 
ries to   nerves,  the  title  of  the  work  is  not  fully 


22 


THE    CANADA    MEDICAL   RECORD. 


tarried  out,  especially  as  the  subject  of  hysteria  is 
omitted.     The  reason  why  hysteria  is  omitted  is 
because  the  author  considers  that  it  has  been  suf- 
ficiently described  in  detail  in  other  works,    but 
this  argument  might  also  be  applied  to  some  of  the 
other  subjects  written  on  in  this.      However,  itisa 
work  of  merit  and  cannot  fail  to  benefit  the  reader. 
The  Hygiene  of  Catarrh.     By  Thomas  F.  Rum- 
bold,   M.D.,  Part  I.  pp.  178.  St.    Louis,  Geo. 
O.  Rumbold  &  Co.,  1880. 
The  author  states  in  his  preface  "  That  some 
may  think  I  have  been  too  prolix  on  some  points." 
A  statement  that  we  fear  will   be  endorsed  by  a 
very  large  some  of  those  who  may  read  the  book. 
But  this  will  depend  upon  the  class  of    readers 
that   the  book  is  designed  for.     If  for  non-pro- 
fessional readers  then  the  work  may  be  of  value  as 
affording  useful   information,  but  if  intended  for 
professional   men,   the  author  must   consider  the 
average     physician     destitute    of    any    hygienic 
knowledge.     There  is  little  but  what  will  be  found 
'm\  any  of  the  ordinary  text-books,  and  that  little 
would  have  shown  better  in  a  pamphlet  form  than 
spread  over  a  large  extent  of  what  every  student 
is  supposed  to  be  informed  on  before  graduation. 


REPORT  OF  i  THE  SEMI-ANNUAL  MEET- 
ING OF  THE  COLLEGE  OF  PHYSICIANS 
AND  SURGEONS  OF  QUEBEC. 

The  semi-annual  meeting  of  the  Board  was  held 
at  Laval  University,  Quebec,  on  September  29th. 
There  were  present  the  following  Governors  : — Dr. 
Howard,    President  ;    Drs.  Trudel  and  Lemieux, 
Vice-Presidents  ;  Dr.  A.  G.  Belleau,  Secretary  ;  Dr. 
L.  LaRue,  Registrar ;    Dr.  E.  P.  Lachapelle,  Treas- 
urer ;    Drs.  David,  Kingston,    Rodgers,    Gibson, 
Robillard,  T.  LaRue  (of  Compton),  Bonin,  Lafon- 
taine,  Gervais,  Austin,  Perrault,  Ladouceur,  Rottot, 
Rousseau,  Gingras,  Lanctot,  Simard,  C.  Rinfret,  De 
St.  Georges,  Worthington,  Parke,  Laberge,  Craig, 
Marsden,  R.  F.  Rinfret,  Hon.  J.  J.  Ross  and  Jas. 
Sewell.     Mr.  C.  E.  Lamirande  of  Montreal  was  ap- 
pointed by  the  Board  to   take  legal   proceedings 
against   charlatans   and    unlicensed   practitioners 
throughout  the  Province  of  Quebec.     It   was  also 
moved  that  this  officer  be   instructed  to  take  legal 
proceedings    against     unregistered     practitioners 
forthwith,  and  also  that  the  Registrar  be  instructed 
to  place  the  names  of  those  members  12  months 
in    arrears  for  their    annual   contribution  in  the 


hands  of  the  prosecuting  officer.     Dr.  Donald  A. 
Livingstone  of  St.  Jean  Chrysostome,  County  of 
Chateauguay,  was  granted  the  license  of  the  Col- 
lege.    The  following  graduates,  on  presentation  of 
their  respective  diplomas  and  being  duly  sworn, 
obtained  the  license  of  the  College  : — Laval  Uni- 
versity, Quebec  :     C.  Mayrand,  M.D.,  Descham- 
bault  ;  J.  F.  Landry,  M.D.,  Beauport  ;  A.  Paradis 
M.D.,  Quebec  ;  W.  A.  Verge,  M.D.,  Quebec;  E. 
Bedard,  M.L.,  Pembroke  ;  O.  Clouthier,  M.D.,  Que- 
bec ;   E.  Prevost,  M.D.,  Sorel.     Laval   University, 
Montreal :  D.  Carrier,  M.D.,  Lacolle.     McGill  Uni- 
versity :  L.  Mignault,  M.D.,  CM.,  Montreal.    Vic- 
toria University:    E.  Lafarge ,  M.D.,  St.  Theodore 
d'Acton  ;   E.  Fournier,  M. P.,  St.  Jerome;    C.  La- 
roque,  M.D.,  Chambly ;  Jos.  M.  Beau,soleil,  M.D., 
Montreal ;  Hamilton  Meikle,  M.D.,  Montreal.  Drs. 
David,  Trudel  and  Lachapelle  of  Montreal,  Drs. 
Marsden,  J.  A.  Sewell  and  Gingras  of  Quebec,  were 
appointed   examiners  for  the  examination  of  mid- 
wives.  A  new  tariff  for  practitioners  both  in  town  and 
country  was  adopted,  and  will  shortly  be  submitted  to 
the  Lieut-Governor  in  Council  for  his  sanction.  The 
following  Examining  Committee  was  appointed  for 
the   next   semi-annual  meeting  : — Anatomy,    Dr. 
Lemieux  ;  surgery.  Dr.  Hingston  ;  medical  jurispru- 
dence. Dr.  Gervais  ;   physiology.  Dr.  Lachapelle  ; 
practice  of  medicine,  Dr.  Austin  ;  materia  medica. 
Dr.  Rousseau  ;  midwifery.  Dr. Trudel ;  Botany  and 
hygienics.   Dr.    Lanctot ;  chemistry.  Dr.  Rogers. 
Votes  of  thanks  were  tendered  to  the  officers  of  the 
College    and   also    to   Laval    University   for    the 
gratuitous  use  of  its  rooms. 

The  preliminary  examination  of  students  for  ad- 
mission to  the  study  of  medicine  took  place  on 
Thursday  and  Friday  at  Laval   University,  when 
the  following  gentlemen  (21  out  of  37  candidates) 
were  admitted  to  study  :  Stanislas  Caron,  George 
Matte,  James  M.  Foy,  Arthur  Delisle,  Alfred  Mor- 
risette,  Ls.  Philippe   Picard,   of  Quebec  ;    Hector 
Leduc,  of  Three  Rivers  ;    Alfred  Richard,  of  St 
Paschal,    County    of    Kamouraska  ;      Napoleon 
Blackburn,  of  Chateau    Richer  ;     Albert  De  Vil- 
lers,  of  Lotbiniore  ;  Wilbrod  Fournier,  of  Ottawa  ; 
Theophile  Pare,  of  Nicolet ;  Roderique  Mignault, 
of    Acton    Vale  ;     Hormisdas    Gauthier,    of  St. 
Eustache  ;  Gaudiose  Paradis,  of  Notre  Dame  de 
Levis  ;    Odilon   Berthiaume,   of  St.  Aimee  ;  Nar- 
cisse  Valin,  ofSt.  Damase, County  of  St.  Hyacinthe  ; 
John  Elder,  of  Huntingdon  ;    Seraphin  LeBlanc, 
Epiphanie  ;   Hector  Brosseau,   Lacadie,    County 
of  St.  John  ;   Arthur   David,  of  Montreal.     Ten 


THE   CANADA   MEDICAL   RECORD. 


23 


were  rejected  on  certain   branches,  and  six  on  all 
the  branches. 

At  the  above  meeting  the  following  business 
was  transacted. 

The  assessor's  report  being  read,  on  motion  was 
adopted  with  the  condition  that  the  names  of 
C.  N.  Barry,  J.  E.  Bergeron,  P.  Gaulreau,  Antoine 
Genereux,  who  have  not  completed  their  four 
years  medical  studies,  be  also  inserted.  Dr. 
McGowan's,  of  Stanstead,  letter  was  read,  asking  to 
be  reimbursed  certain  alleged  expenses  said  to 
have  been  incurred  the  last  session  of  Local  Legis- 
lature in  opposing  Witcher's  private  bill  to  practice 
medicine  in  this  Province — laid  on  table. 

A  letter  was  read  from  the  President  of  the 
Michigan  College  of  Medicine,  enquiring  whether 
the  students  of  the  said  College  who  may  desire 
to  continue  their  studies  in  the  Province  of 
Quebec  will  be  considered  as  having  passed  the 
matriculation  examination  required  by  the  Pro- 
vince. On  motion  the  letter  was  referred  to  a 
Committee  composed  of  Dr.  F.  W.  Campbell, 
Robt.  Craik,  J.  P.  Rottott,  and  E.  H.  Trudel, 
with  instructions  to  report  at  next  semi-annual 
meeting. 

Dr.    Prime,  of    Knowlton,    applied   by  letter, 
asking  if  his  son,   who  for    special  reasons  was 
inable  to  present  himself  for  the  license  at  this 
meeting,  may  be  permitted  to  assist  him  in  visit- 
ing patients,  stating  that  at  the  next  May  meeting 
n  Montreal  he  would  present  himself  for  license 
md  registration.     The  letter  was  laid  on  the  table. 
Dr.  F.   D.   Gilbert's  claim  against  the  College  in 
Drs,   Fenwick   and   Worthington's  case  was  next 
wrought  forward.    On  motion  the  matter  was  left  in 
he  hands  of  the  President  and  Ex-President,  who 
fere  to  act  on  legal  advice,  and  if  this  and  other 
:laims  were  just  had  authority  to  settle.     It  was 
irranged  that  the  prosecuting  officer  give  a  guar- 
.ntee  policy  to  the  extent  of$i,ooo  to  the  Board  to 
lay  the  premium.     This  officer  to  send  monthly 
etums  of  moneys  received  to  the  Treasurer,  and  a 
St  of  those  who  have  paid  to  the  Registrar. 
Dr.  E.  Longley's  pretended  claim  against  the 
College  in  a  prosecution  against  a  quack  was  read, 
nd  on  motion  it  was  resolved  :    That  Dr.  Longley 
e    written  to  for  the    authorization  he  received 
"om  the  President  in  the  matter,  and  that  in  the 
vent  of  his  producing  the  said  authorization,  with 
promise  on  the  part  of  the  College  to  pay  costs, 
lat  he  shall  send  in  an  attested  bill  of  costs  to 
»e  Secretary  of  the  College.     It  was  resolved  on 


motion  that  a  bonus  of  $250  be  voted  to  the 
Registrar  for  his  services  during  the  present  year. 
Dr.  Rottot,  seconded  by  Dr.  Robillard,  gave 
notice  of  motion  at  the  next  meeting  to  amend  the 
law  so  as  to  increase  the  Registrar's  annual  salary 
to  $400. 

On  motion  of  Dr.  E.  Laberge,  M.P.P.,  seconded 
by  Dr.  L.  D.  Lafontaine,  M.P.P.,  it  was  resolved 
that  a  copy  of  the  resolution  adopted  at  the  last 
triennial  meeting,  and  which  was  moved  by  Dr. 
Kingston,  one  of  the  members  of  the  College,, 
relative  to  ^proposed  amendments  to  the  Medical 
Act,  be  sent  to  the  Provincial  Attorney  General 
so  as  to  officially  inform  the  Quebec  Government 
of  the  contents  of  the  said  resolution. 

The  proposed  Medical  Tariff  as  adopted  unani- 
mously by  the  Governors  of  the  College  of  Physi- 
cians and  Surgeons  of  the  Province  of  Quebec, 
representing  the  medical  profession,  respectfully 
submitted  for  the  approbation  and  sanction  of  His 
Honor  the  Lieutenant  Governor  in  Council : — 


2.00 


Visits  from  8  a.m.  to  9  p.m.,  not  exceeding  half  a 

mile % 

Visits  from  9  p.m.  to  8  a.m.,  not  exceeding  half  a 

mile.     Not  to  exceed 4.00 

Visits,  each  additional  mile  in  day-time 50 

Visits             do              do     at  night i .  00 

Detention  a  whole  day 20 .  00 

do       a  whole  night 25 .  00 

Ordinary  office  consultation  with  prescription ....  2.00 

do       do              do             do              do  at  night  3.00 

Consultation  with  special  examination 5 .  00 

do       with  a  practitioner 5 .  00 

do       by  letter  between  practitioners 10.00 

Ordinary  certificate  of  health 5 .  00 

Special           do        attested  with  report 8 .  00 

Certificate,  with  report  on  disease  and  death 5.00 

Post-mortem  examination  external 5 .00 

do                     do         with  sectio  cadaveris  ..  10.00 
Ordinary  case  of  midwifery  (subsequent  attendance 

extra) j^qq 

Turning,  application  of  forceps,  extraction  of  Pla- 
centa, (Subsequent  attendance  extra) 30  00 

Miscarriage,  premature  confinement   (subsequent 

attendance  extra) I?. 00 

For  attendance    with  a  midwife  in  all  cases  the 

charge  is  the  same  as  for  delivery 

Catheterism,  ordinary  cases 

do       each  subsequent  operation 

Vaccination,  Bleeding,  Extraction  of  teeth,  Hypo- 
dermic Injection,  etc. ,  etc \.oo 

Introduction  of  stomach  pump 5 .  00 

Application   of  cupping  glasses,   leeches,   setons, 

moxa,  plugging,  etc.,  etc 5.00 

Chloroformization  or  other  anaesthetics 5  •  00 

Setting  fracture  of  the  thigh 25 .  00 

do          do         do     leg  or  arm 20 .  00 


3.00 
1. 00 


THE   CANADA   MEDICAL   KECORD. 


Reducing  dislocation  of  the  thigh 50 .00 

do             do            do     leg  or  arm 25. 00 

Amputation  of  the  thigh 100.00 

do             do       leg  or  arm 50 .  00 

Operation  for  strangulattd  hernia 100.00 

Jteduction  of  the  hernia  by  taxis 25.00 

Lithotomy  or  lithotripsy 200.00 

•Ovariotomy 5°°  •  °° 

Tracheotomy 5°  ■  °° 

Operation  for  cataract lOO.OO 

Extirpation  of  the  breast 50.00 

Do         of  a  tonsil lo.oo 

Amputation  of  fingers  or  toes 10.00 

Capital  operations  not  already  specified 100.00 

Minor             do       do         do         do          25. OO 

The  above  charges  for  surgical  operations  are 
for  the  operation  only,  subsequent  attendance  and 
services  are  extra. 

FOR    MEDICINES  ANU  DRUGS. 

Mixtures  and  draughts,  up  to  two  ounces 25 

Do  do  do    4         do     50 

Do  do  do    8         do     i  .00 

Powders  from  one  to  six  ( i  to  6) 25 

do       do    six  to  twelve  (6  to  12) 5° 

Pills  per  box  of  one  dozen 5° 

Do  for  each  additional  dozen 25 

Lotions,  Injections,  etc.,  etc.,  4  to  16  ounces. ...  50  to  $  I 

Liniments,  Embrocations,  etc.,  4  to  8  ounces 50  to  $1 

Blisters  and  Plasters,  according  to  size 50  to  $1 

Ointments  per  ounce  box 25  to  50c . 

When  costly  drugs  or  medicines  are  used  the 
charge  to  be  augmented  according  to  value. 
Quebec,  29th  September,  1880. 


CANADA  MEDICAL  ASSOCIATION. 

Report  ok  the  Committee  on  Necrology. 

Gentlemen  : — With  the  annually  recurring  meet- 
ing and  festivities  of  this  association,  it  becomes 
our   duty   to  pay   our   respects  to   the   departed 
brethren   in  the  profession,  by  an  annual  roll-call 
of  the  honored  dead.     Some  of  the  members  who 
joined  us  in  our  meeting  in  London  last  year  have 
since  been  called  to  their  fathers,  and  it  may  be 
that  some  who  meet  together  to-day  in  such  health 
and  buoyancy  of  spirits  meet  for  the  last  time  on 
earth.     These  are  solemn  warnings  which  we  do 
well    occasionally   to   recall   to    mind.     We    are 
continually  reminded  that  life   is  short,  and  the 
thread  soon  runs  out.     The  span  of  our  earthly 
existence  at  best  is  narrow,  and  we  know  not  how 
soon  it  may   be  crossed.     The  destroying  angel 
has   been  busy   among  our   ranks  since   last  we 
met  together.     Our  list  contains  thirty  names,  but 


there  are  no  doubt  many  more  whose  names  have 
not  been  handed  in.  Among  those  we  have  are  to 
be  found  both  young  and  old,  but  those  of  middle 
life  are  most  numerous.  A  few  have  lived  to  a 
green  old  age,  and,  ripe  in  experience  and  full  of 
honors,  have  gone  down  to  the  grave  lamented. 
Some  have  been  cut  off  ere  they  had  yet  entered 
the  threshold  of  professional  life,  but  by  far  the 
greater  number  have  been  taken  away  in  the 
prime  of  life,  in  the  vigor  of  manhood,  and  in  the 
midst  of  active  professional  duties.  The  list  is 
as  follows  : — 

Dr.  R.  W.  W.  Carroll,  Barkery,  B.C. 
Dr.  E.  L.  Hopkins,  Hamilton. 
Dr.  J.  Garvey,  Ottawa. 
Dr.  W.  A.  Doupe,  Zurich. 
Dr.  O.  Rupert,  Maple. 
Dr.  J.  Clarke,  Pugwash,  N.S. 
Dr.  James  Bovell,  Toronto. 
Dr.  J.  R.  Ash,  Centreville. 
Dr.  A.  Higinbotham,  Belleville. 
Dr.  R.  N.  Burnham,  Port  Hope. 
Dr.  Chas.  F.  A.  Locke,  Hamilton. 
Dr.  J.  R.  Philip,  Gait. 
Dr.  R.  S.  Campbell,  Dartmouth,  N.S. 
Dr.  J.  Demers,  St.  Jean,  Que. 
Dr.  C.  B.  Hall,  Toronto. 
Dr.  J.  Struthers,  Kentville,  N.S. 
Dr.  S.  G.  Rutherford,  Newry,  Ont. 
Dr.  J.  Cook,  Sault  St  Marie. 
Dr.  J.  McGrath,  Bothwell. 
Dr.  J.  Turquand,  Woodstock,  Ont. 
Dr.  W.  R.  Rose,  Newcastle. 
Dr.  W.  J.  Gracey,  Comber,  Ont. 
Dr.  Herriman,  Port  Hope,  Ont. 
Dr.  Thomas  White,  Hamilton. 
Dr.  W.  N.  Campbell,  Wellington,  Ont. 
Dr.  P.  W.  Smith,  Digby,  N.S. 
Dr.  J.  M.  Fowler,  Burford. 
Dr.  Thos.  P.  Eckhardt,  Unionville,  Ont. 
Dr.  H.  W.  Rath,  Toronto. 
Dr.J.A.  Wolfe,  Ottawa. 
Two  of  the  above  were  cases  of  accidental  poison . 
ing,  viz.,  Drs.  Gracey  and  Clark,  and  one  a  sac 
case   of  drowning,    Dr.   Doupe,    on   the  ill-fate< 
Steamer  Waubuno. 


MARRIED. 


On  September  30th,  at  St.  John  the  Evangelist' 
Church,  Montreal,  by  Rev.  E.  Wood,  H.  E.  Mitchell 
M.D.,  of  Slanbridge  Station,  Que.,  to  Miss  Ellen  Actoi 
of  Lichfield,  Staffordshire,  England. 


THE  CANADA  MEDICAL  RECORD. 


Vol.  IX. 


MONTREAL,  NOVEMBER,  1880. 


No.  1. 


C  OlsTTEIsTTS- 


ORIGINAL  COMMUNICATIONS. 

Paqb 

Yaccination  in  Chronic  Skin  Dis- 
eases. Read  before  the  Medico- 
Chirurgical  Society  of  Montreal, 
25 — On  the  Local  After-treatment 
of  Operations,  bj  C.  E.  Nelson, 
N.Y.,  30— Fracture  of  the  Cervix 
Femoris,  External  to  the  Joint,  in 
a  lady  71  years  old,  weighing  over 
200  pounds  :  cure  by  Bony  Union, 
0.  E.  Nelson,  N.Y 32 


PROGRESS  OF  MEDICALSCIENCE 

Paqb 
On  the  use  of  Arsenic  as  a  Blood  and 
Cardiac  Tonic,  33 — Clinical  Lec- 
ture on  Burns,  by  R.  J.  Levis,  Hi.. 
D.,  34 — A  case  of  Inveterate  Epi- 
lepsy successfully  treated  by  Ergot 
and  Bromide  of  Sodium,  by  J.  K. 
Bauduy,  M.D.,  37— Vaginitis,  Dr.  J. 
M.  Duncan,  38 — Heat  and  Light  in 
the  Sick-room,  39— The  Collodion 
Bandage  in  the  treatment  of  Um- 
bilical Hernia,  40— Cough  produc- 


ed by  accumulations  in  the  Ear, 
40 — Liniment  for  Sore  Nose,  40 — 
Formula  in   Gonorrhoea,  41— Ear- 


.41 


ache  and  Chloroform  Vapor. 

EDITORIAL. 

Page 
Laval  Medical  Faculty,  41 — Trom- 
mer's  Extractof  Malt,  43  — Personal 
43— Obituary,  43-44— St.  Nicholas 
for  1881,  44—21  Numbers  of.Scrib- 
ner's  for  $5,  45 — Pamphlets  receiv- 
ed, 4.5 — Reviews,  45 — Medico-Chi- 
rurgical  Society 47 


driiinai  Bommunkaimn^i. 

VACCINATION  IN  CHRONIC  SKIN 
DISEASES. 

(Read  before  the  Medico-Chirurgical  Society  of  Montreal, 
Oct.  29th,  1880.) 

Mr.  President  and  Gentlemen  : — In  the 
number  of  the  British  Medical  Journal  for  Sept. 
4th,  1880,  a  letter  appeared  from  Chas.  D.  Drury, 
M.D.,  Bucklersbury,  Eng.,  giving  his  experience  of 
the  result  of  vaccination  in  three  cases  of  chronic 
€czema,  which  was  most  gratifying. 

This  communication  interested  me  very  much 
at  the  time,  inasmuch  as  it  recalled  to  mind  many 
cases  in  my  experience  as  public  vaccinator,  in 
which  I  had  seen  skin  eruptions  of  various  kinds 
disappear  at  the  time  of  vaccination,  and  apparent- 
ly as  the  direct  result  of  it. 

I  am  aware  that  it  is  contrary  to  the  pre- 
•conceived  notions  of  the  profession  to  vaccinate 
any  child  having  a  skin  eruption,  and  when  in 
1876  I  was  appointed  one  of  the  public  vaccina- 
tors we  were  strictly  prohibited  from  vaccinating 
any  child,  "  with  eruptions  behind  the  ears  or 
elsewhere  on  the  skin."  And  we  were  particularly 
■cautioned  against  collecting  vaccine  lymph  from 
any  child  with  "  eruptions  on  the  skin,"  notwith- 
standing that  some  of  our  prominent  local  medical 
authorities  then  held,  and  still  hold,  that  no  other 
virus  or  blood  contamination  can  be  communi- 
cated or  conveyed  with  vaccine  lymph. 


Four  years  of  experience  (during  which  time  I 
have  vaccinated  over  7,000  persons)  has  taught 
me  many  practical  lessons  on  this  subject,  among 
others  these :  that,  ist.  There  is  no  danger  incurred 
and  there  need  be  no  hesitation  in  vaccinating 
any  child  suffering  from  a  cutaneous  eruption. 

2nd.  That  most  skin  eruptions  disappear  im- 
mediately after  vaccination. 

3rd.  That  there  is  very  strong  presumptive 
evidence  of  the  communicability  of  various  blood 
contaminations  through  the  medium  of  vaccine 
lymph ;  and, 

4th.  That  the  absence  of  red  blood  corpuscles 
from  lymph  does  not  guarantee  the  absence  of 
blood  taints,  simply  because  germs  of  disease 
float  in  the  serum  of  the  blood  in  the  same  way 
that  blood  corpuscles  themselves  do,  and  may  find 
their  way  into  the  lymph  poured  out  into  a 
vaccine,  as  well  as  any  other  vesicle  ;  and  who 
shall  say  that  blood  corpuscles  convey  poisons,  or 
that  the  liquor  sanguinis  is  not  the  medium  of 
their  communication.  Or,  that  a  cancer,  or  a 
syphilitic  cell,  may  not  be  present  in  the  lymph 
exuding  from  an  apparently  healthy  child's  arm, 
although  to  the  naked  eye  it  may  appear  per- 
fectly clear  and  transparent. 

Our  authorities  moreover  described  pure  lymph 
as  "  liquid,  clear,  limpid,  translucent,  sometimes 
slightly  yellow  and  moderately  viscid." 

Now  I  take  e.xception  to  the  "  sometimes  slightly 
yellow  "  characteristic,  and  unhesitatingly  say  that 


26 


TUE   CANADA   MEDICAL   RECORD. 


I  believe  if  such  lymph  were  examined  under  a 
microscope  it  would  be  found  to  contain  pus. 
The  lymph  furnished  by  a  vaccine  vesicle  of  a 
scrofulous  or  strumous  child  is  always  yellow,  be- 
cause it  always  contains  pus  after  the  earliest 
stages,  and  such  lymph  will  produce  septicaemia. 

Hence  I  would  prefer  not  taking  vaccine  from 
children  at  all,  except  under  the  most  favorable 
circumstances,  and  for  the  simple  reason  that  com- 
municable blood  taints  may  lurk  in  the  blood  of 
persons,  where  no  outward  evidence  is  yet  ap- 
parent, as,  for  example,  in  children  of  cancerous 
families.  The  sincerity  of  our  faith  in  the  non- 
communicability  of  blood  taints  by  means  of 
vaccine  IjTnph  may  be  easily  discovered  by  asking 
the  question,  who  is  there  among  us  who  would 
be  willing  to  allow  himself  to  be  vaccinated  with 
lymph  from  the  arm  of  a  patient  covered  with  a 
syphilitic  eruption  ? 

When  the  present  system  of  district  vaccination 
was  first  introduced  the  whole  populace  were  in 
a  state  of  excitement  on  the  subject  of  vaccina- 
tion, and  the  French  portion  of  the  community, 
led  by  the  anti-vaccinationists  were  bitterly  opposed 
to  the  practice,  pointing  to  numerous  cases  of  bad 
results  following  it.  Under  these  circumstances, 
in  order  to  conciliate  and  change  the  popular 
prejudice,  it  was  necessary  that  the  greatest  care 
should  be  exercised  in  the  whole  mode  of  pro- 
cedure : 

I  St.  That  the  lymph  used  should  be  absolutely 
pure  and  perfectly  reliable;  and,  2nd.  That  no 
children  unfit  for  the  operation  should  be  vaccin- 
ated. 

The  discovery  of  the  Longue  Pointe  cases  of 
spontaneous  cow-pox  afforded  us  the  opportunity 
required  to  meet  the  first  indication ;  and  the 
instructions  of  the  Board  prohibiting  the  vaccina- 
tion of  any  child  having  "an  eruption  behind 
the  ears,  or  elsewhere  on  the  body,"  and  which 
was  sedulously  adhered  to  for  some  time,  met 
the  second. 

However,  during  the  season  1878-79,  finding 
that  a  very  large  number  of  children  having  slight 
rashes  were  being  passed  over,  and  some  of 
these  in  some  cases,  almost  immediately  after- 
ward were  attacked  and  died  of  small-pox,  relying 
on  the  purity  of  the  lymph,  I  determined  to 
vaccinate  all  children  with  rashes  not  of  a  very 
severe  character — omitting  only  the  very  worst, 
which  I  had  not  the  temerity  to  undertake. 

1  soon  found,  to  my  great  satisfaction,  that  this 


class  of  children  all  did  well,  their  arms  giving 
no  trouble,  and  the  rashes  in  such  as  I  was  able 
to  see  afterwards,  having  disappeared  altogether. 
Emboldened  by  my  success  in  mild  cases,  I  next 
began  to  extend  the  benefits  of  vaccination  to 
cases  of  greater  severity,  as,  for  instance,  general 
eczematous  eruptions,  scald  head,  children  with 
scrofulous  ophthalmia,  &c.,  &c.  And,  although  in 
some  instances  of  slow  recovery  I  doubted  the 
prudence  of  incurring  the  risk,  yet  in  the  end  all 
resulted  satisfactorily,  and  the  skin  eruption  wa^ 
cured. 

I  have  selected  five  cases  as  examples,  which  I 
will  narrate  to  you  as  briefly  as  possible  : 

Case  I.  Eczema  Chronicum. — The  child  of  a 
resident  in  St.  Martin  street,  previously  an  anti- 
vaccinationist.  The  family  consisted  of  seven 
children,  six  of  whom  I  had,  at  the  father's  own 
request,  vaccinated  successfully — although  he  had. 
refused  over  and  over  again,  previous  to  this  time, 
to  have  any  of  them  vaccinated.  This  child,  aged 
fifteen  months,  was  at  first  passed  over  because  of 
an  eczematous  eruption  over  the  whole  body,  but 
chiefly  on  the  head  and  upper  extremities. 

From  an  extreme  opponent  he  became  an  ex- 
treme partisan  by  telling  me  that,  if  it  would  not 
make  the  child  any  worse,  I  might  vaccinate  it 
also.  Feeling  a  little  cornered,  and  as  small-pox 
was  across  the  street,  I  vaccinated  the  child, 
believing  that  there  might  be  something  after  all 
in  the  theory  of  the  "  antagonism  of  poisons," 
and  that,  by  setting  up  one  disease,  it  might  cure 
another.  To  my  great  satisfaction  the  vaccine  did 
well,  and  the  eruption  began  to  decline  as  soon  as 
the  vesicles  were  developed,  and  soon  disappeared 
entirely. 

Case  H.  Porrigo  Capitis. — The  infant  child  of  a 
resident  of  St.  Joseph  street.  At  two  months  old 
an  eruption  on  head  appeared,  which  grew  worse, 
and  spread  over  face,  arms,  and  chest.  Every 
kind  of  treatment  proved  unsuccessful.  When 
eighteen  months  old  I  vaccinated  it,  not  for  the 
purpose  of  curing  it,  but  (as  they  were  patients  of 
my  own)  to  determine  whether  vaccination  in  such 
a  case  would  really  aggravate  the  symptoms  or  not. 

From  the  time  that  the  vaccine  disease  had 
developed  itself  the  eruption  began  to  decline  and, 
in  about  three  weeks,  had  entirely  disappeared. 

Case  III.  Secondary  Syphilis. — During  the 
winter  of  1879  ^  young  gentleman,  calling  himself 
a  commercial  traveller,  called  upon  me  to  be 
vaccinated,  stating  that  a  gentleman  had  just  been 


THE  CANADA   MEDICAL   RECORD. 


27 


taken  to  the  Small-Pox  Hospital  from  his  board- 
ing-house. 

On  stripping  his  arm  I  found  an  extensive 
secondary  syphilitic  eruption  for  which  he  told  me 
ie  was  then  taking  medicine. 

I  hesitated  about  vaccinating  him,  as  I  feared 
a  possible  syphilitic  ulcer  at  the  point  of  vaccin- 
ation. 

However,  as  his  dread  of  small-pox  was  para- 
mount to  every  other  consideration,  I  yielded,  and 
vaccinated  him.  He  reported  to  me  two  or  three 
limes  afterwards,  when  I  found  my  vaccination 
successful.  It  ran  the  usual  course,  but  was  slow 
in  healing,  and  desquamated  a  succession  of 
scabs.  As  the  vaccine  began  to  decline  an 
improvement  in  the  appearance  of  the  eruption 
was  perceptible,  and  it  gradually  disappeared, 
whether  from  influence  of  an  iodide  or  vaccine 
J  am  not  prepared  to  say. 

Case  IV.  Eczema  Simplex. — In  a  small  street 
off  St.  Alexander  I  vaccinated  three  children,  one 
aged  about  two  years  having  an  eczematous  erup- 
tion on  head,  arms  and  body.  It  did  well,  and 
finally  made  a  good  recovery.  After  it  had  been 
vaccinated  the  father,  feeling  dissatisfied  about  it, 
-consulted  a  senior  practitioner,  who  very  gravely 
denounced  my  procedure  as  very  improper.  How- 
ever the  result  was  satisfactory,  and  I  blessed  my 
stars  for  the  old  motto  :  "  Nothing  succeeds  like 
success." 

Case  V. — In  Chaboillez  street  I  vaccinated  a 
child  very  recently  having  a  general  eczematous 
eruption  of  the  body,  with  sores  behind  the  ears  : 
The  vaccination  was  successful,  and,  when  last 
seen,  the  eruption  had  entirely  disappeared. 

I  can  recall  to  mind  several  cases  of  chronic 
skin  disease  in  which  the  eruption  disappeared, 
after  vaccination,  but,  until  I  read  the  letter  of  Dr. 
Drury  in  the  Bi-itish  Medical /ounjal,  I  would  not 
have  had  the  courage  to  advise  another  to  go  and 
■do  likewise. 

Dr.  Drury's  letter  appeared  in  the  Journal  for 
September  4th,  1880,  in  which  he  narrates  having 
vaccinated  an  eczematous  child  at  the  urgent  so- 
licitation of  the  parent,  in  which  case  the  eruption 
began  to  decline  on  the  fifth  day  of  vaccination, 
and  entirely  disappeared.  He  then  repeated  the 
operation  in  a  second  and  a  third  case  with  the 
same  beneficial  result. 

This  letter^  called  forth  letters  from  others,  and 
Dr.  Murray  writes,  September  18th,  1880,  that  "It 
is  or  ought  to  be  known  to  all  obstetricians,  that 


vaccination  is  a  cure  for  infantile  eczema." 
Dr.  Wilson  also  narrates  cases  of  vaccination  in 
eczema,  followed  by  decline  of  the  eruption,  and 
Dr.  Tyler  writes  in  the  same  strain,  narrating  cases 
of  eczema  cured  by  vaccination. 

But  to  Dr.  Grant  of  Ottawa,  seems  to  belong 
the  credit  of  having  first  drawn  attention  to  the 
alterative  effects  of  vaccine  lymph  in  cutaneous 
diseases.  In  the  Medical  Tunes  and  Gazette  for 
March,  1863,  appears  an  article  from  his  pen  from 
which  I  gather  the  following  particulars  pertinent 
to  the  subject  under  consideration. 

Case  I. — Aged  twenty-five,  was  one  of  psoriasis 
palmaris  of  five  years  duration  ;  had  tried  various 
methods  of  treatment  without  success ;  finally  as  a 
dernier  resort  tried  vaccination,  "  to  observe  the 
alterative  effects  of  vaccine  virus  upon  the  system, 
under  the  conviction  that  vaccine  introduced  into 
the  system  is  under  certain  circumstances  one  of 
the  most  powerful  blood  purifiers  we  possess."  Had 
been  previously  vaccinated  when  a  child ;  opera- 
tion successful ;  case  cured  by  20th  day. 

Case  II Torica  numularis  on  right  forearm 

of  boy,  aged  thirteen ;  re-vaccinated  successfully  ; 
on  seventeenth  day  disease  disappeared. 

Case  III. — Tubercula  syphilitica  ;  vaccinated 
on  arm  successfully.  On  fourteenth  day  the  tuber- 
cles flattened  down,  and  in  four  weeks  only  a 
slight  desquamation  remained  in  most  spots. 

Case  IV. — Psoriasis  Lepraformis,  set.  twenty- 
four,  mother  of  four  children  ;  extending  over 
whole  body,  even  to  roots  of  hair ;  tried  alteratives 
without  success.  Six  months  after  its  appearance, 
tried  vaccination.  Disease  disappeared  in  four 
weeks. 

I  have  found  a  case  (similar  to  last  of  Dr. 
Grant's)  of  Psoriasis  Lepraformis  of  eighteen 
years  standing,  which  I  projDOse  showing  to  the 
Society  for  the  purpose  of  submitting  this  method 
of  treating  chronic  cutaneous  diseases  to  a  crucial 
test.  I  propose  to  vaccinate  her  on  both  arms  and 
both  legs  if  she  will  allow  me,  and,  after  sufficient 
time  has  elapsed,  ask  her  to  come  back  and  show 
what  the  results  of  the  experiment  has  been. 

This  patient  was  presented  to  the  Society  and 
presented  a  well  marked  case  of  Chronic  Psoriasis. 
On  Nov.  I  St  she  allowed  herself  to  be  vaccinated 
with  animal  vaccine  on  twelve  places — three  on 
each  extremity.  Nov.  loth,  vaccine  taken  well ; 
patient  very  feverish  and  ill  from  its  effects.  Nov. 
17th — Eruption  rapidly  disappearing. 

I  need  hardly  add  how  pleased  I  have  been  to 


28 


THE   CANADA   MEDICAL   RECORD. 


find  that  others  had  made  like  observations  with 
myself,  and  I  will  read  you  a  note  received  from 
my  colleague,  Dr.  Labcrge,  jiublic  vaccinator  in 
Eastern  District.  In  regard  to  vaccination  in 
cases  of  skin  diseases  :  From  my  experience  as 
public  vaccinator,  I  can  state  that  I  have  vaccin- 
ated in  various  kinds  of  skin  eruption  without  any 
bad  eflect.  Moreover,  I  would  have  no  hesitation 
in  any  kind  of  skin  diseases,  as  I  would  expect 
no  bad  result  to  follow.  I  have  remarked  that  in 
some  cases  the  eruption  is  increased  immediately 
after  vaccination  but  again  declines.  As  to  the 
})oint  raised  whether  cases  are  cured  by  vaccina- 
tion, I  have  not  followed  up  the  cases  vaccinated 
to  be  in  a  position  to  state  the  final  effects. 

In  conversation  with  a  lady  patient  a  day  or  two 
ago,  she  narrated  to  me  a  circumstance  bearing 
on  this  subject.  A  number  of  years  ago  she  was 
residing  temporarily  at  Berthier,  P.Q.,  with  a 
friend  who  had  a  child  with  a  severe  and  obstinate 
eruption  on  the  head.  A  Dr.  Mull,  a  resident 
physician  (an  old  Norwester),  after  trying  various 
remedies,  told  the  mother  that  he  would  try 
vaccination,  and  did  so  with  the  happiest  results. 
The  child  recovered  immediately.  (I  must 
apologise  for  introducing  this  tale  here,  but  I  have 
taken  pains  to  verify  it,  and  believe  the  above  to 
be  a  narration  of  facts). 

I  am  fally  convinced  from  observation  that  the 
three  following  propositions  embody  the  con- 
clusions to  be  drawn  from  my  own  experience  as 
public  vaccinator. 

I  St.  Pure  vaccine  when  introduced  into  the  sys- 
tem of  the  human  subject  acts  as  an  eliminator, 
and  drives  out,  or  causes  to  appear  on  the  surface, 
any  latent  blood  poisons  that  may  have  been  lurk- 
ing in  the  system.  Hence  practitioners  are  some- 
times unjustly  censured  where  an  eruption  has 
followed  vaccination. 

2nd.  No  harm  can  arise  from  the  vaccination  of 
children  suffering  from  cutaneous  eruptions. 

3rd.  Not  only  will  no  harm  result,  but  because 
of  an  eliminative  or  alterative  action  of  the 
vaccine  virus  on  the  human  system,  impurities  in 
the  blood  may  be  got  rid  of,  and  many  cutaneous 
diseases  (not  of  parasitic  origin,  but  depending 
upon  the  presence  of  some  blood  taint  or  poison  in 
the  system)  may  be  radically  cured  by  it. 

4th.  From  all  this  it  must  be  apparent  to  the 
most  casual  observer  that  the  use  of  lymph  taken 
from  human  subjects  must  always  be  attended 
with  considerable  risk. 


Lastly.  From  what  I  have  tried  to  bring  before 
you,  I  think  it  must  be  apparent  that  in  vaccine 
virus  we  have  something  of  much  greater  import- 
ance to  the  profession  than  a  mere  prophylactic 
against  small-pox;  that  in  fact  it  is  powerfully 
eliminative  and  depurative  in  its  action,  which 
will  recall  to  mind  the  popular  prejudice  that  the 
human  system  is  always  much  more  free  from 
impurities  after  an  attack  of  small-pox  than  be- 
fore. 

An  interesting  discussion  then  followed. 
Dr.   Kennedy  said,  with  respect  to  the  theory 
of  the  antagonism  of  blood  poisons,  advanced  by 
Dr.  Bessey,  there  appeared  to  be  a  possibility  of 
such  antagonism  producing  good  results.     He  had 
recently  a  severe  case  of  Psoriasis  in  a  child,  in 
which   various  remedies   had  been  tried  without 
success.      Diphtheria  ensued,   and,  on    recovery 
from  the   latter,  the  skin  affection  entirely  disap- 
peared.     With    regard  to  vaccinating  a  child  suf- 
fering from  eczema,  he  thought   it  was  improper, 
as  the  eruption  was  likely  to  be  made  worse,  and 
thus  bring  discredit  on   vaccination.     Some  time 
ago  had  seen  a  child  that  Dr.  Bessey  had  vaccin- 
ated  a  few  days  previously,  this   child  was  very 
scrofulous,  and  there  existed  an  eczematous  erup- 
tion and  favus  of   the  scalp.     Since  the  vaccin- 
ation the  eczema  was  very  much  worse,  and   the 
favus  had  spread  to  the  arm,  which  was  severely 
inflamed  from  shoulder   to  elbow.     The  parents 
loudly  condemned  the  vaccination,  and  could  not 
be  convinced  but  what  the  vaccine  had  poisoned 
the   arm.     Fortunately  the  disease    yielded   in   a 
few  weeks  to  the  usual  remedies.     'I'his  case   was 
an    example   of  the   impropriety    of  vaccinating 
under  such  circumstances,  and  therefore  he  would 
not  favor  the  operation  in  skin  diseases. 

Dr.  Reddy  would  like  to  ask  Dr.  Bessey  how 
long  a  time  usually  elapsed  after  vaccination  until 
a  cure  was  effected. 

Dr.  Ross  thought  conclusions  drawn  in  the 
paper  too  general.  The  number  of  cases  reported 
were  too  {tw  to  enable  the  Society  to  form  an 
opinion.  A  large  number  of  cases  would  be  re. 
quired.  As  to  how  vaccine  acts  to  produce  this 
effect  is  pure  speculation.  The  attempt  to  show 
that  cases  of  secondary  syphilitis  and  purely  local 
chronic  skin  affections  are  amenable  to  treatment 
by  this  means  was  going  too  far,  notwithstanding 
that  Dr.  Grant's  cases  were  reported  in  substan- 
tiation of  the  theory.  He  thought  the  subject  de- 
serving of  greater  attention  in  future  so  as  to  define 


THE    CANADA    MEDICAL    RECORD. 


29 


the  exact  scope  of  the  appHcation  of  this  agency 
in  the  treatment  of  skin  affections.  He  thought  it 
would  be  difficult  to  apply  where  patients  had 
been  previously  vaccinated. 

Dr.  Larocque,  health  officer,  had  never  given 
the  subject  any  thought,  but  had  never  seen  skin 
affections  cured  by  vaccination.  However,  he 
was  aware  of  the  fact  that  eruptive  blood  poisons 
were  eliminated  by  it. 

Dr.  Henry  Howard  considered  much  credit  due 
to  the  reader  of  the  paper  for  bringing  the  subject 
before  the  Society.  More  cases  were  required  to 
form  an  opinion — all  eruptive  diseases  are  not 
blood poisotis  as,  for  example,  gouty  eczema,  which 
is  due  to  nerve  irritation.  Nervous  irritable  old 
people  are  liable  to  be  eczematous.  Impure  b  ood, 
he  considered  to  be  blood  laden  with  disease  germs, 
and  in  many  skin  affections  the  blood  was  not 
impure.  He  hoped  the  observations  would  be 
continued,  and  more  facts  bearing  on  the  subject 
elicited. 

Dr.  Roddick  said  it  was  an  entirely  new  subject, 
and  the  observations  made,  and  the  boldness  of  the 
conception  reflect  credit  on  the  reader  of  the  paper. 
He  would,  however,  not  have  feared  any  trouble 
arising  from  the  vaccination  of  a  person  having  a 
secondary  syphilitic  eruption  as  Dr.  Bessey  appears 
to  have  done.  The  cases  which  gave  trouble  were 
those  in  which  syphilis  had  been  conveyed  or 
transmitted  from  a  diseased  to  a  healthy  subject. 
The  theory  required  to  be  supported  by  further 
evidence  before  it  could  be  accepted  by  the  pro- 
fession, He  would  watch  with  interest  the  result 
of  vaccination  in  the  case  of  Psoriasis  Leprafor- 
mis  of  eighteen  years  standing,  presented  before 
the  Society  Co-night. 

The  President  (Dr.  Hingston)  said  the  portion 
of  the  paper  introductory  to  the  subject  proper  re- 
ferred to  the  "  Instructions  given  to  Public  Vac- 
cinators." Having  been  Chairman  of  the  Board 
of  Health  at  the  time  those  instructions  were  issued, 
he  considered  himself  personally  responsible  for 
them.  They  were  compiled  in  the  most  careful 
manner  from  various  codes  of  other  countries,  and 
io  the  careful  manner  in  which  the  instructions 
were  carried  out  by  the  public  vaccinators  the  City 
was  indebted  for  the  remarkable  freedom  from 
accident  which  attended  their  work. 

On  former  occasions,  and  before  attention  was 
directed  to  certain  details  which  were  formerly 
considered  unimportant,  accidents  were  of  frequent 
occurrence,  and  of  a  nature  to  give  a  sort  of  ex- 


cuse to  the  anti-vaccinators  to  continue  their  un- 
fortunate attacks  against  the  practice  of  vaccina- 
tion. One  of  these  instructions  was  not  to  vac- 
cinate infants  suffering  from  febrile  disturbance  or 
from  cutaneous  eruptions.  He  (Dr.  Hingstori) 
thought  this  a  wise  advice.  As  to  chronic  eczema 
he  had  nothing  to  say,  not  having  seen  vaccination 
practised  for  that  disease.  But  in  acute  eczema 
the  case  was  quite  different.  The  latter  is  not  a 
blood  disease.  Eczematous  eruptions  frequently 
occur  about  the  period  of  teething,  and  the  highest 
authority.  West,  for  instance  advises  non-interfer- 
ence. It  would  be  hardly  fair  to  the  little  sufferer 
to  add  another  irritant,  such  as  that  of  vaccine,  to 
one  already  producing  so  much  disturbance.  He 
hoped  nothing  in  the  paper  just  read  would  induce 
practitioners  to  vaccinate  infants  suffering  from 
acute  febrile  or  cutaneous  disorders.  If,  however, 
vaccination  were  found  to  modify  and  cure  chronic 
eczema,  the  Society  would  certainly  be  indebted  to 
Dr.  Bessey  for  having  so  earnestly  drawn  attention 
to  the  matter. 

Dr.  Bessey,  said,  in  reply  to  Dr.  Kennedy,  he  did 
not  see  case  referred  to  after  vaccination,  as  he  un- 
derstood the  family  physician  had  been  called  in, 
and  he  accordingly  retired.  However,  judging  from 
the  time  in  which  the  cure  was  effected,  he  thought 
the  case  might  be  claimed  for  vaccination,  which 
would  at  first  greatly  increase  the  eruption,  and 
that  would  be  followed  immediately  by  decline 
and  disappearance.  In  answer  to  Dr.  Reddy, 
he  said  the  time  in  which  cures  were  effected 
in  cases  observed  by  him  had  been  in  about 
three  weeks.  Exceptional  cases  might  be  longer. 
In  reply  to  Dr.  Ross,  he  said  he  had  not  expected 
to  establish  a  new  departure  in  the  treatment  of 
skin  diseases,  but  had  merely  wished  to  add  his 
quota  from  the  ample  opportunity  for  observa- 
tion which  his  position  had  afforded  him.  As  to 
the  difficulty  about  re-vaccination,  Dr.  Grant's 
cases  were  mostly  re-vaccinated,  and  the  result  had 
been  satisfactory,  and  no  one  would  deny  that  Dr. 
Grant  was  a  most  creditable  medical  witness.  Dr. 
Larocque  had  simply  not  paid  any  attention  to  the 
subject. 

A  day  or  two  ago,  while  in  conversation  with  a 
lady  of  this  city  on  the  subject  of  vaccination  in 
skin  diseases,  she  related  a  circumstance  of  a  Dr.- 
Mull,  of  Berthier,  having  vaccinated  a  child  suffer- 
ing from  an  inveterate  eruption  on  head  of  what  she 
termed  Canadian  Reef,  for  the  express  purpose  of 
curing  it,  and  with  the  happiest  results. 


30 


THE    CANADA    MEDICAL    RECORD. 


Dr.  Howard's  objection  was  a  valid  one,  but  he 
did  not  propose  to  apply  the  remedy  in  any  acute 
cases  nor  the  skin  affections  of  the  aged,  but 
thought  its  action  specific  in  cases  dependent  up- 
on a  blood  taint  or  germ  in  the  system.  Dr. 
Roddick's  question  might  be  answered  by  saying 
that  he  had  feared  an  ulcer  of  a  syphilitic  character. 

In  reply  to  the  President's  remarks  he  stated  that 
he  merely  referred  to  chronic  cases  of  skin  affec- 
tions, and,  notwithstanding  the  President's  positive 
opinion  against  the  possibility  of  contagion  being 
conveyed  by  vaccine  lymph,  he  would  still  believe 
it  next  to  impossible  to  extract  lymph,  from  a 
syphilitic  patient,  except  in  the  earlier  stages  of  the 
eniption  and  under  the  most  favorable  circum- 
stances. Would  not  be  as  willing  as  the  Presid- 
ent to  be  vaccinated  from  a  syphilitic  person. 

He  trusted  good  results  might  flow  from  the 
discussion  of  the  subject,  and  that  it  might  prove 
beneficial  to  the  course  of  vaccination  generally. 


ON  THE  LOCAL  AFTER-TREATMENT  OF 
OPERATIONS. 

By  Dr.  C.  E.  Nelson,  New  York. 

The  writer  begs  to  apologize  to  the  readers  of 
the  Montreal  Record  for  intruding  his  views  once 
more  upon  their  notice — especially  on  such  a 
hackneyed  subject  as  is  indicated  in  the  above 
title. 

Lately,  the  attention  of  the  surgical  profession 
has  been  much  attracted  to,  and  even  exercised  by 
the  treatment  of  wounds  made  in  operations — the 
main  cause  of  this  has  been  the  vaunted  eflliciency 
of  applications,  where  carbolic  acid  entered,  in 
various  ways.  We  should  be  thankful  to  carbolic 
acid,  or  anything  else,  that  would  cause  surgeons 
to  look  more  closely  into  the  result  sof  their  sur- 
gical practice.  It  is  not  ray  intention,  this  time, 
to  discuss  the  merits  or  demerits  of  carbolic  acid  ; 
nor  is  it  my  intention  to  weary  the  reader's 
patience  with  what  surgeons  have  done,  since  the 
beginning  of  civilization,  down  to  Lister ;  we  all 
know  the  celebrated  names,  which  are  like  house- 
hold words.     To  the  subject  at  once. 

How  should  a  wound  (surgical,  accidental,  or 
caused  by  the  bursting  forth  of  matter)  be  dressed, 
and  in  what  way  should  we  endeavor  to  make  it 
htan 

The  Duke  of  Wellington  was  asked  in  Spain  by 
one  of  the  staff,  in  case  of  his  death,  if  he  had 
left  papers,  or  a  draught  of  a  plan,  which  his  surviv- 


ing officers  might  follow  closely?  "  Plan,"  he  said, 
"  1  have  no  plan  :  my  plan  is  to  beat  the  French."^ 

And  there,  I  think,  is  the  secret  of  our  treating, 
wounds,  surgical  or  otherwise. 

The  great  Russian  General  Suwarrow  had  a  pro- 
found contempt  for  "  councils  of  war,"  or,as  doctors 
say  amongst  themselves,"  consultations."  After  the 
junior  officers  had  given  their  opinion  severally,, 
he  would  rise  (with  contempt  marked  upon  his 
countenance),  walk  to  the  blackboard,  draw  two 
parallel  chalk  lines,  saying,  one  was  the  Turks,, 
the  other  the  Russians ;  he  would  then  wipe 
out  one  line,  saying,  to-morrow^we^beat  the  Turks 
— he  then  would  walk  away. 

All  this  is  to  show  that  when  we  have  got  a 
thing  to  do,  do  your  best,  and  let  not  your  mind 
be  disturbed  by  what  this  man  and  that  man  does. 

Personally,  I  have  no  plan  of  treating  wounds, 
or  of  operating  either  ;  before  entering  the  room  I 
have  no  idea  of  what  I  am  going  to  do  ;  after  the 
operation  has  begun,  or  during  its  progress,  I 
have  not  the  slightest  idea  what  I  may  be  required 
to  do  next. 

The  after-treatment  of  wounds  (surgical  or  other- 
wise) is  universally  divided  into  two  sections,  ac- 
cording to  whether  they  be  likely  to  heal  (I)  by 
the  first  or  (II)  second  "intention  "  ;  the  old  sur- 
gical term  being  retained,  which  I  suppose  means. 
"  stretching,"  in  allusion  to  the  edges,  or  (as  ia 
case  of  amputation)  the  flaps. 

But  I  do  not  know  beforehand  which  way  it  is^ 
going  to  be  ;  I  may  endeavor  as  much  as  I  please 
to  obtain  union  by  the  "  first  intention  "  (with  or 
without  that  eternal  carbolic  acid),  but  my  best 
endeavors  may  be  frustrated  just  as  likely  as  not. 

Here  I  will  note  that  I  do  not  stick  to  one 
line  of  treatment  either  ;  I  may  keep  continually 
changing,  even  twice  in  one  day,  if  necessary. 

\{  z.  physician  were  asked  what  were  his  plaa 
for  treating  diarrhoea  or  headache,  he  would  an- 
swer, "  If  I  had  six  cases  of  each  to-morrow,  very 
possibly  I  might  treat  every  one  of  them  differently 
according  to  their  causation."  It  should  be  the 
same  with  the  surgeon  in  my  humble  opinion. 

THE   OPERATION.    (INCISIONS,    (ScC.) 

Learned  and  lengthy  treatises  have  been  writ- 
ten (wasting  people's  time  reading  them)  as  to  the 
different  kinds  of  incision,  and  to  the  way  of 
making  them  ;  as  if  it  made  any  difference  how 
you  made  them,  if  you  had  a  tumour  to  get  out. 
Special  inculcations  have  been  given,  "  how  to 
hold  the  knife  ; "  this  can  surely  make  very  little 


THE   CANADA   MEDICAL    RECORD. 


31' 


-difference,  although  I  hold  it  more  by  the  blade 
than  by  the  handle. 

SPONGING    AND    LIGATURING. 

For  years  I  have  been  averse  to  this  practice, 
mainly  because,  instead  of  stopping  the  blood, 
it  generally  causes  it  to  flow  more,  thereby  tanta- 
lizing the  operator  :  in  a  small  degree,  it  irritates 
the  part,  all  and  every  irritation  being  best  avoided 
by  a  careful  operator.  After  the  incision  is  made, 
wait  half  a  minute  and  let  the  blood  run  down 
•over  the  person's  skin.  If  the  officious  assistants 
insist  on  stuffing  the  sponge  down  between  the 
■edges  of  your  incision,  there  will  almost  certainly 
■be  an  afflux  of  blood,  which  will  most  completely 
mask  the  incision,  so  that  the  operator  does  not 
know  where  he  made  his  cut :  the  eyes  of  the 
bystanders  are  now  on  him.  he  gets  impatient  and 
perhaps  nervous, — plunges  ahead  ;  then  there  is 
-much  more  blood,  from  his  having  severed  many 
•small  vessels  ;  now,  all  is  in  hopeless  confusion  ; 
the  bystanders  press  forward  offering  tenacula 
and  ligature  threads  ;  the  operator  draws  him- 
self up,  stands  aside,  letting  assistants  pull  out 
.and  ligate  a  great  many  more  vessels  than  it  is 
necessary  to  do :  the  operator  now  feels  con- 
siderably relieved,  and  proceeds  to  the  conclusion 
•of  the  operation  likely  without  any  further  contre- 
temps. 

I  think  the  following  a  better  method  of  pro- 
ceeding [of  course,  I  do  not  intend  to  apply  the 
preceding  or  following  remarks  to  hospital  sur- 
geons, but  to  young  gentlemen  who  have  seen  but 
a  limited  private  practice]  :  after  having  made  the 
preliminary  incision  with  a  scalpel  (I  am  not 
particular  about  its  being  very  sharp),  no  sponge, 
then  take  a  sharp  bistouri,  and  cut  right  down  to 
where  you  want  to  go,  regardless  of  severed 
arteries ;  as  long  as  your  knife  fills  up  the  cut, 
there  will  be  little  blood  as  yet  come  forth ;  it  is 
■only  on  taking  the  knife  out,  and  cutting  round 
the  tumour,  e.  g.  in  another  part,  that  the  blood 
begins  and  continues  to  come  smartly  ;  if  not  an 
important  loss,  you  may  finish  the  operation 
■there  and  then.  If  the  blood  is  in  largish  jets 
{because  the  small  jets  soon  stop  of  themselves) 
one  of  two  things  may  be  done :  you  may  stop 
long  enough  to  clap  artery  forceps  (spring,  or 
fitting  close  together)  on  each  vessel,  having  seve- 
ral pairs  at  hand,  lying  on  the  patient  ;  or,  assis. 
tant  may  press  his  different  fingers  on  the  vessels 
in  severally,  firmly,  keeping  them  there  till  the 
•cutting  is   finished, — this  latter  plan  requires  an 


able  and  cool  assistant — its  disadvantage  is  that 
his  fingers  are  in  your  way.  When  the  tumour  is 
exsected,  or  an  important  art^^ry  'ligatured  (as 
the  carotid),  whatever  the  operation  may  be,  next 
thing  to  do  is  to  take  a  look  and  see  how  things 
are :  if  it  is  cancer,  see  that  none  is  left  behind  ;  if 
it  is  ligature  of  an  important  vessel  take  your 
time,  and  observe  the  chasm  coolly  ;  if  it  all  ap- 
pears satisfactory,  ligate  the  severed  arteries,  and 
close  the  wound,  if  it  can  be  done. 

Sometimes  plasters  (strips),  sometimes  not. 

Sometimes  sutures,  sometimes  not. 

Uncovered,   or  lightly  covered,  compress    and 
bandage,  entirely  excluding  the  air. 
'  I  think  in  the  majority  of  cases  it  is  best  to  put 
some  kind  of  covering  on,  as  the  "aura"  of 
atmosphere  might  possibly  bring  on  tetanus. 

ACUPRESSURE 

I  think  is  objectionable ;  the  needle  may  cause 
irritation,  and  is  difficult  to  take  away,  let  alone 
the  possibiUty  of  tetanus  accruing  therefrom : 
foraaerly  much  in  vogue,  I  believe  very  few  now 
practice  it,  Hke  many  other  passing  inventions  and 
methods. 

TORSION. 

Is,  I  think,  bad,  besides  dangerous.  There  are 
different  degrees  of  torsion,  but  with  all  of  them 
a  devitalized  piece  is  left,  which  has  to  slough 
away  afterwards,  which  is  not  exactly  what  a  per- 
son wants  when  endeavouring  to  produce  union 
by  the  first  intention;  the  argument  put  forward 
in  that  case  is  that  the  little  ends  may  be  absorbed. 

Leaving  the  chasm  open,  before  finally  closing. — 
This  has  been  a  disputed  question.  Perhaps  it 
would  be  as  well  to  wait  a  quarter  of  an  hour, 
allowing  surface  to  be  "  glazed  over." 

How  to  get  rid  of  the  blood  after  cutting. — 
May  rub  it  out  with  one's  fingers,  wiping  them 
as  often  as  necessary  on  the  patient's  skin,  which 
can  be  washed  clean  after  the  operation  is  over. 

If  the  sponge  is  insisted  on,  dip  a  small  one 
slowly,  deeply,  and  firmly  down,  keep  it  there  a 
little,  then  take  it  up  vertically,  and  slowly,  but  no 
rubbing  or  scraping  out,  which  irritates  the  vasa 
vasorum,  and  the  nervous  tendrils  winding  aroun 
and  among  the  larger  vessels. 

Styptic  cotton  I  have  found  of  not  the 
slightest  use.  Haemostatics  I  suppose  are 
only  used  by  timid  surgeons,  who  have  not  had 
very  much  experience :  the  same  remark  applies 
to  Esmarch's  bandage  for  "  bloodless  operations  "; 
although  many  distinguished  men  have  used  it,  for 


32 


TDE   CANADA    MEDICAL   RECORD. 


the  sake  of    experiment,  it    is  now   falling    into 
disuetude. 

Applications  on  wounds ^  with  thevieiv  of  exclud- 
ing the  air. — These  may  be  tried,  and  found  very 

serviceable  ;  but  the  contemporary  practice  is  rather 
to  dress  the  wound,  so  as  to  be  able  to  frequently 

examine  it. 

Stuffing  charpie  into  the  wound,  a  French  prac" 

tice,  need  only  be  mentioned  to  be  condemned. 

Leaving  a  piece  of  sponge  in  the  wound  is  an 
exceedingly  dangerous  practice  ;  the  idea  is  that 
it  will  mechanically  stop  hemorrhage,  it  favours 
it,  on  the  contrary. 

Applying  bandages  requires  a  certain  amount 
of  discretion.  In  the  first  i)lace,  a  bandage  should 
never  be  applied  so  tightly  as  to  cause  extensive 
ecchymosis,  or  to  impede  the  patient's  breat  ing 
freely.  A  bandage  need  not  be  applied  with  the 
same  amount  of  tightness  in  all  of  its  parts,  but 
modified  according  to  circumstances.  I  should  be 
inclined  to  put  more  faith  in  making  a  firm  hori- 
zontal pressure  than  a  vertical  (or  lateral)  pressure 
there  may  be  then  less  chance  of  abscess(suppura- 
tion)  forming. 

Drainage  tubes,  three  horse  hairs{or  one  only), 
leaving  depending  portion  of  incision  open.  I  think 
all  these  expedients  are  faulty.  I  should  suppose 
as  much  pus  ran  outside  of  the  tube,  as  through  it  i 
in  that  case  (like  in  the  hollow  style  in  fistula 
lachrymalis)  it  is  of  no  use  :  it  certainly  must  be  a 
great  inconvenience  to  the  patient  if  he  wants  to 
turn  in  bed.  JPorse  hairs. — As  to  these,  Lister  has 
already  found  that  one  is  better  than  three;  by-and- 
bye,  he  will  find  out  that  none  at  all  is  the  best. 
Leaving  depcnditig  section  of  cut  gaping  ope7i. — I 
think  this  often  tends  to  forming  abscess,  trouble- 
some to  treat  afterwards,  and  sometimes  dangerous. 

Sutures. — For  a  while,  those  pretty  silver  wire 
sutures  were  all  the  rage.  I  dressed  many  cases 
for  other  surgeons,  who  had  employed  these.  I 
was  put  to  a  great  deal  of  trouble  in  vainly  trying 
to  get  the  dressings  to  lie  down  flat  on  their  ends, 
people  said  they  cause  jn  suppuration,  but  it  was 
not  always  true.  Catgut  ligature  has  sometimes  the 
inconvenience  of  dissolving  away.  Thread  is  tlie 
est ;  silk  cuts  the  flesh  too  much. 

Deep  and  supeffcial  sutures  in  the  same  opera- 
tion.— 1  think  it  best  to  use  the  deep  merely  in 
cases  of  ovariotomy  and  laparotomy  ;  to  make  up 
for  not  applying  the  deep  sutures  firm  pressure 
can  be  made  by  one  or  more  pads  and  bandages. 


I  think  I  have  tired  out  my  readers  now,  and 
may  as  well  draw  the  line,  hoping  I  have  not 
offended  anybody — if  so  it  is  unintentional. 


FRACTURE  OF   THE  CERVIX  FEMORLS, 
EXTERNAL  TO  THE  JOINT,  IN  A  LADY 
71  YEAR.S  OLD,    WEIGHING  OVER  200 
POUNDS:   CURE,  BY  BONY  UNION. 

Dr.  C  E.  Nelson,  New  York. 

Some  of  these  cases,  as  related  by  doctors  as 
cures,  are  thought  by  other  doctors  to  be  spurious, 
/.  e.,  that  a  mistake  was  made  in  the  diagnosis  ;  this 
seems  to  be  a  severe  verdict  upon  the  relators,  al" 
though  undoubtedly  not,  in  some  instances  ;  how- 
ever, in  defense  of  the  relators,  these  cases,  in  many 
instances,  present  more  or  less  difficulty  in  their 
diagnosis — especially  in  very  fleshy  persons  ;  then, 
again,  a  nervous  doctor,  who  may  not  have  beea 
in  the  habit  of  examining  such  cases,  may  be  more 
or  less  influenced  by  the  patient  crying  out,  if  he 
causes  the  patient  pain,  and  would  thereby  make 
a  hurried  examination,  and,  consequently,  a  very 
imperfect  diagnosis. 

I  really  believe  that  the  facts  of  this  case  were 
as  stated  in  the  heading  to  this  article. 

Miss  Canfield,  of  471  Hudson  street,  New  York, 
an  unwieldy,  heavy  woman,  71  years  old,  tripped 
on  the  carjiet,  and  fell  solidly  on  her  left  hip,  that 
is  greater  trochanter,  of  course, — the  solid  floor  of 
the  house  being  the  counter-weight — the  weight  of 
her  large  body,  the  direct  weight ;  between  these 
two  opposing  forces  (as  every  medical  student 
knows)  the  neck  of  the  thigh-bone  gave  in ;  she 
was  unable  to  rise,  and  unable  to  raise  or  move 
that  limb  in  any  way  whatsoever ;  the  bystanders 
with  difficulty  placed  her  in  bed.  I  w^as  not  sent 
for  till  next  day  :  I  took  with  me  my  friend,  Dr. 
Schultze,  sr.,  (who  occupied  a  high  rank  in  the  army 
medical  staff,  in  our  late  civil  war,  in  the  United 
States).  This  gentleman,  on  digging  his  fingers  deep 
in,  felt  a  break  ;  on  moving  (rotating)  the  limb,  he 
heard  crepitus  ;  I  then  felt  the  break  myself  (quite 
decided),  but  did  not  examine  as  to  crepitus,  not 
wishing  to  put  the  lady  to  any  extra  pain.  Accord- 
ing to  Dr.  Schultze's  recommendation,  we  put  her 
affected  limb  (after  extension)  on  a  plane,  inclined 
upwards  from  the  knee  to  the  foot  at  an  angle  of 
about  2,0'^, — adhesive  plaster  on  each  side  of  lower 
leg,  and  roller ;  to  this  was  attached  a  loop  of 
bandage,  holding  a  kitchen  iron  (about  five  pounds 
weight),  which  was  left  hanging  for  weeks,  by- 
means  of  a  string  through   an  auger   hole  in  the 


THE    CANADA    MEDICAL   RECORD. 


33 


foot-board  of  the  bedstead.  The  patient  was  kept 
on  her  back,  in  bed,  for  ahnost  three  months,  in 
intensely  hot  weather  (summer  of  1880).  Once 
the  nates  felt  irritable, — I  had  the  skin  of  same 
washed  with  brandy,  no  further  trouble  occurred. 
For  the  first  few  days  she  was  annoyed  with  start- 
ings  (spasmodic  drawings  up)  of  the  affected  limb  ; 
to  day,  perhaps  four  months  after  the  accident, 
I  saw  her  in  company  with  Dr.  Schultze,  sr.  : 
shortening,  5  inches  ;  walks  on  crutches,  care- 
fully ;  gets  off  the  bed.  first  one  leg,  then  the  other  i 
cannot  stand  without  the  crutches,  putting  on 
stockings  ;  bends  sound  limb,  but  cannot  bend 
affected  limb,  owing  in  great  part  to  swelling  of 
knee,  which  latter  has  accompanied  the  fractured 
condition  during  most  of  the  time.  This  knee 
swelling  is  very  likely  due  to  her  having  hit  her 
knee  also  in  falling.  Is  obliged  to  sit  on  a  high 
chair.  I  must  say  that  a  few  weeks  ago  I  took 
Dr.  Schultze,  sr.,  there,  for  the  purpose  of  "  getting 
her  up".  On  examination,  he  dug  his  fingers  in, 
and  pronounced  the  bone  perfectly  united  ;  I  did 
not  examine  myself,  being  content  to  take  his  word 
for  it :  we  then  proceeded  to  get  her  up,  which 
was  no  small  matter.  After  great  difficulty,  got  her 
sitting  up  on  edge  of  bed, — an  easy  chair  was 
wheeled  to  edge  of  bed  ;  she  then  became  be- 
dewed with  sweat,  and  fainted.  When  she  was 
slightly  come  to  we  got  her  into  the  large  chair, 
were  she  fainted  again.  After  a  while  we  got  her 
up  on  the  crutches  j  in  less  than  a  moment  she 
fainted,  so  we  had  to  lay  her  down  on  the  bed,  with 
iustructions  to  the  people  to  get  her  up  the  best 
way  they  could.  We  at  last  got  her  into  the  chair 
once  more,  she  again  fainted  dead ;  after  re- 
vival, we  left.  I  must  confess  to  the  readers  of 
the  Canada  Medical  Record  that  I  am  not  in 
the  habit  of  seeing  cases  of  fracture  of  the  cervix 
femoris,  so  I  asked  Dr.  Schultze  if  it  was  cus- 
tomary for  them  to  faint  the  first  day  on  getting 
up  ;  he  answered  he  had  often  met  with  it.  I  have 
seen  plenty  of  these  cases  when  I  was  a  student 
in  the  hospital ;  but,  compared  to  the  chances  of  a 
hospital  house-surgeon,  a  medical  student  has  very 
little  opportunity  of  making  himself  acquainted 
with  the  surgical  treatment  of  fracture.  A  few 
words  now  to  the  younger  readers  of  the  Record  : 
in  my  opinion,  I  think  the  usual  way  of  measur- 
ing in  fracture  cases  is  erroneous  and  illusory.  To 
ascertain  the  amount  of  shortening,  it  is  recom- 
mended to  put  one  end  of  the  tape-measure  on 
the    anterior   superior    spinous    process    of    the 


ilium,  taking  it  down  to  the  sole  of  the  foot  of  the 

corresponding  side — repeating  the  like  procedure 
on  the  other  limb  ;  this  cannot  be  accurate,  for, 
when  you  place  the  end  of  the  tape  on  the  ilium 
process  (above  named)  you  cannot  be  sure  whether 
it  be  placed  half  an  inch  too  high,  or  half  an  inch 
too  low, — andof  course  the  measurement  is  faulty. 
I  prefer  taking  the  "  natural  measurement",  i.e., 
bringing  the  knees  and  ankles  together ;  the  differ- 
ance  is  then  (in  case  of  shortening,  in  fracture) 
very  obvious.  To  ascertain  the  exact  difference  in 
length  of  the  two  limbs,  put  one  end  of  the  tape 
against  under  surface  of  heel  of  shortened  limb, 
then  run  the  tape  dowTi  to  under  surface  of  heel 
of  sound  limb  ;  the  exact  amount  of  shortening 
will  thus  be  immediately  obtained  from  J^  to  2^2 
inches,  to  do  this  nicely  three  little  points  require 
to  be  attended  to  :  I.  The  patient's  feet  must  be 
drawn  up  so  as  to  be  at  right  angles  with  the  le^. 
II.  A  thin,  hard-cover  book  must  be  placed 
beneath  the  feet  so  as  the  heels  do  not  sink  into 
the  mattress.  III.  The  tape  must  be  held  closely 
against  the  foot  of  the  sound  side.  Some  persons 
might  object  to  this,  that,  if  the  patient  does  not 
"  lie  square  "  in  the  bed,  this  mode  of  natural 
measurement  might  be  illusory  ;  however,  a  little 
care  on  the  part  of  the  medical  attendant  would 
obviate  this. 


ON  THE  USE  OF  ARSENIC  AS  A  BLOOD 
AND  CARDIAC  TONIC. 
In  a  communication  to  the  British  Medical 
Journal,  Dr.  Lockie  calls  attention  to  the  remark- 
able results  obtained  by  him  in  the  administration 
of  arsenic  in  certain  cases  of  ansemia,  and  those 
cases  in  which  iron  and  good  food  had  failed  to 
produce  any  benefit.  His  attention  was  first 
directed  to  the  power  of  arsenic  in  this  respect  by 
a  paper  published  by  Dr.  Eyron  Bramwell,  of 
Newcastle,  in  which  he  narrated  several  cases  of 
essential  or  progressive  pernicious  ansemia  where 
remarkable  benefit  accrued  from  the  administration 
of  this  drug.  Whether  it  really  has  the  power  of 
curing  this  disease— a  disease  which  has  hitherto 
baffled  the  resources  of  our  art,  and  the  good 
results  apparently  promised  by  phosphorus  in  the 
hands  of  1  )r.  Broadbent  not  having  been  obtained, 
to  any  extent  at  all  events,  by  other  observers-— 
remains  for  the  future  to  detennine.  Certain  it  is 
that  in  cases  of  anaemia  approaching  in  gravity 
the  so-called  essential  or  pernicious  anemia,  it  is 
capable  of  producing  great  benefit.  In  support  of 
this  statement  Dr.  Lockie  reports  several  striking 
cases. 


31 


THE   CANADA    MEDICAL    RECORD. 


CLINICAL  LECTURE  ON  BURNS. 

Bt  R.  J.  Levis,  M  D  ,  Surgeon  to  the  Pennsjlvania  Hos- 
pit*l  and  to  the  Jefferson  College  Hospital.  Delivered  at 
the  PennsjlTania  Hospital. 

No  injuries  of  ordinary  occurrence  produce 
such  great  and  prolonged  suffering  as  burns. 
Unfortunately,  they  are  rapidly  increasing  in 
frequency  and  severitj-,  due  to  the  use  of  heat 
in  mechanical  occupations,  to  the  universal  pre- 
sence of  friction -matches,  and,  most  seriously, 
to  the  extended  application  of  highly-inflam- 
mable and  even  explosive  fluids  for  the  purpo.se 
of  illumination.  Petroleum  is  answerable  for 
a  great  number  of  the  most  dreadful  of  these 
injuries  that  we  admit  to  the  wards,  and  the 
ignorant  or  careless  use  of  it  in  attempting  to 
kindle  fires,  or  in  filling  lamps  whilst  the  wick 
is  still  burning,  causes  some  of  the  greate.st 
Iiuman  misery  and  frequent  death. 

Probably  our  hospital  experience  would  show 
that  no  class  of  injuries,  in  proportion  to  the 
number,  is  so  fatal.  The  majority  of  burns  are 
of  domestic  occurrence,  and  women  and  children 
the  most  frequent  sufferers.  Our  records  give 
evidence  of  the  great  mortality  of  cases  of  burns 
among  children,  and  of  the  termination  of  the 
sufferings  of  many,  dying  within  a  short  period 
after  their  admission  to  the  wards,  without 
reaction  from  the  primary  shock  of  injury. 

You  have  seen  already,  during  this  clinical 
term,  li')\v  varied  may  be  the  character  of  injuries 
from  tlie  application  of  either  dry  or  moist  heat, 
from  a  mere  erythematous  redness  of  the  skin 
produced  by  a  momentary  flash  of  burning  gas 
or  escaping  steam  to  the  total  disorganization 
and  destruction  of  a  part.  Burns  vary  in  se- 
verity according  to  their  extent  of  surface  as 
•well  as  to  destructive  depth.  The  complete 
incineration  of  apart,  as  a  hand  or  a  foot,  might 
be  a  matter  of  less  gravity  than  even  a  merely 
diffuse  erythema  affecting  a  large  area  of  the 
skin.  A  man  once  walked  into  this  hospital 
who  had  fallen  into  a  vat  or  tank,  and  was 
immersed  in  water  not  hot  enough  to  produce 
more  than  a  superficial  irritation  of  the  derma, 
and  without  in  any  place  blistering,  yet  he  died 
within  a  very  few  hours.  I  have  had  cases  in 
which  part  of  a  limb  has  been  totally  charred, 
through  integuments,  muscles,  and  even  bone. 
One  was  that  •f  a  man  who  had  been  held  for 
some  time  in  the  ruins  of  a  fallen  bla3^furnace, 
whilst  portions  of  his  feet  and  hands  were  im- 
mersed in  flowing  molten  metal  until  even  the 
bones  were  charred ;  yet  be  recovered, — of 
course  in  a  maimed  condition.  In  another  ins- 
tance a  man's  leg  was,  by  a  curious  accident,  so 
held  in  a  j)Otof  molten  iron  that  he  could  not  ex- 
tricate it,  and  the  disorganization  was  total.  So 
ii  is  evident  to  you  how  the  grades  of  such  in- 
jury must  var}'. 

Arbitrary  classifications  of  burns  are  made  by 
some  surgical  authorities,  ba  ed  on  their  depth. 


but  you  need  not  be  troubled  about  memorizing 
six  or  eight  distinctions  if  you  will  merely  bear 
in  mind  that  the  pathological  significance,  the 
prognosis,  and  the  treatment  of  the  injury  will 
vary  with  its  locality,  the  extent  of  surface 
involved,  and  the  depth  of  penetration.  If  the 
application  of  heat  be  only  momentary,  a  mere 
erj'thematous  redness  will  follow,  the  cuticle 
will  soon  desquamate,  and  then  complete  res- 
toration will  ensue.  A  more  prolonged  applica- 
tion of  heat  will  produce  serous  effusion,  eleva- 
ting the  cuticle  in  the  familiar  blisters  of 
bullae.  A  deeper  burn  disorganizes  the  entire 
skin,  so  that  effusion  cannot  take  place  ;  and  j 
have  spoken  of  still  deeper  destruction,  even  to 
the  complete  incineration,  of  a  part. 

A  scald  results  from  the  application  of  moist 
heat,  which,  with  water  or  steam,  is  not  usually 
above  a  temperature  of  212*,  and  the  action  is 
liable  to  be  but  momentary  and  superficial  in 
effect.  But  the  prolonged  impression  of  moist 
heat  may  be  as  destructive — and  in  a  patholo- 
gical view  the  effect  is  the  same— as  that  of  dry 
heat,  and  I  am  inclined  to  use  the  word  burn  in 
a  generic  sense,  to  include  the  general  action  of 
heat,  moist  or  dry,  on  the  body. 

Some  of  the  cases  of  deeply  destructive  burn- 
ing of  parts  I  have  seen  among  persons  who 
were  insensible  at  the  time  of  receiving  the 
injury,  as  in  cases  of  epileptics  who  tiave  fallen 
into  open  fires  or  against  stoves,  and  the  coma 
of  drunkenness  has  frequently  caused  the  same. 
One  of  the  most  extensive  and  deep  burns  I 
have  ever  seen  in  these  wards  was  in  the  case 
of  a  man  who  was  at  the  time  intoxicated  by 
the  fumes  of  a  lime-kiln  by  which  he  had  lain 
to  warm  himself  until  his  back  was  deeply  roast- 
ed from  the  nape  to  the  coccyx. 

It  is  one  of  the  curious  traditions  of  surgery 
that  the  effect  of  exposure  of  the  surface  of  the 
body  to  the  rays  of  the  sun,  producing  erythema 
of  the  skin,  is  in  the  text-books  classed  with 
burns.  That  effect  is  rather  due  to  the  intensity 
of  solar  light  than  to  heat.  I  have  seen  the  so 
called  sun-burn  produced  when  the  air  was  cold 
and  the  parts  exposed  necessarily  colder  than 
those  which  remained  covered  by  clothing  ;  and 
in  the  case  of  a  boy  whose  nock  and  back  were 
extensively  vesicated  from  exposure  to  the  sun 
whilst  bathing,  the  skin  had  been  continually 
wet  with  cold  water,  and  actual  burning  was 
impossible. 

When  a  severely  burned  patient  is  first  brought 
into  the  wards,  our  intension  is  at  once  directed 
to  two  important  and  urgent  demands  of  treat- 
ment,— the  great  pain  that  he  is  suffering,  and 
the  shock  of  injury.  The  immediate  inhalation 
of  an  anaesthetic  and  a  hypodermic  injection  of 
morphia  are  the  speedy  recourse,  and  these 
should  be  followed,  if  pain  continues,  by  the  in- 
ternal administration  of  morphia,  decisively,  but 
yet  with  caution.  When  the  injury  is  verj' 
severe  and  the  prostration  extreme,  the  patient 


THE    CANADA    MEDICAL   RECORD. 


35 


is  sure  soon  to  have  well-marked  rigors,  with 
tremor,  and  the  sensiation  of  heat  yields  to  a 
distressing  chilliness.  In  the  severest  cases  coma 
comes  mercifully,  and  continues  until  death 
relieves  the  sufferer.  When  there  is  evidence 
of  great  general  shock,  it  must  be  treated,  as  in 
ordinary  traumatic  injuries,  by  stimulants,  qui- 
nine, nutrients,  and  warmth.  If  the  clinical 
thermometer,  placed  beneath  the  tongue,  indi- 
cates a  temperature  below  the  normal,  it  may 
not  be  enough  to  wrap  the  patient  in  blankets, 
which  merely  retard  the  escape  of  heat  from 
the  body,  but  warmth  must  be  artificially  impart- 
ed by  contact  with  cans  of  hot  water  placed  be- 
neath the  coverings. 

The  removal  of  the  clothes  of  a  badly-burned 
patient  should  be  efiected  with  the  greatest  care, 
cutting  them  off  and  removing  them  in  portions, 
so  as  to  avoid  detaching  the  adherent  cuticle. 
When  blisters  or  bullae  exist,  they  should  be 
merely  punctured  with  the  point  of  a  needle,  so 
as  gradually  to  drain  away  the  serum,  always 
leaving  the  epidermis  as  the  natural  and  unirri- 
tating  protection  for  the  burned  surface. 

After  the  first  considerations  of  relieving  pain 
and  shock  to  the  system,  the  local  treatment  of 
burned  surfaces  will  require  attention,  and  this 
must  vary  with  the  portion  of  the  body  injured, 
and  also  with  the  superficial  extent  and  depth. 
Patients  are  always  distressed  by  the  vesiccating 
influence  of  the  air  on  even  slightly-burned  parts, 
and  protection  by  dressings  with  lotions  or  un- 
guents is  essential.  We  are,  in  these  wards,  in 
the  habit  of  applying,  at  first,  mildly-astringent 
and  antiseptic  unguents  for  this  purpose,  such 
as  the  benzoated  ointment  of  the  oxide  of  zinc, 
or  the  carbolized  ointment  of  the  oxide,  in  the 
droportion  of  one  part  of  carbolic  acid  to  six- 
teen or  twenty  of  the  ointment.  Such  applica- 
tions are  soothing  and  disinfectant :  and,  if  the 
surface  is  extensively  blistered,  with  the  epider- 
mis broken,  the  comfort  of  the  patient  will  be 
much  increased  by  encasing  the  part  in  a  layer 
of  carded  cotton,  frequent  disturbance  of  the 
dressing  being  carefully  avoided. 

In  cases  of  extensive  burn  of  the  surface  of 
the  trunk  and  extremities,  involving  a  very 
large  area  of  skin,  and  where  changes  of  the 
dressing  would  cause  much  suffering,  I  have 
directed  that  almost  the  entire  body  be  simply 
wrapped  in  a  linen  sheet  saturated  with  a 
slightly  carbolized  oil.  For  this  purpose  linseed 
oil,  from  its  viscid  character,  is  probably  the 
best. 

Most  of  the  domestic  remedies  which  are  re- 
sorted to  have  some  merit  in  at  least  protecting 
the  parts  from  the  air,  but  such  popular  appli- 
cations as  flour,  molasses,  starch,  soap,  and  glue 
have  the  inconvenience  of  being  dirty,  and  some 
of  them  incline  to  form  crusty  masses  over  the 
surface  which  are  not  easily  removable.  The 
familiar  combination  of  linseed  oil  and  lime- 
water — a  soapy  emulsion — has  no  real   merit, 


and  has  the  disadvantage  of  becoming  disgust- 
ingly offensive  when  combined  with  the  dis- 
charges from  burned  surfaces.  It  is  at  all  times 
exceedingly  difficult  to  prevent  fetid  effluvia 
from  the  bodies  of  patients  who  are  extensively 
burned  ;  and  such  are  the  most  offensive  surgical 
cases  we  ever  have  in  the  wards.  As  ablutions 
and  frequent  changes  of  dressing  are  attended 
with  suffering,  the  prevention  of  putridity  is  best 
effected  by  the  use  of  carbolic  acid,  which  has 
the  property  of  being  a  local  anaesthetic  as  well 
as  an  antiseptic. 

The  application  of  a  paint  of  carbonate  of 
lead  and  linseed  oil,  as  practised  by  Professor 
Gross,    is   said   to    be   very  soothing,   quickly 
relieving  pain,  and  it  has  the  merit  of  being 
readily  attainable  in  places  where  severe  burns 
are  apt  to  occur.    The  originator  of  this  treat- 
ment says  that  he  has  never  seen  evidence  of 
its  being  followed  by  the  specific  toxical  effects 
of  lead,  even  where  the  dressing  is  extensively 
applied  ;   but  in  individuals  who  are  peculiarly 
susceptible  to  saturnine  influence  it  might  be 
dangerous.   A  recently-proposed  remedy,  which 
has  remarkable  virtues  claimed  for  it,  is  the  bi- 
carbonate of  sodium,  in  fine  powder,  dusted  over 
the  burned  surface  or  applied  as  a  saturated 
aqueous   solution.     It  is   said  to   relieve   pain 
instantly,  and  that  burns  heal  readily  under  the 
application.   The  watery  solution  of  bicarbonate 
of  sodium  would  have  the  serious  objection  of 
other  wet  dressings, — in  chilling  the  patients 
when  largely  used, — and  it  must  be  remembered 
that  dui-ing  the  existence  of  shock  from   burn, 
the  temperature  is  often  much  below  the  normal, 
and  that  the   restoration  and  maintenance  of 
warmth  should  be  a  primary  object.  Dr.  Ludlow, 
of  this  city,  states  that  the  application  of  the 
ordinary   brown   resin   soap,  spread   on    linen 
cloths,   quickly  relieves  pain,   and  is   a  very 
satisfactory  dressing. 

When  mortification  of  a  part  occurs  from  a 
deeply-penetrating  burn  it  must  be  treated,  as 
gangrene  from  other  traumatic  causes,  with 
cataplasms  and  antiseptics,  to  facilitate  separa- 
tion of  the  dead  from  the  living  tissues,  and  to 
avoid  fetor  and  septic  infection  of  the  patient's 
system. 

There  are  some  remarkable  visceral  compli- 
cations of  burns  which  you  should  watchfully 
and  carefully  anticipate,  and,  if  possible,  guard 
against.  The  statistics  of  death  from  burns  show 
that  associated  intra-thoracic,  intra-abdominal, 
and  cerebral  lesions  are  the  causes  of  death  in 
nearly  one-half  of  the  fatal  cases.  These  affec- 
tions are  usually  either  congestion  or  inflamma- 
tion, and  are  ordinarily  associated  with  burns  of 
the  overlying  integument.  Generally  tonic  and 
stimulating  treatment  seems  to  be  the  most 
available  in  such  complications. 

There  are  other  serious  pathological  associa- 
tions of  burns,  to  which  I  can  at  this  moment 
make  but  passing  reference.     Intestinal  ulcera- 


36 


THE    CANADA    MEDICAL    RECORJ. 


tion  is  a  froquont  an<J  curious  .lUemlunt  of  ex- 
tensive burns,  particularly  of  the  trunk,  and 
causes  many  fatal  turniiiiatioiis.  This  remark- 
able  associated  lesion,  which  affects  the  mucous 
memhrane  of  the  small  intestines,  particularly 
the  duoilcnum,  is  not  well  explained,  an<l  can- 
not always  be  diagnosticated,  but  the  persistence 
of  uncontrollable  diarrh<pa  and  vomitinij  shouM 
incline  you  to  direct  your  attention  to  the  pro- 
bability of  the  existence  of  such  lesion. 

There  are  some  structural  changes  resulting 
from  burn  involving  destruction  of  integument 
which  result  in  cicatricial  contraction,  and  often 
require  the  aid  of  reparative  or  plastic  surgery 
for  their  relief.  The  contact  of  denuded  surfaces 
is  liable  to  result  in  their  unnatural  union  :  so 
they  should,  by  position  and  by  dressings,  be 
kept  apart,  and  in  parts  liable  to  bo  deformed 
bv  contraction  the  healing  integument  should 
be  kept  stretched  until  long  after  cicatrization 
is  completed. — Fhila.  Medical  Times. 


A  CASE  OF  INVETERATE  EPILEPSY 
SUCCESSFULLY  TREATED  BY  ERGOT 
AND   BROMIDE  OF  SODIUM. 

ByJ.K.  BAiiDDY.M.D.,Profe330rofNerrou3  Diseases  and  Psj- 
cholog.cal  Medicine  in  the  Missouri  Medical  College. 

In  the  treatment  of  such  an  implacable  affec- 
tion as  epilepsy,  specialists  in  the  treatment  of 
nervous  diseases  have  few  successes  to  signal  in 
confirmed  cases. 

Therapeutic  measures  are  ordinarily  crowned 
with  good  results  only  under  special  circum- 
stances, peculiarly  favorable  for  their  attainment. 
When  the  malady  orginates  in  eccentric  causes 
which  can  be  removed,  reflex  irritations,  which, 
whi  1st  recognizable  are  suscepti  ble  of  eradication, 
together  with  epileptic  manifestations  which  are 
acute  or  strictly  incipient  in  character,  and  cer- 
tain dy.scrasia  from  blood  poisoning:  all  these 
conditions  constitute  the  sole  varieties  of  this 
morbid  affection  which  furnish  a  reasonable  hope 
of  cure.  Idiopathic  cases  are  usually  irremedia- 
ble; such  at  least  is  the  usual  experience  of  the 
profession  at  large.  The  following  case,  there- 
fore, is  of  no  little  interest,  and  its  peculiarities 
will  afford  an  ample  apology  for  its  publication. 

Miss ,(et.  18,  consulted  me  in  1874.     Her 

mother  gave  the  history  of  her  case,  which  I  will 
state  as  concisely  as  possible. 

She  had  been  subject  to  attacks  of  epileptic 
convulsions  from  the  age  of  2  years.  The  attacks 
were  of  the  nature  of  grand-mal,  and  occuri'cd 
monthly.  The}'  thus  continued  until  about  the 
period  of  puberty,  when  they  became  greatly 
aggravated  in  frequency  and  intensity.  The  eti- 
ology was  very  obscure,  if  not  altogether  want- 
ing. There  was  a  vague  reference  to  an  accident 
sustained  in  early  childhood  or  infancy,  occa- 
sioned by  the  nurse  falling  with  all  her  weight 


upon  her  causing  her  to  experience  a  severe  blow 
upon  the  l)ack  of  her  bend.  Beyond  the  state- 
ment of  the  fall  sustained,  it  was  impossible  to 
recall  the  subsequent  development  of  symptoms 
which  were  directly  or  indireftly  to  bo  traeel  to 
such  an  injury.  A*^  stated  before,  when  the  cata- 
monia  were  ostal)lished,  all  the  manifestations  of 
the  epileptic  disea'je  wcro  intensified,  on  which 
occasions  the  periodical  hemorrhage  was  ushered 
in  with  a  violent  convulsion.  Five  or  six  lighter 
attacks  invarial)ly  followed  during  the  course  of 
the  first  day.  On  the  second  c\ny  two  or  three 
more  seizures  occurred.  On  the  third  day  she 
usu all}' escaped  with  one. 

In  order  to  convince  the  most  skeptical,  I  may 
state  en-passant  that  a  most  careful  analysis  of  all 
the  symptomatic  developments  most  obviously 
corroborated  thediagnosis  of  epilepsy.  The  pro- 
found loss  of  consc'ou'^ness,  the  laceration  of  the 
tongue,  the  tonic  f)llowed  by  clonic  convulsions, 
the  great  pallor  of  countenance  at  the  commence- 
ment of  the  seizure  succeeded  by  great  lividity, 
the  foaming  at  the  mouth,  the  stupor  or  coma- 
tose condition  which  followed  the  convulsions, 
were  all  susceptible  when  viewed  in  one  picture 
of  but  one  possible  interpretation. 

The  case  could  not  properly  be  relegated  to 
the  nosology  of  hystero-epilepsj'^,  because  the 
characteristic  <^onforfwn.s  which  are  almo'^t  patho- 
gnomoic  of  that  disease  were  entirely  absent. 

The  most  interesting  collateral  fact  connected 
with  the  case  was  the  frequent  development  of 
a  singular  and  anomalous  state  of  mental  auto- 
matism. 

Dr.  Hughlings  Jackson  has  offered  to  the 
literature  of  this  subject  some  most  interesting 
observations,  the  explanation  of  which  has 
many  features  of  the  orginality  for  which  that 
distinguished  observer  is  so  justly  celebrated. 
He  states  that "  the  condition  after  the  paroxysm 
is  duplex:  (1)  there  is  loss  or  defect  of  consci- 
ousness, and  there  is  (2)  mental  automatism. 
In  other  words,  there  is  (I)  loss  of  control,  per- 
mitting  (2)  increased  automatic  action." 

Dr.  Hammon<i,  in  commenting  upon  these 
views  in  the  recent  edition  of  his  most  excellent 
work  on  Diseases  of  the  Nervous  System,  states 
that  "whilst  in  the  main  agreeing  with  Dr. 
Jackson,  I  am  scarcely  prepared  to  deny  that 
such  unconscious  attacks  may  not  be  substitu- 
ted for  the  more  fully-developed  paroxysms  in- 
stead of  as  in  his  opinion,  always  following  a 
seizure." 

My  experience,  however,  especially  that  which 
is  illustrated  by  the  remarkable  case  we  are  cit- 
ing, concurs  with  Dr.  Jackson's  views,  that  such 
phenomena  are  ])ost-epileptic.  and  not  mere  sub- 
stitutions for  the  seizure  proj)or.  This  young 
lady,  who  was  an  accomplished  musician,  would 
perform  most  difficult  pieces  upon  the  piano, 
and  when  subsequently  complimented  by  visit- 
ors, who  were  then  present,  would  not  have  the 
most  remote  recollection  of  ever  having  played 


THE    CANADA    MEDICAL    RECORD. 


37 


in  their  presence.  She  would,  under  these  influ- 
ences, knit  marvelousl}'  and  achieve  prodigies  of 
fancy  work  with  her  needle,  and  upon  being 
interrogated  by  her  mother  would  be  entirely 
•oblivions  of  such  accomplishments  during  the 
prevalence  of  the  automatic  mental  conditions 
•described.  Being  a  Catholic,  she  frequently 
went  to  confession  and  communion  whilst  sub- 
jected to  these  peculiar  mental  phases,  and  upon 
returning  to  her  normal  mental  state,  would 
Tnost  strenuously  deny  to  her  relatives  any  recol- 
lection of  such  actions,  usually  disavowing  the 
possibility  of  their  occurrence,  without  her  full 
consciousness  and  remembrance  thereof  Her 
general  deportment,  intelligence  and  coherence 
of  conversation  during  the  mental  automatism 
were  all  that  her  most  critical  friends  could  de- 
sire ;  ret  the  oblivion  of  all  actions,  .conversa- 
tions  and  moods,  whilst  thus  acting  automatical- 
ly was  necessarily  perfect  and  incontestable.  Such 
were  the  developments  which  for  years  marked 
this  young  lady's  life,  and  no  one  will  consider 
them  exaggerated  who  is  at  all  familiar  with 
the  literature  of  the  obscure,  remarkable  and 
protean  manifestations  of  epileptic  disease. 

A  case  cited  by  Br.  Hammond,  page  672,  in 
his  sixth  edition,  "  Diseases  of  the  Nervous  Sys- 
tem," occurring  under  his  observation,  and  in 
which  the  mental  automatism  lasted  eight  days, 
will  satisfy  the  doubts  of  the  most  incredulous 
upon  this  subject,  as  it  is  the  most  remarkable 
case  on  record  and  an  undisputed  fact.  That  Dr. 
Hammond  is  facile princeps  the  leading  authority 
on  this  continent  on  all  that  is  allied  to  Neuro- 
logical Science,  will  be  my  apology  for  introduc- 
ing it  in  this  connection. 

The  patient,  who  was  engaged  in  active  busi- 
ness as  a  manufacturer,  left  his  office  at  about  9 
a.  m.,  saying  he  was  going  to  a  florist's  to  pur- 
chase some  bulbs.  He  remained  absent  eight 
days.  He  was  tracked  all  over  the  cit}',  but  the 
detectives  and  friends  were  always  an  hour  or 
more  behind  him.  It  was  ascertained  that  he  had 
been  to  theatres,  to  hotels  where  he  slept,  to 
shops  where  he  had  made  purchases,  and  that  he 
had  made  a  journey  of  a  hundred  miles  from  New 
York,  and,  losing  his  ticket  and  not  being  able 
to  give  a  satisfactory  account  of  himself  was 
put  off"  the  train  at  a  way-station.  He  had  then 
returned  to  New  York,  passed  the  night  at  a 
hotel,  and,  on  the  eighth  day,  at  about  ten  o'clock^ 
made  his  appearance  at  his  office. 

He  had  no  recollection  of  any  event  which 
had  taken  place  after  leaving  his  place  of  busi- 
ness, eightdays  previously,  till  he  awoke  on  the 
morning  after  his  return  to  the  city,  and  found 
himself  in  a  hotel  at  which  he  was  a  stranger. 
It  was  ascertained  beyond  question  that  in  all 
this  time  his  actions  had  been  entirely  correct 
to  all  appearance,  that  his  speech  was  coherent, 
and  that  he  had  acted  entirely  in  all  respects 
as  any  man  in  the  full  possession  of  his  mental 
faculties    would    have   acted.     He   had  drank 


nothing  but  a  glass  of  ale.  which  he  took  with 
some  oysters  at  a  restaurant. 

I  will  not  be  accused  of  a  digression  in  the 
clinical  description  of  this  case  by  the  aforesaid 
references,  as  this  history  would  not  be  com- 
plete without  their  citation.  Then  again,  for 
those  who  (as  regards  its  therapeutic  manage- 
ment which  is  to  follow)  are  incredulous  concern- 
ing the  post  hoc  pr<jo  propter  hoc,  will  at  least  be 
convinced  that  all  the  phenomena  which  had  to 
be  dealt  with  were  purely  of  epileptic  origin. 

The  patient  had  been  treated  most  persever- 
ingly  by  many  eminent  physicans,  and  was 
finally  taken  abroad  in  order  that  nothing  would 
be  left  undone.  She  was  there  under  distin- 
guished professional  care.  In  passing  through 
this  city,  in  October,  1874,  her  mother  was  in- 
duced to  consult  me  by  a  mutual  friend. 

I  must  confess  that  I  felt  that,  under  the  cir- 
cumstances, it  was  almost  useless  to  prescribe. 

As  a  forlorn  ettbrt  at  simple  palliation,  I  de- 
termined to  utilize  the  recommendations 
of  Dr.  Kitchen,  in  a  then  recent  article  in  the 
American  Journal  of  Insanity.  The  article  refer- 
red to  is  headed  as  follows:  "  Krgot  in  the  treat- 
ment of  Nervous  Diseases,"  by  Dan.  II.  Kitchen, 
M.D.,  Assistant  Phj'-sician  of  the  New  York 
State  Lunatic  Asylum.  He  states,  page  90,  July 
Number,  1874: 

"  In  epileptic  headaches  and  in  epilepsy  we 
have  used  ergot  largely." 

"  In  petit  mal  there  are  muscular  twitchings, 
congestions  of  the  face,  sutt'usion  of  the  eyes,  and 
a  rush  of  blood  to  the  head.  We  have  in  many 
of  these  cases  been  able  to  ward  off  the  graml- 
mal  by  large  doses  of  ergotine.  We  have  often 
combined  it  with  coniuni,  and  it  seems  in  this 
combination  to  work  even  more  satisfactorily 
than  alone,  which  is  chiefly  due,  we  suppose,  to 
the  sedative  effect  of  the  conium." 

We  therefore  placed  the  patient  upon  a  for- 
mula almost  identical  with  Dr.  Brown  Sequard's 
celebrated  one  for  epilepsy,  substituting  the  so-^ 
dium  for  the  potassium  salt,  in  consequence  of 
its  less  depressing  effect  and  of  its  greater  toler- 
ance by  the  system,  giving  three  times  daily 
twenty  grains  of  the  former  with  a  half  di-ahm 
of  Squibb's  Fl.  Ext.  Ergot.  She  began  the  rem- 
edy in  October,  1874.  and  took  it  faithfully  fov, 
a  year  and  a  half 

Her  mother  stated  that  at  the  four  sub.sequent 
menstrual  periods  she  had  three  severe  epileptic 
seizures  daily.  They  then  disappeared  entirely. 
Continued  medicine,  notwithstanding  their  ces- 
sation, for  over  eighteen  months.  The  fits  have 
never  recurred  since  early  in  February,  1875, 
now  three  years  and  ten  months. 

Present  condition— Her  general  health  is  ex- 
cellent; she  enjoys  society,  of  which  she  is  an 
ornament ;  her  intelligence  is  far  above  the  aver- 
age ;  no  vertigo  ;  no  nervous  symptoms  of  any 
kind  are  present ;  no  phenomena  which  might 
point  to  the  presence  of  aborted  epileptic  par- 


38 


TUE   CANADA    MEDICAL    RECORD. 


oxsynrnp.  Ono  month  a^'o  sho  was  in  my  oflBco 
in  splendid  mental  and  phynical  condition,  pro- 
Hcnting  no  traces  of  her  old  malady  exc'e]>t  nu- 
merouH  scarH  upon  her  tonijue,  ve-sti^es  of  her 
direful  experience  in  the  past. — St.  Louis  Cour- 
ier of  Medicine. 


VAGINITIS. 

Extracts    from    Dr.   J.    Matthews  Duncan's  clinical 
lecture  in  McJUal.  Times  ami  Gazette. 

Vaginitis  is  a  disease  greatly  neglected  in  med- 
cal  practice  and  literature.  This  arises  from  two 
circumstances  ;  it  is  often  chronic  and  slight ;  and 
it  often  forms  a  part  of  a  more  extensive  disease, 
of  which  other  parts  are  much  more  urgent,  and 
attract  the  whole  attention  of  the  observer  to  them- 
selves. The  frequency  of  this  disease  gives  it 
great  importance. 

Diphtheritic  vaginitis  is  a  rare  disease.  Erysipe- 
latous vaginitis  is  a  rare  disease  ;  and  there  is  a 
peculiar  fomi  of  it  which  is  rarer — a  diffuse  inflam- 
mation of  the  external  cellular  coat,  causing  swell- 
ing which  almost  occludes  the  whole  length  of  the 
passage ;  and  when  this  ends  in  suppuration  it 
sometimes  so  dissects  out  the  tube  of  the  vagina 
as  to  deserve  the  name  para-vaginitis  dissecans. 
Lately  I  have  seen  a  case  of  vaginitis  with  similar 
inflammation  of  the  cervix  uteri,  where  the  disease 
consists  of  rounded  sloughing  phagedenic  ulcera- 
tions, of  one  or  two  lines  broad,  for  whose  origin 
no  satisfactory  syjjhilitic  account  could  be  given  ; 
the  ulcers  were  on  the  laquear  vaginae  and  on  the 
cervix.  Then  an  ulcerous  vaginitis  ending  in 
adhesions  is  described ;  and  I  have  seen  a  pustu- 
lar vaginitis. 

Besides  these  differing  kinds  there  are  varieties 
of  vaginitis,  as  where  the  disease  attacks  only  parts 
of  the  passage,  as  the  laquear,  in  which  case  it  is 
very  frequently  associated  with  inflammation  of  the 
cervix  uteri.  It  also  frequently  attacks  the  lower 
part  alone  of  the  vagina,  and  in  that  case  it  is  often 
associated  with  inflammation  of  the  pudendum. 
Besides,  the  inflammation  may  be  of  small  parts, 
so  that  when  the  vagina  is  looked  at  it  has  a  map- 
ped, or  a  marbled,  or  a  mottled  appearance.  I 
have  seen  also  a  vagina  spotted  like  a  Dalmatian 
dog,  as  if  the  chronic  inflammation  were  only 
around  the  openings  of  numerous  little  mucous 
follicles,  regularly  arranged.  Again,  as  in  a  case 
which  I  showed  you  in  "  Martha  "  last  Tuesday, 
the  inflammation  may  so  affect  the  ridges  of  the 
rugK  of  the  vagina  that  they  alone  appeared,  the 
sulci  being  pale. 

Vaginitis  may  be  a  local  or  a  constitutional 
disease.  The  characteristic  acute  vaginitis,  gon- 
orrhea venerealis;  or  the  same  disease  occurring 
after  marriage,  or  the  same  disease  occurring  after 
the  introduction  or  during  the  wearing  ofa  pessary, 
are  examples  of  local  (purely  local)  disease.  If  the 
disease  is  severe  it  draws  the  constitution  into  sym- 
pathy with  it,  and  you  have  a  constitutional  affection 
secondary  to  the  local.     But   a   large  number — 


indeed  I  think  the  majority  of  case? — are  constitu- 
tional in  their  origin  ;  they  exhibit  an  order  the 
reverse  of  that  which  I  have  mentioned  as  charac- 
teristic of  local  diseases ;  it  is  the  constitutional 
that  brings  on  the  local  affection  secondary  to  the 
constitutional. 

In  this  hospital  it  seems  natural  to  speak  at 
length  on  the  constitutional  origin  and  treatment 
of  local  disease,  of  which  Abernethy  made  so  much. 
There  is  an  inflammatory  diathesis  which  accounts 
for  the  occurrence  of  local  diseases,  and  this  is 
occasionally  well  exemplified  in  lying-in  women. 
Such,  while  well  and  tenderly  cared  for  and  scru- 
pulously nursed,  and  after  the  time  of  septicemia 
and  ])yemia  are  far  past,  may  have  a  violent  attack 
of  pleuritis  or  pleuropneumonia,  for  which  no  e.\- 
planation  can  be  discovered,  and  which  begins  and 
ends  as  a  simple  inflammatory  disease,  but  not  a 
mere  local  disease  ;  it  springs  from  a  constitutional 
origin,  and  this  origin  we  call  the  inflammatory 
diathesis  for  want  of  a  more  definitely  intelligent 
name.  .  .  . 

What  are  the  constitutional  conditions  which 
give  rise  to  vaginitis?  Alcoholism  is  the  most 
important ;  the  next  is  old  age ;  the  next  is  lupus, 
or  rather  the  constitution  accompanying  lupus ; 
and  the  next  diabetes,  and  in  this  case  the  vaginitis 
is  generally  accompanied  by  vuhatis. 

The  importance  of  this  distinction  of  vaginitis 
into  local  and  constitutional  is  seen  in  treatment. 
A  local  vaginitis  is  to  be  managed  almost  entirely 
by  local  treatment.  A  constitutional  vaginitis  will 
be  very  imperfectly  and  unsuccessfully  treated  if  you 
pay  attention  only  to  the  local  treatment ;  whereas 
if  you  pay  attention  to  the  constitutional  treatment 
and  even  omit  local  treatment,  you  will  succeed.  .  .  . 

This  inflammatory  affection  of  the  whole  genito- 
urinary organs  by  alcoholism,  and  of  which  vaginitis 
is  a  part,  is  not  a  disease  which  stands  alone.  There 
is  a  well-described  disease,  for  instance,  which 
affects  the  same  systems  oforgans,  and  them  alone, 
in  women,  called  genito-urinary  tuberculosis,  a 
good  example  of  which  in  the  post-mortem  room 
is  one  of  the  most   interesting   sights  I  know.  .  .  . 

This  form  of  vaginitis  is  often  easily  cured,  but 
it  is  very  liable  to  relapse  ;  for  I  have  classed  it  as 
of  constitutional  origin  ;  and  who  will  remove  lupus 
from  the  constitution?  .  .  . 

Epoch  or  age  here  produces  not  different  diseases 
of  the  vagina,  but  it  produces  vaginitis  of  different 
kinds.  You  have  no  vaginitis  in  childhood.  I,  at 
least,  have  never  seen  any  except  of  the  lower  part 
adjoining  the  hymen.  Then  during  mature  life  you 
have  the  characteristic  acute  vaginitis,  the  venereal 
gonorrhea,  or  a  like  disease,  which  may  owe  its 
origin  to  a  perfectly  pure  sexual  intercourse.  An 
acute  vaginitis  is  not  to  be  so  designated,  unless 
it  has  the  combination  of  characters  necessary  to 
entitle  it  to  that  name.  You  must  have  intense 
inflammation  rapidly  coming  on  after  the  cause 
has  acted,  coming  to  a  climax  in  eight  or  nine  days, 
and  then  rapidly  fading  and  going  away  altogether 
.  or  becoming   chronic ;  and  you  must  have  during 


THE   CANADA    MEDICAL   RECORD. 


39 


the  height  of  the  disease  a  copious  flow  of  laudable 
pus. 

The  vagina  in  this  disease  generally  presents  a 
red,  raw-like  surface,  beneath  which  there  is  Httle 
edema,  the  rugae  not  being  obliterated.  It  is  some- 
times punctated,  which  probably  arises  from  the 
injection  of  papillae,  and  it  is  often  granulated  from 
the  same  cause. 

The  vaginitis  of  old  age  is  generally  subacute, 
and  a  similar  disease  is  not  rare  during  preg- 
nancy and  in  the  puerperal  state.  Rarely  does 
the  vagina,  when  inspected,  present  the  same 
appearance  as  in  the  acute  vaginitis  of  youth.  It 
is  oftener  smooth,  having  a  glazed  appearance  and 
feeling,  the  rugse  being  obliterated  and  reappearing 
as  the  disease  is  cured  ;  and  sometimes  you  see 
areas  over  which  the  mucous  surface  seems  to  be 
destroyed,  and  these  bleed  readily,  especially  when 
touched.  In  many  of  these  cases  you  are  consulted 
not  for  vaginitis,  but  for  so-called  menorrhagia, 
which  the  woman  supposes  she  is  suffering  from ; 
and.  as  you  know,  this  is  an  alanning  symptom  in 
old  women. 

This  disease,  especially  in  old  women,  leads  to 
garrulitas  vulvae,  not  the  garrulity  of  feeble-minded- 
ness  to  which  I  have  before  referred.  The  vagina 
secretes  air,  and  the  woman  may  be  extremely 
annoyed  by  passing  it  from  the  body.  This  is  not 
the  only  explanation  ofpassing  air  from  the  vagina, 
but  it  is  the  only  one  I  at  present  mention ;  and  I 
may  remind  you  of  the  disease  called  vaginitis 
emphysematosa.  In  the  subacute  vaginitis  of  old 
women  the  bladder  is  very  often  simultaneously 
affected.  The  pus  is  generally  thin  and  green. 
It  is  sometimes  extremely  copious.  Although  the 
disease  may  depend  greatly  upon  the  permanent 
constitutional  influence  of  senescence,  it  is  upon 
the  whole  amenable  to  simple  treatment.  .  .  . 

Chronic  vaginitis  of  youth  occurs  in  various  forms. 
There  is  a  chronic  vaginitis  in  which  the  vagina  is 
hard  and  small,  its  rugae  well  seen,  seen  but  yet 
evidently  swollen,  edematous,  and  with  either  no 
secretion  or  with  the  rugae  painted  over  by  an  old 
gray-white  accumulation  of  sordid  epithelial  detri- 
tus. This,  which  may  be  called  dry  vaginitis,  has 
its  analogue  in  a  disease  of  the  deep  cavities  of  the 
nose,  which  I  have  suspected  as  producing  peculiar 
headache  and  giddiness,  and  which  is  assuaged  or 
cured  by  the  same  soothing  remedies  as  act  on  the 
disease  in  the  vagina. 

The  chronic  vaginitis  of  old  age,  as  I  have 
already  said,  is  generally  accompanied  by  pruritus, 
and  frequently  causes  alarm  by  bleeding. 

I  have  mentioned  many  forms  of  vaginitis,  and 
one  important  practical  subject  I  must  discuss 
briefly  in  connection  with  the  forms  of  this  disease. 
Is  it,  in  any  special  case,  venereal  or  not  venereal  ? 
You  will,  in  practice,  often  be  asked  this  question, 
and  I  advise  you  never  to  answer  it  explicitly.  You 
can  not  decide  absolutely  whether  a  case  is  vene- 
real or  not.  At  one  time  it  was  supposed  that  the 
discovery  of  trichomonads,  or  a  leptothrix,  or  a 
vibrio,  would  decide  whether   it  was   venereal   or 


not.  But  this  is  now  given  up.  I  have  seen  gon- 
orrhea which  was  certainly  not  venereal  bear  every* 
character  of  the  ordinary  venereal  disease.  I  do 
not  say  that  there  is  no  distinction,  but  only  that 
the  distinction  can  not  be  made  out  by  the  practi- 
tioner so  as  to  justify  him,  from  his  own  inquiries 
into  a  case,  in  giving  a  decided  opinion  on  the 
subject.  Meantime,  the  distinctions  of  venereal 
gonorrhea  are  simply  marks  of  severity.  It  has 
been  said  that  venereal  gonorrhea  is  infectious, 
while  simple  gonorrhea  is  not ;  but  I  ha%'e  seen 
every  character  that  can  be  predicated  of  the  one 
occur  in  the  other,  as  I  said  before,  including 
infection. 

What  are  the  characters  that  make  you  suspect 
that  a  vaginitis  is  of  venereal  origin?  It  begins 
within  a  few  days  (generally  two  or  three)  of  the 
infection ;  it  is  very  severe,  and  runs  an  acute 
course  ;  the  secretion  of  pus  is  copious,  beginning 
about  the  third  day  of  the  inflammation,  and  remains 
copious  for  about  a  week  or  nine  days.  The  vulva 
is  generally  affected,  so  that  the  woman  has  more 
or  less  difficulty  in  walking  ;  and  the  vulva  being 
affected,  the  inguinal  glands  are  liable  to  be  affected 
and  you  may  even  have  bubo.  The  urethra  is 
affected,  and  also  the  bladder ;  there  is  liability  to 
ovaritis  and  to  perio-ophoritis ;  and  there  is  the 
almost  certain  infection,  not  only  by  sexual  inter- 
course, but  by  the  matter  touching  any  mucous 
surface,  such  as  that  of  the  eye. 

The  treatment  of  this  disease  is  so  well  described 
in  every  text-book  that  it  would  be  waste  of  time 
to  enter  upon  it.  It  must  be  based  upon  a  care- 
ful diagnosis,  including  the  diagnosis  of  the  local 
or  constitutional  origin  ofthe  disease,  the  diagnosis 
of  the  simplicity  of  the  affection,  or  of  its  compli- 
cation or  extension  to  other  parts. 


HEAT  AND  LIGHT  IN  THE  SICKROOM. 

A  recent  writer  gives  the  following  sensible  sug- 
gestions on  this  subject : — 

Each  person  in  a  room  should  be  supplied  with 
3000  cubic  feet  of  air  per  hour;  and  this  should  be 
done,  where  possible,  without  creating  a  percept- 
ible draft,  for  the  nervous  irritation  induced  by 
drafts  is  liable  to  produce  internal  inflammations. 

The  temperature  of  the  sick-room  should  be 
kept  at  a  uniform  height,  the  best  average  being 
from  65°  to  70°  F.,  except  for  infants  or  very  old 
people,  who  require  a  temperature  from  75°  to  80' 
F. ;  and  for  these  it  is  especially  important  to 
guard  against  changes,  and  keep  it  as  uniform  as 
possible.  All  cases  of  fever  require  a  temperature 
lower  than  the  average,  as  from  50°  to  60°  F.,  to 
assist  in  reducing  the  high  temperature  of  the 
body ;  but,  when  the  fever  subsides,  and  there  is 
much  debihty  remaining,  the  temperature  should  be 
raised  somewhat  above  the  average.  As  a  patient 
can  bear  a  greater  degree  of  cold  when  in  bed  than 
when  out  of  it,  convalescents  from  severe  diseases, 
fevers  especially,  should  have  the  temperature  of 
their  rooms  higher  than  that  maintained  during 


40 


THE   CANADA    MEDICAL   RECORD. 


the  height  of  the  attack.  Diseases  of  the  air  pas- 
sages, as  croup  and  diphtheria,  require  a  high  tem- 
perature (80°  to  85°  F.)  and  a  moist  atmosphere. 
The  best  method  for  heating  the  sick-room  is  by 
the  open  grate  fire. 

I'he  sick-room  should  not  be  darkened  by  Winds, 
except  where  there  is  disease  of  the  eyes,  with  photo- 
j)hobia,  or  where  the  patient  is  very  restless  and 
cannot  sleep  ;  then  strong  light  must  be  excluded. 
Otherwise  the  sunlight  should  be  allowed  to  enter 
and  act  chemically  by  decomposing  the  noxious 
gases,  and  thus  purifying  the  air.  Of  course  it  is 
not  advisable  to  place  the  patient  under  a  strong, 
uncomfortable  glare  of  sunlight,  nor  in  summer  to 
allow  the  sun's  rays  to  shine  into  the  room  and 
raise  the  temperature  too  high.  Artificial  light 
has  no  useful  effect,  but  does  harm  by  burning  up 
oxygen. 


THE   COLLODION    BANDAGE    IN   THE 
TREATMENT  OF  UMBILICAL  HERNIA. 

Umbilical  hernia;  are  very  frequent  in  the  first 
year  of  life. 

They  are  of  different  forms,  according  to  their 
chronicity  and  the  age  of  the  child  :  (i)  A  slight 
enlargement  of  the  umbilical  ring  through  which  a 
small  tumour  projects.  (2)  A  considerable  en- 
largement of  the  umbilical  ring,  through  which  a 
tumour  projects  varying  in  size  from  a  walnut  to 
an  apple.  (3)  A  slight  enlargement  of  the  umbili- 
cal ring,  with  small  or  large  projections,  variously 
located  about  the  ring,  above  which  the  principal 
mass  of  the  tumour  projects.  (4)  A  considerable 
enlargement,  and  simultaneously  a  considerable 
projection  of  the  ring.  Under  this  latter  form  the 
largest  umbilical  hernise  occur.  The  first  category 
heals  without  artificial  aid,  the  2nd,  3rd  and  4th 
classes  require  treatment  on  account  of  their  size, 
and  continual  increase. 

In  the  Vienna  general  Polyclinic,  the  collodion 
of  Rappa  (of  Naples)  is  used.  It  is  applied  in  the 
following  manner.  The  mother  takes  the  child  on 
her  lap,  the  shoulder  lying  on  the  left,  the  hips  on 
the  right  leg.  The  upper  extremities  of  the  child 
are  held  fast  by  the  left  hand  of  the  mother,  the  lower 
extremities  by  the  right  hand. 

The  hernia  and  its  vicinity  are  now  penciled 
over  with  a  broad  layer  of  collodion.  The  hernia 
is  now  reduced,  and  a  folded  comj)ress  4  centi- 
meters wide  and  3  centimeters  long  is  placed  over 
the  ring,  the  side  next  to  the  hernia  having  been 
covered  with  collodion.  This  compress  is  held  in 
])lace  by  an  assistant,  and  a  long  strip  of  adhesive 
])laster,  3  centimeters  broad,  is  placed  over  it. 
This  strip  must  be  long  enough  to  pass  around  the 
body  and  cross  upon  the  abdomen.  During  the 
application  of  the  plaster  the  recti-muscles  must 
be  pressed  together  by  an  assistant.  Finally,  over 
this  a  linen  bandage  equally  long  and  broad  is 
applied,  and  the  entire  surface  of  the  bandage 
over  the  abdomen  is  covered  with  collodion. 

'i'o  protect  from  eczema  Monti  applies  a  mix- 


ture of  emplast.  diachyli  simp,  and  cerat.  fuscum, 
instead  of  the  adhesive  plaster.  The  formula  is, 
emplast.  diachyl.  simp.,  30;  cerat  fusci  10;  ol. 
oliv.  9.5  ;  ut  liquifact,  ft.  emplast. —  Centt.  Zeit.  f. 
Kdrhlk.  21,  Der.  Prak.  Arzt.,  8,  1878. — Cincin- 
natt  Lancet  and  Clinic. 


COUGH    PRODUCED    BY    ACCUMULA- 
TIONS IN   THE  EAR. 

The  patient,  a  singularly  robust  young  lady,  con- 
sulted me  in  regard  to  a  cough  of  some  three 
years  standing.  The  cough  was  loud,  incessant 
and  peculiarly  hollow.  It  was  dry,  unaffected  by 
times  of  day,  seasons,  or  weather.  It  deprived 
her  often  of  rest  at  night,  and  rendered  her  a 
source  of  annoyance  and  anxiety  to  her  friends. 
She  had  consulted  various  medical  men,  and  had 
taken  almost  every  conceivable  patent  medicine, 
including  some  powerful  sedatives,  without  obtain- 
ing even  slight  relief.  The  heart  and  lungs 
proved,  as  I  had  expected,  to  be  healthy.  The 
functions  of  the  uterine,  gastro-intestinal,  and 
renal  systems  were  stated  to  be  strictly  normal. 
There  were  no  symptoms  indicative  of  the  presence 
of  entozoa.  The  condition  of  the  throat  was 
natural ;  there  was  no  relaxation  of  the  uvula.  I 
had  come  to  the  conclusion  that  the  cough  must 
be  of  a  hysterical  nature,  when  it  occurred  to  me 
to  e.xamine  the  ears.  The  left  membrana  tympani 
was  plainly  visible  and  healthy.  The  state  of  the 
right  one  was  hidden  by  a  dark  mass.  On  touching 
this  mass  with  a  probe,  through  the  speculum,  the 
patient's  peculiar  cough  was  immediately  produced, 
and  by  keeping  up  a  very  slight,  steady  pressure 
on  it,  a  fit  of  coughing,  not  unlike  a  violent 
paroxysm  in  whooping  cough,  resulted.  By  the 
aid  of  a  large  ear-syringe  and  a  w^eak,  hot  alkahne 
solution,  a  piece  of  hard  wax,  fons  et  origo  maliy 
was,  with  some  diflliculty,  produced.  It  weighed 
over  three  grains.  I  followed  up  the  syringing  by 
the  use  of  Politzer's  apparatus.  The  cough  ceased, 
and,  though  some  weeks  have  now  elapsed,  it 
shows  no  sign  of  returning. — A.  E.  Bridger,  M.B., 
in  the  Lancet^  March  6,  1880. 


LINIMENT  FOR  SORE  NOSE. 

Hager,  who  is  strong  in  "  learned  "  names,  calls 
this  Licquor  rhinohygranticiis.  He  recommends 
it  for  the  soreness  of  the  nose  caused  by  the  acrid 
secretions  due  to  a  cold  in  the  head  : 

Corrosive  sublimate i.grain. 

Benzoic  acid ^  " 

Rose  water  2     drachm'^. 

Diluted  alcohol 32  drachm. 

Glycerine Yz     " 

Tincture  of  opium 10     drops. 

Apply  three  times  a  day  with  a  camel  hair  brush. 
—Pharm.  CM. 


THE   CANADA   MEDICAL   RECOED. 


41 


FORMULA  IN  GONORRHCEA. 

Dr.  Herbert  L.  Snow  publishes,  in  the  British 

Medical  Journal,  April  17th,  1880,  the  following 

formula,  which  in  his  hands  has  proved  of  great 

service,  and  which  is  not  particularly  unpalatable: — 

I^.     01.  copaibae, 

01.  cubebae,  aa      3  ij 

Liquor  potassse,  3  iiiss 

Tinct.  aurantii,  3  "j 

Syrupi  simplicis,  3  ij 

Aq.  menth.  pip.,  q.s.  ad  iviij.  M. 
SiG. — Two  tablespoonfuls,  three  times  daily. 
As  an  injection,  he  regards  the  liquor  potassse 
permanganatis  (  3  iij  ad  aqus  =  vj)  as  by  far  the 
best  injection,  and  it  has  the  great  advantage  of 
being  serviceable  all  through  the  acute  stage  of 
gonohorrcea.  It  should  be  used  very  frequently  ; 
and  subsequently,  a  little  zinc  sulphate  may  be 
added,  with  benefit. 


EARACHE  AND  CHLOROFORM  VAPOR. 

Dr.  Morgan  states  that  he  has  often  promptly 
relieved  the  distressing  earache  of  children  by 
filling  the  bowl  of  a  common  new  clay  pipe  with 
cotton  wool,  upon  which  he  dropped  a  {q.\\  drops 
of  chloroform,  and  inserted  the  stem  carefully 
into  the  external  canal,  and  adjusting  his  lips  over 
the  bowl,  blew  through  the  pipe,  forcing  the 
chlorofonn  vapor  upon  the  membrana  tym- 
pani. — National  Medical  Review. 

The  Canada  Medical  Record, 

^  .fttouti)ln  Jounxsl  of  ^cUiciite  auU  ISfjarmacn- 
FKANCIS  W.  CAMPBELL. MA..  M. D.,L.K.C. P. ,LOND. 

ASSISTANT  EDITORS  : 

R.  A.  KENNEDY,  M.A.,  M.D. 

JAMES  PEERIGO,  M.D.,  M.R.C.S.  Eng. 

EDITOR  OP   PHABMACEtJTICAL   DEPARTMENT: 

ALEX.  H.  KOLLMYER,  M.A.,  M.D. 

SUBSCRIPTION  TWO  DOLLARS  PER  ANNUM. 

All  communications  and  Eyichanges  vnist  he  addressed  to 
the  Editor,  fJraiver  356,  Post  'Office,  Montreal. 

MONTREAL.  NOVEMBER,  1880. 

LAVAL  MEDICAL  FACULTY. 

No  small  degree  of  excitement  and  ill-feeling  has 
arisen  among  our  French  confreres,  in  consequence 
of  the  Laval  University  of  Quebec  having  opened 
a  branch  college  in  the  city  of  Montreal,  which 
they  have  done,  they  say,  with  the  intent  of 
affording  a  more  efficient  system  for  the  higher 
education  in  this  city  of  the  French  and  other 
Roman  Catholic  Medical  Students,  which  state- 
ment in  itself  would  seem  to  imply  that  the  Roman 


Catholic  Medical  Students  following  the  courses  ia 
the  already  well-established  schools  and  universi- 
ties of  Montreal  had  not  been  able  hitherto  to 
secure  a  first-class  education  ;  which  assertion,  tO' 
say  the  least  of  it,  was  not  only  egotistical  and 
bombastic,  but  decidedly  discourteous  to  the  Mon- 
treal Colleges,  which  have  always  ranked  high  as- 
educating  establishments  all  over  the  world. 

There  were  already  in  this  city  McGill  Univer- 
sity, which  was  established  somewhere  about  1830  ;, 
The  Montreal  School  of  Medicine  and  Surgery, 
opened  in  1S45,  ^'^'^^  affiliated  with  the  University 
of  Cobourg,  Ontario,  about  1866 ;  and  the  Medical 
Faculty  of  the  University  of  Bishop's  College  of 
Lennoxville,  Province  of  Quebec,  established  in 
187 1.  When  the  latter  Faculty  commenced  opera- 
tions by  opening  their  doors  to  Medical  students, 
there  was  a  great  outcry  against  multiplying  the 
seminaries  for  higher  education  ;  for  it  was  main- 
tained that  the  two  schools  before  existing  were 
fully  competent  to  afford  all  the  facilities  for  ac- 
quiring a  knowledge  of  medicine  that  could  be  re- 
quired, inasmuch  as  the  lectures  were  given  in 
English  in  the  one  (McGill)  and  in  the  French 
language  in  the  Montreal  School  of  Medicine. 
Therefore,  they  contended,  there  was  no  necessity 
for  the  opening  of  another  medical  school  in  this 
city,  and  all  that  could' be  done  was  tried  to  pre- 
vent its  success,  but  without  avail ;  the  very  op- 
position of  its  rivals  having  perhaps  assisted  rather 
than  injured  it.  The  Laval  University,  however, 
appears  to  have  entertained  different  views,  since 
they  have  established  a  fourth  school  in  our  midst ;. 
but  concerning  this,  more  anon. 

Shortly  after  the  opening  of  Bishop's  Medical 
School,  there  were  certain  reports  circulated  to  the 
effect  that  the  Jesuits  were  endeavoring  to  obtain 
University  privileges,  in  fact  that  they  were  about 
to  apply  to  the  Provincial  Parliament  for  a  charter, 
and  that  should  they  obtain  one  it  was  their  inten- 
tion to  adopt  the  Montreal  School  of  Medicine 
and  Surgery  as  their  Medical  Faculty.  But  not- 
^vithstanding  the  power  of  that  august  order  they 
found  their  equals  in  the  authorities  of  the  Laval 
University,  who  had  determined  to  oppose  such  a 
procedure  by  every  available  means,  as  it  would 
injure  their  College  at  Quebec,  and  so  the  matter 
stood. 

However,  about  this  time  Monseignor  Conroy 
was  sent  out  from  Rome  as  a  special  envoy-  to 
endeavor  to  arrange  amicably  the  disputes  that  had 
arisen  between  the  ecclesiastical  bodies  of  LavaU 


42 


THE    CANADA    MEDICAL   RECORD. 


St.  Sulpice  and  the  Jesuits  concerning  this  and 
■other  matters  spiritual  as  well  as  temporal,  and  he 
thought  that  he  had  fulfilled  his  mission  in  this 
I)articular  instance  most  satisfactorily  when  he  had 
obtained  their  consent  to  form  an  amalgamation 
between  the  bodies  just  named,  and  the  French 
Montreal  School  of  Medicine  and  Surgery  was  in 
this  manner  absorbed,  as  it  were,  by  the  Laval 
University,  professors,  buildings,  hospitals  and  all, 
.and  was  henceforward  to  be  regarded  and  known 
^s  the  Montreal  branch  of  the  Laval  University. 
His  Holiness  the  Pope  shortly  afterwards  issued  a 
bull,  approving  of  this  arrangement  and  confirm- 
ing the  appointments  then  made.  The  professors 
of  the  Montreal  School  of  Medicine  fell  into  the 
trap  set  for  them  most  unsuspiciously,  and  this 
apparently  satisfactory  state  of  affairs  lasted  for 
about  a  couple  of  months  ;  when  the  Faculty  of 
the  Montreal  School  of  Medicine,  now  the  Mont- 
real branch  of  Laval,  felt  the  necessity  of  making 
certain  alterations  in  their  staff  of  professors,  and 
wishing  to  make  a  certain  appointment,  the  party 
named  was  refused  at  Quebec,  and  they  were 
coolly  informed  that  in  future  they  would  be 
spared  this  trouble,  and  that  all  appointments 
would  henceforward  be  made  by  the  authorities  of 
the  Parent  University  at  Quebec.  This  clipping  of 
their  wings  opened  their  eyes,  and  a  revolution 
followed,  most  of  the  professors  preferring  to  re- 
main as  the  Montreal  School  of  Medicine,  and  to 
retain  their  rights  as  such  as  heretofore,  rather 
than  sell  their  birthright  for  a  mess  of  pottage. 
Laval  then  endeavored  to  compel  them,  but  the 
nuns  of  the  Hotel  Dieu,  in  consequence  of  an  old 
arrangement,  supported  the  Montreal  School,  and 
refused  Laval  the  use  of  their  valuable  Hospital, 
which  was  indispensable  to  the  latter.  From  that 
time  the  Montreal  School  has  continued  to  carry 
on  its  lectures  independently  and  under  affiliation 
with  Cobourg,  as  before. 

Laval,  however,  having  once  obtained  a  footing 
(though  only  nominal)  in  this  cit>',  is  determined 
to  maintain  her  ground,  and  proceeded  to  fill  up 
the  vacancies  in  her  medical  staff,  created  by  the 
secession  of  most  of  the  old  professors,  a  few  only 
remaining  with  her,  and  opened  her  doors  to 
medical  students  in  this  city  the  same  year  (1878), 
and  as  a  hospital  was  indispensable,  she  opened  a 
new  one  for  the  accommodation  of  her  students, 
he  Hospital  of  Notre  Dame,  in  1880, 

As  this  step  injured  the  Montreal  School  very 


materially,  the  lectures  being  delivered  in  the 
French  language  only,  in  both  of  these  institutions, 
they  strenuously  objected  to  it,  and  finally  sent  one 
of  their  members  (Dr.  d'Orsonnens)  both  to  Lon- 
don and  to  Rome,  to  obtain  a  legal  opinion  upon 
the  powers  and  privileges  allowed  by  the  Royal 
Charter  of  Laval,  and  also  to  lay  the  matter  before 
His  Holiness  the  Pope.  The  following  was  the 
opinion  received  from  Sir  Farrer  Herschell,  Soli- 
citor-General of  England,  after  a  careful  investiga- 
tion of  that  charter : — 

Re  Universitv  Laval  at  Quebec. 

"  I  am  of  opinion  that  the  Laval  University  of 
"Quebec  is   not  entitled   under  its    Charter    to 
"  establish  itself  elsewhere  than  in  Quebec,  or  to 
"establish  faculties  of  Theology,  Law,  Medicine 
"  and  Arts,  to  exist  at  the  same  time  at  Quebec 
"  and  Montreal.     I  think  the  Charter  by  which  it 
"  is  incorporated  establishes  it  as  a  local  Univer- 
"  sity  at  Quebec^  and  that  it  acts  in  excess  of  the 
"  powers  and  privileges  conferred  upon  it  by  the 
"  Charter   when   it    establishes   itself    elsewhere. 
"  There  are  various  considerations  which  point  to 
"  this  conclusion,  amongst  others,  I  may  mention 
"  that  the  title  is  strictly  local,  that  the  visitor  is 
"the  Archbishop  of  Quebec,  that  the  Rector  is 
"  the  Superior  of  the  Quebec  Seminary,  and  that 
"  the  Council  consists  principally  of  the  Directors 
"  of  that   Institution.     If  it  were  in  the  power  of 
"  the  Laval   University  to  do  what  is  contended 
"  for,  great  inconvenience  might  arise  :  for  all  the 
"  senior  professors  who  form  part  of  the  Council 
"  might  at  any  particular   time   be  professors  of 
"  the  branch  at  Montreal  whilst  the  other  ex  officio 
"members  of  the  Council  were  all  at  Quebec. 
"  Further,  it  is  to  be  observed   that  the  express 
"  power  is  given  to  affiliate  to  and  connect  with  the 
"  University  Colleges,   &c.,  anywhere  within  the 
"  province,  and  this  I  think  is  all  that  the  Charter 
"authorizes  to  be  done  outside  Quebec.     It  is  to 
"  be  noted  that  the  word  '  connect '  on  which  I 
"  understand  reliance  is  placed  as  justifying  the 
"  action  of  the  University  Laval  is  joined  to  the 
"word   affiliate  \>y  the  conjunctive  ^ancT.      The 
"  words  are  not  '  affiliate  or  connect '.     It  seems 
"  to  me  clear  therefore  that  the  Charter  does  not 
"  warrant  a  connection  apart  from  an  affiliation. 

"  It  follows  from  what  I  have  said  that  professors 
"  of  the  succursale  at  Montreal  are  not  entitled  to 
"be  styled  professors  of  the  University  Laval. 

"  I  think  that  professors  of  the  succursale  are 
"  not  entitled  as  such  to  take  part  in  the  Council  of 
"the  University  Laval. 

"  For  the  reasons  given  I  think  faculties  estab" 
"  lished  by  the  University  Laval  at  Montreal  or 
"  elsewhere  than  at  Quebec  cannot  form  part  of  the 
"  University  Laval. 


THE   CANADA   MEDICAL   RECORD. 


43 


"  As  I  have  already  stated  the  University  can- 
not in  my  opinion  establish  itself  in  different 
places  or  have  branches  there.  And  I  see  noth- 
ing in  the  articles  of  the  Code  referred  to  to 
modify  my  opinion. 

"  I  am  disposed  to  think  that  the  University 
Laval  when  exceeding  the  powers  conferred  upon 
it  by  its  Charter  would  fall  within  the  scope  of 
article  997  of  the  Code  of  Civil  procedure  of 
Lower  Canada. 

"  The  University  Laval  having  derived  its  exist- 
ence from  Royal  Charter,  I  think  that  the 
Pope  can  neither  derogate  from  the  rights  con- 
ferred by  the  Charter,  nor  confer,  so  as  to  give 
them  legal  effect,  any  powers  beyond  those 
created  by  it.  I  ought  to  add  that  the  Pope 
does  not  seem  to  have  intended  either  to  dero- 
gate from  or  extend  the  rights  possessed  under 
the  Charter,  but  merely  to  have  given  directions 
under  a  misapprehension  as  to  what  those  rights 
really  were 

"  I  may  add  to  the  above  that  I  concur  gene- 
rally with  the  views  expressed  by  Mr.  Archam- 
bault  in  his  Etude  Legale  on  the  various  ques- 
tions with  which  he  deals. 


(Signed)         Farrer   Herschell. 
"  Temple,  July  20th,  1S80." 

Having  received  an  opinion  so  favorable  to 
their  views,  the  Montreal  School  Authorities  have 
served  the  Laval  University  with  a  notarial 
protest,  demanding  the  said  University  to  abolish 
the  Faculty,  which  it  has  formed,  forthwith ;  and 
threatening  that  if  they  do  not  they  will  carry  the 
matter  before  the  Courts,  as  their  action  has  been 
illegal  and  beyond  the  powers  given  them  by 
their  charter. 

Laval  still  maintains  that  she  has  the  power 
and  right,  and  is  perfectly  wiUing  to  test  the 
case  in  the  Courts,  ard  further  report  says  that, 
should  they  lose  their  suit,  they  intend  to  apply 
to  the  proper  authorities  to  have  their  charter 
amended  so  as  to  enable  them  to  continue  their 
operations  in  this  city. 

Before,  however,  taking  extreme  measures,  the 
professors  of  the  Montreal  School  have  again  sent 
a  protest  to  the  Holy  See  at  Rome,  requesting 
them  to  command  Laval  to  discontinue  teaching 
here,  for  they  say,  since  it  was  through  a  mis- 
understanding of  the  powers  of  the  charter  that 
his  Holiness  the  Pope  authorized  the  opening  of 
the  said  Laval  branch,  it  is  only  right  that  the 
matter  should  be  laid  before  the  Holy  See,  that 
they  should  have  the  opportunity  of  rectifying  the 


mistake  by  countermanding  the  act;  bit  in  the 
event  of  their  refusal,  no  other  resource  will  be 
'eft  them,  they  having  done  their  duty  first  as 
Catholic  Churchmen,  but  to  bring  the  natter 
before  the  proper  legal  tribunals  of  the  Dominion. 


TROMMER'S  EXTRACT  OF  MALT. 

Let  no  physician  allow  the  value  of  this  great 
constructive  medicine,  this  palatable  and  potent 
remedy  in  cachectic  and  asthenic  conditions,  to 
become  obscured  in  his  memory  by  the  ocean  of 
new  remedies  ever  pouring  in  on  the  profession. 
No  one  who  fairly  tries  it  can  fail  to  learn  that  it- 
is  a  great  boon  to  the  race. 


PERSONAL. 

Dr.  Fenwick,  Professor  of  Surgery  in  Mc  Gill 
College,  returned  from  a  brief  visit  to  Europe,  early 
in  October. 

Dr.  Francis  W.  Campbell,  Professor  of  Practice 
of  iMedicine  in  Bishop's  College,  returned  from 
Europe  by  the  Allan  Mail  Steamship  "  Sardinian," 
arriving  on  the  7  th  of  November. 

Dr.  Oakley,  formerly  apothecary  to  the  Mon- 
treal General  Hospital,  and  a  graduate  of  McGill 
College,  (1877)  is  at  present  attending  the  Londork 
Hospital,  in  London,  Eng. 

Dr.  Hunt  (McGill  College,  1872)  is  one  of  the 
most  rising  physicians  in  Sheffield,  Eng.,  where  he 
has  been  in  practice  for  the  last  seven  years. 

Dr.   Tetreault,  (M.D.,  Bishops  College,  i88o> 
has  commenced  practice  in  Orange,  New  Jersey, 
^U.S. 

Dr.  Chandler  (M.D.,  Bishop's  College,  and 
Gold  Medalist,  1880)  has  obtained  the  House 
Surgery  of  one  of  the  New  York  Hospitals,  having 
taken  the  first  position  among  a  host  of  competi- 
tors. 

Dr.  Drake,  of  Montreal,  has  left  the  city  fur  a. 
brief  period  of  travel.  His  numerous'friends  will  join 
us  in  the  wish  that  he  may  soon  return  fully 
restored  to  health. 


OBITUARY. 


SAMUEL  B.    SCHMIDT,   M.D. 


Dr.  S.  B.  Schmidt,  one  of  Montreal's  oldest  and 
best  esteemed  physicians,  died  on  the  4th  of  No- 
vember at  his  residence  at  the  corner  of  Union  Av- 
enue and  Bumside  Place.  Dr.  Schmidt  was  born  ia 


44 


THE   CANADA    MEDICAL    RECORD. 


Montreal  in  1826,  and  was  consequently  54  years 
of  age  at  the  time  of  his  death.   He  was  of  German 
extraction,  his  father  having  come  from  Germany 
to  settle  in  Montreal  at  the  beginning  of  the  pre- 
sent century,  engaging   in    commercial    pursuits- 
The  subject  of  this  notice  when  very  young  com- 
menced the  study  of  medicine,  and  hav  ng  pre- 
viously graduated  in  Arts  became  an  M.  D.  of  Mc- 
Gill  College  at  the  early  age  of  twenty-one.     Dur- 
ing the  terrible  ship  ffyphusj  fever  in  1847  Dr. 
Schmidt  was  among  the  most  active  in  attending 
to  the  disease-stricken  immigrants.     He  was  one 
of  the  well  remembered  "  thirty"  physicians  from 
Montreal,  Quebec,  Three  Rivers  and  elsewhere, 
who  volunteered  to  go  to  the  quarantine  station 
at  Grosse  Isle,  and  attend  the  ships  as  they  arrived. 
Of  the  entire   thirty,  two  only  returned  alive.  Dr. 
Schmidt  being  one,  the  other  dying  shortly  after 
his  return.     He  was  active  throughout  life  in  all 
works  of  charity,    was  attendant    surgeon  of  the 
St.  Patrick's  Orphans    Asylum   during    the   past 
thirty  years,  was  surgeon  to  the  Grey  Nuns'  Hos- 
pital  for  seventeen   years,  and  physician    to    the 
Seminary  for  twenty-five  years,  all  of  which  offices 
he  held  up  to  the  time  of  his  death. 

An  honorary  life  member  of  the  Montreal  Ger- 
man Society  he  was  highly  esteemed  for  his  gratui- 
tous work  among  the  poor  of  the  German  population 
when  such  was  needed.  He  was  a  fellow  of  Mc- 
Gill  University,  and  was  regarded  as  a  ripe  scholar. 
He  was  a  member  of  the  Medico-Chirurgical  So- 
ciety of  Montreal,  which  Society  at  its  meeting  on 
the  1 2th  of  November  passed  suitable  resolutions 
of  condolence  to  his  family.  He  had  been  ailing 
for  the  past  four  months,  but  his  death  was  not 
expected  till  about  three  weeks  ago,  when  he  be- 
gan to  decline  rapidly.  His  disease  was  cancer 
of  the  liver.  The  removal  of  Dr.  Schmidt  by  death 
leaves  a  blank  in  medical  and  social  circles  in  this 
city  which  will  not  readily  be  filled. 

Dr.  C.  C.  Hamilton. 

Dr.  C.  C.  Hamilton,  of  Canard,Nova  .Scotia,  died 
on  the  23rd  of  Oct.  last,  aged67  years.  Dr.  Hamil- 
ton was  widely  known  throughout  the  Dominion, 
having  taken  a  warm  interest  in  the  Canada  Medi- 
cal Association,  of  which,  a  few  years  ago,  he  was 
Vice-President  for  Nova  .Scotia.  He  sat  in  the 
Nova  Scotia  Legislature  from  1863  to  1867,  and 
took  an  active  interest  not  only  in  the  local  politics 
of  his  Province,  but  in  those  of  the  Dominion.  In  all 
works  for  the  advancement  of  the  people  he  took 


a  personal  interest — the  temperance  cause  receiving 
his  constant  support.  Dr  Hamilton  was  a  practical 
farmer  of  a  thoroughly  scientific  type  and,  next  to 
his  profession,  of  which  he  was  a  devoted  member, 
his  farm  occupied  his  thoughts. 


ST.  NICHOLAS  FOR  1881. 
5000  for  England,  100,000  for  America. 

Sf.  Nicholas,    the  charming  magazine  for  boys 
and  girls,  edited  by  Mrs.  Mary  Mapes  Dodge,  has 
increased  so  much  in  size  and  number  of  pages 
during  the  year  past  that  the  publishers  have  been 
obliged  to  issue  the  yearly  volume  in  two  parts, 
instead  of  one    as    heretofore.     As  to   its   circu- 
lation,  they     report    a    gain    of    10,000    in   the 
average  monthly  editions  of  1880  over  1879.  The 
announcements  for  the    coming    year    include    a 
capital    serial    story    for    boys,    full  of   exciting 
adventure,  "In Nature's  Wonderland,"  or.  Adven- 
tures in  the  American    Tropics  ;   Stories    of  Art 
and   Artists,    by   Mrs.    Clara    Krskine    Clement, 
a  faithful  outline  of  the  history  of  European  Art, 
with    many   illustrations  ;  "•  Phaeton   Rogers,"    a 
delightful  andhumorous  serial  by  Rossiter  Johnson  ; 
"  Mystery  in  a  Mansion,"  a  six  months'  serial ; 
The   Treasure-Box    of  Literature,    directing  and 
encouraging  young  people  in    the  best  reading  ; 
The  Agassiz  Association,  fully  explained  in  the 
November  number ;  "  Two  English  Queens,"  by 
Mrs.  Oliphant ;  "  The  Land  of  Nod,"  d  children's 
operetta,  with   music, — full  of  charming  tableaux 
and    effects ;   A    series  of  beautifully  illustrated 
Ballads    for   Young    Folks,    beginning   with    the 
Christmas  number  ;  A    Special  Budget   of  Fairy 
Stories  by  Frank  R.  Stockton — the  first  of  which 
is  in  the  November  number ;  An  Indian  Story  by 
''  Bright    Eyes,"    the   Ponca    Indian    maiden ;    a 
splendid   holiday  story,  "  A    Christmas  with  the 
Man  in   the    Moon,"    by    Washington   Gladden. 
Open-air  Papers,  stories  of  sports,  and  games,  will 
be  continued,  with  all  the  popular  departments. 

Subscriptions  beginning  with  the  November 
issue  will  include  "  the  wonderful  Christmas  num- 
ber," of  which  the  edition  will  be  5,000  in  England 
and  100,000  in  America.  The  price  of  this  num- 
ber, to  be  issued  about  November  30th,  will  be 
30  cents. 

Regular  price  $3.00  a  year  ;  25  cents  a  number. 
For  sale,  and  subscriptions  received,  by  all  dealers, 
or  the  publishers,  Scribner  &  Co.,  743  Broadway, 
New  York. 


THE    CANADA   MEDICAL    RECORD. 


45 


21  NUMBERS  OF  SCRIBNER'S   FOR  $5. 

The  richly  illustrated  November  number  of 
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the  monthly  circulation  was  about  90,000  copies  ; 
during  the  past  nine  months  it  has  averaged  115, 
000,  while  the  first  edition  of  the  November  issue  is 
225,000. 

The  first  Part  of  the  now  famous  serial  by 
Eugene  Schuyler,  "The  Life  of  Peter  the  Great," 
was  finished  in  October.  With  November  begins 
Part  II.,  Peter  the  Great  as  Ruler  and  Reformer," 
which  will  be  an  advance,  in  point  of  poplar 
interest  and  wealth  of  illustration,  upon  the  part 
already  published.  To  enable  readers  to  secure 
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offers  to  new  subscribers  after  October  20th,  who 
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Scribner' %  is  $4.00  a  year,  35  cents  a  number. 


PAMPHLETS  RECEIVED. 

Hernia  in  Children,  by  Dr.  Edward  Swasey, 
reprinted  from  the  American  Journal  of  Obstetrics, 
July  1880. 

Some  Practical  Suggestions  in  the  Treatment  of 
Diphtheria,  by  Dr.  R.  J.  Munn  of  Savannah,  Ga- 

Proceedings  of  the  Medical  Society  of  the 
County  of  King's,  November,  1880. 

Peptonized  Milk  as  a  Food  for  Infants  and  In- 
valids, by  Dr.  Munn. 

Acts  of  the  Legislature  of  Louisiana — Health. 
Ordinances. 


REVIEWS. 

Geo.  P.  Rowell  &  Co  ,  American  Newspaper  Direc- 
tory for  1880. 

This  book  contains  an  immense  mass  of  inform- 
ation concerning  the  press  of  the  United  Stateii 
and  Canada,  which  is  of  service  to  advertisers. 
It  is  a  most  creditable  production,  and  shows  the 
energy  of  the  great  advertising  house  of  George 
Rowell  &  Co.,  of  New  York. 

Ophthalmic  and  Otic  Memoranda.  By  D.  B. 
St.  John  Rosa,  M.D.,  Professor  of  Ophthalmo- 
logy in  the  University  of  the  City  of  New  York, 
and  Edward  S.  Ely,  assistant  to  the  Chair  of 
Ophthalmology  University  of  the  City  of  New 
York.  New  York,  William  Wood  &  Co.  ;  Mont- 
real, Dawson  Bros. 

This  is  a  small-sized  volume  of  almost  three 
hundred  pages,  and  is  worthy  of  attention.  It 
contains  a  complete  digest  of  the  whole   subjects 

Cutaneous  and  Venereal  Memorajid a.  By  Henry 
G.  Piffard,  A.M.,  M.D.,  Professor  of  Dermato- 
logy University  of  New  York,  and  George  H. 
Fox,  A.M.,  M.D.,  Lecturer  on  Skin  Diseases, 
College  of  Physicians  and  Surgeons,  New  York. 
William  Wood  &  Co.,  New  York;  Montreal^ 
Dawson  Bros. 

This  is  a  companion  book  to  Oi)hthalniic 
Memoranda.  It  is  especially  valuable  to  students 
going  over  thoroughly,  though  briefly,  the  subjects 
upon  which  it  treats. 

Medical  Heresies,  historically  cmisidered :  a  series  of 
critical  essays  on  the  origin  and  evolution  of 
Sectarian  Medicine,  etnbracing  a  special  sketch 
and  review  of  Homceopathy  past  and  present. 
By  GoNZALvo  C.  Smythe,  A.M.,  M.D.,  Pro- 
fessor of  Practice  of  Medicine  in  the  College  of 
Physicians  and  Surgeons,  Indianapolis.  Philadel- 
phia, Presley  Blakiston ;  Montreal,  Dawson 
Bros. 

This  is  a  thoroughly  interesting  book  of  two 
hundred  and  twenty-eight  pages.  It  begins  with 
ages  in  medicine,  then  traces  its  origin  and  gradual 
evolution  into  Primeval  Medicine.  Egyptian  My- 
thology is  then  considered,  followed  by  the  gene- 
alogy, writings  and  opinions  of  Hippocrates.  The 
Dogmatic  school  and  its  prominent  characters  are 
well  described,  followed  by  brief  mention  of  the 
Empiric  and  Methodic  schools.  The  influence  of 
Christianity  upon  medicine,  and  its  gradual  im- 
provement down  to  the  present  day,  form  the  sub- 


46 


THE   CANADA   MEDICAL   RECORD. 


jcct  of  six  chapters.  The  Homeopathic  question 
is  well  put,  and  its  adherents  cannot  say  they  have 
been  unfairly  dealt  with.  Altogether,  the  work  is 
a  very  readable  one,  and  will  find  not  a  few  ad- 
mirers. 

Lindsay  H  Blakiston's  Visiting  List.  Philadel- 
phia, 1880;  Montreal,  Dawson  Bros. 

This  is  the  thirtieth  year  of  the  publication  of 
this  visiting  list,  which,  in  spite  of  the  keen  com- 
petition of  late  years,  still,  in  our  opinion,  main- 
tains its  place  as  the  very  best  which  is 
published.  Good  as  it  always  has  been,  it  is  this 
year  made  even  more  valuable  than  heretofore  by 
the  addition  of  the  Metric  or  French  Decimal 
-system  of  weights  and  measures,  and  of  Posological 
tables,  shewing  the  relations  of  our  present 
-system  of  Apothecaries'  weights  and  measures  to 
that  of  the  Metric  system.  It  gives  the  dose  in 
both.  ^Ve  urge  its  use  by  our  readers  Ve  have 
for  years  found  it  invaluable. 

Therapeutics  of  Gynecology  and  Obstetrics.  By 
Wm.  B.  Atkinson,  M.D.  Philadelphia,  D.  G. 
Brinton ;  Montreal,  Dawson  Bros. 

This  work  is  a  compilation  of  the  methods  of 
treatment  recommended  by  writers  and  well  known 
obstetricians  and  gynecologists  of  the  present 
time,  each  chapter  being  prefaced  with  a  "  Synop- 
sis of  Diagnostic  points."  In  no  way  can  it  replace 
:any  of  our  standard  text  books,  but  for  the  busy 
practitioner  it  will  be  found  extremely  useful, 
grouping  as  it  does  the  various  formulae  recom- 
mended 

The  author  has  shown  great  diligence  in  collect- 
ing his  material,  and  the  result  is  to  be  commended. 

Frequently  it  happens  that  some  particular  form 
of  treatment  or  formula  has  attracted  attention, 
and,  when  the  necessity  for  its  application  arises, 
cannot  be  remembered  :  the  book  supplies  this  de- 
ficiency, so  that  as  a  work  for  ready  reference  it 
fills  a  want  felt  by  many. 

Lessons  in  Gynecology.  By  Wm.  Goodeli,,  A.M.. 
M.D.,  Professor  of  Clinical  Gynecology  Uni- 
versity Pennsylvania,  &c.  92  Illustrations.  Svo, 
pp.  454.  Philadelphia,  D.  G.  Brinton  ;  Montreal, 
Dawson  Bros.,  1880. 

One  year  had  not  expired  before  a  second 
edition  was  called  for,  and  the  author  in  preparing 
this  volume  has  taken  advantage  of  the  o])por- 
tunity  to  carefully  revise,  add  new  matter,  and  of  a 
necessity  enlarge  upon  his  former  work.  Con- 
sisting of  a  series  of  lessons  or  lectures,  it  bears 


the  practical  impress  of  the  lecture  room,  of  which 
it  is  the  outcome.  The  author  has  not  given  us 
a  systematic  treatise  on  gynecology,  although  these 
lessons  are  almost  as  comprehensive.  Many 
original  suggestions, the  result  of  a  large  experience, 
and  the  details  of  cases  give  them  a  clinical 
character  which  is  instructive,  while  at  the  same 
time  due  credit  is  given  to  the  latest  teachings  on 
the  subject.  The  lessons  are  33  in  number, 
ranging  over  a  wide  extent,  and  specially  valuable 
for  the  practical  indications  given  for  treating 
the  diseases  most  commonly  met  with.  In  the 
enumeration  of  instruments  wanted,  modes  of 
examination,  &c.,  it  is  pleasing  to  note  that  the 
author  does  not  parade  his  own  inventions  unduly 
as  is  the  fashion  with  many  authors,  who  consider 
their  instruments  to  be  essential,  and  without  which 
gynecological  practice  would  be  in  vain.  The 
lessons  o  i  the  hygienic  and  moral  treatment  in 
the  prevention  of  uterine  disease  should  be  read 
by  every  physician,  matters  which  are  unfortunately 
too  often  neglected. 

These  lessons  are  valuable  additions  to  the 
literature  of  gynecology,  and  every  physician  who 
obtains  them  will,  we  have  have  no  doubt,  be 
satisfied  that  he  has  done  so. 

Diseases  of  the  Bladder  and  Urethra  in  JVomen. 
By  Alexander  J.  C.  Skene,  M.D.,  Professor  of 
the  Diseases  of  Women,  Long  Island  College 
Hospital,  &c.,  &c.  New  York,  Wm.  Wood  & 
Co. ;  Montreal,  Dawson  Bros. 

The  volume  before  us  contains  the  substance  of 
lectures  delivered  originally  in  the  class  room 
amplified  and  improved,  and  is  the  only  systematic 
work  jHiblished  which  treats  specially  of  this  class 
of  disorders  in  women.  A  knowledge  of  the  ana- 
tomy and  functions  of  an  organ  is  essential  to  a 
proper  understanding  of  its  diseases  and  treatment, 
and  therefore  at  the  outset  these  are  given  in  de- 
tail. The  formation  of  the  bladder  and  urethra  is 
described,  resulting  malformations  due  to  arrest  of 
development  explained,  and  methods  for  treatment 
given.  Functional  derangements  due  to  nervous 
and  constitutional  conditions,  to  inflammatory 
affections  of  neighboring  organs,  to  disi)lacements 
of  uterus  or  malposition  of  bladder,  are  fully  re- 
viewed ;  organic  disease,  various  forms  of  cystitis, 
morbid  growths,  are  all  described  in  a  clear  and 
concise  manner.  Urethral  affections  also  receive 
due  attention.  The  reputation  that  Dr.  Skene  has 
obtain  jd  in  this  particular  de])artment  is  a  suffi- 


THE   CANADA   MEDICAL   RECORD. 


4T 


cient  guarantee  that  the  work  will  be  found  a  val- 
uable addition  to  the  library  of  the  physician.  In 
pelvic  disorders  the  condition  of  the  bladder  is 
often  entirely  overlooked,  and  the  uterus  alone 
blamed  for  symptoms  which  have  their  origin  in 
the  bladder,  so  that  it  is  not  to  be  wondered  at  that 
many  so-called  uterine  cases  should  be  unsuccess- 
fully treated.  A  study  of  this  work  will  materially 
aid  in  preventing  such  mistakes  to  the  great  com- 
fort and  benefit  of  the  unfortunate  sufferers. 

The     Compend    of    Anatomy.      By     John    B. 

Roberts,   A.M.,    M.D.     Philadelphia,  C.  C. 

Roberts  &  Co. 

This  compend  has  been  compiled  "for  use 
in  the  dissecting  room,  and  in  preparing  for 
examinations."  Anatomy  is  in  this  little  work  so 
boiled  down  as  it  were  as  to  be  almost  a  skeleton^ 
for  we  have  not  yet  met  with  its  equal  as  a  con- 
densation. It  consists  in  great  part  of  names^ 
there  being  the  briefest  of  detail.  We  cannot  re- 
commend the  work  to  students  and  others,  for  we 
believe  that  the  student  should  know  his  anatomy 
before  proceeding  to  examination,  and  not  cram 
by  such  aids  in  the  hope  that  the  smattering  thus 
obtained  will  carry  him  through.  In  the  dissect- 
ing room  it  can  never  take  the  place  of  other  well- 
known  works  which  instruct  and  aid  the  student 
in  acquiring  a  knowledge  of  the  human  body.  In 
fact  we  think  that  to  the  mind  of  the  ill-prepared 
neophyte  any  attempt  to  get  posted  by  it  would 
only  make  confusion  worse  confounded. 

Eyesight,    Good  and  Bad :    a     Treatise  07i   the 

Exercise  afid Preservation  of  Vision.  By  Robt. 

Brudenell  Carter,  F.R.C.S.,  Eng.   For  sale 

by  Dawson  Bros.,  St.  James  St. 

This  is  an  excellent  little  book,  which  we  have 
read  with  pleasure.  It  gives  in  a  concise  and 
clear  manner  an  account  of  all  matters  relating  to 
the  use  of  the  eyes,  and  preservation  of  the  sight. 

Asthenopia  or  weak  sight  is  fully  treated  of 
under  the  heads  of  Myopia,  Hypermetropia  and 
Astigmatism. 

The  properties  of  lenses  are  described,  and  the 
New  "  Dioptric  "  system  of  expressing  their  num- 
ber or  power  explained,  and  some  practical  hints 
given  on  spectacles  and  their  use  in  defects  of 
vision. 

Mr.  Carter  calls  particular  attention  to  the 
necessity  of  caring  for  the  eyes  of  infants  and 
young  children,  as  loss  of  sight  in  a  considerable 
number  of  cases  dates  from  the  first  few  days  or 


weeks  of  life.  And  when  the  child  begins  to  use 
the  eyes  for  constant  work,  defects  of  vision  first 
begin  to  show  themselves,  and  should  at  once  be 
treated. 

The  Transactions  of  the  American  Medical  Asso^ 
ciation.  Volume  XXX.  Philadelphia  :  i)rinted 
for  the  Association,  1879. 

The  thirtieth  annual  meeting  of  the  American 
Medical  Association  was  held  in  the  City  of  Atlanta^ 
Georgia,  on  the  6th  of  May,  1879,  and  was  as 
successful  as  any  previous  meeting.  A  large  num- 
ber of  very  interesting  communications  were  read^ 
and  they  now  appear  in  this  volume  of  the  Trans- 
actions. The  volume  is  therefore  a  valuable  one. 
We,  however,  are  of  the  opinion,  that  the  sugges- 
tion of  the  late  President,  Dr.  Sayre,  to  have  aa 
association  journal,  in  which  these  communications 
could  rapidly  appear,  is  a  most  valuable  one. 
No  matter  how  interesting  communications  read 
before  a  society  may  be,  much  of  their  value  is^ 
lost  by  being  hid  between  the. cover  of  a  ponderous 
volume  of  transactions.  The  number  who  will 
read  through  the  book  now  before  us  is  compar- 
atively small,  and  in  this  way  much  of  the  benefits 
like'y  to  follow  the  preparation  of  the  papers  is- 
limited.  If  they  appeared  weekly  in  the  columns- 
of  an  association  or  other  journal,  they  would  be 
read  by  thousands,  to  whom  they  are  now  all  but 
absolutely  dead.  We  hope  therefore  to  see  Dr. 
Sayre's  suggestion  carried  out  before  very  long. 


MEDICO-CHIRURGICAL  SOCIETY. 

Oct.  15th,  1880. 

The  President,  Dr.  Kingston,  on  taking  the  chair 
thanked  the  members  for  the  honor  conferred 
upon  him  in  electing  him  once  more  to  the  Pre- 
sidential chair. 

Dr.  Osier  presented  to  the  Society  a  case  of 
Progressive  Muscular  Atrophy,  accompanied  with 
a  carefully-prepared  chart  of  the  family  history  for 
three  generations.  Dr.  Osier  said  the  point  of 
interest  in  this  case  is  the  locality  affected.  The 
majority  of  cases  reported  begin  in  the  upper 
extremities  ;  in  this  case  the  left  leg  and  thigh  are 
most  affected.  The  muscles  generally  over  the 
body  show  peculiar  vibrillar  t^vitching.  He  has 
been  suffering  for  over  a  year.  There  is  no  pain  nor 
disturbance  of  sensibility,  but  there  is  impairment 
of  motor  power  in  the  leg,  in  proportion  to  the 
degree  of  muscular  atrophy.  The  point  of 
greatest  interest  is  the  remarkable  family  history. 


48 


THE    CANADA    MEDICAL    RECORD. 


Probably  there  is  no  other  disease  in  which 
heredity  is  shown  to  such  an  extent.  The  most 
noted  instance  of  this  disease  was  that  of  the 
Bessel  family,  in  which  it  was  seen  in  seven  gener- 
ations. In  the  family  of  the  case  presented  thirteen 
members  have  been  or  are  affected  ;  only  two  were 
affected  under  thirty,  the  others  were  past  forty. 
Dr.  Osier  remarked,  in  conclusion,  that  this  was 
the  disease  that  supplied  the  living  skeletons  ex- 
hibited at  circuses,  &c. 

Dr.  R.  P.  Howard  said  he  had  had  a  case  under 
observation  for  thirty  years,  and  he  is  still  living. 
He  had  treated  him  by  a  course  of  electricity, 
but  the  result  was  negative.  The  original  locality 
has  extended  :  the  extension  and  flexors  of  the 
upper  extremities  were  first  affected,  now  the  lower 
limbs  are  involved. 

Dr.  Edwards  then  read  a  paper  on  "  A  Case  of 
Obstruction  in  the  Bowels,"  where,  after  various 
measures  were  used  to  excite  the  bowels  to  act, 
and  had  failed,  the  patient  was  left  alone.  After 
■sixty-seven  days  obstruction  the  bowels  acted 
naturally,  but  the  patient  being  advanced  in  life 
-and  much  wasted,  died  three  days  after. 

Dr.  R.  P.  Howard  said  that,  in  addition  to  the 
means  used,  kneading  the  bowels  might  have  been 
tried. 

Dr.  Osier  stated  that  he  had  seen  a  case  in  one 
of  the  Chicago  Journals  where  the  patient  had  a 
motion  once  a  year. 

Dr.  Gardner  mentioned  one  case,  where  the 
direct  current  had  excited  peristaltic  action.  Dr. 
Kingston  mentioned  a  case  where  the  custom  was 
for  the  patient  to  have  an  evocuation  once  in 
sixty  days. 

Dr.  Alloway  mentioned  one  case  where  no 
action  had  taken  place  for  five  weeks,  and  then,  by 
-assistance,  the  patient  was  delivered  of  a  mass  the 
■size  of  a  childs  head. 

Dr.  Roddick  then  read  a  paper  entitled  "  Re- 
marks on  Club  Foot,"  presenting  to  the  Society  a 
little  child  on  whom  he  had  operated. 

Dr.  Roddick  claims  for  his  method  originality 
only  in  connection  with  the  application  of  plaster  of 
Paris,  soon  after  the  division  of  the  tendons.  The 
plaster  bandage  is  applied  directly  to  the  skin, 
so  that  the  foot  cannot  move  out  of  position  .so 
readily  as  it  otherwise  would.  A  child  was  ex- 
hibited on  which  he  had  operated. 

In  the  remarks  following  this  case.  Dr.  R.  P. 
Howard  asked  how  young  a  child  had  an  opera- 
tion been  performed,  and  thought  the  plan  adopted 


by  Dr.  Roddick  a  most  admirable  one.  Too 
often  in  these  cases  muscles  are  divided,  where,  if 
proper  pressure  was  made,  the  operation  would 
not  be  necessary.  Dr.  Smith  quoted  the  practice 
of  Dr.  Broadhurst,  which  was  to  have  the  foot  for 
five  days  after  operating  before  putting  it  in  its 
place,  diffenng  from  that  practiced  by  Dr.  Roddick 
in  putting  the  foot  in  position  immediately  after 
operating. 

Dr.  Hy.  Howard  asked  Dr.  Roddick  if  he  would 
operate  on  a  child  at  the  age  of  eight. 

The  President  remarked  that  this  paper  was 
eminently  practical.  It  is  a  great  drawback  that 
we  are  obliged  to  send  to  surgical  instrument, 
makers  for  appliances  in  these  cases,  it  being 
certain  that  no  instrument  devised  can  accomplish 
that  which  the  human  hand  fails  to  do.  The 
strip  of  plaster  round  the  ankle  will  add  to  the 
success  of  this  plan  of  treatment.  The  reader  of 
this  paper  said  that  he  considered  one  or  two 
months  the  best  time  for  operating ;  had  he  said, 
one  or  two  hours  he  would  have  agreed  with  him. 
The  two  operations  for  club  foot  and  hair  lip  should 
be  done  immediately  after  birth.  In  what  cases 
should  we  operate  ?  When  we  cannot  bring  the 
foot  into  proper  position  by  the  hand.  In  regard 
to  the  order  of  division  of  the  tendons,  in  his 
early  practice  Dr.  Kingston  always  divided  the 
tendo  achillis  first;  he  did  not  do  so  now:  this 
tendon  should  come  last ;  divide  the  plantar  fascia 
first. 

He  did  not  favor  the  plan  of  bringing  the  foot 
immediately  into  position. 

In  reply.  Dr.  Roddick  said  he  had  operated  on 
a  child  of  eighteen  months  of  age. 

As  to  delay  after  operation,  Dr.  Roddick  had 
seen  Broadherst,  Adams  and  Sayre  operate,  and 
was  more  impressed  with  the  latter's  mode  after 
operation,  which  is  to  bring  it  into  immediate  posi- 
tion. He  finds  that,  by  so  doing,  the  tendon  is  not 
weakened.  He  would  not  do  the  operation  above 
four  years  of  age  ;  at  the  age  of  eight  if  anything 
was  done,  he  would  excise  some  of  the  ankle  bones. 

A  vote  of  thanks  to  Dr.  Koddick  was  moved 
and  carried. 

The  Secretary,  on  behalf  of  Dr.  Osier,  announced 
that  two  members  of  the  Society  have  given  $io 
for  an  album,  to  place  photographs  of  cases  and 
specimens  of  disease. 

The  meeting  then  adjourned. 

O.  C.  Edward.s,  M.D., 

Secre/a/y. 


THE  CANADA  MEDICAL  RECORD. 


Vol.  IX. 


MONTREAL,  DECEMBER,   1880. 


No. 


3- 


C  OnSTTElsTTS- 


ORIGINAL  COMMUNICATIONS. 

The  Question  of  Prostitution  and  its 
Relations  to  the  Public  Health,  by 
Casey  A.  Wood,  CM.,  M.D., 
Attending  Physician  to  the  Wo- 
man's Hospital,  Prof,  of  Chemistry 
Medical  Faculty  Bishop's  College, 
49 — Inflammation  :  Its  Chemical 
cause  and  Cure,  by  W.  Y.  Bran- 
ton,   M.D.,   60  — On  Septicaemia 


and  its  Effects,  by  Dr.  Litten,   of 
Berlin 6 1 

PROGRESS  OF  MEDICALSCIENCE 
Incontinence  of  Urine  in  Children, 
62 — Notes  on  the  Croton-Oil  Treat- 
ment of  Ringworm,  63  —  Treat- 
ment of  Housemaid's  Knee,  64 — 
Treatment  of  Nocturnal  Incontin- 
ence of  Urine,  by  Dr.  Kelp,  64 — 
Ointment  for  Itch 64 


EDITORIAL. 
To  our  Subscribers,  65  —  Animal 
Vaccine,  how  it  is  Propagated,  65 
— Typhoid  Fever  at  Bishop's  Col- 
lege School,  Lennoxville,  67 — The 
Case  of  Psoriasis  Lepraformis,  67 
—Dr.  Robert  Nelson,  68- College 
of  Physicians  and  Surgeons,  Pro- 
vince of  Quebec,  69 — An  Omis- 
sion, 69 — Reviews,  69-— Meeting 
of  Medico-Chirurgical  Society. . . .] 


^n^irial  Bomnmnicafto/n^ . 

THE  QUESTION  OF  PROSTITUTION 

AND   ITS 

RELATIONS  TO  THE  PUBLIC  HEALTH. 

BY 

Casey   A.  Wood,  CM.,  M.D.,  Attending"]  Physician  to 

the  Woman's  Hospital,  Professor  of  Chemistry 

in  the  Medical  P'aculty,  University 

of  Bishop's  College. 

Whatever  action  may  be  taken  regarding  them 
"by  the  people  at  large,  whatever  influence  may  be 
subsequently  exerted  by  public  opinion,  questions 
of  Hygiene  are  primarily  the  property  of  the  med- 
ical profession.  For  example,  it  is  rarely  that  we 
have  to  thank  the  priest,  with  his  time  occupied 
with  matters  of  another  world,  and  caring  little  for 
things  of  earth  ;  nor  the  statesman,  with  his  atten- 
tion taken  up  by  affairs  apparently  more  important ; 
nor  even  the  laity,  who  have  ever  exemplified  the 
proverb,  "  what's  everybody's  business  is  nobody's 

business  " we  have  seldom  been  indebted  to 

any  of  these  for  the  inauguration  of  whatever 
progress  has  been  made  in  a  single  department  of 
sanitary  science.  No  fact  could  add  more  to  the 
dignity  of  our  profession,  because,  in  consequence, 
it  must  prove  to  all  candid  observers  that,  as  a 
rule,  medical  men  really  hope  and  work  for  a  per- 
manent lessening  of  the  diseases  that  infect  the 
race. 


The  statement  that  the  primary  discussion  of 
any  measure  to  improve  the  health  of  communities 
and  individuals  has  almost  always  been  introduced 
by  medical  men  might  be  supplemented  by  show- 
ing that  the  conclusions  arrived  at  by  them  have 
always  formed  an  important  factor  in  determining 
action  taken  by  the  authorities  to  remedy  the 
trouble  under  consideration.  It  is  a  fortunate  cir- 
cumstance, perhaps,  that  such  is  the  case  in  the 
questions  about  to  be  ventilated  in  this  article,  for 
the  same  spirit  of  false  modesty  which  prevents  a 
proper  discussion  by  the  laity  of  many  a  vital 
question  affecting  the  social  economy  has  relegated 
the  treatment  of  prostitution  and  its  attendant 
evils  to  whomsoever  cares  to  occupy  himself  with 
it.  With  this  double  warrant  there  can  be  no  rea- 
son why  the  matter  should  not  be  freely  and  fully 
discussed  in  the  pages  of  a  medical  journal,  no 
reason  why  the  medical  scientist  should  not  decide 
what  measures  will  have  the  greatest  influence  in 
limiting  the  spread  of  prostitution  and  in  neutral- 
izing those  moral  and  physical  maladies  it  so  uni- 
formly gives  rise  to. 

"  Fornicatio  autem ncc  nominetur  in  vobis 

sicut  decet  sanctos"  wrote  Paul  to  the  little  church 
at  Ephesus,  but  probably  he  never  imagined  that 
in  later  times  a  whole  people  would  arise  who, 
while  tacitly  ignoring  the  spirit,  would  scrupu- 
lously insist  upon  its  ///^r^z/ obedience  !  But  only 
in  these  latter  days,  for,  "  in  the  good  old  days 
when  George  the  Third  was  king,"  Fielding  was 


50 


THE   CANADA    MEDICAL    RECORD. 


the  popular  novelist,  and  everyone  read  and 
openly  discussed  the  questionable  ways  and  doings 
of  his  heroes  and  heroines.  Nobody  then  saw 
harm  in  reading  Richardson  (who,  by  the  way, 
was  a  clergyman),  nor  is  it  probable  that  any  great 
harm  came  of  it  because  of  that  very  fact.  There 
were  no  "  expurgated "  editions  of  Shakespeare 
then,  because  it  was  held  that  to  call  a  "  spade  " 
by  any  other  than  its  proper  name  was  quite  un- 
necessary and  likely  to  mislead.  The  author  of 
"Vanity  Fair"  frccjucntly  draws  one's  attention  to 
this  change  in  public  sentiment.  For  instance; 
"  Ladies,  I  do  not  say  that  you  are  a  society  of 
vestals, — but  the  chronicle  of  a  hundred  years 
since  contains  such  an  amount  of  scandal  that 
you  may  be  thankful  you  did  not  live  in  such  dan- 
gerous times.  No,  on  my  conscience  I  believe 
that  men  and  women  are  both  better ;  not  only 
that  liie  Susannahs  are  more  numerous,  but  that 
the  Elders  are  not  nearly  so  wicked.  Did  you 
ever  hear  of  such  books  as  '  Clarissa,'  '  Tom 
Jones,'  'Roderick  Random;'  paintings  by  con- 
temporary artists  of  the  men  and  women,  the  life 
and  society  of  their  day  ?  Suppose  we  were  to 
describe  the  doings  of  such  a  person  as  Mr.  Love 
lace,  or  my  Lady  Bellaston,  or  that  wonderful 
■  I^dy  of  Quality,'  who  lent  her  memoirs  to  the 
author  of '  Peregrine  Pickle.'  How  the  pure  and 
outraged  nineteenth  century  would  blush,  scream, 
run  out  of  the  room,  call  away  the  young  ladies, 
and  order  Mr.  Mudie  never  to  send  one  of  that 
odious  author's  books  again  !  You  are  fifty-eight 
years  old,  Madam,  and  it  may  be  that  you  are  too 
squeamish,  that  you  cry  out  before  you  are  hurt, 
and  when  nobody  has  any  intention  of  offending 
your  Ladyshi]).  Also,  it  may  be  that  the  novel- 
ist's art  is  injured  by  the  restraints  put  upon  him, 
as  many  a  harmless  honest  statue  at  St.  Peters  and 
the  Vatican  is  spoiled  by  the  tin  draperies  in  which 
ecclesiastical  old  women  have  swaddled  the  fair 
limbs  of  the  marble.  But  in  your  prudery  there  is 
reason.  So  there  is  in  the  state  censorship  of  the 
Press.  The  pages  may  contain  matter  injurious 
to  bonos  mores.  Out  with  your  scissors,  censor, 
and  clip  off  the  ])nuient  paragraph  !  "  * 

Whi'e  we  may  believe  with  Thackeray,  that 
people  now-a-days  are  "  of  a  cleaner  conversa- 
tion," we  cannot  close  our  eyes  to  the  fact  that,  if 
we  do  not  hear  of  and  see  so  much  moral  unclean - 
ness  it  is,  to  some  extent,  because  it  is  disguised 


•  Thackeray's  "  Virginian£,"chap.  rli. 


and  hidden,  and  not  because  it  has  ceased  to  exist. 

It  is  tolerated,  but  not  recognized,  or  at  least 
only  recognized  under  certain  conventional  forms. 
Society  is  quite  candid  in  this  matter.  One  is  not 
positively  commanded  not  to  eat  of  the  forbidden 
fruit,  but  the  meal  must  be  taken  en  regie  and 
respectably.  Shakespeare's  poems,  the  tales  of 
Boccaccio,  and  the  wonderful  adventures  of  Gulli- 
ver "  smell  to  heaven"  and  are  altogether  detest- 
able— cela  va  sans  dire — but,  without  giving 
offence,  you  may  (if  you  judiciously  avoid  particu- 
lars) discuss  the  merits  of  Alexandre  Dumas  and 
Emile  Zola.  Or,  if  it  happens  that  you  have  a 
taste  for  lighter  literature,  what  popular  novels  will 
more  quickly  satisfy  that  literary  appetite  than  the 
entrees  and  dessert  served  up  by  Rhoda  Brough- 
ton  and  "Ouida.?  " 

Nor  need  you  pay  much  attention  to  the  abuse 
they  have  received  from  the  discontented  few,  for 
has  not  Madame  Grundy  taken  these  productions 
under  her  protection  ?  Is  not  "  socially  author- 
ized "  stamped  on  each  title-page  ?  What  right  thert 
have  men  like  Goodell  to  call  them  "namby- 
pamby  trash  "  and  '  printed  erysipelas  ?  " 

This  attitude  of  society  towards  open  discussion 
of  the  evils  that  threaten  to  undermine  the  found- 
ations of  its  structure,  has  a  more  practical  bearing 
upon  attempts  to  remedy  the  evils  themselves  than 
is  apparent  at  first  sight,  because,  while  it  very  pro- 
perly negatives  gross  and  immodest  conversation, 
it  has  always  displayed  an  unfortunate  lack  of  dis- 
crimination in  including  in  the  proscription  agita- 
tions having  for  their  object  the  eradication  of  the 
maladies. 

And  this  absence  of  a  becoming  discernment  is 
nowhere  more  marked  than  when  the  trade  of  the 
.strumpet  is  under  consideration.  Here  prudery 
might  be  forgiven  if  honest  investigation  were  per- 
mitted. But  it  is  not,  and  has  not  been,  and  we 
are  consequently  obliged  to  believe  with  Char- 
lotte Bronte  that  "  to  such  grievances  as  society 
cannot  readily  cure  it  usually  forbids  utterance  on 
jjain  of  its  scorn  ;  this  scorn  being  only  a  sort  of 
tinseled  cloak  to  its  deformed  weakness."* 

Starting  out  then  with  the  premise  that  the 
endeavor  to  solve  the  problem  of  the  social  evil 
must  not  be  hampered  either  by  the  opinions  or 
prejudices  of  the  classes  for  whom  the  work  is 
undertaken,  or  by  the  neutrality  of  other  classes 
whom  we  might    have   expected   to   have   been 


•'  Shirley." 


THE    CANADA    MEDICAL   RECORD. 


51 


ardent  workers  with  us,  it  is  yet  pardonable  to 
say  without  the  slightest  feeling  of  bitterness,  and 
almost  without  a  sentiment  of  disappointment,  that 
there  is  an  additional  reason  why  the  profession 
should  not  shun  this  particular  labor  of  mercy,  for 
is  it  not  one  of  its  daily  functions  to  minister  to 
the  despised,  the  wretched  and  the  unclean  in 
every  shape  ?  Bearing  in  mind  the  story  related 
by  a  Physician  who  in  his  day  had  seen  "  pass  by 
on  the  other  side  "  the  priest  and  the  Levite,  we 
need  not  wonder  that  the  "  cry  of  those  who  have 
wounds  without  cause  "  should  still  insult  their 
sanctified  ears  ;  that  it  should  still  be  left  to  less 
fastidious  hands  to  pour  in  the  wine  and  the  oil — 
to  less  worthy  brains  to  work  out  the  poor  enigmas 
of  our  lot !  In  the  case  of  the  man  of  Samaria  we 
may  comfort  ourselves  wiih  the  reflection  that  his 
charity  probably  did  not  seriously  diminish  his 
income,  and  that  there  was  no  contumely  con- 
nected with  his  act  of  mercy  ! 

Three  queries,  it  appears  to  the  writer,  cover 
the  whole  ground  included  in  the  heading  of  this 
article.  Side  issues,  important  from  other  stand- 
points, force  themselves  on  one's  notice  and,  while 
it  is  impossible  always  to  avoid  or  ignore  them^  be- 
cause they  are  so  intimately  bound  up  with  the 
causes  and  effects  of  every  social  disturbance,  they 
can  receive  but  a  passing  mention  in  the  space  so 
necessarily  limited  as  the  pages  of  a  journal  devoted 
to  medical  science,  (i)  Is  it  possible  to  repress 
in  toto  houses  of  ill-fame  and  assignation  ?  (2) 
If  it  were  possible  to  suppress  les  maisons  des  dames, 
would  it  be  wise  to  make  the  attempt  ?  (3)  In 
the  event  of  prohibition  failing  to  accomplish 
its  object,  what  measures  are  most  likely  to  limit 
the  evil  of  prostitution  and  to  curtail  the  misery 
and  disease  it  engenders  ? 

It  is  difficult  to  separate  the  first  two  questions, 
and  they  may  be  answered  together.  The  history 
■of  every  nation  that  has  reached  a  high  state  of 
civilization  furnishes  us  with  stories  of  endeavors 
made  by  the  State  to  wipe  out  the  immediate 
sources  of  prostitution,  and  these  attempts  are  both 
interesting  and  instructive. 

In  the  early  history  of  the  Greeks,  we  find  that 
one  of  their  laws,  incorporated  in  the  code  of 
Draco,  imposed  the  death  penalty  on  adultery.  If 
severity  could  have  accomplished  the  desired  end 
it  ought  to  have  done  so  in  this  instance,  but  so 
powerless  did  it  prove  that  Scion,  seeing  the  fu- 
tility of  the  measure,  established  by  law  houses  of 
prostitution  at  Athens,  and  filled  them  with  slaves 


bought  by  the  public  money.  These  Di.iera,  as 
they  were  called,  being  in  a  sense  public  servants, 
handed  over  their  miserable  earnings  to  the  State, 
and  naturally  assisted  in  increasing  its  revenue. 
The  Romans,  wiser  in  their  generation,  and  pro- 
fiting, in  all  probability,  by  the  experience  of  their 
Grecian  neighbors,  seem  never  to  have  attempted 
to  wipe  out  the  calling  of  the  harlot.  Tacitus  tells 
us  that  long  before  his  time  the  prostitute  was 
obliged  to  register  herself  at  the  aedile's  office, 
where  she  received  a  license — stupri  licentia — in  a 
similar  manner  and  almost  upon  the  same  terms  as 
those  imposed  by  existing  French  laws  regulating 
brothels  and  tbeir  inmates.  It  must  be  observed, 
also,  that  the  Romans  exacted  in  their  code  the 
penalty  that  modern  society  imposes  by  its  un- 
written law  upon  the  unfortunate  erring  one ;  it 
closed  every  avenue  to  refomi.  "  Once  a  prosti- 
tute, always  a  prostitute,"  is  a  Roman  proverb. 

Passing  to  more  modern  times  an  instructive 
lesson  may  be  learned  from  early  attempts  to  sup- 
press prostitution  in  France.  Sanger,  in  his  ad- 
mirable work  on  the  subject,  tells  us  that  Louis  IX. 
made  the  first  serious  endeavour  to  stem  the  rising 
tide  of  evil  in  his  dominions. 

"His  edict,  which  dates  from  1254,  directed 
that  all  prostitutes,  and  persons  making  a  living 
indirectly  out  of  prostitution,  such  as  brothel 
keepers  and  procurers,  should  be  forthwith  exiled 
out  of  the  kingdom.  It  was  partially  put  in  force  : 
a  large  number  of  unfortunate  females  were  seized 
and  imprisoned  or  sent  across  the  frontier  ;  severe 
punishments  were  inflicted  on  those  who  returned 
to  the  city  of  Paris  after  their  expulsion.  A  panic 
seized  the  customers  of  brothels,  and  for  a  few 
months  public  decency  was  restored.  But  the 
inevitable  consequences  of  the  arbitrary  decree  of 
the  King  soon  began  to  be  felt. 

"Though  the  officers  of  justice  had  forcibly 
confined  in  establishments  resembling  Magdalen 
hospitals  a  large  proportion  of  the  most  notorious 
prostitutes,  and  exiled  many  more,  others  arose  to 
take  their  places.  A  clandestine  traffic  succeeded  to 
the  former  open  debauchery,  and  in  the  dark  the 
evils  of  the  disease  were  necessarily  aggravated. 
More  than  that,  as  has  usually  been  the  case  when 
prostitution  has  been  violently  and  suddenly  sup- 
pressed, the  number  of  virtuous  women  became 
less,  and  corruption  invaded  the  family  circle. 
Tradesmen  complained  that  since  the  passage  of  the 
ordinance  they  found  it  impossible  to  guard  the 
virtue  of  their  wives  and  daughters  against  the  en- 


52 


THE    CANADA    MEDICAL    RECORD. 


terprises  of  the  military  and  the  students.  At  last 
complaints  of  the  evil  effects  of  the  ordinance  be- 
came so  general  and  so  pressing  that,  after  a  lapse  of 
two  years,  it  was  repealed.  A  new  royal  decree 
re-established  prostitution  under  rules,  which, 
though  not  particularly  enlightened  and  humane, 
still  placed  it  on  a  sounder  footing  than  it  had 
occupied  before  the  royal  attention  had  been  direct- 
ed to  the  subject. "  * 

Charles  IX.,  in  1560,  published  an  edict  pro- 
hibiting the  opening  or  keeping  of  any  house  of 
reception  for  prostitutes  in  Paris.  Here  was  an 
instance,  it  is  said,  of  the  actual  suppression  of  the 
traffic  in  a  large  city,  but  the  cure  was  infinitely 
worse  than  the  disease,  for  secret  debauchery  and 
seduction  took  the  place  of  open  sin.  Society 
became  at  last  so  corrupt  that  a  prominent  Huguenot 
clergyman  named  Cayet,  advocated  the  re-opening 
of  the  brothels  in  the  interests  of  public  tnorals. 
Twenty-eight  years  afterwards  Henry  IH.  reaf- 
firmed the  ordinance  established  by  Charles,  and  in 
1635  the  law  was  made  still  more  rigorous,  but  it 
does  not  appear  that  the  illicit  commerce  was  ever 
seriously  diminished  or  the  interests  of  morality 
sensibly  advanced. 

These  French  prohibitory  laws  have  a  melancholy 
interest  for  us,  because  a  wise,  paternal  government 
at  home  (in  answer  to  an  urgent  request  for  female 
emigrants)  was  enabled,  through  their  provisions, 
to  present  the  colonists  in  Canada  with  wives  fresh 
from  the  brothel-houses  of  Paris  !  The  edge  is  taken 
off  this  reflection,  however,  when  we  consider  that 
the  officials  who  so  considerately  furnished  the 
colonials  with  this  class  of  helpmates  were  but 
little  better  off  than  their  customers;  since  the 
adultery  and  seduction  that  followed  the  forced 
emigration  affected  in  no  slight  degree  the  class  it 
was  expected  to  .protect,  and  in  many  instances 
penetrated  to  the  families  of  those  who  had  been 
guilty  of  so  vile  an  outrage  on  the  virtue  of  the 
colony.  So  may  wrong  ever  recoil  upon  the  heads 
of  its  perpetrators  ! 

In  Spain  the  profligacy  of  public  morals  had  at 
one  time  reached  a  height  hitherto  unprecedented, 
and  this  state  of  affairs  has  been  ascribed  almost 
altogether  to  legislation  of  the  Draconian  kind. 
The  history  of  suppressive  measures  in  Italy  tells 
the  same  story.  Our  word  bagnio,  expressive  of  a 
house  of  ill-fame,  originated  in  efforts  to  root  out 
brothels  and  punish  their  inmates.     When  driven 


*  History  of  Prostitution,  pp.  95,  96. 


from  their  usual  haunts,  loose  women  were  obliged 
to  frequent  places  of  public  resort,  so  that  in  a 
short  time  every  keeper  of  a  bath  became  also  a 
brothel-master. 

The  laws  of  Hamburg  passed  through  the  sev- 
eral phases  of  suppression,  toleration  and  regula- 
tion, until  now  they  present  a  fair  sample  of  the 
manner  in  which  most  European  cities  manage 
their  rakes  and  harlots. 

A  local  writer,  arguing  in  favor  of  the  laws  now 
in  force  there,  speaks  thus  of  repressive  measures, 
and  his  assertions  undoubtedly  apply  to  all  other 
cities :  "  Suppression  is  absolutely  impracticable, 
inasmuch  as  the  evil  is  an  unconquerable  physical 
requirement.  It  would  seem  as  if  the  zeal  against 
public  brothels  implied  that  by  their  extinction  a 
limitation  of  sexual  intercourse,  except  in  marriage, 
would  be  effected.  This  is  erroneous,  for  reliable 
details  prove  that  for  every  hundred  brothel  women 
there  would  be  two  hundred  private  prostitutes, 
and  no  human  power  could  prevent  this.  "  * 

The  Puritan  Fathers  were  in  the  habit  of 
dealing  directly  and  sharply  with  social  shortcom- 
ings. Their  laws  against  adultery  and  fornication 
were  stern  and  unrelenting.  Their  policy  of  re- 
pression is  well  depicted  in  Nathaniel  Hawthorne's 
"  Scarlet  Letter, '  and  the  plot  of  the  novel  rests 
upon  an  instance  of  its  failure  to  keep  in  the  straight 
path  a  shepherd  of  the  people  and  one  of  his  flock. 

When  the  mythical  deputy  of  the  Duke  of 
Vienna  issued  a  proclamation,  dooming  all  sub- 
urban houses  of  resort,  the  decree  is  made  the 
subject  of  conversation  between  a  clown  (whom 
Shakspeare  usually  puts  forward  as  a  wise  man  in 
disguise)  and  a  noted  procuress,  in  this  wise  : 

Bawd. — "  Why  here's  a  change  indeed  in  the 
commonwealth  !  what  shall  become  of  me  ? 

Cloxvn. — Come  ;  fear  not  you  :  good  counsellors 
lack  no  clients :  though  you  change  your  place 
you  need  not  change  your  trade ;  I'll  be  your  tap- 
ster still.  Courage,  there  will  be  pity  taken  on 
you  :  you  that  worn  your  eyes  almost  out  in  the 
service,   you  will  be  considered."! 

And  this  has  been  the  result  of  all  attempts  to 
eradicate  an  innate  social  evil.  So  long  as  present 
conditions  obtain  among  members  of  human  com- 
munities, just  as  long  will  they  give  rise  to  their  pre- 
sent results.  Driven  from  the  "  suburbs,"  the  harlot 
will  ply  her  trade  in  the  city,  and  if,  after  infinite 


'Sanger  on  Prostitution,  p.  197. 

t  "  Measure  for  Measure,"  Act  i,  Scene  2, 


THE    CANADA   MEDICAL    RECORD. 


53 


pains,  she  be  banished  altogether,  we  resurrect  the 
twin  demons  of  seduction  and  adultery  to  fill  her 
place. 

(^)  In  the  event  of  prohibition  failing  to  accom- 
plish its  object,  what  measures  are  most  likely  to 
limit  the  ei>il  of  prostitution,  afidto  curtail  the  misery 
and  disease  it  engetidersi 

Before  attempting  to  furnish  a  direct  answer  to 
this  important  question  it  is  necessary  to  deal  with 
the  arguments  of  those  who  condemn  all  regulative 
measures.    The  laisserfaire  idea  has  a  great  many 
advocates,    and  in  reference  to   them  some  terse 
sentences  from  Dr.  Beardsley's  article  will  not  be 
out  of  place  : — "  The   importation  of  cholera   is 
intercepted,  variola  aborted,  yellow  fever  vigilantly 
patrolled,  pestilence  of  any  form  no  longer  stalks 
among  us  without  being  hotly  chased,  but  a  disease 
%vhich  lacks  not  a  whit  the  type  of  a  plague,  and 
which,  upas-like,  infects  nation  after  nation,  contri- 
buting generously  to  their  charnel-houses,  nestles 
among  us  and  travels    on  friction  wheels.  Hun- 
dreds are  honest,  ardent  in  their   researches   after 
some  antidote  to  this  virus,  but  never  essay  to  stop 
or  modify  the  evil.     Prophylaxis  against  venereal 
suffering  sounds    to  these   but  balderdash.       To 
quarantine   a   syphilitic  is   passing  strange.     The 
experiment  is  ridiculed  as  if  the  evil  was  self-limited, 
or  repudiated  as  contending  against  a  dispensation 
from  heaven,  to  meddle  with  which  was  to  befriend 
a  crime.     The  stench  of  this  leprosy  already  fi  s 
our  nostrils,  but  no  mettle  is  sounded  in  our  legis- 
lators to  face  the  railings  of  those  who  hate  truth, 
and  are   timid  at  every  revolution.     To  qualify  a 
wrong    is  not  to  endorse  it.     The  health  and  lon- 
gevity of  the  race  are  paramount  to  the  defence  of 
ethics  or  rude  platitudes  in  morals.    If  life  is  jeo- 
pardized,   sacrifices    are  imperative.      Individual 
prejudices,  dogmas  however  dear,  the  faith  of  ages, 
all  must  unloose  their  hold  when  the  perpetuation 
of  a  perfect  species  is  called  in  question.     If  the 
arm  of  the  law  is  powerless  to  stay  the  gratification 
of  our  passions,  if  the  admonitions  and  misfortunes 
of  others  do  not  dissuade  us  from  the  same  snare, 
if  the  whore  will  ply  her  vocation,  is  it  criminal  to 
disarm  her  of  her  sting?     Is  it  not  conniving  at  the 
practice  to  suffer  that  foul  doxy  to  parade  her  goods 
and  pollute  a  neighborhood  ?      The  time    is  nigh 
when   this  vapid  sentimentalism  in  religion — this 
morality  which  dubs  every  dissenter  from  creeds 
an  anti-Christ,  and  translates  the  license  of  pros- 
titution as  free  love,  should  be  undone.  The  social 
evil  cannot  be  remedied  without  some  compromise. 


It  is  a  monster  too  huge  to  be  smothered,  and  we 
must  curry  favor  with  it  to  lessen  its  depreda- 
tions." * 

Mr.  Solly,  whose  reputation  as  a  surgeon  is  not 
confined  to  his  native  country,  at  a  meeting  of  the 
Royal  Medico-Chirurgical  Society  some  years  ago, 
gave  utterence  to  sentiments  that,  more  than  any 
other,  have  inspired  the  vehement  opposition 
encountered  by  reformers  in  their  efforts  to  meet  this 
evil  by  legislation.  Said  he  : — "  Far  from  consider- 
ing syphilis  an  evil  I  regard  it,  on  the  contrary,  as 
a  blessing,  and  believe  that  it  was  inflicted  by  the 
Almighty  to  act  as  a  restraint  upon  the  indulgence 
of  evil  passions.  Could  the  disease  be  exterminated, 
as  I  hope  it  cannot,  fornication  would  ride  ram- 
pant through  the  land."  It  is  quite  within  the 
limits  of  truth  to  say  that  this  doctrine  is  responsible 
for  the  barbarous  refusal  to  admit  syphilitic 
patients  into  the  public  hospitals  of  London,  not  a 
great  while  ago,  and  prevented  the  erection  of 
special  hospitals  for  a  still  longer  period.  It  is  this 
same  enunciation  of  the  Creator's  "  intentions  "  that 
condemned  the  use  of  anaesthetics  in  midwifery, 
and  like  interpretations  of  God's  "  will,"  carried  to 
their- legitimate  conclusions,  have  obstructed  many 
a  needed  reform  in  social  customs. 

At  one  period  in  its  history  the  Royal  Free 
Hospital  magnanimously  devoted  the  whole  of 
26  (!)  beds  to  diseased  prostitutes,  but,  says  the 
report,  "  the  venereal  wards  have  been  for  some 
time  untenanted,  owing  to  loss  of  funds  occa- 
sioned by  the  outcry  raised  against  this  hospital 
in  one  of  the  medical  journals."  This  issue  is  now 
almost  a  dead  one,  but,  it  might  be  asked,  if  we 
follow  out  Mr.  Solly's  argument,  is  not  pneumonia 
a  disease  inflicted  by  the  Deity  upon  the  indulgence 
in  thin  slippers  and  low-necked  dresses  ?  Are  not 
typhoid  fever  and  diphtheria  penalties  imposed  by 
God  on  civic  uncleanness  ?  Are  we  justified  then, 
in  view  of  the  fact  that  it  is  hardly  possible  to  do 
away  with  their  causes,  in  tr>'ing  to  cure  these 
serious  troubles?  Rejecting  the  theory  that 
syphilis  was  imported  from  the  newly  discovered 
American  continent  by  Columbus,  we  may  sup- 
pose it  first  showed  itself  in  Europe  about  the 
beginning  of  the  fifteenth  century.  How  then  did 
the  Lord  punish  licentious  Europeans  before  that 
time  ?  What  penalty  paid  the  worshippers  at  the 
shrine  of  Venus   Mucheia,  or  of  that  beastly  old 


*  "Chartered  Brothels."     New  Orleans  Med.  and  Surg 
journal  for  Sept.,  1880. 


64 


TUK    CANADA    MEDICAL   RECORD. 


god  Priapus?  If  Mr.  Solly's  followers  declare 
their  intention  of  going  into  mourning  were  a  drug 
discovered  capable  of  ensuring  illicit  intercourse 
without  the  dread  consequences  of  syphilis,  surely 
their  grief  would  find  some  solace  in  the  knowledge 
that  it  would  no  longer  be  possible  to  hand  that 
awful  disease  down  to  the  third  and  fourth  genera- 
tion ;  that  innocent  children  could  no  longer  be 
made  to  suffer  for  the  wrong  of  a  diseased  father 
or  mother. 

Another  fallacy  contained  in  this  so-called  argu- 
ment is  that  the  fear  of  acquiring  venereal  disease 
acts  as  a  check  upon  the  wrongful  indulgence  in 
the  amatory  passion.  That  this  is  a  grave  error 
the  experience  of  most  physicians  will  prove- 
The  man  who  commits  any  offence  against  his 
physical  or  moral  nature  is  either  careless  of  the 
consequences,  or  he  hopes  to  be  one  of  the  fortu. 
nate  few  who  escape  contamination. 

But  in  discussing  this  matter  are  we  not  intro- 
ducing into  a  question  purely  scientific  an  element 
essentially  religious  ?  What  has  Hygiene  to  do 
with  "a  monstrous  outrage  on  religion  "?  How  does 
this  "  rupture  of  moral  law "  affect  Sanitary 
Science  ?  Theological  dogmas  and  problems  in 
science  may  run  in  parallel  lines,  but  any  attempt 
to  make  them  intersect  should  be  cried  down. 
Without  dismissing  the  subject,  as  some  writers 
have  done,  with  the  assertion  that  in  any  conflict 
between  Religion  and  Science  the  former  must  go 
to  the  wall,  it  might  here  be  mentioned  that  a  way 
out  of  the  difficulty  has  been  indicated  by  no  less 
an  authority  than  the  Anglican  Bishop  of  Carlisle. 
Writing  in  a  late  review  his  Lordship  says:  "It 
seems  to  me  we  want  a  new  word  to  express  the 
fact  that  all  physical  science,  properly  so-called,  is 
compelled  by  its  very  nature  to  take  no  account  of 
the  being  of  God:  as  soon  as  it  does  this,  it 
trenches  upon  theology,  and  ceases  to  be  physical 
science.  If  I  might  coin  a  word,  I  should  say  tliat 
science  is  athcous  and  therefore  could  not  be 
atheistic ;  that  is  to  say,  its  investigations  and 
reasonings  are  by  agreement  conversant  simply 
with  observed  facts  and  conclusions  drawn  from 
them,  and  in  this  sense  it  is  at/ieous  or  without 
recognition  of  God.  And  because  it  is  so,  it  can- 
not trench  upon  theism  or  theolo^sj,  and  cannot 
be  atheistic,  or  in  the  condition  of  denying  the  ex- 
istence of  God  "* 


*  "  God  and  Nature,"  Nineteenth   Century  for   March, 
a88o. 


The  melancholy  fact  (following  the  foregoing 
line  of  thought)  in  Sanitary  Science  is  that  a  wide- 
spread and  terrible  contagious  disease  is  in  our 
midst,  and  the  conclusion  we  draw  from  a  careful 
investigation  of  its  nature  is  that  it  is  [X)ssible  by 
taking  certain  precautions,  to  prevent  to  a  very 
considerable  degree,  the  extension  of  the  malady  ; 
consequently  objections  born  of  theological  dogmas 
or  religious  creeds  must  not  be  allowed  to  have 
weight  in  determining  either  the  amount,  kind  or 
extent  of  these  prophylactic  measures.  Sanitary 
science,  as  such,  is  necessarily  beyond  the  pale  of 
religious  faith,  as  such. 

Living  in  a  country  where  the  policy  of  laisser- 
/aire  holds  sway,  one  is  forcibly  reminded,  in 
reading  of  the  occasional  descents  by  the  police 
upon  houses  of  ill-repute,  of  the  story  told  of  an 
old  gentleman  who  endeavored  to  ward  off  diph- 
theria from  his  household,  by  disinfecting  the 
sewer  that  ran  past  his  residence.  Every  mom- 
ning  before  proceeding  down  town  he  gravely 
carried  a  piece  of  chlorinated  lime  to  the  street 
ventilator,  and  holding  his  nose  with  the  disen- 
gaged hand,  dropped  the  germ-destroying  morsel 
into  the  filthy  waters  beneath.  This  solemn  duty 
performed,  he  felt  himself  and  his  family  quite  safe 
for  the  following  twenty-four  hours.  No  doubt  a 
similar  feeling  animates  the  authorities  when  they 
make  one  of  their  periodical  raids  upon  the  inmates 
of  brothels  that  are  not  subject  to  further  regulation. 
With  some  slight  and  unimportant  modifications 
Beardsley's  description  of  the  spasmodic  repres- 
sive method  in  vogue  within  the  limits  of  the  city 
of  New  Orleans  will  apply  to  the  action  of  the 
police  in  Montreal : — "  There  is  no  determined 
nor  concentrated  movement  against  brothels  as 
against  a  nest  of  counterfeiters.  Now  and  then  a 
raid  is  made  on  some  disorderly  house  after  the 
neighbors  have  become  exasperated,  and  de- 
manded sternly  an  abatement  of  the  nuisance. 
These  descents  are  limited — four  a  month  is 
about  the  average.  In  the  interval  the  traffic 
flourishes  and  loses  nothing  by  the  interruption. 
As  the  time  approaches  for  another  .sally,  for  they 
come  with  mathematical  regularity,  the  proprietor 
with  the  girls,  if  cunning,  prepares  to  vacate  the 
premises  only  to  return  as  soon  as  the  ofl!icial  in- 
truders have  quit.  If  a  few  mopies  are  nabbed, 
one  dollar  and  costs  the  next  morning  purchases  a 
reprieve,  and  they  at  once  steer  straight  for  the 
same  den  to  greet  their  comrades  in  anus. 
It  is  another  commentary   on  our  police  system 


THE   CANADA    MEDICAL   RECORD. 


55 


that  these  houses  are  not,  after  the  arrest,  shut  up 
and  the  prop)erty  confiscated.  The  business  is 
tacitly  recognized  as  contraband,  else  the  storm- 
ing of  the  place  is  not  justifiable.  The  intent  of 
the  law  seems  gratified,  however,  if  only  the  ten 
ants  are  ousted.  The  building  is  not  cleared,  as 
it  ought  to  be,  of  its  appointments,  and  its  charac- 
ter publicly  arraigned — the  owner  is  not  fined  nor 
imprisoned  for  his  conniving  at  the  business.  No 
ordinance  directs  the  rent  to  be  forfeited — nor 
are  bonds  set  to  the  landlord  for  the  healthy  use 
of  the  property  thereafter.  The  machinery  of  the 
concern  is  not  disabled,  it  is  merely  stopped  for  a 
few  days."  *  The  high-level  purist  does  not  be 
lieve  in  either  digging  up  or  pruning  the  social 
Upas  tree  ;  he  would  occasionally  pick  off,  here 
and  there,  a  few  green  leaves,  or  at  most  restrain 
a  too  flourishing  branch.  This  policy  of  indiffer- 
ence has  been  tried  again  and  again,  and  each 
time  it  has  been  found  wanting.  Indeed  it  is 
based  on  the  assumption  that  we  are  powerless  to 
deal  with  the^  social  evil,  and  consequently  it 
would  be  idle  to  attempt  it. 

Turning  from  those  who  deny  the  right  of 
governments  to  interfere  with  prostitution  because 
such  interference  involves  its  ''  recognition  ;"  from 
tliose  who  are  governed  by  ignorant  apathy,  and 
fiom  those  who  would  institute  a  vigorous  crusade 
without  quarter  against  all  kinds  of  brothels  and 
brothel  keepers,  we  are  led  to  enquire  what  means, 
if  any,  are  likely  to  restrain  prostitution  and  limit 
its  attendant  diseases. 

When  we  recollect  that  most  European  cities, 
Paris,  Vienna,  Madrid,  Hamburg,  Berlin,  Brussels, 
etc.,  have  instituted  systems  of  regulating  the 
inmates  of  /es  maisons  des  dairies,  and  that  for 
certain  military  and  naval  towns  of  Great  Britain 
an  act  was  passed  (The  Contagious  Diseases  Act, 
1866)  with  the  same  object,  we  have  abundant 
legislation  to  choose  from.  The  French  laws  (re- 
presenting continental  legislation)  and  the  provi- 
sions of  the  Contagious  Diseases  Act  may  first  be 
considered,  their  good  and  bad  points  referred  to, 
and  then  an  attempt  will  be  made  to  show  thai, 
with  some  material  modifications  in  the  direction 
of  allowing  prostitutes  greater  freedom  of  action 
than  is  possible  under  the  latter  law,  a  bill  might 
be  framed  applicable  to  Canadian  cities,  or,  at  all 
personals,  more  consonant  with  Canadian  ideas  of 
event  liberty. 


*Nai)  Orleans  Med.  and  Surg.  Journal,  vol.  viii,  pp.  203, 
104, 


In  Paris  le Bureau  des  Moeurs  has  charge  of  all 
prostitutes  within  the  city.  This  office  employs  a 
body  of  police  which  in  1870  comprised  twenty- 
four  inspectors  and  three  superior  officers.  This 
service  is  altogether  charged  with  searching  for 
those  connected  with  clandestine  prostitution 
(prostitut^es  insou7nises).  There  is  a  sanitary 
department  attached  to  the  bureau  which  superin- 
tends the  health  of  the  women,  and  for  this  purpose 
employs  ten  superior  and  ten  assistant  surgeons, 
who  examine  all  prostitutes  subject  to  police  sur- 
veillance. All  women  found  diseased  are  at  once 
sent  to  the  St.  Lazare  Hospital,  where  they  are 
detained  until  cured.  They  are  then  allowed  to 
resume  their  occupation  subject  to  certain  regula- 
tions. All  courtesans  over  sixteen  years  of  age 
are  registered  at  the  Bureau  des  Moeurs,  and  are 
divided  into  two  classes;  ist,  filles  des  maisons, 
who  live  in  houses  of  ill-fame  and  are  subject  to 
weekly  examination  at  their  residences  ;  2nd,  filles 
a  carte  or  isolees,  who  occupy  furnished  houses  by 
themselves,  and  are  obliged  to  present  themselves 
at  the  Dispensary  for  medical  inspection  every 
fifteen  days.  Each  of  the  latter  class  carries  a 
carte  or  "  bill  of  health,"  dated  and  signed  by  the 
surgeon  who  examines  her.  On  the  back  of  the 
carte  are  printed  certain  regulations  to  which  she 
is  ordered  to  conform.  These  orders  refer  to  her 
conduct  in  public,  forbidding  her  to  ply  her  trade 
in  daytime  or  after  11  p.m.  She  must  be  simply 
dressed,  walk  quietly  along,  and  she  caimot 
approach  within  a  radius  of  25  yards  any  church, 
chapel,  the  Palais  Royal,  Jardin  des  Plantes,  etc. 
It  is  needless  to  say  that  clandestine  strumpets 
resort  to  all  sorts  of  artifices  to  elude  the  police, 
and  the  registered  prostitutes  evade,  by  all  means 
in  their  power,  the  regulations  intended  to  control 
their  conduct. 

M.  Parent-Duchatelet,  speaking  of  the  severity 
of  the  French  laws  against  "  those  who  abuse  a 
girl  not  yet  arrived  at  the  age  of  discretion,  and 
the  severe  punishment  inflicted  on  those  who  pro- 
mote this  premature  debauchery,"  shows  how 
this  severity  makes  it  difiicult  to  bring  home  the 
crimes  to  their  perpetrators  on  account  of  the 
secresy  employed,  and  hence  he  says  "  these  young 
persons  are  the  greatest  destroyers  of  public  morals 
and  health.*  That  is  to  say,  the  law  does  not 
recognize  prostitutes  under  sixteen,  so  they  are  all 
the  more  sought  after. 


*De  la  prostitution  dans  la  ville  de  Paris,  1S57. 


56 


THE   CANADA    MEDICAL    RECORD. 


It  will  at  once  be  seen  that  French  laws  are  too 
tyrannical,  too  costly  and  too  elaborate  to  intro- 
duce into  Canada.  Here,  as  long  as  she  behaves 
herself  decently,  a  prostitute  has  as  good  a  right  to 
walk  during  daylight  on  the  public  streets,  to  go 
to  church,  to  attend  the  theatre,  and  dine  at  hotels 
as  any  other  woman,  and  nothing  would  justify  her 
forcible  removal  from  any  of  these  places  on  mere 
suspicion  of  her  being  there  for  the  purpose  of 
plying  her  trade.  Again,  to  hunt  up  clandestine 
women  involves  an  arbitrary  search  of  private 
houses  which  public  opinion  would  not  tolerate. 
That  there  is  something  radically  wrong  in  the 
system  is  proved  by  the  acknowledged  fact 
that  out  of  the  30,000  loose  women  in  Paris  in 
1870  only  4,000  were  registered  and  subject  to 
sanitary  inspection,  and  this  in  spite  of  a  strict 
application  of  the  almost  despotic  powers  possessed 
by  the  police.  Notwithstanding  this,  hygienic 
measures  have  wonderfully  reduced  syphilis  among 
the  registered  prostitutes,  as  may  be  seen  by  the 
following  table,*  in  which  is  given  the  proportion 
of  diseased  to  healthy  women  among  both  the 
registered  class  and  the  clandestines  captured  by 
the  police. 


Registered 

Year. 

Prostitutes 

in  brothels 

inside  of  the 

walls. 

Ditto  in  the 
suburbs. 

Ditto  in  pri- 
vate lodging 

Unregister- 
ed prosti- 
tutes. 

1845 

I  in  142 

I  in    59 

I  in  261 

I  in  6.40 

1846 

I  in  152 

I  '"    53 

I  in  183 

I  in  6.37 

1847 

I  in  154 

I  m    52 

I  in  351 

I  in  6.46 

1848 

I  in  126 

I  in    37 

I  in  182 

I  in  5.66 

1849 

I  in  128 

I  in    44 

I  in  201 

I  in  5.76 

1850 

I  in  148 

I  in    47 

I  in  142 

I  m  5.31 

1851 

I  in  199 

I  in    60 

I  in  180 

I  in  5.47 

1852 

I  m  184 

I  in    76 

I  in  349 

I  in  5.64 

1853 

I  in  183 

I  in  123 

I  in  402 

I  m  5.12 

1854 

I  in  176 

I  in  102 

I  in  377 

I  in  4.26 

A  similar  proportionate  reduction  has  likewise 
been  effected  in  other  continental  cities,  but,  as 
will  be  seen  by  the  above  table,  the  dislike  of  forced 
impri.sonment  in  St.  Lazare  has  had  the  effect  of 
making  unregistered  harlots  hide  their  diseases 
more  than  ever,  bringing  about  a  frightful  condition 
of  things  among  that  class.  The  proportion  of 
syphilitic  to  healthy  women  increased  from  i  in 
6.40  in  1845  to  I  in  4.26  in  1854,  and  in  1866  it 
had  risen  to  one  in  every  four. 

The  Contagious    Diseases  Act  in  some  points 
resembles   the    French    laws.     Of  course  it  was 


limited  to  certain  naval  and  military  stations  with 
their  suburbs. 

One  feature  of  these  enactments  provides  that 
all  prostitutes  shall  be  registered  and  regularly 
inspected,  and  that  when  information  is  made  on 
oath  that  a  woman  is  a  common  prostitute  a  justice 
may  issue  a  notice  to  such  woman,  through  the 
superintendent  of  police,  to  appear  for  surgical 
examination.  Certified  Lock  hospitals  are  pro- 
vided for  her  if  she  is  discovered  to  be  ill.  It  im- 
poses a  heavy  penalty  on  any  brothel-keeper  who 
harbors  a  prostitute  knowing  her  to  be  diseased. 
Health  tickets  are  issued  to  prostitutes  ;  they  are 
punished  for  evasion  of  the  inspection,  and  the 
hospitals  are  supported  by  fines  and  taxes  on  the 
business.  These  provisions,  after  much  opposition, 
were  passed  by  Parliament,  and  many  were  in 
favor  of  extending  them  to  the  civil  population. 

Mr.  Wm.  Acton,  in  his  exhaustive  work,* 
writes  that  he  considers  it  very  desirable  that  the 
Diseases  Act  should  be  made  general  and  a  very 
high  authority,  Dr.  Parkes  says,  "  The  Act  at 
these  large  stations  has  done  great  good ;  but,  a 
framed  and  administered,  it  is  far  too  feebly  drawn, 
and  too  partially  carried  out,  to  cope  entirely  with 
the  evil.  The  prostitutes  are  not  thoroughly  under 
inspection;  many  are  not  inspected  at  all  neigh- 
boring towns  send  in  prostitutes  ;  hospital  accom- 
modation is  insufficient,  it  is  clear  that  the  evil  is 
too  great  to  be  dealt  with  piecemeal ;  it  is  inevit- 
able but  that  the  Act  must  eventually  be  made 
compulsory  over  the  whole  country,  and  the  entire 
system  of  prostitution  dealt  with  carefully  and 
completely  once  for  all."t 

The  agitation  for  repeal  of  the  Contagious  Dis- 
eases Act  has  brought  out  all  sorts  of  objections 
to  it,  some  of  which  appear  quite  valid  and  still 
more  of  them  absurd.  Dr.  Birkbeck  Nevins,  of 
Liverpool,  has  written  one  of  the  few  pamphlets, 
against  the  Act  that  are  worth  perusal. J  Besides 
the  evidence  collected  by  Dr.  Nevins  and  others, 
the  editor  of  the  Westminster  Ra>iav  has  bravely 
laid  aside  those  feelings  of  false  delicacy  which  had 
hitherto  prevented  the  Press  from  arousing  and 
instructing  the  people  concerning  the  extent  and 
malign  influence  of  the  social  evil ;  and  in  a  num- 


JJ*  American  edition  of  Westminster]JReview,  vol.  xciii,  p. 
77i 


•  Prostitution  considered  in  iti  Moral,  Social,  and  Sani- 
tary Aspects.     Third  Edition. 

t  Manual  of  Practical  Hygiene,  page  503 

X  Statements  of  the  Grounds  upon  which  the  Contagious 
Diseases  Acts  are  Opposed,  1875. 


THE   CANADA    MEDICAL    RECORD. 


57 


ber  of  articles  and  reviews  furnishes  his  readers 
with  unanswerable  arguments  against  the  extension 
of  the  Act  of  1866,  and  its  amendments  in  1869. 

Without  attempting  to  particularize  the  evidence 
furnished  by  these  writers  the  chief  points  may  be 
briefly  indicated  as  follows  :     (i)  Such  acts  legis- 
late for  man,  but  treat  woman  as  if  she  were  only, 
an  instmment  to  satisfy  his  evil  passions,  and  they 
subject  her  to  a  moral  degradation  below  that  of 
ordinary  prostitutes  not  subject  to  the  enactments. 
(2)     The  law  compels  women  to  commit  them- 
selves absolutely  to  a  life  of  infamy,  whereas  before 
they  had  it  in  their  power  to  turn  back  and  reform. 
There  is  always  a  class  (in  some   places  a  large 
class)  of  females  who  are  driven  to  adopt  prostitu- 
tion temporarily  as  a  means  of  gaining  a  livelihood 
or  to  support  others  dependent  upon  them.  These 
unfortunates,  if  they  wisely  keep  their  own  counsel, 
may  resume    their   ordinary  position   in  society  ; 
but  never  if  they  are  forced  to  register  themselves 
and  become  public  prostitutes.    (3)  The  enforced 
examination   by  a  public  officer    wipes   out   any 
sense   of   modesty    or   delicacy   they  may   have 
retained,  and  confirms  them  in  a  life  of  prostitution. 
(4)  The  whole  system  places  serious  obstacles  in 
the  way  of  attempts  to  reform   the  erring    ones. 
When  in  hospital  they  naturally  regard  any  advice 
or  instruction   as  a  part   of  the  compulsory  pro- 
gramme.    They  are  bound  to  listen  to  it,  and  for 
that  reason  derive  little  benefit  from  it. 

(6)  It  is  impossible  to  carry  out  the  provisions  of 
the  acts  in  large  cities,  when  conveniences  for 
clandestine  prostitution  are  so  many  and  so  varied. 

(7)  It  is  asserted  that  "  in  towns  where  registra- 
tion and  forced  examination  are  introduced  the 
effect  upon  the  morals  of  the  rising  generation  is 
exceedingly  injurious."  * 

How  to  avoid  the  evil  effects  of  governmental 
regulation,  and  yet  do  something  towards  lessening 
the  diseases  arising  from  the  social  evil,  is  the 
question  that  must  now  be  considered. 

To  begin  with,  the  seduction  by  a  man  come 
to  years  of  discretion  of  a  girl  under  sixteen  years 
of  age,  with  or  without  her  consent,  should  be 
made  a  crime  and  severely  punished.  There  may 
be  some  excuse  urged  for  the  satisfaction  of  the 
sexual  passion  when  the  female  is  of  age  and 
already  a  prostitute — it  may  be  that  "  prostitution 
in  man  is  an  irregular  indulgence  in  a  natural 


Report  of  Royal  Comnttission  on  Contagious  Diseases 


Act. 


impulse,"  as  the  Royal  Commissioners  have  put  it, 
but  to  take  advantage  of  the  ignorance  and  inex- 
perience of  a  mere  child  is  inexcusable,  and  the 
offender  should  be  rigorously  dealt  with.  Such  a 
law  would  strike  at  the  root  of  one  of  the  moat 
fruitful  sources  of  sub.sequent  prostitution. 

Then  "  Homes  "  for  the  reception  of  womon 
reclaimable  by  such  an  agency  ought  to  be  pro- 
vided, and  above  all,  voluntary  lock  hospitals 
should  be  established,  where  diseased  females 
could  be  properly  treated  and  cared  for,  and 
women  should  be  encouraged  to  enter  them  with- 
out being  forced  to  do  so. 

The  absence  of  opportunities  for  adequate 
treatment  has  always  been  one  of  the  reasons  why 
unclean  prostitutes  persist  in  their  career  after  be- 
coming diseased.  In  hospitals  of  this  kind  the 
patient  should  be  surrounded  by  all  the  moral, 
intellectual  and  sanitary  influences  that  would 
tend  to  elevate  her  from  her  degraded  position, 
and  perhaps  induce  her  to  abandon  her  evil 
courses. 

The  wards  should  be  graded,  so  as  not  to  confine 
in  the  same  room  the  hardened  prostitute  with  the 
girl  who  is  new  in  crime  and  comparatively  redeem- 
able.   For  other  reasons  this  gradation  is  necessary. 
To  quote   Parent-Duchatelet  [  op.   cit.]  :    "  It   is 
difficult  to  convey  an  idea  of  the  contempt  which, 
according  to  the  class  to  which  she  belongs,  each 
woman  manifests  for  those  of  the  other  classes. 
Those  women  who  associate  with  men  of  wealth 
or  of  high  position  look  only  with  disdain  upon 
women  as  are  only  sought  after  by  men  of  merely 
ordinary  fortune.     Women  of  this    class,    again, 
contemn  in  like  manner  the   unhappy   creature 
who  only  appears  in  the  rags  of  the  most  disgust- 
ing misery.     This   distinction   which   prostitutes 
establish  among  themselves  is  avowed  by  all,  and 
is  specially  remarkable  when  circumstances  cause 
them  to  meet  each  other  at  the  same  place  ;  they 
avoid  each  other  ;  they  do  not  sit  down  on  the 
same  seat ;  they  form  isolated  groups,  and  do  not 
mix  together   in  conversation.     It   may   be   said 
generally  that  these  classes  do   not  intermingle ; 
that  is  to  say,  the  girls  do  not  pass  imperceptibly 
from  one  class  to  another,  and  successively  from 
the  highest  to  the  lowest ;  they  remain  till  the  end 
in  that  class  in  which   they  began  their  career,  or 
out  of  which  they  have  been  unable  to  go ;  and 
thus  it  is  that  very  beautiful  girls  may  be  seen  to 
begin   and  end  their  life    of  prostitution  in  the 
most  infamous  places.     Each   of  these   localities 


58 


TnE    CANADA    MEDICAL    RECORD. 


being  frequcnte  J  by  a  particular  class  of  men,  the 
women  there  acquire  a  tone,  habits  and  manners, 
the  result  of  which  is  that  the  girl  destined  for 
the  artisan,  the  laborer  and  the  mason  finds  her- 
self misplaced  with  the  officer,  and  is  devoid  of 
the  necessary  attractions  for  the  latter.  'I'he  same 
is  true  with  respect  to  the  woman  who  has  contract- 
ed the  habit  of  living  with  the  educated  and  eleva- 
ted classes  of  society  :  she  shrinks  from  associating 
with  coarse,  vulgar  people,  who  themselves  are 
unable  to  appreciate  the  qualities  which  distin- 
guish her.  Tliis  rule  may  be  considered  general. 
A  girl  who  makes  her  debut  in  one  class  would 
believe  herself  to  be  losing  caste  in  leaving  the 
class  she  occupies  for  one  immediately  below  it. 
This  is  partly  the  reason  why  so  many  girls  with- 
draw themselves  from  prostitution  a  short  time 
after  they  have  entered  upon  it." 

As  these  hospitals  are  essentially  charitable  insti- 
tutions there  is  no  reason  why  the  inmates  should 
not  i)ay  a  weekly  sum.  proportionate  to  the  kind  of 
accommodation  received  and  the  patient's  ability 
to  pay.  It  is  extremely  important  that  the  nurses 
and  medical  officers  should  be  especially  respect- 
ful, kind  and  gentle.  On  this  point  the  philosophic 
Duchatelet  is  very  decided.  "Experience,"  he 
says,  "  has  proved  the  utility,  indeed  the  necessity, 
that  the  medical  officers  should  observe  great 
gentleness,  both  in  their  speech  and  procedure ; 
prostitutes  overwhelmed  with  humiliation,  treated 
with  the  utmost  disdain,  and  feeling  acutely  their 
abjection,  know  how  to  appreciate  a  method  of 
treatment  less  rude,  and  feel  grateful  for  the  kindly 
feeling  it  indicates.  ******  This  gentle- 
ness, far  removed  from  familiarity,  and  which  is 
not  incompatible  with  the  reserve,  gravity,  and 
dignity  which  indeed  it  is  necessary  to  emphasize 
under  the  circumstances,  enables  the  physicians  to 
command  the  respect  and  deference  which  arc  due 
to  them,  and  which  the  women  are  eager  to  ren- 
der." 

Such  a  hospital  should  be  overlooked  by  a 
matron  of  tried  skill,  and  she  should  have  under 
her  nurses  upon  whom  the  greatest  reliance  could 
be  placed.  These  officials  should  have  full  charge 
of  the  sanitary  and  moral  regulations  of  the  insti- 
tution. 

The  medical  staff  should  have  charge  of  the 
medical  def)artment;  and  should  advi.se  with  a  com- 
mittee of  management  when  required.  From  these 
remarks  it  will  be  seen  that  we  contend  for  a  hospital 
supported  principally  by  public  charity  and  certain 


fees  (the  source  of  which  will  be  hereafter  referred 
to),  because  anything  like  governmental  regulstions 
of  the  internal  economy  of  such  an  institution 
should  be  avoided,  if  possible. 

The  charitable  contributions  of  the  coraTiunitj 
to  aid  in  the  support  of  these  hospitals  wili  be  all 
the  more  readily  forthcoming  when  it  is  understood 
that  the  cure  of  disease  and  the  alleviation  of  suf- 
fering are  their  main  objects,  and  not  the  render- 
ing of  fallen  women  fit  to  co-habit  with  m0.1e  pros- 
titutes. Carried  out  in  a  proper  spirit,  suck  refuges 
for  diseased  females  would  effect  a  vast  amount  of 
good. 

The  work  of  social  and  moral  regeneration  might 
be  carried  on  with  an  effect  impossible  in  lock 
hospitals  under  the  regulations  that  obtain  under 
the  Contagious  Diseases  Act.  Dr.  Nevins  gives 
the  following  significant  extract  from  the  Metropo- 
litan Police  Report  of  1874  :  —  "  Women  come  from 
unprotected  districts,  and  insist  on  signing  the 
voluntary  submission  form,  in  order  that  their  names 
may  be  placed  on  the  register,  and  that  by  this 
means  they  may  gain  admission  into  hospital."  * 
How  much  more  readily  would  diseased  unfortu- 
nates seek  a  shelter  where  they  would  meet  with 
sympathy,  where  they  would  not  be  looked  upon 
with  disdain,  and  where  they  would  be  assisted  to 
recover  their  lost  place  in  society,  than  if  they  had 
to  incur  the  degradation  and  penal  consequences 
of  registration. 

But  there  is  another  side  to  the  story,  which 
justice  and  the  public  health  demand  should  receive 
attention.  A  diseased  prostitute,  whatever  else  she 
may  be,  is  a  local  centre  of  contagion  and  a  dan- 
gerous member  of  society ;  and  means  should  be 
taken  to  prevent  her  from  spreading  the  disorder 
from  which  she  suffers  should  she  persist  in  doing 
so.  When  a  woman  has  a  venereal  disease,  and 
in  that  condition  knowingly  gives  it  to  others,  it 
behooves  the  authorities  to  step  in  and,  if  possible, 
prevent  the  infection.  The  same  arguments  that 
justify  removal  to  civic  hospitals  of  cases  of  small- 
pox and  cholera  apply  to  .syphilis  and  gonorrhoea. 

In  the  interests  of  the  public  health  such  Ciises 
should  be  isolated.  It  has  been  suggested  that 
physicians  should  have  power  to  communicate  to 
the  chief  of  police  the  names  of  those  prostitutes 
from  whom  any  of  their  patients  has  contracted 
disease.  'iMie  medical  man  should  satisfy  himself 
that  the  patient  is  in  a  position  to  state  positively 


•  Capt.  Ilaris's  Ileport,  see  sect.  10,  par.  7. 


THE   CANADA   MEDICAL    RECORD. 


59 


when  where,  and  from  whom,  he  caught  the  con- 
tagion and  that  the  female  is  in  the  habit  of  dis- 
tributiig  her  favors  promiscuously  or  for    money. 
Where  there  is  any  doubt  about  the  last  two  points 
the  susjected  woman  should  have  the  benefit  of  it, 
but  in  tie  majority  of  instances  the  police  would  be 
able  to  sttle  the  question  satisfactorily.     Having 
satisfied  limself  on  these  points  theChief  should  have 
power  to;erve  a  notice  on  the  woman  to  forward  to 
him,  witkin  24  hours,  a  certificate  from  a  regular 
practitiorer  of  her  being  in  a  healthy  state,  or  else,  if 
she  be  a  common  prostitute,  to  present  herself  at  the 
hospital  for  treatment.     In  the  case  of  those  who 
are  not  'common"  in  the  ordinary  acceptation  of 
the  term,  i.  e.,  who  do  not   practice  their   trade 
openly,  and  do   not  live  in  brothels,  it  would  be 
ju?cifiable  to  accept  a  certificate    from  a  regular 
prictitioner  that  the  woman  is  under  treatment  by 
hva,  and  that  he  would  use  every  means  in  his 
power  to  prevent  her  from   co-habiting  until  she 
recovered.     In  this  way  (for  all  these  proceedings 
would  be  kept  secret,  and  neither  the  name  of  the 
male  sufferer  nor  of  the  female  patient  would  be 
divulged)  scandal  would  be  prevented  in  the  case 
ofoccasional  and  otherwise  "  respectable  "  females- 

For  the   other  class,  those  who   are   generally 

recognized  strumpets,  neglect  or  refusal  to  furnish 

a  proper   certificate,  or  to   undergo  treatment   if 

diseased,    would  justify   their  arrest  and   forcible 

detention   in   special   wards  of  the  hospital  for  a 

time    discretionary  with    the  oflficials   in    charge. 

Action  of  this  kind  would  encourage  the  voluntary 

system  and  leave  coercion  as  a  dernier  resort.     It 

would   incite  women  to  apply   for    treatment    at 

once,    and  not  wait    until  they  were  compelled 

to    quarantine    themselves   by    the    strong    arm 

of  the  law.     It  would  respect  the  respectable,  but 

punish  the  guilty.     Voluntary    patients  might  be 

allowed  to  leave  the  hospital  when  they  desired,  but 

they  should  be  warned  that  any  attempt  to  return 

to  their  trade  until  fully  cured  would  involve  their 

semi-imprisonment  in  the  "coercion"  wards  of  the 

hospital,  and  cut  them  off  from  all  the  privileges  of 

the  voluntary  side.       Examinations     should     be 

made    voluntary   in    a  Dispensary    attached    to 

to  the  hospital,  and  a  small  fee   (in  Hamburgh, 

where  the  regulation  system  is  in  vogue,  it  is  only 

a   mark)  should  be   charged.       As   soon  as   the 

intention  of  periodical  examinations   was   known 

they  would  begin  to  be  appreciated  and,  in  time,  the 

great  majority  of  the  prostitutes  in  the  city  would 

be  likely  to  present  themselves  for  medical  inspec 


tion.  A  larger  fee  might  be  charged  for  attending 
the  prostitutes  at  their  houses.  Certificates  of  good 
health  might  be  issued  if  asked  for  by  the  worai  n, 
but  it  must  be  understood  that  they  are  not  con- 
sidered necessary.  It  would,  of  course,  be  out  of 
the  question  to  admit  students  to  any  part  of  the 
hospital  except  to  the  coercion  wards.  This  por- 
tion of  the  institution,  being  in  some  sense  a  city 
house  of  correction,  would  have  a  good  claim  for 
civic  support,  and  in  that  case  might  be  overlooked 
by  a  local  inspector.  In  the  event  of  a  hardened 
sinner  persisting  in  spreading  venereal  diseases 
instead  of  applying  to  hospital  for  relief,  and 
necessitating  repeated  arrests,  it  would  be  justifiable 
to  have  her  registered  and  examined  by  the 
medical  officer  not  less  frequently  than  once  a 
week.  This  would  be  a  greater  punishment  to  her, 
in  view  of  the  treatment  of  her  other  sisters  in  vice, 
than  imprisonment. 

To  complete  these  suggested  regulations  it  ought 
to  be  made  possible  for  an  inmate  of  a  house  of  ill- 
fame  to  abandon  her  life  of  infamy  free  of  any  claim 
for  board,  liquors,  clothes,  etc.,  the  brothel-keeper 
may  have  upon  her.  It  is,  of  course,  to  the  interest 
of  procurers  and  keepers  to  exert  as  great  an 
influence  upon  their  stock-in-trade  as  possible,  and 
for  this  purpose  many  of  them  try  to  keep  the  girls 
in  debt,  so  that  ihey  are  compelled  to  continue  in 
their  old  ways.  It  would  be  a  good  idea,  also,  to 
subject  brothel  keepers  to  a  heavy  fine,  if  it  be 
proved  that  they  allow  any  of  their  women  to 
remain  in  their  houses  after  becoming  diseased. 
The  proceeds  of  such  fines  would  go  to  defray  the 
expenses  of  the  hospital.  The  advantages  of  the 
measures  above  specified  recommend  themselves, 
because  :  (i)  the  legislation  involved  is  not  a  one- 
sided treatment  of  woman  as  if  she  were  made  for 
man  simply  to  gratify  his  lust  upon  3(2)  they  leave  a 
way  open  to  those  erring  ones  who  desire  to  reform ; 
(3)  women  are  not  compelled,  except  as  a  last 
resort,  to  undergo  a  degrading  periodical  examina- 
tion by  public  officers ;  (4)  the  system  does  not 
condemn  to  a  life  of  hopeless  infamy  those  who 
err  temporarily,  or  who  are  seduced  by  designing 
men  ;  (5)  they  provide  for  clandestine  prostitution  ; 

(6)  they  are  voluntary  to  a  very  great  degree,  and 
attempt  to  do  by  kindness  what  coercion  has,  over 
and  over  again,  failed  to  accomplish  ;  and,  lastly, 

(7)  they  do  not  violate  the  sanctity  of  private 
houses,  as  the  system  of  forced  registration  is  sure 
to  do. 

An  enumeration  of  the  benefits  to  be  derived  from 


60 


THE   CANADA    MEDICAL    RECORD. 


Magdalen  hospitals  would  not  be  complete  with- 
out a  reference  to  that  noble  band  of  religious 
women  belonging  to  the  order  of /«  Sceurs  de  la 
Compassion  who  have  charge  of  rhdpital  de  Lour- 
cine  in  Paris.  These  devoted  women  have  caught 
the  true  significance  of  Christ's  teaching  when  He 
stepped  in  between  the  woman  taken  in  adultery 
and  her  accusers,  the  stem  Scribes  and  Pharisees, 
and  rebuked  them  for  their  self-righteousness  : — 
"  Woman,  where  are  those  thine  accusers  ?  Hath 
no  man  condemned  thee?  She  said.  No  man, 
Lord.  And  Jesus  said  unto  her.  Neither  do  I  con- 
demn thee  :  go,  and  sin  no  more."  *  And  these 
considerations  bring  us  back  to  the  old  question, 
When  shall  we  see  prostitution  itself  abohshed  ? 
and  while  the  discouraging  and  too  ready  reply  is, 
not  while  society  exists  in  its  present  state,  one  is 
inclined  to  believe  that  a  great  deal  of  the  difficulty 
arises  from  the  unjust  and  despicable  manner  in 
which  society  treats  women  who  lose  their  virtue 
from  any  cause.  A  man  sins,  and  social  custom 
either  excuses  or  forgives  the  transgression.  A 
woman  goes  astray,  and  every  avenue  of  hope  is  at 
once  closed  against  her.  The  escapades  of  the 
rake  bear  such  social  interpretations  as  "  sowing 
his  wild  oats,"  "  young  men  will  be  young  men,  " 
and  so  on ;  but  upon  the  temple  of  the  harlot's 
shame,  as  over  the  portals  of  Dante's  Inferno  is 
carved  the  dread  anaglyph : — "  All  ye  abandon 
hope  who  enter  here."  If  society  expects  to 
abolish  prostitution  it  must  first  insist  upon  meting 
out  the  same  measure  of  condemnation  to  both 
sexes  for  offences  committed  by  either. 

November  24,  1880. 


INFLAMMATION  :  ITS  CHEMICAL  CAUSE, 
AND  CURE. 


BY 


W.  Y.  Brunton,  M.D.,  London,  Ont. 

I  have  just  finished  the  perusal  of  Dr.  Hingston's 
paper  on  the  "Treatment  of  Surgical  Wounds," 
and  have  been  very  much  interested.  I  trust  it 
will  not  be  deemed  either  obtrusive  or  impertinent 
in  offering  a  few  remarks  on  it.  He  speaks  of 
foreign  bodies  producing  irritation  ;  has  it  occurred 
to  him  why  foreign  bodies  in  the  system  produce 
irritation,  inflammation,  suppuration,  and  some- 
times death.  He  quotes  Richard,  who  states  that 
"  suppuration  ever  commences  around  a  foreign 

"John  viii.  10,  11. 


body."  If  you  permit  I  will  explain  why  they  d#  so. 
As  soon  as  any  foreign  body  is  in  the  system, 
— whether  it  is  a  thorn,  or  resulting  from  the  ise  of 
the  surgeon's  knife  when  he  divides  the  bloal  ves- 
sels, or  from  the  germ,  or  any  other  sourc,  that 
foreign  matter  becomes  an  impurity,  and  having  heat 
and  moisture  in  the  system,  it  ferments.  Thi  result 
of  all  organic  fermentation  is  of  course  acid,  aid  this 
is  the  active  principle  of  inflammation.  I  luve  not 
written  this  from  a  purely  theoretical  point.  I  can 
establish  the  fact  to  Dr.  H.'s  full  satisfacton,  can 
give  him  reliable  data  ;  in  fact,  Dr.  H.  in  his  practice 
can  illustrate  it  every  day  of  the  year.  Becatse  that 
which  neutralizes  or  absorbs  the  inflammation  from 
a  wound  or  surgical  operation  will  produce  the  same 
effect  in  erysipelas,  syphilis,  ulcers,  or  any  other 
form  of  inflammation.  There  can  be  but  one  ia- 
flammation  chemically  varying  in  degree,  character 
and  intensity. 

In  the  history  of  medicine,  nothing  is  more 
obscure  than  the  cause  of  inflammation,  and  this  is 
evidenced  by  the  variety  of  remedies  prescribed. 
But,  as  nearly  all  disease  originates  or  terminates 
in  inflammation,  it  becomes  at  once  apparent  that 
it  is  of  the  utmost  importance  to  ascertain  the 
cause,  without  which  the  disease  cannot  be  phi- 
losophically or  intelligently  treated.  I  submit  the 
following  for  the  consideration  of  the  profession  : 
Inflammation  arises  in  every  case,  from  one  com- 
mon cause,  viz.,  fermentation,  the  result  of  which 
is  acid  ;  this  acid  is  the  active  principle  of  inflam- 
mation. How  is  disease  reproduced  ?  Whether  the 
germ,  or  any  other  principle  is  adopted,  it  simply 
means  that  an  impurity  has  entered  into  the  circula- 
tion, and  having  heat  and  moisture  in  an  eminent 
degree  in  the  body,  a  principle  of  ferment  is  set 
up,  which,  in  many  cases,  rapidly  reproduces  the 
particular  specific  disease.  It  will  occur  to  the 
mind  at  once  that  if  acid  is  the  active  principle  of 
inflammation,  the  remedy  must  be  very  simple;  it 
is  so,  the  remedy  in  all  cases  of  inflammation 
is  an  alkali.  I  do  not  wish  you  to  understand  by  an 
alkali,  an  alkaline  salt,  but  a  pure  alkali;  the  strong 
affinity  existing  between  acids  and  alkalis,  the  one 
immediately  acting  on  the  other,  neutralizes  and 
absorbs.  I  would  respectfully  suggest  the  use  of 
a  solution  of  alkali,  taking  the  gravity  of  liquor 
potassa  as  a  standard,  one  part  of  liquor  potassa 
to  eight  or  ten  parts  water,  say  in  syphilitic  ulcers, 
or  in  fact  for  any  kind  of  suppuration  or  ulceration, 
modifying  the  gravity  of  the  alkali  to  suit  circum- 
stances. Within  three  days,  the  effect  in  every  case 


THE    CANADA    MEDICAL    RECORD. 


61 


will  be  very  marked.  Of  course  in  acute  inflam- 
mation it  may  require  the  alkali  to  be  of  a  much 
higher  specific  gravity  than  even  the  liquor 
potassa  for  wounds  and  surgical  operations.  The 
alkaline  spray  or  bandage  will  be  found  of  more 
service  than  any  other  in  use  (not  excepting  car- 
bolic acid).  Used  judiciously  and  intelligently, 
suppuration  becomes  almost  an  impossibility. 
I  would  remark  here  that  to  be  effective  in  every 
case,  the  alkali  must  produce  a  slight  tingling 
sensation  ;  on  the  other  hand,  if  it  feels  hot  after 
its  application,  it  must  be  discontinued  for  the  time 
being ;  and  when  next  applied  the  solution  must 
have  been  reduced. 

I  am  fully  aware  the  foregoing,  from  its  novelty 
and  innovation,  may  meet  M-ith  hostile  comments 
by  many.  It  is,  however,  a  simple  matter  to  test, 
and  can  be  illustrated,  in  every  day  practice.  I 
will  here  observe  a  natural  illustration  of  this 
subject,  which  corroborates  my  statements,  and 
wiiich  can  be  vouched  for,  by  any  person  who  has 
visited  the  country  named.  If  a  person  were  to 
die  on  the  plains  of  Colorado,  the  body,  if  left  to 
the  rays  of  the  sun  for  months,  would  not  be 
decomposed,  in  consequence,  I  believe,  of  the  alkali 
contained  in  the  soil  preventing  fermentation  and> 
therefore,  decomposition. 


ON  SEPTICEMIA  AND  ITS  EFFECTS. 

Paper  by  Dr.   Litten,  of  Berlin, 

Read  at   the  53rd  Convention   of  German  Naturalists  and 

Physicians  at   Dantzic.     Translated  from  Die.  Allg. 

Wien.  Med.  Zeitung,  by  Owen  C.   Brown,  M.D. 

(Acton  Vale,  Quebec). 

The  Doctor  gave  an  exhaustive  review  of  the 
results  of  his  observations  of  thirty-five  cases  of 
septic  disease,  clinically,  anatomically,  and  patho- 
logically homogenous. 

The  aetiological  principles  though  seemingly 
different,  agreed  in  general,  being  apparently 
traumatic — followed  by  septic  infection. 

Of  the  thirty-five  cases,  thirty  (^6  per  cent.) 
occurred  in  women  ;  and  of  these,  in  twenty-three 
cases,  the  general  disease  arose  from  puerperal 
conditions. 

The  clinical  form  assumed  by  the  disease  was 
in  some  cases  that  of  typhoid  in  its  first  stage — 
in  others  that  of  severe  rheumatic  arthritis,  and  in 
others  an  intermittent  form. 

The  Doctor  referred  especially  to  the  lesions  of 
the  eyes,  the  skin,  the  medulla  of  the  bones  and  of 
the  heart. 


The  eyes  were  affected  generally,  in  twenty-eight 
cases  (eighty  per  cent.),  and  shewed  retinal 
hemorrhage,  with  or  without  a  white  centre,  twenty- 
eight  times  ;  hemorrhage  from  the  iris  and  choroid, 
once ;  bacteritic  deposits  in  the  choroid  once  ; 
panophthalmitis  eight  times,  five  double  and  three 
one-sided;  trigeminal  neuralgia,  with  maceration 
and  anaesthesia  of  the  cornea,  once  ;  retinitis  septica 
(according  to  Roth,  white  specks  in  the  retina) 
three  times. 

One  or  more  of  the  above  were  seen  to  occur 
in  the  same  eyes,  so  that  retinal  hemorrhage  and 
white  specks  could  be  seen  on  one  eye  at  the  same 
time  as  panophthalmitis  on  the  other.  Conjunctival 
hemorrhage  was  very  frequently  observed. 

The  eyes  were  unaffected  only  in  seven  cases, 
twenty  per  cent. 

The  affection  of  the  posterior  parts  of  the  eyes 
was  referred  to  with  special  significance  by  the 
lecturer  as  a  means  of  diagnosing  the  septic  from 
typhus  processes,  as  had  already  been  shewn  by 
him  in  1878,  at  the  Ophthalmological  Congress  at 
Heidelburg. 

The  skin  was  affected  in  twenty- eight  cases 
eighty  percent,  intact  in  seven  (twenty  percent), 
and  the  lesions  presented  the  following  forms  : 
as  multiple  hemorrhage,  twenty-one  times  (sixty 
per  cent.) ;  as  roseola-like  exanthema  fonr  times, — 
this  last  had  its  seat  principally  upon  the  abdo- 
men, and  could  not  be  distinguished  from  typhus  ; 
as  a  pemphigus-like  affection,  with  maceration 
of  the  epidermis,  three  times  ;  as  an  erythema-like 
scarlatina  four  times  ;  and  the  Doctor  shewed  that, 
contrary  to  the  views  of  Olhausen,  there  are  cases 
of  dermatitis  of  septic  origin  as  well  as  those 
peculiar  to  puerpural  scarlatina,  which,  neverthe- 
less, may  present  the  same  appearances  or  form  of 
disease. 

Angina  never  occurred  ?  Herpes  hemorrhagica 
twice  ;  an  exantha-like  measles,  once ;  multiple 
phlegmon,  twice  (icterus,  three  times)  ;  erysipelas, 
once  ;  miliaria  as  a  complication  occurred  often 
An  affection  of  the  skin  of  quite  a  peculiar  nature 
was  once  observed,  in  this,  that  the  skin  of  the 
whole  body  became  rapidly  covered  with  hemor- 
rhages about  the  size  of  the  hand,  and  which  then 
became  quickly  confluent,  and  assumed  a  shading, 
passing  from  the  clearest  red  to  the  darkest  red, 
and  even  to  a  black  color.  These  dermal  hemor- 
rhages had,  like  the  retina,  often  white  centres. 

In  the  bone  medulla  were  seen  in  many  cases 
local  lesions  of  a  grayish-green  color,  surrounded 


62 


THE   CANADA    MEDICAL    RECORD. 


by  a  bloody  halo.  Some  of  these  localities  of 
disease  presented  the  appearance  of  having  been 
dissected  out  by  suppuration.  In  some  of  them 
could  be  distinguished,  next  to  the  bloody  halo,  a 
well-defined  puriform  zone. 

The  lesions  of  the  heart  shewed — as  endocarditis 
ulcerosa,  sixteen  times,  in  which  the  valves  of  the 
right  heart  were  concerned  four  times  ;  as  the  warty 
form  without  ulceration,  six  times;  as  pericarditis 
hemorrhage  once  ;  chronic  endocard  occurred  five 
times  ;  the  cardiac  valves  were  intact  thirteen  times. 

In  many  cases  were  seen  miliary  abscesses  of 
the  cardiac  muscular  substance  :  besides  the  Doctor 
pointed  out  the  frequent  occurrence  of  pachymening 
hemorrhagica. 

In  regard  to  the  pathological  significance  of  the 
organic  lesions  above  described,  the  lecturer 
observed  a  general  analogy  in  the  collective  pro- 
cesses, in  which,  on  the  one  hand,  are  the  hemor- 
rhages occurring  with  such  regularity  conjointly  in 
the  affected  organs ;  on  the  other  hand,  the 
suppurative  processes  which,  likewise,  were  met 
with  in  almost  all  parts. 

Both  groups  of  this  affection  are  considered  by 
him  as  caused  by  embolic  closure  of  the  vessels. 
Thus,  while  the  bleedings  which  were  so  common, 
and  the  endocard.  verrucosa  were  caused  simply, 
by  Bacteritic  emboli — whereby  the  hemorrhages 
could  apparently  be  traced  back  to  necrotic 
lesions  of  the  walls  of  the  vessels, — on  the  other 
hand  the  suppurative  processes  (Panophthalt 
endocarditis  ulcerosa,  dermatitis  of  a  pemphigus 
like  form)  were  referred  to  closure  of  the  vessels 
from  broken-down  organic  particles  ainsing  from 
the  irritating  broken-down  thrombi  from  ihe  veins 
and  lymphatic  vessels. 

Koester  considers  endocard.  as  caused  by 
embolic  infection,  and  accepts  two  forms  of 
Bacterio-embolic  substance,  of  which  one  causes 
the  benign,  the  other  the  very  severe  ulcerative, 
form  of  endocarditis. 

The  Doctor  shares  these  views  in  regard  to  the 
two  processes  arising  from  the  same  causal 
irritant,  which,  however,  gradually  differ  and  pro- 
duce different  effects.  According  as  one  or  the 
other  of  these  processes  has  affected  the  blood,  do 
we  .see  either  the  mild  forms  of  the  disease  or 
that  very  severe  form  of  endocard.  ulcerosa,  with 
its  accompanying  phenomena — hemorrhages  or 
hemorrhages  with  suppuration. 

Weigert's  investigations  agree  with  the  above, 
for  he  shewed  long  ago  that  Bacteria  sometimes 


produced  no  ill  effect,  sometimes  only  degenera- 
tion, sometimes  degeneration  with  suppuration. 
All  these  different  conditions  may  be  studied  in 
the  same  organ  :  upon  the  eye,  for  instance  may  be 
seen  hemorrhage  or  simple  degeneration  (appear- 
ing on  ophthalmoscopic  examination  simply  as 
white  specks),  or  central  degeneration  with  peri- 
pheral hemorrhage,  or,  finally,  degeneration  with 
suppuration,  appearing  under  the  form  of  panoph- 
thalitis,  and  differing  according  to  the  seat  of  the 
embolic  closure— embolism  of  the  retinal  vessels 
or  of  the  vessels  of  the  iris  and  choroid. 

In  the  heart  is  observed  simply  valvular  degener- 
ation with  or  without  hemorrhage,  or  degeneration 
with  suppuration  and  ulceration. 

Naturally,  in  these  cases,  the  endocard.  must  be 
regarded  as  an  accompanying  phenomenon  of 
the  septic  process,  whilst  panophthalmitis,  in  like 
manner,  represents  the  retinal  form  of  the  disease. 
Hence  it  is  incorrect  to  distinguish  this  diseased 
form  as  endocard.  ulcerosn,  as  it  is  only  a  symptom 
of  the  general  disease.  A  most  important  principle 
to  be  noted  is  the  circumstance  that  the  embolic 
material  does  not  arise  from  the  broken-down 
valves,  but  from  bacteria  floating  in  the  blood  or 
from  the  decayed  thrombic  contents  of  the  lymph, 
and  blood-vessel«. 

3^m4i^tAiof  Jiltdkui  Smeme. 

INCONTINENCE  OF  URINE  IN 
CHILDREN. 

At  the  Harveian  Society  of  London,  recently, 
Dr.  Farquharson  read  a  paper  on  the  subject.  After 
some  preliminary  remarks  on  the  bearings  of  in- 
continence of  urine  on  surgery  and  obstetric  medi- 
cine, he  referred  to  the  subject  under  three  head- 
ings. In  some  cases  this  affection  is  found  children 
of  pale,  weakly  organization,  depressed  and  languid, 
and  feeling  keenly  their  infirmity.  Here  there  is, 
no  doubt,  some  weakened  condition  of  the  sphinc- 
ter vesicoe,  or  of  the  nervous  centres  in  the  lum- 
bar cord  ;  and  tonic  remedies,  and  more  especially 
small  doses  of  wine,  will  usually  act  with  excellent 
effect.  Secondly,  there  were  cases  of  much  greater 
severity,  usually  dating  from  soon  after  birth  ;  and 
here  it  is  necessary  to  make  a  distinction  between 
the  enuresis  by  day  and  that  by  night,  for  the  lat- 
ter is  much  more  difficult  of  cure  than  the  former, 
and  frequently  resists  all  medical  treatment — de- 
parting, if  it  do  so  at  all,  spontaneously,  about 
the  period  of  puberty.  The  remedies  which  have 
been  generally  spoken  of  as  most  deserving  of  con- 
fidence or  those  which  act  on  unstriped  muscular 
tissue,  and  of  these  belladonna  is  the  only  one 


THE    CANADA    MEDICAL   RECORD. 


63 


which,  in  the  experience  of  the  author,  has  given 
good  results.  It  is  necessary  to  give  full  doses, 
and  two  ounces  have  been  administered  to  a  boy 
of  seven  before  success,  and  even  then  only  tempo- 
rary success  was  attained.  Ergot  proved  disap- 
pointing, and  santonin  has  been  entirely  without 
influence  under  the  morbid  condition.  Class  three 
includes  those  cases  which  may  support  the  belief 
that  incontinence  of  urine  is  truly  a  neurosis  ;  for 
here  we  find  this  symptom  coinciding  with,  and  even 
alternating  with  other  nervine  lesions.  Thus,  on 
two  occasions  it  was  observed  concurrently  with 
eczema,  and  once  a  very  long  standing  case  was 
attacked  with  chorea,  during  the  continuance  of 
which  perfect  control  over  the  bladder  was  regained, 
Nervine  tonics  are  of  little  use  here  ;  but  the  care- 
ful use  of  galvanism  seems  specially  indicated,  as 
well  as  blistering  over  the  fifth  lumbar  vertebra, 
where  modern  experiment  has  shown  the  motor 
centre  to  be  situated.  The  recently  proposed  plan 
of  excluding  meat  from  the  dietary  was  not  found 
to  be  of  much  service,  no  special  acidity  of  urine 
being  ever  observed  to  require  the  counteracting 
agency  of  purely  non-nitrogenous  food. 


NOTES    OF    THE    CROTON-OIL    TREAT- 
MENT OF  RINGWORM. 

I  see  in  the  Jowna/  of  May  29th,  that  the  art- 
ificial production  0/  kerioji  is  advised  as  a  cure  for 
chronic  ringworm.     As  I  have  been  using  croton- 
oil  (in  imitation  of  Nature's  cure)  for  the  last  six 
years,  and  have  already  fully  described  my  method 
of  producing  kerion  in  my  paper  on  the  Diagnosis 
and  Treatment  of  Ringworm,  published  in  the  Lan- 
cet of  January  loth,  24th,  and  31st,  I  think  it  right 
to  advise  the  profession  to  be  very  careful  in  select- 
ing proper  cases  for  this  treatment.     In  the  paper, 
I  strongly  recommend  the  production  of  an  artifi- 
cial kerion  by  croton-oil ;  i.e.,  "  that  sv/oUen,  raised 
inflamed  and  infiltrated  state  of  the  scalp  which 
sometimes  accidentally  occurs  during  treatment, 
and  which  always  results  iji  a  speedy  cure  of  the 
disease.     Kerion  should  be  produced,  if  possible, 
in  old  chrofiic  small  patches  of  ringworm  that  have 
resisted  all  other  treatment  for  many  months,  but 
not  in  those  cases  where  the  disease  extends  over 
a  large  extent  of  surface.     The  great  aim  of  this 
treatment  is  to  cause  inflammatory  swelling  and 
effusion  into  the  tissues  around  the  follicles,  so  shat 
the  stumps,  which  otherwise  would  break  off  on 
attempted   epilation,  will  now  come  out  with  the 
discharge,  or  can  easily  be  extracted ;  in  fact,  very 
often  in  a  short  time  an  inveterate  patch  of  ring- 
worm, that  has  withstood  every  other  treatment 
for  years,  can  be  transformed  into  a  smooth  slight- 
ly-raised place,  utterly  destitute  of  all   hair   and 
stumps,  and  practically  well."  "  Even  if  the  swol- 
len condition  of  kerion  cannot  be  produced,  this 
treatment  very  rarely  fails  in  loosening  the  stumps 
and  curing  the  disease." 

I  republished  these  observations  of  mine,  as  I 
should  be  sorry  for  the  profession  to  think  that  I 


advocated  the  production  of  kerion  indiscriminate- 
ly in  chronic  ring^vorm,  especially  where  a  large  ex- 
tent of  surface  is  involved.  In  fact,  the  chief  cases 
for  which  I  urge  it  are  those  I  so  constantly  see, 
where,  after  ordinary  treatment  for  a  time,  the  hair 
has  grown   again    on    the   patches,  and  then  the 
child  has  been  neglected  for  months,  or  even  years, 
until  some  special  reason  brings  it  under  treatment 
again.     "  Here  the  difficulty  is  not  to  find  some 
parasiticide  that  will  destroy  the  ringworm-fungus, 
but  to  bring  the  remedy  into  contact  with  it.     In 
recent  ringworm,  conidia  only  penetrate  a  certain 
distance  into  the  follicles,  and  therefore  the  disea-se 
is  easily  cured  by  almost  any  ren  .edy ;  but  after  a 
time  they  penetrate  to  the  very  bottom  of  the  folli- 
cles, which,  it  must  be  remembered,  are  even  below 
the  true  skin."     In  such  cases,  it  is  impossible  to 
reach  the  fungus  by  any  of  the  usual  remedies  ap- 
plied to  the  surface  of  the  scalp.  Ordinary  chronic 
forms  can  generally   be  cured  without  producing 
kerion.     Painting  the  place   with  croton-oil  lini- 
ment is  a  good  plan  ;  but  other  remedies  will  often 
cause  a  moderate  amount  of  inflammation,  and  even 
slight   suppuration,   and   thus   cure   the   disease. 
Citrine  ointment  with  carbolic  acid  (as  advised  in 
my  paper)  will  frequently  produce  this  result,  espe- 
cially in  young  children. 

The  following,  in  my  experience,  are  the  most 
suitable  cases  in  which  the  production  of  kerion 
may  be  attempted : 

1 .  Inveterate  cases  that  have  resisted  all  other 
treatment  for  months  or  years,  if  not  very  exten 
sive ;  especially  those  where  the  inveterate  parts 
of  the  patches  have  been  marked  out  and  reduced 
in  size  by  other  treatment,  as  by  oleate  of  mercury. 

2.  Any  small  patch  of  ringworm,  not  larger,  say, 
than  half  a  crown,  where  time  is  of  the  utmost  im- 
portance, and  a  cure  is  desired  as  quickly  as  pos- 
sible. 

3.  Such  a  case  as  where  ringworm  has  been  de- 
tected and  properly  treated  for  a  time,  until  the 
new  hair  has  made  its  appearance ;  after  which  it 
has  been  discontinued,  although  many  diseased 
stumps  remained.  Months,  or  even  years,  have 
passed,  and  the  child  is  perhaps  rejected  at 
some  public  examination.  One  or  more  patches 
are  to  be  seen  where  the  hair  is  growing  freely  and 
firmly,  but,  on  close  inspection  with  a  lens,  some 
scurfiness  and  broken  hairs  or  stumps  are  observed, 
scattered  among  the  long  hairs  on  the  patches. 

Pustulation  in  minute  spots  should  also  be  at- 
tempted, as  probably  the  only  cure  for  that  variety 
of  the  disease  I  described  as  dissefninated  ring- 
worm;  "one  rarely  diagnosed,  and  the  most 
chronic  and  difficult  to  cure.  The  hair  is  growing 
freely  and  firmly  all  over  the  head;  there  are  no 
patches  to  be  seen,  although  probably  they  have 
existed  at  an  earlier  stage  of  the  disease ;  the  skin 
appearsgenerallyhealthy, and  perhaps  almost  free 
from  scurf,  but  numerous  isolated  stumps,  or  groups 
of  stumps,  are  seen  in  every  direction,  often  scat- 
tered all  over  the  scalp.  This  v  ariety  is  almost  always 
overlooked,  and  can  only  be  de  tected  by  very  careful 


64 


THE   CANADA    MEDICAL   RECORD. 


examination.  The  stumps  in  these  old  chronic  cases 
are  very  brittle,  and  almost  always  break  on  at- 
temjjted  epilation,  showing,  after  soaking  some  little 
time  in  liquor  potassse,  under  the  microscope  a 
most  extensive  im[)lication  with  fungus,  even  down 
to  the  root  of  the  hair." 

I  have  often  succeeded  in  curing  cases  like  this 
when  they  have  resisted  all  other  treatment  for 
years,  but  they  require  great  care  and  patience. 
The  entire  scalp  must  be  subjected  to  a  very  close 
inspection  with  a  lens,  and  an  attempt  made  to 
])ull  out  each  stump  as  it  comes  into  view,  and 
then  if  it  break  off,  which  is  most  probable,  a 
drop  of  oil  should  be  applied  at  once  to  the  folli- 
cle, with  a  very  fine  sable  brush.  At  the  next 
examination,  the  oil  must  again  be  put  on  any 
stumps  that  break  off,  as  well  as  upon  any  fresh 
ones  that  appear. 

A  deep  pustular  rash  alone  will  often  cure  chronic 
ringworm,  but  certainly  not  all  inveterate  cases. 
My  knowledge  of  such  is  great,  and  I  know  full 
well,  from  painful  experience,  that  croton-oil  may 
be  painted  on  time  after  time,  and  a  pustular  rash 
repeatedly  set  in,  and  yet  diseased  stumps  will  re- 
appear. 

I  must  remark  that  it  is  useless  for  medical  men 
to  attempt  to  cure  very  chronic  ringworm,  espe- 
cially the  disseminated  variety,  unless  they 
thoroughly  realize  how  intractable  some  forms  of  the 
disease  are,  possess  a  good  lens  and  good  eyesight, 
and  have  plenty  of  time  and  patience. 

Ringworm  must  never  be  considered  cured,  al- 
though the  hair  has  grown  again  on  the  patches, 
as  long  as  a  single  stump  remains  affected  with  the 
fungus,  or  any  black  dots  are  seen.  These  black 
dots  are  the  orifices  of  diseased  follicles,  in  which 
the  stumps  have  been  broken  off  on  a  level  with 
the  surface  of  the  scalp  by  friction,  or  are  the  aper- 
tures, filled  with  dirt,  left  by  the  retraction  of  the 
broken  and  shortened  stump  into  the  follicle  after 
attempted  epilation. 

It  is  most  difficult  to  certify  that  any  case  of  ring- 
worm is  absolutely  well.  Time  after  time,  stumps 
that  were  not  visible  at  one  examination  will 
crop  up  again,  Tareaking  off  when  any  attempt  is 
made  to  extract  them,  and  reappearing  again  and 
again  for  months  after  the  case  in  other  respects 
seems  cured.  Nor  must  it  be  forgotten  that  stumps 
are  not  removed  when  they  only  break  off",  and 
that  no  reliance  for  diagnosis  or  prognosis  can  be 
j)laced  on  the  microscojjical  examination  of  short 
ordinary  hairs  taken  from  a  patch,  but  only  of  the 
stumps. 

In  conclusion,  I  would  warn  medical  men  not  to 
apply  croton-oil  without  due  consideration  for  or- 
dinary cases  of  chronic  ringworm.  If  they  do,  they 
will  be  sure  to  get  into  trouble,  sooner  or  later.  The 
oil  often  causes  much  inflammation,  and  parents 
get  frightened,  and  imagine  the  doctor  has  made  the 
disease  ten  times  worse.  Sometimes  they  will  seek 
other  advice,  and  are  told  that  their  former  medi- 
cal attendant  has  been  overtreating  the  case,  and 
has  been  using  too  strong  remedies.  Under  soothing 


applications,  the  little  patient  gets  well,  and  the 
second  attendant  gets  the  credit  of  curing  the  ring- 
worm, which  was  practically  well  when  he  first  saw 
the  case.  I  always  explain  to  parents  beforehand 
the  reasons  for  adof)ting  this  treatment,  and  the 
results  to  be  expected  from  it.  It  is  also  important 
to  bear  in  mind  that  simple  remedies  will  generally 
be  efficacious  in  eradicationg  ringworm  in  young 
children,  and  that  stronger  ones  in  such  cases 
should  never  be  employed. — Alder  Smith,  M.B. 
Lond.,  P'.R.C.S.,  in  the  British  Afedical  Journal. 

TREATMENT  OF  HOUSEMAID'S  KNEE. 

Dr.  G.  W.  H.  Kemper,  of  Muncie,  Ind.,  writes 
as  follows  : 

"  In  Braithwaite's  Retrospect,  part  62,  page  151, 
Dr.  C.  R.  Thompson  contributes  a  summary  of 
six  cases  of  this  affection  cured  by  the  plaster  of 
ammoniacum  and  mercury.  He  says,  '  I  believe 
that  the  treatment  of  inflamed  bursa  patella  by  the 
plaster  of  ammoniacum  and  mercury  is  not  so  gen- 
erally known  and  accepted  as  it  deserves  to  be.' 
After  reading  this  strong  indorsement  I  determin- 
ed to  try  the  remedy  at  the  first  opportunity. 
About  the  ist  of  April  of  the  present  year  Mr.  M., 
a  miller  by  profession,  came  to  me  with  a  well- 
marked  case  of  '  housemaid's  knee.'  The  affection 
had  existed  for  several  weeks,  and  had  arrested  his 
attention  by  the  enlargement  and  uneasiness.  I 
directed  the  above-named  plaster  spread  upon  lea- 
ther and  worn  over  the  patella.  He  attended  to 
his  usual  duties,  and  his  cure  was  effected  before 
the  month  was  ended." 


TREATMENT  OF  NOCTURNAL  INCON- 
TINENCE OF  URINE. 

BY  DR.  KELP. 

The  author  has  treated  successfully  rebellious 
cases  of  the  trouble  by  the  hypodermic  use  of 
nitrate  of  strichnia.  The  injection  is  made  in  the 
neighborhood  of  the  sacrum.  A  single  dose  stops 
the  trouble  for  a  little  time.  When  the  symptoms 
return  the  injections  are  renewed.  The  last  obser- 
vation was  on  a  young  woman  of  sixteen  years, 
who,  after  an  attack  of  scarlet  fever,  suffered  sev- 
eral months  from  incontinence,  in  spite  of  every 
precaution.  The  first  injection  of  strichnia  pro- 
cured a  cessation  of  the  incontinence  for  several 
nights.  The  treatment  was  repeated,  and  the  cure 
was  completed.  The  patient  was  a  strong  girl  in 
good  health  and  had  never  before  suffered  from 
incontinence. — Gaz.  Hebdomadaire. —  Cincinnati 
Lancet  and  Clinic. 


OINTMENT  FOR  ITCH. 

Balsam  of  Peru,  i  ounce;  benzoic  acid,  no 
grains  ;  oil  of  cloves,  40  drops  ;  alcohol,  2^ 
drachms  ;  simple  cerate,  7  ounces.  Dissolve  the 
essential  oil  and  the  benzoic  acid  in  the  alcohol, 
and  mix  them  with  the  cerate.  Lastly,  add  the  bal- 
sam of  Peru.  It  is  said  to  effect  a  cure  in  twenty- 
four  hours. — Drug.   Circular. 


THE   CANADA   MEDICAL    RECORD. 


65 


The  Canada  Medical  Record, 

a  iaoutfjln  Journal  of  ifHeUiciue  ana  ^fjarmacM 
FBANCIS  W.  CAMPBELL, MA.,  M.D.,L.14.C.P.L0ND. 

ASSISTANT  KDITOnS  : 

E.  A.  KENNEDY,  M.A,,  M.D. 

JAMES  PERRIGO,  M.D.,  M.R.C.S.  Eng. 

KDITOR  OP   PHABMACKUTICAL    DEPARTMENT; 

ALEX.  H.  KOLLMYEE,  M.A.,  M.D- 

SUBSCRIPTION  TWO  DOLLARS  PER  ANNUM  . 

All  communications  and  Exchanges  mvsi  he  addressed  to 
the  Editor,  Drawer  356,  Post  OJlce,  Montreal. 

MONTREAL.  DECEMBER,  1880. 

TO  OUR  SUBSCRIBERS. 

We  desire  to  say  to  our  Subscribers  that  it  will 
oblige  us  if  they  will  take  a  look  at  the  date  on 
their  address  label.  Many,  very  many,  are  in 
arrears,  some  greatly  so.  Will  these  remember 
that  the  Record  costs  money,  and  remit  the 
amount  due  us. 


On  Dit. — It  is  reported  the  UrsuHnes  are 
making  overtures  to  the  authorities  of  Laval 
University  for  the  purchase  of  their  buildings  at 
Quebec,  and  that  it  is  possible  the  whole  Univer- 
sity may  be  removed  to  the  city.  We  give  the 
report  for  what  it  is  worth. 


ANIMAL  VACCINE,    HOW  IT   IS  PROPA- 
GATED. 

The  following  account  is  from  the  pen  of  the  re- 
porter of  a  secular  paper  (Montreal  Witness),  who 
visited  and  described  what  he  saw  at  the  vaccina- 
tion stables  of  our  confrere,  Dr.  Bessey  of  this  city. 

"  We  may  echo  the  words  of  our  contemporary, 
the  Canadian  Medical  and  Surgical  Journal,  in  a 
recent  issue,  when  it  says  :  "  Small-pox  may  be 
said  to  scarcely  exist  in  Montreal  at  the  present 
time,  and  the  closing  of  the  small-pox  hospital  is 
seriously  contemplated.  There  can  be  no  doubt 
that  this  very  satisfactory  state  of  things  is  largely 
due  to  the  supply  of  pure  lymph  which  has  been 
at  the  disposal  of  our  public  vaccinators  for  the 
past  three  years." 

"  Through  the  courtesy  of  Dr.  Bessey  our  reporter 
visited  his  vaccination  stables,  and  was  shown  the 
vaccine  disease  in  a  well-developed  stage  on  a 
handsome  young  heifer.  None  but  the  best  ani- 
mals are  fit  for  the  purpose.  This  animal,  which 
had  been  vaccinated  seven  days  previous  on  the  in" 


side  of  the  buttocks,  previously  cleanly  shaven  for 
the  purpose,  was  literally  covered  over  the  vaccin- 
ated region  with  well-defined  genuine  cow-pox 
pustules,  singly  and  in  groups  of  six  to  ten." 

Fig.  1  gives  the  appearance   presented  on  this, 
heifer. 


J 


"  Another  choice  heifer  stood  in  a  stall  awaiting- 
vaccination  from  this  animal,  one  being  vaccinated 
from  the  other  consecutively.  This  had  been  kept 
up  in  uninterrupted  succession  from  the  original 
cases  of  spontaneous  cow-pox  found  upon  the  Le- 
ney  farm,  Longue  Pointe,  in  November,  1877,  of 
which  Fig.  2  is  a  representation." 


^iiig?"  -V^:-^ 


Fig.  2. 
"  There  has  already  been  furnished  from  this 
source  lymph  for  the  vaccination  of  over  50,000 
persons,  with  uniformly  mild  and  gratifying  results. 
It  is  now  used  by  the  profession  from  Halifax  to 
Winnipeg  in  Canada,  and  by  a  goodly  number  of 
the  profession  in  the  border  States.     Lymph  has 


«G 


THE   CANADA    MP:DICAL    RECORD. 


een  sent  to  members  of  the  profession  in  England 
interested  in  vaccination  and  to  Dr.  Buchanan  of  the 
National  Vaccine  Establishment,  Whitehall,  S.W., 
which  has  been  duly  ackuowlcJj^eJ  a^  ;"ollows  ; 

National  Vaccine  Establishment, 

Whitehall,   S.  W., 

loth  Nov..    1880. 
Dkar  Sir, 

The  animal  lymph  which  you  have  so  kindly 
sent,  has  been  duly  received,  and  Dr.  Buchanan 
desires  me  to  thank  you  for  the  same;  he  is, 
besides,  much  interested  in  your  proceedings  in  the 
cultivation  of  animal  lymph. 
1  am,  Dear  Sir, 

Yours  faithfully, 
A.  B.  Faru, 
Examiner  of  Vaccine  Lymph  to  H.  M.  Governmettt. 
W.  E.  Bessev,  Esq.,  M.D. 

"  During  last  winter  vaccine  was  furnished  from 
this  stable  for  the  vaccination  of  the  viceregal 
household  of  the  Princess  Louise  at  Ottawa,  and 
used  by  Dr.  Grant,  physician  to  H.  R.  H.  At  that 
time  a  variolous  epidemic  prevailed  in  many  parts 
of  Canada,  and  to  meet  the  increased  demand  se- 
veral heifers  were  vaccinated  at  one  time,  but  the 
number  is  diminished  to  one  every  eight  days  in 
ordinary  times,  which  is  absolutely  necessary  to 
keep  up  the  succession  and  prevent  delays.  The 
city  is  furnished  once  a  month  at  present  wit^a  a 
fresh  stock  direct  from  the  animal,  and  most  of  the 
city  physicians  obtain  their  supplies  here,  so  that 
the  absolute  purity  and  the  protective  power  against 
srnall-pox  of  true  Jennerian  vaccination  is  guaran- 
teed. Dr.  Bessey  is  full  of  hope  that  one  day 
the  Government  may  be  able  to  spare  sufficient 
money  from  their  railway  and  other  enterprises  to 
establish  a  national  vaccine  institute  where  this 
mode  of  supply  would  be  perpetuated  to  future 
generations." 

HOW   IT  i.s  noNE. 

"Two  appliances  for  managing  the  animal  stood 
in  the  stable — one,  a  strong  wooden  frame  held  to- 
gether with  iron  bolts,  supported  a  suspended  sheet 
of  canvas  over  two  rollers.  This  is  used  for  large 
animals,  which  are  driven  in  and  the  head  securely 
fastened,  after  which  the  sheet  of  canvas  is  adjust- 
ed under  the  belly,  and  by  a  turn  or  two  of  the  rol. 
lers  the  animal  is  suspended  a  few  inches  from  the 
ground,  the  feet  being  fastened  to  prevent  kicking, 
while  the  shaving  and  vaccinating  goes  on.  The 
other  is  a  strong     wooden    frame   supporting    a 


tumbling  table.  This  being  upright  the  animal  i-s 
brought  alongside  and  securely  strapped  thereto,  a.s 
shown  in  Fig.  i.  It  is  then  upturned  and  the  ani- 
mal finds  itself  on  its  side  and  i)erfectly  helpless, 
unable  to  make  the  slightest  resistance  to  the  oper- 
ator, who  proceeds  either  to  vaccinate  or  collect 
the  lymph  as  the  case  may  be." 

"  Fig.  3  illustrates  the  plan  of  construction  of  this 
table,  which  is  modeled  on  the  pian  of  those  in  use 
by  Prof  Depaul,  France,  and  Dr.  Martin,  Boston, 
U.S.,  no  originality  being  claimed  for  it." 


"  The  animal  being  thus  perfectly  secured,  the 
vessels  are  pinched  up  and  ruptured,  when  a  clear 
watery-looking  lymph  exudes.     This  is  collected 
upon  ivory  points  (specially  made  for  the  purpose) 
and  spread  out  on  a  shelf  to  dry.  A  number  of  the 
vesicles  are  usually  left  untouched  to  dry  up  and 
form  scabs  which  are  still  preferred  to  points  by 
many  senior  practitioners.     The  points  are  then 
carefully  wrapped  up  in  cotton  wool,  to  prevent  the 
absorption  of  moisture  from  the  atmosj)here,  and 
next   in  blue  paper  to  prevent  the  action  of  the 
sunlight,  which  rapidly  destroys  any  virus  exposed 
to  it.  They  are  then  wrapped  in  tin  foil  to  preserve 
an  equal   temperature,  and  finally  enveloped  in 
rubber  tissue,  hermetically  sealed,  to  preserve  therm 
air-tight  when  transmitted  to  a    distance.     With 
each  package  sent  out,  bearing  date  and  registra- 
tion, is  a  printed  sheet  of  directions  and  observa- 
tions on  the  use  and  preservation  of  vaccine.  Any 
package  proving  inert  is  also  replaced  with  fresh 
active  virus.     By  this  means  the  public  sentiment 
among  the  masses  of  the  City  of  Montreal  has  been 
entirely  changed  in  favor  of  vaccination.  Small-pox 
is  so  far  extinguished  that  the  Board  of  Health  have 
decided  to  abolish  the  Small-pox  Hospital,  and  we 
hear  110  more  of  ulcerated  arms  from  vitiated  virus, 


THE   CANADA    MEDICAL   RECORD. 


6T 


or  small-pox  following  vaccination  with  degener- 
ated lymph." 

*'  In  a  fortnight  all  traces  of  the  disease  disappear 
from  the  animal,  which  is  then  disposed  of,  and 
fresh  animals  are  provided  to  take  their  place, 
these  not  being  again  susceptible  to  the  infection." 

"  The  history  of  the  Longue  Pointe  stock  of  vac- 
cine may  be  given  briefly  as  follows  :  On  Nov. 
6th,  1877,  Dr.  Bessey  visited  the  farm  of  Mr.  John 
Leney  (since  deceased),  at  Longue  Pointe,  oppo- 
site the  Provincial  Lunatic  Asylum,  and  found 
there  six  animals  affected  with  cow-pox  in  various 
stages  of  development.  From  these  cows  suffi- 
cient lymph  was  taken  to  make  a  beginning,  and 
on  Nov.  7th  the  first  child  in  Montreal,(one  Michael 
O'Mara)  was  vaccinated  successfully  with  this 
stock  of  lymph.  Animals  at  Logan's  farm  were 
also  inoculated  with  it,  and  thus,  from  animal  to 
animal,  and  child  to  child,  the  stock  has  been  kept 
up  ever  since.  Whenever  it  has  been  used,  the  re- 
sults have  been  mild  and  satisfactory." 

*•  We  may  now  repeat,  in  Nov.,  1880,  with  in- 
creased emphasis,  the  statement  made  by  our  con- 
teruporary  iheC/nion  Medicaie,  in  Nov.,  1878,  as  it 
has  now  been  much  more  extensively  used  : 

"  The  lymph  produced  by  Dr.  Bessey  was  at 
first  found  on  the  cows  of  a  milkman  at  Longue 
Pointe,  near  Montreal,  a  year  ago,  and,  although 
this  vaccine  has  been  used  on  several  thousand 
persons  in  Montreal  and  the  other  Canadian  cities 
in  the  course  of  that  year,  no  accident  has  been 
noticed,  no  undue  irritation,  no  erysipelas,  no  in- 
fection of  the  blood — a  thing  which  is  easily  under- 
stood, as  this  lymph  is  taken  from  the  animal,  and 
extracted  from  vesicles  well  developed." — L^  Union 
Midicale,  Nov.,  1878. 

Any  members  of  our  profession  requiring  a 
supply  of  pure  vaccine  could  not  do  better  than 
obtain  it  from  this  source.  Animal  lymph  is  be- 
coming annually  more  popular,  and  is  that  variety 
used  by  the  leading  members  of  the  profession 
everywhere,  because  of  the  safety  it  ensures. 


TYPHOID  FEVER  AT  BISHOP'S  COL- 
LEGE SCHOOL,  LENNOXVILLE. 

This  school,  regarded  by  a  large  number  as  the 
best  boys'  school  in  the  Dominion,  has  been  unfor- 
tunate this  year,  in  the  breaking  out  of  typhoid  fever 
upon  two  separate  occasions,  the  last  being  early 
the  present    month.     When    the    first    outbreak 


occurred,  the  school  was  broken  up,  and  the  sani- 
tary condition  examined  ;  defects  were  found  in  the 
drainage,  and  these  were  remedied,  and  the  whole 
system  examined  by  competent  engineer  authority, 
and  pronounced    to  be  most   complete  in  every 
respect.     A  second  outbreak  took  place,  as   we 
have  stated,  early  this  month,  and  of  course  the 
school  was  closed.     Six  of  the  boys  in  attendance 
upon   the    school   have  become    victims    to    the 
disease,  and   one  of  them   has    died.     Such  an 
occurrence   taking   place   at    such   a  well-known 
school  has  caused  no  end  of  talk ;  while  reports 
the  most  outrageous  have  been  circulated.    Feeling 
the   importance  of   the    situation,  and   the  duty 
which  they  owed  to  the  public,  the  College  authori- 
ties determined  to  act  with  vigor.     On  the  17th 
December,  R.  W.  Heneker,  Esq.,  the  Chancellor 
of  the  University,  came  to  Montreal,  and  at  the 
Windsor  Hotel    had  a    conference   with    several 
friends  of  the  institution.     Dr.  J.  Baker  Edwards, 
Dr.    F.  W.    Campbell,    Dr.    Cameron,    and   Dr. 
Simpson  of  the  Faculty  of  Medicine  of  Bishop's 
College  were  present,  as  also  was  Dr.  Osier  of  the 
McGill  Faculty  of  Medicine.     The  result  of  this 
conference  was  the  appointment  of  a  committee ^ 
consisting  of  Walter  Shanly,  C  E.,  Drs.  Cameron. 
Osier  and  Simpson,  to  examine  into  the  matter 
thoroughly.     On    the    i8th    they    proceeded   to 
Lennoxville  and  commenced  their  labors.     As  we 
go  to  press  we  learn  they  have  returned,  and  that 
while  we  are  as  yet  unable  to  say  positively  that 
the  origin  of  the  epidemic  has  been  discovered, 
we  believe  that  the  general  impression  is  that  a 
line  of  investigation  is  beir-g  followed,  which  at 
this  moment  seems  to    promise   most  important 
results.     We  are  strongly  of  the  opinion  that  the 
result  of  the  labors  of  this  committee  will  be  such 
as  to  restore,  after  a  time,  full  confidence  in  the 
sanitary  arrangements  of  the  school. 


At  the  regular  meeting  of  the  Medico-Chirurgi- 
cal  Society  of  Montreal,  held  on  November  26th,, 
Dr.  Bessey  produced  the  case  of  Psoriasis  Lepra- 
formis  previously  vaccinated,  stating  in  course  of 
his  remarks  thereon  that  he  had  vaccinated  her  on 
each  arm  and  each  leg.  all  of  which  twelve  places 
had  taken  well.  She  was  very  ill  and  feverish  for 
some  days  from  the  vaccination,  and  a  secondary- 
eruption  had  followed  the  operation.  The  original 
eruption  had  almost   entirely  disappeared  (fromc 


€8 


THE   CANADA    MEDICAL    RECORD. 


ome  parts  more  than  others)  ;  the  secondary  rash 
still  remained  more  distinct. 

Many  of  the  members  expressed  surprise  at 
the  great  change  which  had  already  taken  place 
in  twenty-six  days,  the  scales  had  fallen  off,  the 
itching  of  the  skin  had  disappeared.  The  erup- 
tion had  every  Spring  declined  of  itself,  but  never 
to  the  same  extent  and  not  at  this  season. 

Dr.  Ross  said  the  experiment  was  a  most  inter- 
esting one,  but  he  had  no  faith  in  the  curative  ac- 
tion, and  held  that  the  fever  excited  by  vaccina- 
tion might  account  for  thejchange. 

Dr.  Roddick  facetiously  remarked  that  more  soap 
and  water  than  usual  might  have  been  used. 

Dr.  Bessey,  in  reply,  stated  that  the  disappear- 
ance of  the  eruption  had  been  very  gradual  up 
to  date,  that  no  other  means  had  been  used  in 
her  case,  and  that  no  special  applications  of 
soap  and  water  had  been  resorted  to.  He  re- 
garded the  case  as  yet  in  a  state  of  trafisiiion, 
and  might  again  avail  himself  of  an  opportun- 
ity at  a  future  meeting  to  exhibit  the  final  results. 
No  one  could  deny  that  the  improvement  in 
the  condition  of  the  patient  had  been  already 
very  marked,  amounting  almost  to  a  perfect  cure. 
He  had  his  own  view  of  the  cause  of  cure  which 
differed  from  that  of  Dr.  Ross.  He  had  been 
desirous  of  establishing  two  points  in  practice,  in 
which  he  thought  he  had  succeeded,  viz.  :  First- 
That  there  need  be  no  hesitation  in  vaccinating 
any  child  or  individual  with  a  skin  eruption,  not- 
withstanding the  old  dogma  on  this  point,  which 
was  obsolete.  Second.  That  the  action  of  vaccine 
in  such  a  case  would  tend  to  ameliorate,  if  it  did 
not  entirely  cure,  the  patient's  condition,  although 
in  every  case  a  temporary  increase  or  secondary 
eruption  would  be  likely  to  follow  vaccination. 

Dr.  Edwards  stated  that,  since  the  reading  of 
Dr.  Bessey's  paper,  he  had  vaccinated  a  child 
covered  with  eczema  and  that  the  eruption  had 
■entirely  disappeared,  with  the  exception  of  a  small 
spot  on  left  arm,  and  he  supposed  that  if  he  had 
vaccinated  on  both  arms  that  would  have  disap- 
peared also  by  this  time. 


In  the  October  number  of  the  Medical  Record 
we  stated  that  Dr.  C.  Eugene  Nelson,  of  New 
York,  had  decided  to  perpetuate  the  name  of  his 
father — the  late  Dr.  Robert  Nelson,  who  many 
years  ago  was  a  prominent  Surgeon  in  Montreal--by 
founding  in  the  Medical  Faculty  Bishop's  College 


a  gold  medal— to  be  known  as  the  "  The  Robert 
Nelson  Gold  Medal."  The  details,  we  are  pleased 
to  say,  are  now  fully  completed,  Dr.  Nelson  having 
placed  in  the  hands  of  the  University  the  sum  of 
one  thousand  dollars,  the  interest  upon  which  will 
yearly  pay  for  the  medal.  At  Dr.  Nelson's  desire 
the  medal  will  be  awarded  for  the  best  special 
examination  in  surgery — oral,  written  and  practical 
Believing  that  many  would  desire  to  know  some- 
thing of  the  man  in  whose  memory  the  medal 
has  been  founded,  we  copy  a  memoriam  of  him, 
published  in  New  York  at  the  time  of  his  death. 

DR.  ROBERT  NELSON. 
[in  memoriam.] 

Dr.  Nelson  was  born  in  Pot-au-Beurre,  near 
Sorel,  Province  of  Quebec,  Canada,  August,  1794- 
His  father,  William  Nelson,  came  from  Yorkshire, 
England,  before  the  Revolutionary  War,  and 
settled  with  his  wife  in  Catskill,  N.  Y.  Being  a 
royalist  he  was  obliged  to  leave  this  place,  and 
settle  in  Three  Rivers,  Canada.  He  moved  some- 
time later  to  Montreal,  and  finally  to  Sorel,  where 
he  lived  and  taught  school  for  many  years.  Over 
seventy  years  ago  he  built  the  Manor  House, 
where  the  descendants  at  present  reside,  his  son 
Robert  assisting  in  the  manual  labor.  His  mother 
Jane  (Dyce)  Nelson  was  English,  of  Dutch  ex- 
traction. 

His  youth  was  passed  at  Sorel  under  the  tuition  of 
his  father,  and  at  Pot-au-Beurre,  where  he  worked 
very  hard.  It  must  have  been  at  this  period  of 
his  life  that  he  acquired  the  thorough  knowledge 
of  agriculture  which  was  portrayed  in  the  minutest 
detail  during  his  life  at  Giffard's,  Staten  Island. 
At  an  early  age  he  left  home  on  account  of  the 
severity  of  his  father,  and  went  to  Montreal ;  this, 
however,  did  not  influence  him  in  regard  to  his  pa- 
rents in  after  life,  as,  when  a  member  of  Parliament 
for  Montreal,  he  would  stop  at  Sorel  on  his  way  to 
Quebec — make  a  hurried  visit,  and  leave  them 
some  funds.  In  Montreal,  he  was  apprenticed  to 
Dr.  Ryan,  and  subsequently  to  Dr.  Arnoldi ;  at 
the  age  of  16,  he  was  gazetted  assistant  army  sur- 
geon in  charge  of  the  auxiliary  force  known  as  the 
Indian  department ;  he  remained  encamped  with 
the  Indians  five  years,  during  which  period  the 
war  of  181 2  occurred.  After  the  expiration  of  his 
term  of  service,  he  lived  in  Montreal  under  the 
superintendence  of  Dr.  Arnoldi,  assisting  him  in 
his  practice  ;  he  soon  began  practice  on  his  own 
account,  subsequently  building  on  Gabriel  street, 


THE    CANADA   MEDICAL    RECORD. 


65^ 


where  he  remained  till  the  rebellion  of  1837.  Dur- 
ing his  life  in  Montreal  he  was  elected  member  of 
Parliament  for  the  Eastern  District,  health  com- 
missioner during  the  cholera  invasion  of  1832-34, 
President  of  the  Medical  Board  for  the  District  of 
Montreal,  Physican  in  charge  of  the  Lunatic  Asy- 
lum, Gaol,  several  of  the  convents,  and  the  Hotel 
Dieu  Hospital.  He  rapidly  acquired  fame  and  for- 
tune, especially  from  his  success  in  Lithotomy,  oper. 
ating  8 1  times  with  only  two  deaths.  In  1 83  5  he  visit- 
ed Europe,  where  he  became  acquainted  with  Astley 
Cooper^  Hodgkin,  Roux,  Baron  Boyer  and  Dupuy. 
tren.  It  was  during  this  period  that  he  married 
Miss  Emily  de  Bathe,  born  at  Oakley,  near 
Cirencester,  England.  In  1836,  Dr.  Nelson  return- 
ed to  Montreal  with  his  wife  ;  about  this  time  things 
began  to  wear  a  threatening  aspect,  and  he  es- 
poused the  revolutionary  cause,  more  because  his 
brother,  Dr.  Wolfred  Nelson,  had  done  so,  than 
from  his  own  desire.  He  was  chosen  leader  of 
the  revolutionary  party  in  Lower  Canada.  In  the 
winter  of  1837  ^^  ^^^^  obliged  to  fly  to  the  United 
States  ;  in  1838  he  made  an  incursion  into  Canada, 
which  failed  of  its  object.  Dr.  Nelson  then  resided 
as  an  exile  in  different  towns  in  Vermont,  where 
he  pursued  the  practice  of  medicine.  He  was 
afterwards  appointed  to  the  chairs  of  Anatomy  and 
Surgery  at  Castleton,  Vt.,  and  Pittsfield,  Mass., 
having  for  colleagues  Dr.  Willard  Parker  and  Dr. 
Horace  Green.  He  then  removed  to  New  York, 
where  he  practiced  medicine  till  1849.  During 
his  residence  in  this  city  he  delivered  a  course  of 
lectures  on  Physiology,  based  on  original  researches. 
In  1849,  ^^  went  to  California,  where  he  practiced 
a  number  of  years,  and  distinguished  himself 
especially  in  his  operations  for  ovarian  tumors  ; 
during  this  period  he  visited  Europe  several  times, 
making  the  acquaintance  of  Queckett,  Luke,  South, 
Baker  Brown,  Milne  Edwards,  Bois  du  Noel,  and 
others.  While  in  California  he  spent  much  of  his 
time  in  researches  in  the  natural  kingdoms  for 
the  purpose  of  illustrating  physiological  truths. 
He  subsequently  practiced  in  New  Tork  for  a 
term  of  years.  He  has  written  on  his  ''  Fracture 
Bedstead  for  the  Thigh  ; "  "  Lithotomy  in  the 
Female,"  his  own  operation ;  "  Gastrotomy,"  a 
pamphlet  describing  his  operations  on  different 
kinds  of  abdominal  tumors  ;  and  a  "  Treatise  on 
Asiatic  Cholera."  His  wife  died  at  Richmond,  Eng- 
land, in  1859,  during  one  of  his  visits.  He  died  at 
Gififard's,  Staten  Island,  N.  Y.,  March  ist,  1873,  in 
the  79th  year  of  his  age.     His  remains  were  taken 


to  Greenwood,  where  a   white  marble  monument, 
representing  grief,  marks  his  burial  place. 


COLLEGE  OF  PHV^SICIANS  AND 
SURGEONS, 

PROVINCE   OF   QUEBEC. 

Our  readers  in  the  Province  of  Quebec  will 
perhaps  be  interested  in  knowing  that  Mr.  Lami- 
rande,  who  was  appointed  by  the  College,  at  its 
last  Semi-Annual  meeting,  prosecuting  officer, 
has  been  making  things  quite  lively  among  those 
who  have  neglected  to  comply  with  the  new  law. 
We  understand  that  many  feel  annoyed  at  having 
to  pay  the  fine  imposed  by  the  Act.  They  can, 
however,  only  blame  themselves,  for  ample  and 
sufficient  notice  was  given  of  the  requirements  of 
the  law.  When  Mr.  Lamirande  has  brought  the 
regular  profession  into  line,  we  hope  he  will 
pursue  the  irregulars  with  unabated  zeal.  At 
last  the  Profession  is  commencing  to  Fealize  that  the 
College  of  Physicians  and  Surgeons  of  Quebec  is. 
a  live  institution. 


AN  OMISSION. 

The  paper  on  vaccination  in  chronic  skin 
diseases,  published  in  our  last  issue,  was  from  the 
pen  of  Dr.  Bessey  of  Montreal.  By  a  strange 
omission  his  name  did  not  appear  as  its  author. 


REVIEWS. 

How  p 67- sons  afflicted  with  Brighfs  Disease  ought 
to  live.  By  Joseph  F.  Edwards,  M.D.  Phila- 
delphia :  Presley  Blakiston. 

The   title  of  this  little  book   does   not   at    alJ 
fully  convey  its  character,  for  it  does  more  than 
tell  those  who  have  Bright's  Disease  how  they 
ought  to  live.    It  describes  briefly,  but  clearly,  the 
functions  of  the  kidneys,  and  their  derangements  ; 
a  chapter  is  given  on  Bright's  Disease — What  is  it  "> 
The  remaining  chapter  indicates  the  mode  of  life 
most  likely  to  be  followed  with  benefit  by  those 
.  who  suffer  from  it.    Bright's  Disease  is  one  which, 
within   the  last  two  or  three  years,  has  received 
much  attention  from  the  profession,  and  there  is 
no  doubt  now  that,  with  judicious  medical  treat- 
ment,  avoidance  of  great  mental   exertion  and 
pure  country  air  (of  a  nearly  regular  temperature 
all  the  year)   many  cases  which   were   formerly 


70 


THE  CANADA  MEDICAL  RECORD. 


looked  upon  as  hopeless  are  now  able  to  pass  a 
long  period  in  comparative  comfort.  Dr.  Edwards 
puts  some  stress  upon  what  he  terms  "  moral 
medicine,"  believing  jt  to  be  a  powerful  agent  in 
all,  but  especially  so  in  ihis  disease.  By  moral 
medicine  he  means  a  belief  in  the  existence  of 
-an  All-wise  Creator  who  ordains  everyihing  for 
the  best.  A  firm  faith  in  this  doctrine  tranquillizes 
the  mind,  and  thus  favors  convalescence.  We  do 
not  generally  believe  in  patients  having  in  their 
possession  works  treating  upon  the  disease  they 
may  be  suffering  from.  It  does  not,  as  a  rule, 
promote  recovery.  This  little  work  is,  however, 
an  exception,  and  may  with  safety,  yes,  with  profit, 
be  placed  in  the  hands  of  all  patients  with 
Albumen  Urea.  It  will  calm  many  of  the  fears, 
and  give  them  faith,  which  will  do  much  to  prolong 
life. 

A  Treatise  on  Diphtheria.  By  A.  Jacobi,  M.D., 
Clinical  Professor  of  Diseases  of  Children  in 
the  College  of  Physicians  and  Surgeons  of  New 
York.  William  Wood  &  Co.,  New  York  ; 
Montreal,  Dawson  Brothers. 

For  twenty  y^ars  Dr.  Jacobi  has  been  a  con- 
tributor to  the  literature  of  Diphtheria  and  an 
acknowledged  authority  upon  the  subject.  His 
various  monographs  have  always  been  well 
received,  and  we  predict  the  same  for  his  latest 
effort  in  the  volume  before  us.  We  have  gone 
through  most  of  it,  and  find  that  not  only  does  Dr. 
Jacobi  ventilate  a  theory,  of  his  own  slashing  at  the 
Bacteric  School  with  a  will,  but  that  he  is  par- 
ticularly profuse  in  the  therapeutical  portion.  This 
section  of  the  book  is  really  admirable,  and  will 
commend  itself  to  all  who  read  it.  We  consider 
it  a  valuable  contribution  to  the  literature  of 
Diphtheria. 

Tht  Practitioner's  Reference  Book.  By  Richard 
J.  DuNGLisoN,  A.M.,  M.D.  Philadelphia, 
Lindsay  &  Blakiston  ;  Montreal,  Dawson  Bros. 

Upon  a  previous  occasion,  when  the  first  edi- 
tion appeared,  we  expressed  a  very  favorable 
opinion  of  this  work,  and  a  constant  use  of  it 
has  only  served  to  confirm  our  first  impression. 
The  present  volume  has  largely  outgrown  tlie 
previous  one,  being  almost  double  its  size,  and  yet 
we  do  not  see  anything  that  could  have  been 
omitted.  A  use  of  the  first  edition  showed  many 
wants,  most  of  which  seem  supplied  in  the  pre- 
sent one.  Several  entirely  new  chapters  have 
been  introduced,  among  them  the  following  :  ist. 


How  to  write  metric  prescriptions.  2nd.  How  to 
use  the  hypodermic  syringe.  3rd.  The  galvanic 
battery  in  medicine  and  surgery.  4th.  How  to 
use  the  clinical  thermometer.  We  believe  the  work 
to  be  the  most  universally  useful  book  that  has 
appeared  for  a  long  time. 

The  Druggist's  Hand  Book  of  Private  Formulas. 
By  John  H.  Nelson,  seventh  edition.  Cleve- 
land, Ohio,   1881.     Price  $3. 

This  is  a  volume  which  contains  an  immense 
number  of  receipts,  and  it  cannot  but  be  ex- 
ceedingly useful  to  druggists.  The  formulas  are 
varied,  and  embrace  many  which  cannot  be  found 
anywhere  else.  We  regret,  however,  to  notice  in  it 
recipes  for  curing  Gonorrhoea.  They  are  out  of 
place  in  such  a  book,  for  the  practice  of  medicine 
is  no  portion  of  a  druggist's  business. 

The  Microscopist :  a  Manual  of  Microscopy  and 
Compendium  of  the  Microscopic  Sciences  :  Micro- 
Miner  alogy,  Micro-Chemistry.,  Biology,  Histo- 
logy, and  Practical  Medicine.  Fourth  Edition, 
greatly  enlarged,  with  two  hundred  and  fifty - 
two  illustrations.  By  J.  H.  Wythe,  A.M-, 
M.D.,  Professor  of  Microscopy  and  Histology 
in  the  Medical  College  of  the  Pacific,  San 
Francisco,  California.  Philadelphia,  Lindsay  & 
Blakiston  ;  Montreal,  Dawson  Brothers. 

This  book  aims  to  be  a  compendium  of  the 
microscopic  sciences ;  whether  it  is  all  that  it 
claims  we  are  unable  to  say,  but  that  portion 
devoted  to  Practical  Medicine  is  most  complete, 
and  we  should  therefore  judge  favorably  of  the 
other  portions.  The  illustrations  are  very  fine, 
and  many  of  them  are  colored  to  the  life.  No 
one  at  all  pretending  to  a  scientific  knowledge  of 
the  medical  profession  can  afford  not  to  be  a 
microscopist,  be  his  ability  in  that  direction  g^eat 
or  small.  This  volume  is  one  that  commends 
itself,  therefore,  to  all  in  tlie  profession  who  use 
the  micro.scope.     Price  $5.00. 

"  The  Trials  of  Paissa,"  a  Russian  Love  Story. 
By  Henry  Greville.  T.  B.  Peterson  &  Bros., 
Philadelphia. 

This  is  a  story  full  of  fascination  and  power,  the 
more  felicitous  and  interesting  because  out  of  the 
common  track.  Henry  Greville  has  written  many 
stories,  but  none  more  absorbing  and  natural  than 
this.  The  scene  is  laid  in  Russia,  where  Henry 
Greville  is  most  at  home,  and  the  action  takes  place 
in  St.  Petersburg,  the  country,  and  Siberia.  The 
descriptions  are  admirable,  and  the  reader  is  given 


THK    CANADA    MEDICAL    RECORD. 


71 


a  number  of  exceedingly  picturesque  pen-sketches 
of  winter  and  winter  scenery  in  the  dominions  of  the 
Czar.  Raissa  is  one  of  Henry  Greville's  best-drawn 
characters,  and  no  one  can  fail  to  be  touched  by 
her  sorrows,  her  trials  and  her  loftiness  of  purpose. 
Indeed,  as  a  picture  of  pure  and  upright  woman- 
hood, Raissa  is  an  example  worthy  of  emulation. 
The  task  of  translation  has  been  excellently  per- 
formed by  Mary  Neal  Sherwood.  It  is  published 
in  a  large  square  duodecimo  volume,  paper  cover, 
price  75  cents,  and  will  be  found  for  sale  by  all 
Booksellers  and  News  Agents.  Copies  of  it  will  be 
sent  to  any  one,  on  their  remitting  75  cents  to  the 
Publishers,  T.  B.  Peterson  &  Brothers,  Philadel- 
phia, Pa. 

A  Manual  of  Minor  Surgery  and  Bandaging. 
By  Christopher  Heath,  F.R.C.S.  Sixth 
Edition.  Philadelphia  ;  Lindsay  &  Blakiston  ; 
Montreal :  Dawson  Bros. 

This  little  work  fully  sustains  the  reputation  of 
the  author.  It  is  complete  in  almost  every  respect, 
and  goes  beyond  the  usual  limits  of  works  of  this 
class.  It  should  be  indispensable  to  a  dresser  in 
the  surgical  wards  of  a  hospital ;  in  fact,  older  men 
would  find  it  of  benefit  in  refreshing  their  memories. 

A  Treatise  on  the  Practice  of  Medicine  for  the  use 
of  Students   and  Practitioners.      By    Robert 
Bartholow,      M.D.,      LL.D.,     Professor     of 
Therapeutics  in  the  Jefferson  Medical  College 
of  Philadelphia.     New  York :  D.  Appleton  & 
Co.;  Montreal :  Dawson  Bros. 
Dr.   Bartholow   has   for    a    number  of    years 
ranked  among  the   closest  observers   in  our  pro- 
fession in  the  United  States.     His  pen  has  not  been 
idle,  and  more  than  one  volume,  and  many  papers, 
have  enriched  the  Medical  literature  of  his  coun- 
try, this  being,  we  believe,  his  second  systematic 
work.     We  congratulate  him  upon  the  result,  for 
although  the  volume  before  us  does  not  pretend 
to  be  a  full  and  thorough  exposition  of  the  entire 
subject,  it  presents  in  concise  language  the  main 
and  important  points  of  all  the  principal  diseases 
to  which  the  human  family  is  heir.     The  clinical 
material  he  has  drawn  from  his  own  observations 
at  the  bed-side,  and  that  it  has    been  abundant 
and   closely    observed   is    evident    in    the    very 
complete    manner   in    which    the   symptoms   are 
detailed.       We   are   pleased    to   notice   that  Dr. 
Bartholow    repudiates    any    sympathy    with    the 
therapeutic  Nihilism  of  the  day.    On  the  contrary, 
he  is  emphatic  in  his  conviction  that  remedies 


are  an  important  factor  in  determining  the  course 
of  disease.  He  therefore  gives  the  treatment  with 
a  certain  amount  of  dogmatism — which  is  quite 
excusable,  considering  the  experience  which  he  has 
had.  In  this  respect,  the  work  differs,  and  we  be- 
lieve differs  beneficially,  from  some  other  works  on 
the  same  subject,  where  prominent  Medical  writers 
seem  opposed  to  the  value  of  medicine  in  the 
treatment  of  disease.  We  believe  that  it  will 
prove  a  very  valuable  addition  to  Medical  litera- 
ture ;  and,  from  the  fact  that  it  utters  no  uncertain, 
sound  as  to  the  value  of  treatment,  it  will  do 
much  to  restore  confidence  among  those  weak  in 
the  faith. 


The  January  number  of  Scribner's  will  contain 
an  account  of  the  aims  and  methods  of  the  new 
Horological  and  Therm ometrical  Bureau,  recently- 
established  by  the  Winchester  Observatory  of  Yale 
College,  from  careful  personal  inspection  on  the 
spot.  This  is  the  first  bureau  of  the  kind  estab- 
lished in  this  country,  and  cannot  fail  to  raise  the 
standard  of  excellence  in  both  clocks,  watches, 
and  thermometers.  The  curious  machinery  used 
to  correct  watches  to  the  tenth  of  a  second,, 
together  with  some  singular  facts  in  the  behavior 
and  habits  of  thermometers,  make  the  article  of 
more  than  usual  interest  to  the  reader.  The  same 
number  also  contains  some  account  of  Mr.  John 
La  Farge's  and  Mr.  Louis  C  Tiffany's  recent  work 
in  stained  glass. 


"  Most  perfect  of  juvenile  Magazines,"  is  what 
the  Detroit  Free  Press  calls  St.  Nicholas.  Its 
growth  in  England  is  keeping  pace  with  its  success 
in  this  country,  and  the  English  papers  are  as 
unanimous  in  praise  of  its  beauties  as  the  American 
press.  The  "wonderful  Christmas  number," just 
issued,  the  first  edition  of  which  is  105,000,  is  a 
grandly  illustrated  Holiday  book  of  one  hundred 
pages,  containing,  besides  its  capital  Christmas 
and  fairy  stories,  and  original  pictures  by  the  best 
American  artists,  the  first  chapters  of  two  splendid 
serials — one  a  story  of  the  adventures,  in  the 
American  tropics,  of  a  party  engaged  in  the  cap- 
ture of  wild  animals  for  a  menagerie,  and  a  hu- 
morous serial  by  Rossiter  Johnson. 

A  year's  subscription  to  St.  Nicholas  is  a  holi- 
day gift  the  influence  and  the  joy  of  which  is  felt 
twelve  times  a  year.  Tiie  North  American  recently 
declared,  "  It  would  puzzle  any  one  to  say  in  what 
respect  St,  Nicholas  could    be  improved."  Sub- 


72 


THE    CANADA    MEDICAL    RECORD. 


scriptions  beginning  with  the  beautiful  Christmas 
(December)  number  will  commence  the  two  serials 
mentioned.  Price,  $3  oo  a  year.  The  Christmas 
number  is  for  sale  everywhere  for  30  cents.  Pub- 
lished by  Scribner  &  Co.,  743  Broadway,  New 
York. 


MEETING  OF  MEDICO-CHIRURGICAL 
SOCIETY. 

Oct  29th — Regular  meeting  of  the  Society  was 
held  this  evening,  the  President,  Dr.  Kingston,  in 
the  chair. 

Dr.  Smith  exhibited  a  child  which  had  suffered 
from  tenia  tonsurans.  When  first  seen  the  disease 
was  in  a  very  active  condition,  with  pustules 
about  the  roots  of  the  hair.  Poultices  were  used 
to  remove  the  crusts,  afterwards  dilute  acid  nitrate 
of  mercury  ointment  was  used  with  perfect  success. 
A  mistake  had  been  made  at  one  time  in  using 
the  strong  preparation,  which  excited  a  pustular 
eruption,  but,  on  returning  to  the  use  of  the  diluted 
ointment,  a  complete  cure  was  effected. 

Dr.  Bessey  exhibited  a  patient  covered  with 
psoriasis  lepraformis,  on  whom  he  proposed  to 
vaccinate  for  the  relief  of  the  disease,  and  pro- 
mised to  bring  the  case  before  the  Society  at 
another  meeting,  to  show  the  results.  Dr.  Bessey 
then  read  a  paper  on  vaccination  in  skin  Dis- 
eases (This  paper,  and  the  discussion  which  fol- 
lowed, was  published  in  the  last  number  of  The 
Record). 

Dr.  A.  L.  Smith  read  a  paper  on  Dilatation  of  the 
Stomach.  This  was  a  report  of  a  case  recently 
under  treatment  and  resulted  in  recovery — will  be 
reported. 

Dr.  Henry  Howard  thought  there  must  have 
been  partial  paralysis  of  the  coats  of  the  stomach. 

Dr.  Osier  said  he  had  seen  two  cases.  This 
condition  of  the  stomach  is  known  to  occur  some- 
times as  an  acute  disease,  rapidly  proving  fatal 
in  a  few  days.  Fagg  reports  two  cases  where  the  con- 
dition developed  suddenly  after  a  hearty  meal.  Post- 
mortem :  no  trouble  of  pyloric  orifice  wasobserved. 
Other  forms  are  due  to  simple  constriction  from 
ulcer.  Did  not  know  if  this  could  be  called  a  simple 
case.  If  water  is  drawn  freely,  and  the  muscles  of  the 
abdomen  made  to  move,  a  splashing  noise  could  be 
produced.  Possibly  in  the  case  cited  the  patient 
had  a  trick  of  producing  the  sound  after  drinking 
copiously  of  water.  Dr.  Smith  had  not  given  the 
outlines  of  the  stomach  so  as  to  prove  actual  dila- 


tation. Hysterical  patients  will  drink  freely,  and 
there  must  be  with  it  considerable  distention,  but 
such  cases  do  not  come  under  that  condition 
known  as  dilatation  of  the  stomach. 

Dr.  Ross  thought  the  diagnosis  could  not  be 
substantiated  by  the  reader  of  the  paper.  He 
thought  it  was  likely  that  the  patient  had  been 
hypochondriacal  regarding  his  digestive  organs, 
The  report  stated  that  there  was  extensive  dullness 
from  the  ensiform  cartilage  to  pubes.  If  the  stomach 
was  dilated  there  should  have  been  tympanitis 
above  and  dullness  low  down.  In  a  tolerably 
dilated  intestine  we  may  have  splashing. 

Dr.  Hingston  agreed  with  the  two  last  speakers, 
there  was  no  vomiting,  there  was  also  the  circum- 
stance of  rapid  recovery.  Dullness  extended  lower 
down  than  could  be  expected.  Thought  the  colon 
had  lost  its  arched  condition,  and  had  fallen  down. 
The  diagnosis  is  sometimes  extremely  difficult. 

Dr.  Ross  read  the  notes  of  a  case  of  Pseudo- 
cyesis  which   occurred    in   the    Hospital. 

Dr.  Ross  read  the  notes  of  a  case  occurring 
in  the  M.  G.  H. :  a  woman  who  to  a  remarkable 
degree  simulated  pregnancy — and,  after  the 
time  was  past,  this  passed  away.  Her  history 
was  as  follows :  no  menses  for  three  months  after 
marriage,  and  then  miscarried.  Then  had  no  men- 
ses for  fourteen  years,  and  then  had  a  spon- 
taneous return  of  the  flow.  At  the  next  normal 
period  no  return,  but  had  morning  vomiting  and 
unnatural  desires,  and  at  fifth  month  had  signs  of 
life  ;  milk  escaped  at  nipples.  About  end  of  ninth 
month  had  sharp  shooting  pains  in  back  and 
bearing  down.  The  Doctor  was  summoned,  but  the 
pains  passed  off".  Breasts  were  large,  and  milk  was 
drawn  from  them,  then  signs  of  child-life  gradually 
grew  less ;  abdomen  became  small.  In  March 
thought  again  she  was  to  be  delivered.  On  admis- 
sion to  Hospital  there  was  great  protuberance  of  the 
belly  ;  there  was  large  excess  of  superficial  adipose 
tissue.  On  deep  pressure  nothing  much  could  be 
made  out.  A  sound  was  passed  into  the  uterus 
which  was  of  natural  depth. 

Dr.  Reddy  gave  a  case  of  Tetanus  Neanatorum. 

History  of  a  good  natural  labor ;  cord  was  very 
thick,  and  had  to  be  tied  twice  over.  On  fifth  day 
child  had  short  fit :  on  eighth  day.  Dr.  Reddy  saw 
it.  Slightest  cause  induced  spasms.  Mother  fell 
about  month  before  child  was  bom.  Dr.  Reddy  had 
seen  a  number  of  cases  in  Ireland,  but  in  twenty- 
nine  years  this  was  the  first  case  seen  in  Canada. 
The  meeting  then  adjourned. 


THE  CANADA  MEDICAL  RECORD. 


Vol.   IX. 


MONTREAL,  JANUARY,  1880 


No. 


ORIGINAL  COMMUNICATIONS. 

Man's  Two  Natures,  by  Hy.  Howard, 
Visiting  Physician  to  the  Longue 
Pointe  Lunatic  Asylum,  97 — On 
the  True  Position  of  the  Bladder 
in  the  Male,  and  a  few  Thoughts 
on  passing  the  Catheter,  both  as 
regards  Drawing  off  Urine,  and  as 


C  OlsTTEHsTTS. 

regards  "  Sounding "  for  Stone, 
by  C.  E.  Nelson,  M.D.,  New 
York,  lo8 — Correspondence  ....  1 10 


PROGRESS  OF  MEDICALSCIENCE 
Midwifery    and     Gynaecology  ;    the 
Prevention  and  Treatment  of  Post- 
partum    Hemorrhage,     1 1 1 — On 


Various  Forms  of  Functional  Car- 
diac Disturbances,  by  Beverley 
Robinson,  1 14 — Diabetes  Insipi- 
dus Treated  with  Ergot,  1 18 — 
Surgical  Treatment  of  Epistaxis.  119 


EDITORIAL. 
London  Correspondence . . 


119 


^mdinai  BammunkaUariS. 


TO  THE  READER. 

In  re-writing  this  paper  for  the  press,  I  have  not 
•changed  it  in  the  slightest  degree  from  the  origi- 
nal which  I  read  before  the  Medico-Chirurgical 
Society  of  Montreal,  with  the  exception  that  I 
have  made  it  more  explicit,  corrected  some  phrases 
without  altering  their  meaning,  and  divided  the 
paper  into  four  parts,  as  each  of  these  parts  is  in 
a  great  degree  a  separate  subject.  Part  i.  Man's 
two  natures.  Part  2.  The  theory  of  man's  creation 
by  evolution.  Part  3.  Thinking,  how  produced. 
Fart  4.    Neurology  and  conclusion. 

THE  AUTHOR. 


PART  I. 
man's  two  natures. 

By  Henry  Howard,    M.D.,   Visiting   Physician   to  the 
Longue  Pointe  Asylum. 

Mr.  President  and  Gentlemen, 

In  The  Canada  Medical  and  Surgical 
Journal  for  August,  1880,  there  is  a  piece  of 
poetry  taken  from  the  Western  Lancet  bear- 
ing the  title  of  "  De  Profundis,"  and  dedicated,  I 
presume  without  permission,  to  Mr.  Tennyson. 
I  hope  when  I  have  read  my  paper  this  said  piece 
of  poetry  will  not  be  applicable  to  me,  or  if  so 
be  that  I  should  get  a  little  into  deep  waters,  you 


will  throw  me  a  plank  to  enable  me  to  reach  the 
shore. 

When  we  undertake  to  speak  of  man's  animal 
nature,  we  can  only  do  so  in  virtue  of  our  know- 
ledge of  the  sciences  of  anatomy,  physiology, 
pathology,  and  biology,  and  if  we  do  not  truly  de- 
scribe this  nature  the  error  is  due  to  our  ignorance 
of  these  sciences,  and  not  to  the  fact  that  it  cannot 
be  explained  in  virtue  of  these  sciences. 

When  we  undertake  to  speak  of  man's  higher  or 
human  nature,  we  can  only  do  so  in  virtue  of  our 
knowledge  of  the  science  of  psychology,  and  here 
again,  if  we  fail  to  describe  this  nature  correctly,  it 
is  not  the  fault  of  the  science  but  our  ignorance 
of  it. 

Without  these  five  sciences  it  is  impossible  for 
us  to  treat  of  man  in  the  abstract,  and  in  this  day, 
when  we  are  not  only  learning  so  much  of 
these  sciences,  but  also  unlearning  so  much, 
it  behoves  us,  when  we  advance  any  theory  on 
such  an  important  subject,  to  do  so  modestly,  and 
avoid  dogmatism. 

It  is  in  this  spirit  that  I  venture  this  evening  to 
offer  some  remarks  upon  m  m's  two  natures,  upon 
evolution,  and  upon  mind. 

In  the  papers  I  have  from  time  to  time,  within 
the  last  five  years,  read  before  you,  I  have  at  all 
times  maintained  that  mind  and  body  are  one,  in 
other  words,  that  mind  is  the  product  of  our  men- 
tal organization,  which  is  matter,  as  much  so  as  bile 
is  the  product   of  the   liver,  and  when  I  say  the 


98 


THE   CANADA    MEDICAL    RECORD. 


mental  organization,  I  mean  every  fibre  of  the 
whole  nervous  system,  the  brain  being  its  highest  or 
intellectual  portion. 

If  there  were  any  doubt  of  the  projjosition  that 
mind  and  body  are  one,  and  of  the  material  order, 
that  doubt  should  be  set  at  rest  in  the  mind  of 
every  reasoning  man  by  Dr.  Maudsley's  last  edition 
of  the  Pathology  of  the  Mind,  which  in  my  idea  is 
one  of  the  best  works  that  has  ever  been  written 
on  the  subject,  notwithstanding  the  howl  that  has 
been  set  up  against  it.  Dr.  Maudsley  says,  "  It 
is  a  robust  faith  which  enforces  the  certitude  of  a 
resurrection  to  life  eternal  of  this  mind,  which  is 
seen  to  dawn  with  the  opening  function  of  the 
the  senses,  to  grow  gradually  as  the  body  grows,  to 
become  mature  as  it  reaches  maturity,  to  be  warped 
as  it  is  warped  by  faulty  inheritance,  to  be  sick 
with  its  sickness,  to  decay  as  it  decays,  and  to  ex- 
pire as  it  expires." 

Dr.  Maudsley  has  in  the  above  quotation  spoken 
a  great  scientific  truth  j  but  if  he  so  pleased  he 
might  have  added  that,  as  man's  soul  is  not  mind, 
there  is  no  reason  why  a  man  by  faith  should  not 
believe  in  its  resurrection  to  everlasting  life,  or 
rather  that  the  soul  never  dies.  But  Dr.  Maudsley 
was  not  writing  on  religious  faith,  but  on  science, 
and  wished  to  show  how  absurd  and  materialistic 
was  the  teaching  that  soul  and  mind  were  one,  and 
that  the  logical  inference  of  such  a  theory  must  be 
that  the  mind  was  to  rise  to  everlasting  life  inde- 
pendently of  the  material  body  whence  it  pro- 
ceeded. 

The  sciences  of  anatomy,  physiology  and 
pathology  prove  without  a  possible  doubt  that 
the  mental  organization  is  material,  and  that 
thought  is  one  of  the  products  of  that  material 
organization,  and  that  the  characteristics  of 
thought  depend  upon  what  that  organization  may 
be  either  from  heredity  or  its  development  after 
birth. 

You  are  aware  that  to  give  an  abstract  definition 
of  anything  is  under  the  most  favorable  circum- 
stances a  very  difficult  task,  and  it  is  more  parti- 
cularly so  when  we  try  to  define  man,  there  are  so 
many  different  sorts  of  men.  On  this  point  Dr. 
Maudsley  says  :  "  To  affirm  that  all  men  are  born 
equal,  as  is  sometimes  heedlessly  done,  is  to  make 
as  untrue  a  proposition  as  it  is  possible  to  make  in 
so  many  words.  There  is  as  great  a  variety  of 
minds  as  there  observedly  is  of  faces  and  of  voices. 
As  no  two  faces  and  no  two  voices  are  exactly 
alike,  so  are  no  two  minds  exact  counterparts  of 


one    another.      Each    person  present    a   certain 
ndividuality,     characteristic     marks    of     featurei 
and  disposition  which  distinguish  him  from  any 
other  person   who    may    resemble   him    ever   so 
closely,  and  I  hold  it  to  be  true  that  every  speciaj 
character  which  is  displayed  outwardly  is  repre- 
sented inwardly  in  the  nerve  centre — that  it  is  the 
outward  and  invisible  constitution  of  nerve  struc- 
ture."    It  is  easy  then,  he  says,  to  perceive  that 
we  have,  as  original  facts  of  nature,  every  kind  of 
variation  in  the  quality   of  the  mind    and  in  the 
degree  of  reasoning  capacity ;  and  that  it  is  as 
gross   a   mistake  to   endow    all    persons   with  a 
certain  fixed  mental  potentiality  of  uniform  charac- 
ter as  it  would  be  to  endow  them  with  the  poten- 
tiality of  a  certain  fixed  bodily  standard.     If  a 
man's  nature  have  a  radical  flaw  in  it  he  can  no 
more   get  entirely  rid  of  it   by  training  than  the 
idiot,  whose  want  of  parts  is  incontestable,  can  raise 
his   intelligence   to   the   average   level  by    much 
study,  or  than  a  short  man  can,  by  taking  thought*^ 
add  one  cubit  to  his  stature.  Acquired  habits  may 
do  much  to  compensate  for  natural  deficiencies,  but 
the  misfortune  is  that  the  deficiency  often  shows 
itself  in  a  constitutional  inability  to  acquire   the 
habit." 

From  these  stubborn  scientific  facts,  so  ably  put 
forward  by  Dr.  Maudsley,  you  will  at  once  i^erceive 
how  difficult  a  task  I  have  undertaken — to  define 
man  in  the  abstract.  I  will  assume  that  you  all 
know  the  anatomy  of  man. 

Man  is  an  animal,    and,  in  common   with    al, 
other  animals,  possesses  a  mental  organization, 
divisible  into  intellectual, moral  and  emotional  facul- 
ties, none  of  which  are  altogether  independent  one 
of  the  other,  no  more  than    is  any  other  part  of 
his  physical  organization  independent  of  all  other 
parts.  In  virtue  of  this  animal  mental  organization, 
man,  in  common  with  all  other  animals,  is  intelli- 
gent, moral  and  emotional,  diflfering,  however,  in 
degree  from  his  fellow,  and  from  all  other  animals, 
because  of   the  perfection  or  imperfection  of  his 
physical    mental    organization,  as  do    all    other 
animals  difTer  from  the  same  cause  from  one  an- 
other,   that  is,  animals  of  the  same  species.  Dr. 
Maudsley  says,  and  I  perfectly  agree  with  him,  that 
man,  in  common  with  the  whole  of  the  animal  and 
vegetable    kingdoms,  has  a    non-corporal    entity 
but  what  that  entity  is  he  does  not  define  ;  some  of 
his  critiques  call  it  self — ego — but  if  such  were  the 
case  quoad  man  we  should  have  the  ego  also   in 
all  other  animals,  and  not  only  in   animals  but  in 


THE    CANADA    MEDICAL    RECORD. 


99 


all  created  things,  including  every  tree  and  plant 
*hat  grows  upon  the  earth.  I  cannot  conceive 
how  that  which  is  non-corporal,  not  incorporated 
in  the  body,  could  constitute  self,  or  ego ;  I  would 
call  this  non-corporal  entity,  God.  Remember  I  am 
speaking  of  man  simply  as  animal.  Now,  although  a 
non-corporal  entity,  as  its  name  implies,  is  not 
incorporated  in  the  body,  there  is  no  reason  why 
there  should  not  exist  a  union  between  the  body  and 
its  entity,  and  I  believe  there  is.  I  believe  there  is  a 
union  between  God  and  all  created  things,  and  this 
which  unites  God  with  all  created  things,  of  which 
he  is  the  entity,  I  would  say  was  life.  But  why  life  7 
First,  because  I  cannot  conceive  of  anything  else 
that  it  can  be  ;  secondly,  because  God  is  life-giver, 
and  that  life  emanates  from  him.  I  consider  it  an 
absurd  expression  to  say  God  created  the  world,  and 
all  that  therein  is,  out  of  nothing  ;  something  could 
not  come  from  nothing,  from  negation.  God  created 
the  world  and  all  things  from  Himself,  all  and  every- 
thing emanated  from  Him,  and  with  everything 
life ;  and  by  this  life  is  He,  as  entity  of  all  things, 
united  to  the  animal  man,  and  also  to  all  created 
things.  But  what  is  life  in  the  abstract  ?  I  do  not 
know,  but  it  is  certainly  a  something  that  is 
tangible  and  explicable,  as  exemplified  in  the 
animal.  It  is  in,  but  not  of,  the  blood,  and 
the  same  can  be  said  of  the  respiratory  organs,  al- 
though both  are  necessary  for  its  continued  suste- 
nance in  all  animals.  I  say  it  is  not  of  the  blood 
because  of  the  physiological  fact  that  in  suspended 
animation  the  blood  ceases  to  circulate,  yet  life  is 
not  extinct ;  in  like  manner  it  is  not  of  the  respiratory 
organs,  for  respiration  ceases  in  suspended  anima- 
tion and  life  is  not  extinct ;  and  physiological  ex- 
perimentaUsts  know  that  an  animal  will  live  for 
hours,  sometimes  as  many  as  twelve,  after  the 
division  of  both  the  pneumogastric  nerves.  Again, 
both  the  circulatory  and  respiratory  systems  are 
for  their  action  dependent  upon  the  motor  nerves, 
so  that  it  is  evident  that  these  two  systems  are 
necessary  for  the  continued  sustenance  of  animal 
life,  yet  it  is  not  ot  or  from  either  of  these  two 
systems.  In  what  part  of  our  system,  then,  does  it 
exist  p£r  se  ?  Physiology  proves  that  it  is  in 
the  nervous  system,  as  it  is  in  this  system  is  the 
motor  power  in  man  and  in  all  other  animals, 
and  not  only  from  this  system  comes  our  motor 
power,  but  our  sense  of  hearing,  seeing,  smelling, 
tasting  and  feeling,  &c.  But  the  nervous  system 
is  matter.  What  is  it  that  is  in  this  system,  this 
tangible  something  that  we  call  life,  the  absence  of 


which  causes  death  ?  The  sciences  of  physiology 
and  biology  prove  to  us  that  it  is  an  electric  fluid 
circulating  through  the  whole  nervous  system.  I 
will  have  to  recur  to  this  subject  again  before  clos- 
ing my  paper. 

Man,  in  common  with  all  other  animals,  has,  in 
virtue  of  his  physical  organization,  an  animal 
nature,  but,  like  all  other  animals,  he  has  two  na- 
tures, and,  like  all  other  animals,  this  second  nature, 
not  in  virtue  of  his  physical  organization  but  a 
something  given  to  him,  in  virtue  of  which  he  is  a 
man,  in  fact,  the  animal  man,  I  speak  of  his  human 
nature,  the  highest  nature  possessed  by  any  animal, 
and  possessed  by  him  alone;  the  term  explains 
itself,  human  (Jiumanus)  from  hsmo.,  a  man  and 
flatus,  born,  to  be  born  a  man. 

Now,  my  theory  is  that  this  human  nature  is 
man's  corporate  entity,  whence  he  derived  per- 
sonality, self,  ego,  soul,  free  will,  and  a  higher 
order  of  conscience  than  that  which  he  possesses  in 
virtue  of  his  animal  nature,  consequently  a  higher 
order  of  conscience  than  that  possessed  by  any 
other  animal,  and  that  it  is  this  conscience  which 
makes  man  a  law  unto  himself,  makes  him  know- 
right  from  wrong  in  the  abstract,  and  causes  him  to 
recognise  a  supernatural  power.  This  human  nature 
I  hold  to  be  supernatural  of  itself,  and  never  to  die, 
but  not  actually  necessary  to  the  Hfe  of  the  animal 
man.  Query,  are  there  animal  men  who  never  pos- 
sessed a  human  nature  ?  Judging  some  men  by 
their  brutal  and  inhuman  acts,  we  might  be  led 
to  the  conclusion  that  there  were. 

We  have  such  evidence  of  animal  knowledge, 
and  consequent  animal  conscience,  that  I  need 
not  occupy  your  time  proving  that  fact,  but  this 
animal  conscience  that  we  find  the  best  example 
of  in  the  dog,  what  is  it  ?  It  is  simply  a  trained 
conscience,  trained  to  fear  punishment  if  it  does 
that  which  it  has  been  taught  is  wrong,  and  to  look 
for  reward  if  it  does  that  which  it  has  been  taught 
to  believe  is  right ;  and  such  is  man's  animal  con- 
science, which  would  appear  to  be  universally 
recognised,  if  we  judge  by  the  universal  moral 
teaching  which  man  has  received  and  is  receiving 
every  day.  Are  we  not  taught  that  if  we  do  good  we 
shall  be  rewarded,  if  not  in  this  world  certainly 
in  the  world  to  come  ;  and  if  we  do  evil,  if  we  are 
not  punished  in  this  world  certainly  in  the  world  to 
come.  I  do  not  say  this  is  false  teaching,  but  that 
it  is  an  appeal  to  our  animal  nature,  and  not  to  our 
human,  it  is  the  same  sort  of  appeal  that  is  made 
to  the  lower  order  of  aninal, differing  only  in  de£,ree. 


100 


THE   CANADA   MEDICAL    RECORD. 


My  idea  is  that  the  human  conscience  is  of  a 
much  higher  order  than  the  animal  conscience— a 
conscience  which  approves  a  man  when  he  does 
right  because  it  is  right,  and  disapproves  him  when 
he  does  wrong  because  it  is  wrong.  And  here  I 
would  most  respectfully  ask,  would  it  not  be  better 
if  our  moral  teachers  would  appeal  a  little  more  fre- 
quently to  our  human  nature?  that  we  should  hear 
a  little  more  of  humanity,  uprightness,  integrity 
justice,  benevolence,  of  the  doing  by  others  as  we 
would  that  others  do  by  us,  a  little  encourage- 
ment to  do  right  because  it  is  right,  and  for  the 
scientific  reason  that  every  good  act  a  man  does  the 
act  itself  produces  a  good  physical  change  in  a  man's 
mental  organization,  as  by  every  evil  act  he  does 
he  produces  an  evil  physical  change  in  his  mental 
organization, — the  terms  good  and  evil  being  under- 
stood to  mean  the  fulfilling  or  breaking  of  a 
natural  law  of  our  being. 

I  said  every  man,  in  virtue  of  his  human  nature, 
had  a  free  will — this  requires  no  proof,  every  man 
knows  of  himself  that  his  will  is  free,  no  power 
can  bind  a  man's  free  will,  but  we  must  draw  the 
distinction  between  a  man's  human  free  will  and 
his  animal  desire,  which  he  has  in  common  with 
all  other  animals  :  human  free  will  and  animal 
desire  are  two  very  distinct  things,  a  fiict  which  ^ 
if  generally  known,  is  very  frequently  lost  sight  of 
by  law-makers  and  judges,  aye,  and  by  teachers  of 
the  moral  law,  all  of  whom — law  makers,  judges 
and  teachers — speak  and  act  as  if,  because  a  man 
has  a  free  will,  he  is  necessarily  a  free  agent, 
ignorant  of  the  fact  that  a  man  by  his  free  will 
cannot  always  control  his  animal  desires,  which 
are  the  outcome  of  his  mental  organization,  leading 
to  deeds. 

He  is  a  fortunate  man  whose  animal  organiza- 
tion is  in  accord  with  oriu  subjection  to  his  human 
free  will.  He  is  a  man  of  an  extraordinary  physical 
formation  who  can  bring  his  animal  desires  into 
subjection  to  his  human  free  will.  We  hear  men 
talk  very  flippantly  of  will-power,  and  give  examples 
of  what  men  have  done  by  force  of  will  in  over- 
coming animal  desire  ;  but  perhaps  if  we  knew 
all  the  particulars  of  these  cases  we  would  find 
that  animal  desire  had  ceased  because  of  physi- 
cal change  in  the  animal  organization,  when  indeed 
it  would  be  very  easy  to  submit  to  the  will, — some- 
tliing  like  the  lady  of  doubtful  character  who  gave 
up  the  world  when  the  world  had  given  her  up,  or, 
like  those  very  good  old  men  who  write  doleful 
letters    to  the  chums   of  their   youth,   regretting 


their  youthful  follies,  "  although  they  were  plea- 
sant times,"  but  who  would  not,  if  they  could,  re- 
turn to  them  again.  Of  course  they  would  not,  but 
why?  Simply  because  youthful  animal  desire  has 
leen  subdued  by  the  physical  change  in  their 
emotional  organization  by  time,  so  that  ihey  are 
not  what  they  were.  It  would  be  rather  a  ludi- 
crous affair  to  see  an  old  man  scrambling  over  a 
fence  to  rob  an  orchard,  which  perhaps  was  the 
strongest  desire  of  his  youth. 

If  we  would  prove  wiU-power  let  us  take  cases 
where  the  animal  desire  and  human  will  are  in  strong 
opposition,  for  example,  that  of  the  conscientious 
man,  the  man  who  knows  right  from  wrong  in  the 
abstract,  and  has  an  honest  abhorrence  of  what  is 
wrong,  but  is  the  slave  of  strong  animal  sexual 
desire,  or  a  strong  animal  desire  for  drink,  either 
of  which  desires  is  his  hereditarily.  And  look  at  the 
everlasting  struggle  between  human  free  will  and 
animal  desire,  a  struggle  that  tears  its  victim  to 
pieces,  in  some  cases  driving  the  victim  to  suicide^ 
in  others  into  a  lunatic  asylum.  Never,  indeed,  is 
human  free  will  victorious  till  a  physical  change 
takes  place  in  the  man's  mental  organization — 
for  in  all  such  cases  the  mental  organization  is 
either  hereditarily  abnormal  or  diseased  from  some 
cause.  It  is  a  fearful  sight  to  see  the  human  free 
will  thus  struggling  with  animal  disease.  Our  own 
sweet  poet,  John  Reade,"  well  describes  it  in  the 
following  lines  : 

' '  'Tis  easy  to  cry  Raca  from  within 
"  Cold  passionless  morality's  strong  tower 
"  To  those  who  struggle  fiercely  hour  by  hour 
"  'Gainst  grim  Goliaths  of  unconquered  sin." 

and  "  Shakspe.\re  "  seems  to  have  well  understood 
the  importance  of  the  subject  when  he  put  the 
following  words  into  the  mouth  of  the  unhappy 
''  Hamlet  ": 

"  And  blest  art  those 

"Whose  blood  and  judgment  art  so  well  co-mingled 

"  That  they  are  not  a  pipe  for  fortune's  fingers 

"  To  sound  what  stop  she  pleases  :  Give  me  that  man 

''  That  is  not  Passion's  slavk,  and  I  will  wear  him 

"  In  my  heart's  core,  aye  in  my  heart  of  heart, 

"  As  I  do  thee." 

You  see  I  differ  entirely  from  Dr.  Maudsley,  who 
makes  will  and  desire  one  and  the  same  thing.  I 
maintain  that  they  are  separate  and  distinct,  and 
come  from  different  sources,  desire  being  derivable 
from  our  animal  organization,  and  will  from  our 
human  nature.  If  the  matter  be  normal,  die  desires 


THE   CANADA    MEDICAL   RECORD. 


101 


are  normal ;  if  abnormal,  the  desires  are  abnormal. 
A  man  in  perfect  health  rarely  suffers  from  thirst, 
and  when  he  does  his  desire  for  cold  water  is  easily 
assuaged,  whereas  a  man  suffering  from  fe\er  is 
always  calling  for  drink,  and  nothing  will  stop  his 
craving  for  drink — this  is  the  difference  between  the 
animal  organization  being  in  a  normal  and  abnor- 
mal state.  But  the  will  is  always  normal.  I  main- 
tain that  there  is  no  such  thing  as  a  diseased  will ; 
it  cannot  be  diseased,  for  it  is  not  of  the  material 
order.  Man  to  be  what  he  should  be,  in  virtue  of  his 
two  natures,  must  have  both  natures  in  harmony, 
that  is  to  say,  the  animal  nature  should  be  guided 
by  the  free  will  of  the  human  ;  but  our  animal 
natures  are  generally  so  bad  by  inheritance,  in  con- 
sequence of  our  progenitors  having  broken  natural 
laws,  and  rendered  worse  by  the  wrong  means  used 
to  develop  our  mental  organization,  that  our  animal 
desires  are  not  normal  but  abnormal,  stronger  than 
our  human  will,  so  that  we  may  well  say  man  is 
what  he  is  in  virtue  of  his  animal  nature — too  fre- 
quently not  a  free  man  but  a  slave  to  his  passions, 
in  other  words,  to  his  abnormal  animal  desires. 

It  is  no  uncommon  thing  to  hear  all  our  frailties 
attributed  to  our  human  nature.  I  consider  such 
a  statement  degrading  to  our  humanity  :  our  faults 
and  frailties  are  due  to  our  animal  nature  and  only 
to  be  corrected  by  a  physical  change  in  our  mental 
organization.  I  don't  mean  here  to  enter  into  the 
question  of  all  the  means  at  our  disposal  for  t'le 
accomplishment  of  this,  of  which  medical  treatment 
is  not  the  least  important.  I  would,  however, 
remark  with  respect  to  that  inexplicable  and  undefi- 
nable  something  which  we  call  the  grace  of  God, 
and  in  which  I  fiiTnly  believe  as  much,  if  not  more, 
than  many  of  those  who  are  always  talking  about 
it,  although  I  may  differ  with  them  to  a  very  great 
degree  as  to  the  means  of  obtaining  it ;  I  say  this 
spiritual  gift,  when  it  makes  a  good  out  of  a  bad 
man,  does  so  by  producing  a  physical  change  in 
his  mental  organization,  and  in  accord  i nee  with 
God's  established  natural  laws,  and  not  in  the 
breach  of  them.  God  does  not  break  His  own  laws, 
there  is  no  occasion  for  Him  to  do  so.  He  can  do  a!l 
tilings  by  these  laws  ;  He  created  all  things  by 
means  of  them,  and  by  them  we  live  and  move  and 
be  and  die  ;  and  living  as  we  do  in  the  breach  of 
them,  sometimes  through  ignorance,  but  very  fre- 
quently through  pride  and  presumption,  is  the  chief 
scause  of  man's  suffering,  the  chief  cause  of  crime 
^nd  insanity. 

Jt   is  hardly   necessar)^  for  me   to  defend   my 


statement,  that  man  of  all  other  animals  is  per- 
son, indeed  of  all  created  things,  and  has  an 
ego,  and  that  in  virtue  not  of  his  animal  but  his 
human  nature.  In  fact,  to  be  what  we  are,  person- 
ality is  necessary.  If  we  believe  sacred  history  to 
be  a  history  of  events,  when  God  created  angels 
He  did  not  endow  them  with  personality  ;  they 
never  were  persons,  whatever  else  they  may  be. 
Personality  belongs  to  man  only,  and  perhaps 
it  is  in  this  particular  he  resembles  God,  Creator. 
Recognising,  as  I  do,  that  a  man's  human  nature  is 
born  with  him  as  well  as  is  his  animal  nature,  yet 
I  maintain  that  the  human  nature  comes  direct 
from  God,  and  cannot  be  tainted  through  heredity. 
Therefore,  while  I  agree  with  Dr.  Maudsley  that 
no  two  m^n,  physically  speaking,  (which  includes 
the  whole  mental  organization,  intelligence,  &c., 
&c.,)  are  born  equal.  I  hold  that,  humanly  speak- 
ing, all  men  are  born  equal,  for  to  be  a  man  there 
must  be  a  human  nature. 

I  said  that  man  in  virtue  of  his  human  nature 
possesses  an  immortal  soul,  that  is  to  say,  like  self, 
ego,  free  will  and  a  higher  order  of  conscience  ;  it 
is  one  of  the  attributes  of  our  human  nature.  But 
what  is  the  soul  ?  I  don't  know.  I  cannot  conceive 
what  it  is.  I  cannot  reason  upon  it.  No  science  nor 
anything  else  can  give  me  insight  into  what  it  is ; 
hj  faith  I  believe  in  it,  as  I  do  in  much  above  my 
I'eason. 

Before  concluding  this  part  of  my  subject  you 
will  permit  me  to  summarise  a  little,  that  you  may 
the  better  comprehend  what  I  have  said. 

I  said  man  was  an  animal  in  virtue  of  his  phy- 
sical organization,  and  consequently  has  an  animal 
nature,  and  in  virtue  of  his  mental  organization, 
which  is  physical,  he  is  intelligent  and  moral 
to  a  greater  or  lesser  degree,  depending  upon  the 
high  or  low  order  of  that  organization  ; 
that  as  an  animal,  in  common  with  all  other  ani- 
mals and  the  whole  vegetable  kingdom,  he  has  a 
non-corporal  entity  which  is  God,  and  that  the 
union  between-  God  and  him  is  life.  That  man  in 
common  with  all  other  animals  has  an  animal  con- 
science, and  in  common  with  all  other  animals  two 
distinct  natures ;  that  man's  second  nature  is  his 
human,  in  virtue  of  which  he  h  aspersonality,  self, 
ego,  a  free  will,  a  higher  order  of  conscience  anp 
an  immortal  soul.  I  said  that  his  human  nature* 
although  born  with  him,  was  not,  like  his  animal,  sub- 
ject to  heredity,  therefore,  although  mentally  or 
physically  speaking  no  two  persons  were  born  equal, 
humanly  speaking  all  men  were  born  equal.     That 


102 


THE    CANADA    MEDICAL    RECORD. 


although  man's  will,  which  he  had  in  virtue  of  his 
human  or  higher  nature,  was  free,  yet  his  will  could, 
not  under  all  circumstances  control  his  animal 
nature,  whence  proceed  his  thoughts  and  deeds. 

The  logical  conclusions  of  the  foregoing  propo- 
sitions are,  that  man  is  intellectually  and  morally 
what  he  is  in  virtue  of  his  animal  or  physical  or- 
ganization, and  whatever  the  modus-operand i  may 
be,  whether  moral  or  otherwise,  or  whether  by  the 
consent  of  the  will  or  otherwise,  if  man's  morals  or 
intellect  are  to  be  improved,  the  improvement  must 
be  made  by  producing  a  physical  change  in  his 
mental  organization. 

PART  II. 

MAN  CREATED  BY  EVOLUTION. 

Where  so  much  has  been  written  by  men  of  the 
highest  scientific  standing  upon  the  origin  of  man, 
I  consider,  in  connection  with  the  subject  I  have 
in  hand,  that  I  cannot  pass  over  the  theory  of 
evolution  without  giving  my  views  upon  it,  for  of 
course  I  have  my  own  particular  views. 

You  are  aware  that  the  evolutionary  or  so-called 
Darwinian  theory  is,  that  man  was  evolved  from 
a  lower  order  of  animals,  and  that  it  took  millions 
of  years  before  this  animal  became  man  ;  and 
again,  that  the  vital  organism  in  which  the  process 
of  evolution  began  was  of  the  earth,  either  in  the 
form  of  dust  or  slime. 

I  need  not  enter  into  all  the  arguments  brought 
forward  by  these  great  men  in  proof  of  their  theory. 
Their  opponents  assume  that  the  theory  is  in 
some  way  alike  derogatory  to  God  and  man,  and 
contrary  to  the  teachings  of  "Moses"  as  recorded 
in  the  book  of  "  Genesis." 

For  my  part  I  cannot  see  that  the  evolution 
theory  takes  anything  from  the  honor  and  glory  of 
God  as  first  cause  and  creator,  nor  yet  can  I  see 
that  it  makes  man  anything  more  or  less  than  what 
he  is,  an  animal  with  a  human  nature,  and  to  my 
reading  of  the  i  st  Chapter  of  the  book  of  Genesis— 
the  whole  of  it — is  evolution.  The  historian  says, 
upon  certain  occasions,  in  certain  ])eriods  of  time 
God  did  so  and  so,  but  he  does  not  say  how  God 
did  it,  in  other  words  he  does  not  give  us  the  modus- 
operandi;  he  simply  says  God  made  man  out  of 
the  dust  of  the  earth,  or,  as  the  Latin  Vulgate  has 
it,  out  of  the  slime  of  the  earth.  Now  Biblical  scho 
lars  have  been  forced  by  the  science  of  geology 
to  admit  that  day  means  a  period  of  time,  and 
what  was  the  length  of  time  in  each  of  the  different 


periods,  we  cannot  exactly  say,  but  geology  gives 
proof  that  each  period  must  have  contained  millions 
of  years.  We  then  may  read  the  passages  thus, 
the  evening  and  the  morning  was  the  first  period, 
instead  of  the  first  day,  and  much  of  the  trouble  will 
be  overcome  towards  establishing  the  theory  of 
evolution  to  be  a  scientific  fart. 

According  to  Moses,  in  the  fifth  period  God 
caused  the  waters  to  bring  forth  fish,  creeping 
things  and  winged  fowls, — if  this  is  not  evolution, 
what  is  it  ?  From  water  is  evolved  fish,  creeping 
things  and  winged  fowls,  what  name  shall  we  give 
to  this  mode  of  creation,  if  not  evolution? 

Then  in  the  sixth  period  he  caused  the  earth  to 
bring  forth  the  whole  animal  creation  and,  amongst 
the  rest  of  the  animals,  man  :  evolution  again,  and 
if  not,  what  is  it  ?  And  when  they  were  all  created 
he  did  and  said  to  man  no  more  nor  no  less  than 
he  did  or  said  to  the  creeping  things,  the  fowls  of 
the  air,  the  fish  of  the  sea,  and  all  the  animals  on  the 
face  of  the  earth,  he  blessed  them  and  commanded 
them  to  increase  and  multiply,  and  that  all  might 
fulfill  this  his  natural  law  of  procreation,  according 
to  the  same  historian,  he  caused  both  the  water 
and  earth  to  produce  male  and  female. 

Now,  suppose  that,  in  accordance  with  God's 
established  natural  laws,  the  grain  of  dust  or 
shme  from  which  man  was  evolved,  and  all  other 
animals  evolved — but  I  will  only  speak  of  man, — 
suppose  then  that  this  grain  of  dust  was  first  evolved 
into  an  ovum  whose  seed  was  in  itself,  and  that  it 
took  millions  of  years,  in  fact  the  whole  of  the  6th 
period  of  time,  before  it  became  a  perfect  animal, 
and  then  that  God  endowed  this  animal  with  a 
human  nature  by  which  it  became  man,  there  is 
nothing  in  such  a  supposition  contrary  to  the  teach- 
ings of  Moses,  yet  it  would  be  evolution.  Then  sup- 
pose this  ovum  while  gestating  in  the  womb  of 
time  for  millions  of  years  did  undergo  similar 
physical  changes  that  the  ovum  in  the  uterus 
undergoes  during  nine  months  of  gestation,  before 
there  is  a  perfect  child,  it  would  during  that  time 
present  so  many  phases  that  it  might  be  well  said 
hat  man  was  evolved  from  a  lower  animal.  Every 
tudent  of  embryology  knows  that  the  very  last 
thing  that  the  foetus  resembles  during  the  process  of 
gestation  is  a  child ;  its  first  representation  is 
more  of  a  worm  than  anything  else,  its  second  a 
fish,  its  third  a  bird,  its  fourth  a  quadruped,  and 
fifthly  a  child.  Surely  in  procreation  man  is 
evolved  from  the  very  owest  microscopical  or- 
ganism, very  liitle  ovum ;  and  if  in  obedience  to 


THE   CANADA    MEDICAL    RECORD. 


103 


God's  established  natural  laws  this  low  animal  or- 
ganism is  evolved  through  all  these  different  animal 
stages,  in  nine  months  terminating  in  the  animal 
child,  and  then  that  it  takes  years  of  physical  change 
before  it  is  developed  into  the  animal  man,  and 
then  that  the  animal  man  is  always   undergoing 
evolution,  physical  change,  till  in  process  of  time? 
that  very  property,  life,  by  which  he  is,  shall  wear 
out  the  animal  machine,  and  the  animal  portion  of 
man  shall  return  to  the  earth  from  which  it  came — 
remembering  all  these  facts,   we  will  find  nothing 
extraordinary  in  the  theory  that  the  ovum  formed 
from  the    earth   should,   in  accordance  with  the 
same    natural    laws   evolved    in   a    similar   way 
throughout  millions  of  years,  terminate  by  develop- 
ing into  man,  and  that  the  disciples^of  Mr.  Darwin 
would  by  this  reasoning  be  justified  in  sayingjthat 
man  was  evolved  from  a  lower  animal.     I  believe 
that  all  the  works  of  the  Creator  show  design,  and 
that  He  designed  the  ovum  from  which  man  was 
evolved  to  terminate  in  man. 

In  this  way  do  I  recognise  that  the  evolution 
theory  of  creation  is  more  in  accord  with  nature's 
laws  as  we  now  understand  them,  than  that  God 
called  man  and  all  other  animals  in  perfect  order 
in  a  moment  of  time  out  of  the  earth,  and  there 
does  not  appear  to  me  to  be  anything  in  this  the- 
ory of  creation  to  justify  those  who  call  themselves 
anti-evolutionists  in  giving  such  a  name  to  evolu- 
tion as  the  "  gospel  of  dirt."  Before  they  make 
iise  of  such  an  expression  they  should  rem_ember 
they  themselves  say  man  was  created  from  earth, 
and  they  should  remember  what  procreation  is. 

So  much,  gentlemen,  for  the  theory  of  the  crea- 
tion of  man  by  evolution,  which  to  me  is  a  rea- 
sonable one. 

PART  III. 

THINKING — HOW    PRODUCED. 

What  is  the  cause  of  thought,  of  our  thinking  ? 
If  I  remember  correcdy  it  was  "  Carlyle  "  who 
said,  "  some  men  never  think — they  only^think 
they  think."  When  this  close  observer  of^men  and 
things  made  the  above  remark^he  noMoubt  meant 
to  imply  that  there  are  very  many  men  whojrarely 
make  thinking  a  voluntary  action  or^who  ever 
provide  their  mental  organization  with^wholesome 
food  for  it  to  think  of. 

Thought  is  involuntary,  that  is  to  say,  we'must 
think  whether  we  will  it  or  not,  but  each"person 
with  a  normal  mental  organization  can,  to  a  very 


great  degree,  direct  much  of  this  thinking  by  his 
free  will ;  and  he  can  provide  food  for  thought  by 
seeing,  hearing,  reading,  etc.  A  man  can  make  any 
thinkable  subject  a  matter  of  voluntary  thought, 
but  the  moment  he  ceases  this  voluntary  thinking 
he  will  still  go  on  thinking,  perhaps  of  some  sub- 
ject as  remote  from  what  his  voluntary  thoughts 
had  been  as  it  is  possible  to  conceive.  Although 
thought  is  involuntary  when  not  under  the  control 
of  the  will,  yet  our  mental  organization  cannot 
think  reasonably  of  nothing — it  must  have  some- 
thing to  think  about,  and  that  something  is  sup- 
plied to  it,  either  voluntary  or  involuntary,  from 
objective  cause  or  involuntary  from  subjective 
cause,  and  this  by  means  of  our  organs  of  sense  or 
our  sensory  nerves.  Of  course  you  all  know  that 
the  ingoing  nerves  are  the  sensory  nerves  proper, 
and  the  outgoing  the  motor  nerves  proper^  but  you 
mus  bear  in  mind  that  all  these  nerves  are  anatomi- 
cally integrated  by  ganglionic  nerve  structure  into 
one  nervous  arc,  and,  according  to  Louis,  sensory 
impulse  and  motor  impulse  are  the  polar  aspects 
of  one  vital  process. 

Speaking   of  the    objective  we    cannot    think 
intelligibly^of  what  we  never  saw,  or  felt,  or  smelt, 
or  heard  of  We  may  have  a  kind  of  foggy  unintelli- 
gible thinking,  dreaming  in  our  waking  moments 
as   we  do  in  our  sleep,    sometimes  due    to  some 
abnormal  state  of  our  mental  organization,  either 
sthenic   or   asthenic;  in  one  case  removable    by 
antiphlogistic  treatment,  in  the  other  by  tonics.  That 
sort  of  thinking  persons  have  who  try  to  think  of 
eternity  as  if   it  were  a  multiple  of  time,  when  it 
is  the  very  contrary,   having  nothing  whatever  to 
do  with  time,  being  its  negation,  so  that  it  is  impos- 
sible for  man  to  think  of  eternity,  consequently,  the 
effort  to  do  so  only  weakens  the  mental  organiza- 
tion and  finally  drives   the   victim   into  a  lunatic 
asylum  ;  so  it  is  when  we  try  to  think   of  a  time 
before  the  world  was,   which  cannot   be  made  a 
subject  matter  of  thought^  seeing  there  was  no  dme, 
there  was  no  past  or  future — a  state  incomprehen- 
sible— time  only  began  with  creation. 

To  think  voluntarily  and  intelligibly  there  must 
be  intelligible  subject  matter  for  thought  sup- 
plied to  the  mental  organization  from  either  objec- 
tive or  subjective  sources.  And  this  is  why  we 
can  so  easily  account  for  the  difference  there  is 
between  the  thoughts  of  different  people,  and 
why  they  cannot  think  alike,  because  each  man, 
either  from  accidental  circumstances  or  by  his 
free    will,   has   his   mental   organization  supplied 


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with  a  difTerent  subject  matter  of  thought,  there- 
fore we  have  the  difference  between  the  thoughts 
of  persons  of  different  religions  and  of  different 
nationalities,  between  the  thoughts  of  a  man  who 
i.wj  -edu:ated  and  the  illiterate  man,  between 
clerical  men  and  lay  men,  between  a  man  who  has 
t  avelled  and  seen  much  of  the  world,  and  the 
man  who  was  never  a  mile  from  the  place  of  his  birth, 
the  difference  between  the  thoughts  of  a  physician 
and  lawyer,  between  the  thoughts  of  a  farmer  and 
trader,  a  soldier  and  politician,  an  honest  man 
and  a  dishonest  man,  an  honorable  man  and  a 
dishonorable  man,  of  a  moral  philosopher  and  a 
mental  scientist. 

There  is  one  thinking,  however,  we  all  have  in 
common,  and  that  is  thought  which  is  the  effect  of 
subjective  cause.  AVe  all  think  alike  when  we  suffer 
pain,  whether  it  be  from  hunger,  thirst,  disease, 
mechanical  injur}',  jealousy,  sorrow,  etc.  Our  emo- 
tional organization  produces  similar  thoughts 
in  all,  but  not  followed  in  all  by  similar  effects, — I 
speak  of  love,  joy,  likes  and  dislikes,  hopes  and 
ears,  many  of  which  are  the  prod  ucts  of  our  sexual 
organization  which  are  more  or  less  marked  at  differ- 
ent periods  of  life  as  the  animal  nature  developes 
tjr  decays  by  physical  change  in  our  mental  organi- 
zation. 

The  next  question   in  connection  with  thought 
is,  how  is  it  produced  from  this  nonnal  living  mat- 
ter?     In   answering  this  question  we  must  take 
into  consideration   man's  whole  material  organi- 
zation, and  we  will  find  it  to  be  a  living  animal 
machine,  a  perfect  whole,  all  its  parts  more  or  less 
dependent  upon  one  another ;  and    this   whole  is 
always  in  motion,  heart,  lungs,  stomach,  intestines, 
etc.,  and  the  motor  power  for  all  is   electric  fluid 
circulating   through    the  whole    nervous    system. 
This  has  been  proven  by  numerous  experiments. 
Du  BOis  Raymond,  has  by  his  experiments,  not 
only  established  this  fact,  but  he  has  done  more, 
he  has  established  the  fact  that  each   nerve  con- 
ducts  electricity  in  both  directions.    To  all  these 
motions  thus   produced   by  the  electric  fluid  he 
has  given  the  term  "  Electr omotion,"  and  it  is 
this  nerve  motion    that  produces  all  the  normal 
physical  changes  that  are  constantly  taking  place  in 
man's  physical  organization,  causing  each   organ 
by  its  motor  power  to  fulfil  its  own  peculiar  physi- 
ological functions, — the  brain,  the  heart,  the  lungs, 
the  liver,  the  stomach,  the  kidneys,  the  intestines, 
etc., — so  we  can   well  understand  that  any   thing 
that  interrupts  this  motor  power  must  be  followe 


by  an  abnormal  change  of  some  part  of  man's 
physical  organization ;  and  here  arises  the  question, 
how  does  the  human  will  so  control   tliis  nerve 
force  or  power  so  as  to  change  involuntary   inta 
voluntary  thinking.?      What   connection  there   is 
between  man's  human  will  and  his  mental  organ- 
ization I  do  not  know,  nor  do  I  suppo.se  any  one 
ever  will  know,  but.  as  I  assumed  that  God  was 
man's  and  the  whole  animal  and    vegetable  king- 
dom's non-corporal  entity,   and  that  life  was   the 
union    between  them,  so  I   might  fairly   assume 
that  man's  human  nature  was  his  corporal  entity, 
and  its  free  will   the  union  between  it  and  the 
animal  man  by  means  of  life  also.     This  is  the 
only  theory  I  have  to  offer  on  this  very  difficult  sub- 
ject ;  however,  we  have  positive  proof  that  the  free 
will  does,  to  a  more   or  less  degree,  control  the 
normal  material  thought,  as  it  controls  our  organs 
of  locomotion,  which  are  material  also  ;  and  as  it 
controls  the   latter    when  in  a   normal   state  by 
means  of  the  motor  nerves,  so  I  conclude  it  directs 
the  former  by  means  of  motor  nerves  also,  that  is, 
when  in  a  normal  state;  for  the  human  free  will,  I 
maintain,  has  no   more  power  over    the   mental 
organization  when  in  an  abnormal  state  than  it 
has  over  our  organs  of  locomotion  when   they  are 
in  an  abnormal  state,  it  being  understood  that  I 
^peak  comparatively  as  to  the  different    degrees  of 
abnormality  existing  either  in  our  mental  organ- 
ization or  our  organs  of  locomotion.     There  may 
possibly  be  a  different  set  of    nerves  for  voluntary 
and  involuntary  thinking,  as  there  are  a  different 
set  of  nerves  for  voluntary  and  involuntary  motor 
action  in  other  parts  of  our  animal  organization^ 
or  they  may  be  the  same  nerves  rendered  volun- 
tary under  certain  circumstances,  like  many  other 
of  our  involuntary  nerves,  as   is  best  exemplified 
in  our  respiratory  organs.  I  hold  that  thinking,  whe- 
ther voluntary  or  involuntary,  is,  as  I  have  already 
explained,  the  result  of  nerve  motion  stimulating  the 
mental  organization,  and  the  stronger  and  healthier 
is  the  mental  organization  and  the  stronger  and  heal- 
thier is  the  nerve  force,  the  more  healthy  will  be  our 
thinking,  and  the  more  under  the   control  of  our 
wills.     We  must  not  expect  to  find  healthy  rea- 
sonable   thinking  in    the    idiot,  the    imbecile   or 
insane,  neither  must  we  expect  it  from  the  neuras- 
thenic no  more   than  we  would  expect  from  him 
strong  walking  or  swimming. 

It  is  only  as  I  have  explained  it  can  I  conceive 
cause  for  thought,  whether  it  be  voluntary  or 
Involuntary;  moreover,   it  has  the    advantage   of 


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105 


been  intelligible,  what  Mr.  Huxley  would  call 
a  common-sense  view  of  the  subject,  and  con- 
sequently a  scientific  one. 

PART  IV. 

NEUROLOGY — CONCLUSION. 

Gentlemen,  if  you  were  to  ask  me  the  question, 
how  much  of  the  foregoing  was  original,  the  result 
of  my  own  observation  and  reason  and  how  much 
of  it  contained  the  views  of  others,  I  could  not 
answer  the  question.  A  man  who  "has  spent  the  best 
part  of  his  life  irf  the  special  study  of  mind  in 
health  and  disease,  is  very  likely  unintentionally  to 
mix  up  other  men's  views  with  his  own.  One  thing 
I  am  certain  of  is,  that  the  psychological  and  biolo- 
gica.1  views  I  have  advanced  have  been  of  gradual 
growth,  and  I  could  not  before  now  put  all  the 
threads  together  so  as  to  weave  them  into  one  web, 
and  now  I  am  surprised  that  it  took  me  so  long 
to  find  out  such  clear  scientific  truths. 

The  more  important  question  is.  if  these  views 
which  I  have  put  forward  be  true,  what  lessons 
have  we  to  learn  from  them  ? 

First. — If  a  man's  growth  and  decay,  his 
thoughts  and  consequent  deeds  in  many  instances, 
his  emotions  and  impulsive  actions^  his  sickness 
and  health,  be  all  dependent  upon  physical 
change,  either  normal  or  abnormal,  in  his  mental 
organization,  wherein  does  he  become  a  respon- 
sible being?  I  don't  speak  of  his  responsibility  to 
his  Creator,  that  I  leave  to  God,  it  is  out  of  the 
domain  of  mental  science — but  his  responsibility 
to  his  fellow  man.  It  appears  to  me  self-evident 
that  every  man  who  is  not  insane,  and  possesses 
ordinary  intelligence,  is,  in  virtue  of  his  human  free 
will,  bound  to  use  every  lawful  means  to  bring  his 
animal  nature  into  subjection  to  his  human  free 
will,  that  he  may  perform  the  moral  and  social 
duties  he  owes  to  .society,  and  what  all  these  severa 
duties  are,  are  summed  up  in  a  few  words,  doing  by 
others  as  we  would  wish  others  to  do  by  us,  found- 
ed upon  the  natural  law  of  justice  and  benevo- 
lence. I  say  every  man  should  do  his  best,  and 
when  he  has  done  this  he  can  do  no  more. 

If  by  a  limited  responsibility  is  meant  that  a  man 
is  partially  but  not  entirely  responsible  for  his  act 
which  he  does,  I  do  not  believe  in  it,  but  if  it  is 
meant  that  for  one  act  he  is  responsible  and  for 
another  irresponsible,  or  that  one  time  he  may  be 
responsible  for  an  act  and  at  another  time  irre- 
sponsible for  a  similar  act,  in  this  manner  I  could 
believe  in  a  limited  responsibility.     But  I  believe 


every  man  to  be  either  responsible  or  irresponsi- 
ble for  each  of  his  separate  and  distinct  acts. 

Secondly. — As  there  is  such  a  thing  as  a  crimi- 
nal as  well  as  an  insane  neurosis,  for  the  posses- 
sion of  which  a  man  is  no  more  responsible  than 
he  is  responsible  for  his  parentage,  is  punishment 
the  best  remedy  to  improve  such  a  neurosis,  to  im- 
prove a  man  possessing  such  a  mental  organiza- 
tion }  I  don  t  believe  so.  I  cannot  conceive  how 
punishment,  the  infliction  of  suffering,  can  improve 
a  diseased  or  deformed  physical  organization  like 
the  mind  of  man,  no  more  than  I  can  conceive 
punishment  improving.a  diseased  liver  or  lungs, 
which  are  no  more  nor  no  less  material  than  is 
his  mental  organization. 

Thirdly. — Is  our  mode  or  sy.stem  of  education 
the  best  possible  means  of  developing  the  mental 
organization  of  youth,  of  developing  a  "  mens 
sana  in  corpore  sano,"  which  v.as  considered  the 
greatest  blessing  by  our  Pagan  forefathers?  I  gave 
an  answer  to  this  question  five  years  ago  in  a 
paper  entitled  "  A  protest  against  the  present 
high  pressure  system  of  education."  I  now  repeat, 
no,  a  thousand  times  no ;  by  our  systems,  not  by 
education,  we  are  making  our  youths  criminals  or 
lunatics,  or  sending  them  to  a  premature  grave. 
Hear  what  that  old  conservative  magazine^ 
"  Blackwood  "  says  on  the  subject : — 

INSTRUCTION    AND    SUICIDE. 

Professions  do  not  predispose  to  suicide,  but 
instruction  does.  No  man  kills  himself  because  of 
his  trade,  but  a  good  many  men  kill  themselves  be- 
cause of  their  knowledge.  Not  only  has  the  revival 
of  suicide  almost  exactly  coincided,  in  time,  with, 
the  modern  extension  of  schooling,  but  suicide- 
is  now  most  abundant  in  the  very  regions  in 
which  schooling  is  most  expanded.  The  records 
establish  this  beyond  all  doubt.  The  inhabitants 
of  countries  in  which  every  one  can  read  are  pre- 
cisely those  who  kill  themselves  the  most.  Now 
this  supplies  another  indication  that  people  do  not 
always  make  a  good  use  of  reading.  We  knew 
that  fact  already,  it  is  true,  but  we  scarcely  ex- 
pected that  additional  proof  of  it  would  be  supplied 
in  this  strange  form.  That  reading  conduces  to 
suicide  is  a  new  view  of  reading,  but  it  is  incon- 
testably  an  exact  one — within  limits.  We  could, 
perhaps,  have  imagined,  if  we  had  thought  about 
the  matter  at  all,  that  certain  occupations  might 
possibly  pave  the  way,  under  unfavorable  circum- 
stances of  health,   to   thoughts  of   suicide.     We 


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THE   CANADA    MEDICAL    RECORD. 


could  have  wildly  guessed,  for  instance,  that  newly 
enlisted  recruits,  or  lighthouse-keepers,  or  exiles, 
•or  public  executioners,  lead  lives  in  which  the 
self-killing  tendency  might  receive  a  morbid  deve- 
lopment ;  but  never,  in  our  senses,  should  we 
suppose  that  village  schooling  is,  indirectly,  the 
most  fertile  of  all  the  actual  origins  of  suicide. 
And  yet  it  seems  to  be  so.  And  if  it  is  not,  what 
is  ?  We  have  all  of  us  heard  so  much  of  "  the 
suppression  of  crime  by  education  "  that  we  have 
insensibly  acquired  the  unreasoned  belief  that 
education  is  one  natural  cure  for  moral  evils.  So, 
perhaps,  it  ought  to  be.  And — to  repeat  the 
question — if  it  is  not,  what  can  be  ?  But  evidently, 
as  regards  this  particular  evil,  education  appears 
to  be  a  provocative  rather  than  a  remedy — at  least 
in  the  form  in  which  we  have  hitherto  applied  it. 
The  books  which  are  now  being  published  about 
suicide  on  the  continent  are  all  deploring,  with 
consternation,  the  simultaneity  of  the  spread  of  the 
alphabet  and  of  voluntary  death,  and  are  asking, 
anxiously,  what  can  be  the  connection  between 
them.  They  seem  indeed  to  be  almost  expecting 
that,  if  we  go  on  as  we  have  begun,  we  shall  soon 
see  suicide  officially  recognized  by  Government  as 
an  inevitable  result  of  study  (like  headaches  and 
spectacles),  and  placed  naturally,  all  over  Europe, 
under  the  supervision  of  the  inspectors  of  schools. 
— Blackwood's  Magazine. 

Fourthly. — As  mind  and  body  are  one,  and  as 
the  mental  organization  takes  in  every  fibre  of  the 
whole  nervous  system,  and  as  all  sensation  is  in 
and  by  and  through  the  nervous  system,  have 
we  not  committed  a  great  error  by  such  a  classi- 
fication as  making  mental  and  physical  suffering 
two  distinct  forms  of  suffering,  and  consequently 
establishing  two  distinct  forms  of  treatment  — 
when  the  truth  is,  mental  and  physical  suffering 
are  one  and  the  same  thing,  no  matter  what  the 
causes  may  be  which  produce  the  suffering, 
whether  it  be  a  gunshot  wound,  producing 
mechanical  destructive  lesions,  or  an  unkind  word 
producing  irritative  lesions  :  in  either  case  the 
suffering  is  caused  by  the  production  of  an 
abnormal  change  in  the  nerve  centre,  the  shock  pro- 
duced by  the  unkind  words  being  borne  by  means 
of  the  sense  of  hearing  to  the  nerve  centre,  and 
the  shock  which  is  the  result  of  the  gunshot  wound, 
being  transmitted  to  the  nerve  centre  by  means  of 
the  sensory  nerves, — and  the  suffering  may  be 
just  as  great  in  one  case  as  in  the  other,  and  lead 
to  as  dire  consequences,  that  is,  to  death  or,  what  is 


worse,  to  insanity.  Although  in  one  case  where 
death  is  the  result  the  pathologist  may  not  be 
able  to  show  us  the  lesion  in  the  nerve-centre  it  is  as 
surely  there  as  if  it  were  "  microscopic"  instead  of 
being  as  it  would  be,  "  ascopic." 

Seeing  that  the  nervous  system  or  mental  is  the 
motor  power  by  which  we  live  and  move  and  be* 
and  that  it  is  such  in  virtue  of  its  vital  force  or 
motor  power,  by  which  force  or  power  it  governs 
every  portion  of  our  physical  organization,  every 
fibre  of  which  it  is  integrated  with,  would  I  be 
going  too  far  if  I  said  that,  as  all  suffering  is  mental 
suffering,  so  all  diseases  are  mental  diseases.  I 
mean  that  as  all  diseases  originate  in  nerve  structure 
there  is  no  doubt  but  that  nerve  structure  suffers 
in  all  forms  of  disease ;  but  the  question  is,  does 
disease  originate  in  any  other  of  our  bodily 
tissues,  or  is  the  first  cause  in  nerve-structure. 
I  know  all  the  objections  that  can  be  raised 
against  this  theory  ;  but  are  they  not  all  capable 
of  being  answered  ?  I  am  not  at  present  ])repared 
to  go  into  that  question ;  to  do  so  would  require 
a  paper  longer  than  the  one  I  am  about  to  con- 
clude. I  would,  however,  remark  that  I  believe  we 
can  point  out  very  ity:  diseases,  whether  of  the 
pyrexical  class,  or  otherwise,  that  are  not  ushered  in 
by  asthenft:  symptoms,  shewing  that  the  nervous 
system  is  the  first  part  affected.  And  in  my  opinion 
it  were  better  if  we  treated  all  such  cases  when 
these  symptoms  present  themselves,  than  to  wait 
for  some  specific  form  of  disease  to  be  developed, 
which  disease  may  be  insanity,  and  by  our  early 
treatment  prevent  any  specific  disease  being 
developed.  He  is  a  good  physician  who  so  treats 
his  patient  as  to  enable  the  physical  organization 
to  recover  from  a  diseased  state,  but  he  is  a  better 
physician  who  prevents  in  the  early  stage  the 
physical  organization  from  running  into  a  diseased 
s'.ate.  In  other  words,  prevention  is  better  than  cure. 

For  my  part  I  believe  there  is  a  nerve  centre  for 
each  and  every  of  our  thoughts  and  deeds,  for 
each  and  every  of  all  our  different  forms  of  suffer- 
ing ;  for  each  and  every  of  all  the  different  forms 
of  disease  by  which  we  are  aflllicted,  and  that  each 
and  all  of  these  nerve  centres  can  and  will  in  time 
be  localised  by  the  experts  in  anatomy,  physiology 
and  pathology.  The  sciences  of  psychology  and 
biology  call  upon  these  experts  to  find  out  these 
nerve  centres,  and,  judging  by  the  work  done  with- 
in the  last  few  years  there  will  be  no  disappointment. 
They  have  already  pointed  out  to  us  the  nerve 
centre  for  intelligence  and   emotions,  for  motion 


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107 


and  sensation,  for  respiration  and  digestion,  for 
hearing,  seeing,  tasting  and  smelling,  with  the 
nerve  centre  for  speech.  They  have  shown  us  the 
nerve  centre  diseased  producing  different  forms  of 
paralysis,  and  now  Dr  Dyce  Duckworth  of  St 
Bartholomew's  Hospital,  in  his  plea  "  for  the  neuro- 
tic theory  of  gout,"  gives  us  the  nerve  centre  for 
the  diabetis  accompanying  that  disease.  He  says  : 
"  The  medulla  oblongata,  the  sympathetic  and 
splenic  nerves  have  been  found  chiefly  affected,  and 
the  spinal  cord  Hkewise  in  some  instances.  The 
point  for  the  diabetic  puncture  in  the  medulla 
oblongata  is  believed  by  physiologists  to  correspond 
to  the  vaso-motor  centre  in  the  same  structure." 
With  all  these  facts  before  us  we  have  every  reason 
to  hope  that  the  working  men  of  science  will 
gradually  draw  from  nature  all  her  grand  secrets. 
Then  will  medical  men  be  able  to  treat  the  ine- 
briate and  the  man  of  abnormal  sexual  desires  as 
they  do  the  insane,  on  purely  scientific  principles. 
They  will  recognise  that  they  have  a  diseased  or 
abnormal  mental  organization  to  deal  with,  whether 
either  of  these  states  be  the  result  of  heredita- 
ment or  of  habit,  and  they  will  treat  the  cases  accor- 
dingly. 

They  will  recognise  that  although  one  man  by 
will-power  may  succeed  in  subduing  his  animal  de- 
sire by  producing  a  physical  change  in  his  mental 
organization,  that  such  a  case  is  the  exception,  not 
the  rule.  That,  as  a  rule,  they  might  just  as  well  ex- 
pect the  paralysed  man  to  walk  because  he  willed 
it  as  the  inebriate  to  abstain  from  drink  because 
he  willed  it.  They  will  recognise  that  all  the 
Legislature  can  do  for  such  cases  is  to  provide  an 
asylum  for  them,  where  they  will  receive  proper 
medical  treatment,and  where  they  will  be  detained, 
even  against  their  will  or  desire,  till  they  have 
recovered,  and  where,  if  incurable,  like  an  insane 
person,  they  must  remain  for  life.  In  all  these  cases 
physical  change  must  take  place  before  the  desire 
for  drink  ceases  ;  and,  if  there  be  no  other  remedy, 
forced  abstinence  and  time  will  produce  that 
physical  change  in  the  majority  of  cases,  but  well- 
directed  medical  treatment  should  be  the  great 
consideration.  Temperance  societies  are  very 
good,  and  I  have  the  highest  respect  for  all  those 
well-meaning  persons  who,  seeing  the  evil  results 
of  drink,  have  been  using  what  they  consider  the 
best  means  to  abolish  the  evil.  But  the  evil  is 
where  they  cannot  reach  it,  and  the  removal  of  it 
depends  upon  the  medical  scientist,  and  it  is  time 
that  medical  scientists  should  bend  themselves  to 


work  and  find  out  the  nerve  centre  for  inebriety 
and  find  a  remedy  for  the  case  ;  and  those  gene- 
rous persons  who  for  .so  many  years  have  been 
working  for  the  cause  of  temperance  with,  I  re- 
gret to  say,  so  little  good  results,  should  see  to 
it  that  the  medical  men  are  provided  with  proper 
asylums,  and  all  available  remedies  to  carry  out 
their  work. 

I  don't  think  I  have  gone  too  far  in  attributing 
all  our  diseases,  as  well  as  all  our  sufferings,  to  our 
mental  organization,  certainly  not  further  than  Dr. 
Maudsley,  and  although  Eulenburg,  Gutman, 
Du  Bois  Raymond,  Nothnagel,  Bucknill  and 
Ferrier  have  not  said  the  same  in  so  many  words, 
all  their  writings  tend  to  the  same  conclusions. 

Gentlemen,  I  have,  to  the  best  of  my  ability, 
given  you  my  views  on  man's  two  natures,  on  the 
theory  of  creation  by  evolution,  and  on  mind, 
because  these  three  subjects  are  so  united  in  the 
one  science  of  psychology  that  I  could  not  treat 
of  one  without  treating  of  the  whole. 

I  have  dwelt  more  particularly  upon  mind,  at 
least  in  its  normal  state,  because  I  wished  to  show 
how  important  is  the  knowledge  of  psychology  in 
the  treatment  of  disease ;  and  I  would  have  you  to 
believe  that  you  cannot  study  the  mind  in  health 
without  clinically  studying  it  in  disease,  and  more 
particularly  as  it  developes  itself  in  the  different 
forms  of  insanity.  It  is  only  by  comparison  that 
we  can  learn  the  normal  mind.  I  wish,  however, 
that  you  perfectly  understand  that  I  maintain  that 
no  man  can  enter  upon  the  science  of  psychology 
before  he  knows  its  kindred  sciences — anatomy, 
physiology  and  pathology,  and  the  better  he  knows 
these  sciences  and  all  other  sciences  the  better  will 
he  be  prepared  to  enter  upon  the  science  of 
psychology. 

The  general  increase  of  knowledge  in  our  pro- 
fession will  never  prove  an  obstacle  to  experts  in 
particular  branches  of  it ;  and  men  will  always  be 
found  who  will  devote  themselves  to  some  parti- 
cular branch,  and  it  will  be  always  necessary  they 
should  do  so.  But  it  is  necessary  that  all  medical 
men  should  know  something  of  ail  diseases,  and  I 
hope  the  time  is  approaching  when  every  medical 
man  will  be  able  to  answer  in  the  affirmative  when 
the  "  Shaksperian "    question  is   propounded    to 

him, 

"  Canst  thou  not  minister  to  a  mind  diseased." 


108 


THE    CANADA    MEDICAL    RECORD. 


ON  THE  TRUE  POSITION 


OK    THK 


BLADDER  IN  THE  MALE, 

and  a  ff.w  thotthts  on  rassinc;  the  catheter,  both 

as  rer.arj>.s  drawing  okk  urink,  and  as  regards 

"sounding"  for  STONK. 

By  C.  E.  Nelsok,  M.D.,  New  York. 
I  must  really  apologize  to  my  Montreal  readers 
for  obtruding  my  name  so  often  in  the  pages  of 
the  Record  ;  but,  in  my  humble  opinion,  the 
subject  of  this  article  is  one  of  importance,  as  is 
evinced  in  daily  practice ;  and  also,  with  the 
exception  of  those  who  have  had  an  extensive 
experience  in  this  branch,  such  as  hospital  men, 
many  general  practitioners  are  not  so  well  versed 
in  several  little  points  as  they  themselves  might 
desire, — their  time  being  most  busily  engaged  in 
general  practice. 

I  also  wish  to  lay  before  the  medical  public  the 
idea  that  in  all  likelihood  the  wood- cuts  in  our 
anatomical  text-looks  are  erroneous  ;  and  if  that 
is  the  case,  causing  serious  errors  in  our  practice, 
in  passing  the  catheter — in  sounding — and  in  the 
operations  (seances)  of  lithotrity. 

The  position  of  the  bladder  in  the  pelvis,  which 
is  likely  to  be  the  true  one. 

Erasmus  Wilson,  in  his  "  Anatomy,"  says,  "  the 
bladder,  when  empty,  is  triangular  and  flattened 
against  the  pubes."  As  a  minor  remark,  I  think 
the  statement  that  it  is  triangular  is  open  to 
doubt,  the  idea  being  that  the  urachus  holds  it  up 
from  the  top ;  my  ideas  on  this  point  will  be 
elaborated  further  on,  where  the  connection  will 
be  seen. 

Flattened  against  the  pubes.  With  all  defer- 
ence to  this  celebrated  man,  I  think  this  statement 
is  incorrect ;  I  prefer  the  "  explanation  "  that  will 
be  given  lower  down. 

Apart  from  the  explanation  that  will  be  read 
lower  down,  I  think  the  chief  argument  against  its 
being  flattened  against  the  pubes  when  empty,  is 
the  utter  absurdity  of  it,  when  you  come  to  reflect 
on  the  matter,  likely  for  the  first  time. 

As  a  preliminary  observation,  I  will  remark  that 
professors,  and  medical  men  generally,  are  too  apt 
to  regard  the  relative  position  of  viscera  in  the 
cadaver  as  being  precisely  the  same  as  in  the 
living  subject ;  one  may  say,  "  well,  there  are  the 
same  folds  of  peritoneum,  so-called  ligaments, 
&c,"  but  the  condition  of  things  is  very  different; 
in  the  corpse,  everything  is  collapsed — that  is, 
when  it  is  opened — from  the  pressure  of  atmos- 


pheric air,  fourteen  pounds  to  the  square  inch  ; 
before  the  '•  body "  is  opened,  another  state  of 
things  obtains,  a  little  different  to  that  during  lifci 
i.e.,  ceriain'organs  are  more  distended  than  during 
life ;  also,  certain  portions  of  the  cadaver  are 
swollen  from  various  extravasations,  ante-mortem 
or  cadaveric. 

As  regards  medical  students  examining  closely 
the  relative  position  of  the  pelvic  (or  other) 
organs,  they  rarely  take  the  trouble ;  it  being 
infrequent  for  a  student  to  dissect  the  bladder  and 
rectum  (stuffed  with  tow,  the  anus  sewn  up)  ;  and 
then,  as  regards  the  bladder  at  least,  they  think  a 
great  deal  more  of  cleaning  the  muscular  coat  off 
nicely,  than  of  any  relative  position  of  the  organs. 
Another  great  obstacle  to  our  arriving  at  the 
truth  lies,  I  think,  in  the  fact  that  we  dissect  the 
cadaver  lying  down  (for  convenience  sake) ;  this 
is  very  different  to  the  position  during  life,  as  we 
sit  or  stand  nearly  all  day.  When  the  body  is  laid 
down  (like  in  gynaecological  examinations  as 
usually  conducted,  but  for  which  I  always  ask  the 
patient  to  stand  up),  the  pelvic  and  abdominal 
viscera  recede  from  their  usual  relative  position. 

We  will  take  Wilson's  first  wood-cut,  where  the 
man  is  represented  lying  down  (the  usual  position* 
in  hospitals,  of  passing  the  catheter — but  I  always 
ask  the  man  to  stand  up)  :  there  is  quite  a  longish 
space,  which  is  not  clearly  accounted  for,  between 
prostate  and  pubes  ;  now,  if  the  bladder,  when 
contracting,  flattens  against  the  pubes,  as  is 
stated,  it  would  of  course  have  to  pull  along,  and 
over,  with  it,  rectum,  vesiculne  seminales  and 
prostate,  across  the  pelvic  cavity  (4  inches  !)  to 
behind  the  pubes — a  thing  that  is  very  unlikely 
to  say  nothing  of  the  rectum  being  closely  con 
nected  with  sacrum,  and  held  there  by  a  meso 
rectum.  What  about  pulling  the  triangular  liga- 
ment over  to  pubic  arch,  which  is  very  unlikely  ; 
in  that  case  the  urethra  inside  the  body  would 
become  distorted,  which  we  know  is  not  the  case, 
by  passing  the  catheter. 

A  few  words  more  : — the  terms  that  are  made 
use  of  in  designating  certain  portions  of  the 
bladder  are,  I  think,  apt  to  confuse,  and  thereby 
mislead ;  for  instance,  "  body,"  "  superior  fundus," 
'' inferior  fundus,"  "base";  the  student  has  got 
to  stop  and  think  whether  you  are  sitting  the  man 
or  laying  him  down  ;  and  even  then  the  terms  are 
very  obscure. 

THE  TRUE  EXPL\NAT10N, 

I  think,  is  to  be  found  in  Dr  R.  Nelson's  "  Trea- 


THE    CANADA    MEDICAL    RECORD. 


109 


tise  on  Asiatic  Cholera,"  wherein  he  states  that  (p. 
104)"  the  bladder  does  /r^/"  contract  mall  direc- 
tions,"  as    popularly   supposed ;    but   that   "  the 
base  lies  against  floor  of  pelvis,   between   pubis 
and  rectum,  in  the    male,  wiiere   it   is   tied  down 
(anatomically)  to  this  floor,  and  is  nex>er  removed 
thejice.  however  much  the  viscus  may  be  distended 
with  urine  :    here  it    forms  a  fiat^    adherent  disc, 
about  2  or  2}^  inches  in   diameter,   from    side  to 
side  and  from  before  backwards,  between  pubis  and 
rectum  ;  in  tike  very   centre  of  this  disc  the  urethia 
opens  [I  go  on  transcribing  the  whole  paragraph  as 
it  is  necessary  to  do).     When  the  bladder  expands 
by  accumulation  of  urine,  it  is  the  sides  and  summit 
that   expand,    and    a   portion   of  the    base   also 
stretches  to  some  extent,  but  the  base  never  leaves 
its  attachment  to   the  floor  of  the  pelvis)  this  is  dif- 
ferent to   what   our  books   say),    to    which    it  is 
affixed   by   pretty   close   cellular    tissue.      When 
bladder  is  empty  all  contracts,  summit  and  sides, 
as  far  as   lateral    Hmits  of  the    'base  disc,'   and 
in  this   state   the    summit  forms  another  disc,  of 
equal  dimensions  to    the  base   (lower)    one,    and 
comes  into  immediate  fiat  contact  with  the  lower 
disc.'' 

My  comments  will  come  afterwards,  in  speaking 
of  the  passage  of  instruments. 

My  father's  remark,  that  the  internal  meatus 
urethrse  opens  in  the  very  centre  of  the  bladder 
disc,  certainly  staggers  me,  as  we  are  led  by  our 
pictures  to  believe  that  it  opens  into  what  we  call 
the  "  lower  end  "  of  the  bladder ;  however,  he  ex. 
amined  post-mortem  many  cholera  patients  in  Mon- 
treal. 

PASSAGE  OF  INSTRUMENTS. 

I  have  just  measured  the  central  portion  of  the 
pubis  of  my  skeleton,  and  ascertained  the  fol- 
lowing diameters  :  vertical^  i^  in  :  transverse,  2^ 
in.  ;  oblique,  2^  inches ;  antero-posterior  dia- 
meter,sacrum  to  back  of  pubis(symphysis),4  inches, 
so  that,  if  the' rectum  is  empty,  consequently  easily 
flattened  against  sacrum,  wlien  bladder  is  greatly 
distended, — for  the  bladder  to  contract  (according 
to  Wilson'and  others)  it  would  have  to  traverse 
the  entire  pelvic  cavity,  four  inches  across.  From 
the  anatomical  relation  of  the  parts  in  the  female 
this  question  need  not  be  discussed. 

According  to  Dr.  R.  Nelson  the  diameter  of  the 
*'' bladder  disc"  is  (say)  2^^  inches  every  way, 
that  is  more  than  the  vertical  diameter  of  the 
symphisis  pubis ;  it  would  therefore  rise  above 
upper  border  of  pubis,    so  that  it  can  hardly  be 


said  to  be  flattened  (vertically?)  against  the  pubis. 

A  great  deal  of  trepidation  is  manifested  by  ope- 
rators puncturing  bladder  supra  pubem,  on  account 
of  possibly  wounding  the  peritoneum,  and,  conse- 
quently, passing  the  trocar  into  that  cavity  ;  Mr. 
James  Lane,  a  celebrated  London  surgeon,  as- 
sured his  class  that  when  the  bladder  was  dis- 
tended this  accident  could  not  possibly  take  place, 
as  the  bladder  lifted  the  peritoneum  up  before  it, 
as  it  became  distended. 

Passing  the  Catheter. — I  believe  it  was  Baron 
Heurteloup  who  travelled  over  Europe,  showing 
medical  men  the  easy,  deft,  and  marvellous  way 
in  which  he  passed  the  instrument,  in  the  most 
difiicult  cases.  Most  beginners  suppose  it  is  very 
easy  to  do,  but  in  reality  it  requires  a  great  deal 
of  skill — witness  the  false  passages  that  are  often 
made  by  the  attendants.  After  warming  and 
oiling,  the  general  mistake  is  that  they  "  turn  "  too 
soon,  which  brings  the  beak  strong  against  upper 
wall  of  urethra ;  if  the  attendant  through  "  mau- 
vaise  honte,"  persists  in  pushing,  likely  false  pass- 
age and  abscess  may  supervene. 
Exploring  Bladder  with  Sound  or  Lithotrite. 

The  curve  of  a  catheter  being  too  large,  we 
(through  habit)  explore  all  around,  top,  &c.,  al- 
though w^e  know  the  calculus  can  only  be  on  the 
bottom  ;  this  differing  where  the  man  lies  down  or 
stands,  the  beak  soon  gets  arrested  against  the 
sides,  as  the  transverse  diameter  (Wilson)  is  small- 
er than  the  vertical.  If  a  doctor  will  take  his  cathe- 
ter or  sound,  place  end  in  a  small  bowl,  and  keep 
turning  it  round  in  difierent  directions,  he  will 
see  how  utterly  futile  his  efforts  may  be  for  some 
time,  before  he  hits  it  again  a  pebble  placed  in  the 
bowl ;  but  we  do  a  rather  singular  thing  :  after  ex- 
ploring all  around  we  turn  the  beak  downwards 
to  make  sure  of  that  direction ;  according  to  some 
pictures,  and  according  to  Dr.  R.  Nelson's  state- 
ment, there  can  be  no  downwards,  unless  by  that 
you  term  pressing  the  beak  on  to  the  floor  of  blad- 
der, which  of  course  will  give  to  a  certain  extent. 
When  examining  floor  of  bladder,  I  turn  sound 
right  round  upside  down,  exploring  with  the  beak  ; 
as  the  other  way  it  is  impossible  to  detect  a  calcu- 
lus. 

THE  SUPPOSED  TRIANGULAR  OR  PYRIFORM 
SHAPE  OF  THE  BLADDER. 

I  should  rather  be  inclined  to  state,  or  think, 
that  the  shape  of  the  human  bladder  resembles 
that  of  a  flat  cake,  or,  more  scientihcally  expressed 


110 


THE    CANADA    MEDICAL    RECORD. 


like  the  human  placenta ;  and  also  that  the  inser 
ton  of  the  two  cords  is  analogous  in  both  in- 
stances, in  the  centre  of  course,  but  a  little  de- 
pressed (or  umbilicated).  Persons  may  say^ 
"  why  do  we  not  sec  this  in  the  cadaver?  "  but, 
on  reflection,  a  "  body  "  is  not  opened  in  a  dis- 
secting-room until  some  little  time  after  death  ; 
in  all  likelihood  the  subject  did  not  die  of  Asiatic 
cholera, — by  this  time,  post  mortem  (cadaveric) 
changes  have  taken  place  ;  but  persons  may  again 
say,  in  ordinary  autopsies,  held  a  few  hours  after 
death,  why  do  we  not  see  that  umbilicated  depres- 
sion ?  (I)  there  may  be  urine  in  the  viecus,  in 
many  cases;  (II)  possibly  it  is  only  in  cases 
of  Asiatic  cholera,  where  the  observer  may  have 
the  chance  (as  Dr.  R.  Nelson  had)  of  seeing  it — 
rom  the  "  spasm  "  being  on,  which  would  remain 
after  death  ;  perhaps,  in  one  or  two  days  after 
death,  if  an  autopsy  were  practised  on  a  person 
who  had  died  of  cholera,  this  appearance  would 
no  longer  be  seen,  on  account  of  cadaveric  changes. 
In  the  dissecting-room.  On  sauntering  through 
■we  may  come  across  a  student  "  dissecting  "  the 
bladder ;  but  what  is  the  observed  relation  of  the 
organs,  one  to  the  other  ?  As  it  is  very  trouble- 
some dissecting  the  bladder  down  below  the 
pubes,  we  shall  likely  see  the  bladder  (upper 
portion)  turned  out  and  over  the  pubes ;  the  blad- 
der has  possibly  been  inflated  with  air,  through  a 
blow-pipe,  through  an  incision  ;  rectum,  lower 
portion,  in  connection  with  lower  portion  of  blad- 
der, possibly  stuffed  with  tow,  then  ligatured  and 
cut  ofi";  intestines  have  been  previously  taken 
away,  or  turned  over  to  one  side ;  now,  every- 
thing (especially  in  a  cadaver  of  some  weeks), 
here  is  very  much  distorted  ;  relation  of  the  parts, 
])erfectly  strained  and  unnatural  :  if  water  were 
used  ligaturing  the  neck  of  bladder  below  the 
pressure  would  be  equal  on  all  sides,  and  we 
would  then  get  more  likely  the  true  shape. 

Certain  conditions  where  the  bladder  may,  in 
all  probability,  be  flattened  against  the  pubes. — 
During  the  progress  o(  labor  in  the  female,  when 
the  child's  head  occupies  the  sacral  concavity, 
before  labour  comes  on,  during  the  last  few  days, 
and  especially  hours,  preceding  actual  confine- 
ment, when  the  woman  urinates  every  few  minutes, 
latterly,  I  think  the  bladder  is  still  horizontal ; 
but,  on  account  of  being  pressed  on  above,  it  has 
to  be  frequently  emptied,  simply  because  there  is 
only  room  for  a  small  quantity  of  urine  ]  if,  when 
the  head  passes,   the    bladder  contains    a   large 


quantity  of  urine  (comparatively  speaking),  it  is 
almost  sure  to  be  torn  ;  of  course  this  cannot  take 
place  unless  on  being  flattened  against  the  pubes. 

Ptlvic  turners,  including  large  fibrous  tumors 
of  the  uterus,  which  may  have  a  "  process " 
descending  into  concavity  of  sacrum, — the  action 
of  these  would  depend  on  their  size,  and  situa- 
tion within  the  pelvis.  In  these  cases,  most  like- 
ly, as  the  bladder  gets  filled,  it  rises,  and  gets 
flattened  against  pubes, — or,  in  other  words,  gets 
jammed  between  pubes  and  the  hard  tumor. 

Fracture  0/  ossa  pubis. — It  would  be  interesting 
if  those  who  had  these  cases  to  attend  would  re- 
port whether  the  fractured  edge  caused  extra 
irritation  of  the  bladder  ;  I  do  not  remember  having 
heard  of  it,  and  this  therefore  further  makes  me 
think  that  the  bladder  does  not  flatten  behind  the 
pubes  in  the  emptied  state  ;  if  it  were  so  the  blad- 
der would  very  likely  get  torn,  as  there  is  nothing 
whatever  between,  except  iliac  fascia. 

But  these  are  all  unusual  cases,  and  my  endea- 
vor now  is  to  prove  that  the  bladder  is  not  trian- 
gular ;  of  course  this  view  does  not  militate  against 
the  usual  representation  of  the  lower  zone  in  our 
books. 


BoUeSpondenm. 


DR.  C.  E.  NELSON'S  FRACTURE  CASE. 

CORRECTIONS. 

To  the  Editor  0/  the  Canada  Medical  Record. 

Sir, — The  article  on  "  Operations  "  is  all  right. 
The  second  one,  "  Fracture  Case,'"  contains  several 
inaccuracies  of  the  printer  ;  an  important  one,  as 
regards  punctuation,  about  "  putting  on  the  stock- 
ings," and  "  not  being  able  to  stand  without 
crutches ;  "  these  mistakes  cannot  now  be  helped, 
however ;  but  one  grave  error  I  shall  have  to  ask 
you  to  correct  in  your  next  number  (December), 
that  is,  printer  put  five  inches  shortening  (!)  instead 
of  two  ;  the  older  readers  will  of  course  see  that  is 
a  mistake,  but  it  will  not  so  readily  occur  to  the 
younger  ones,  who  might  think  it  strange,  my 
sending  a  fracture  case  to  the  paper  having  Jive 
inches  shortening. 

C.  Eugene  Nelson,  M.D., 

New  York. 


THE   CANADA   MEDICAL    RECORD. 


ill 


J^miM'i'S  of  JIflecUcai  Scieme . 


MIDWIFERY  AND  GYNAECOLOGY. 

THE    PREVENTION    AND    TREATMENT    OF    POST-PAR" 
TUM  HEMORRHAGE. 

In  a  discussion  on  this  important  subject  at  ths 
late  meeting  of  the  British  Medical  Association 
{British    Med.   Journal,)     Dr.    Thomas    More 
Madden,  of  Dublin,  discussed  seriatim  the  causes 
oi post-pa rtum  hemorrhage,  and  the  treatment  re- 
quired by  each  of  these.  Having  dwelt  on  the  con- 
stitutional conditions  predisposing  to  flooding,  and 
the  preventive  measures  by  which  this  might  be 
waaded  off,  even  in  those  who  had  been  habit- 
urlly  subject  to  this  accident  on  former  occasions, 
he  considered  the  causes  of  flooding  and  the  man- 
agement of  labour,  so  as  to  prevent  subsequent 
inertia  or  irregular  contraction  of  the  uterus.  The 
ill  effect,  in  this  respect,  of  the  premature  applica- 
tion of  the  forceps  before  the  full  dilatation  of  the 
OS  uteri,  and  also  the  production  ot  hemorrhage  as 
the  result  of  undue  delay  in  the  second  stage,  were 
next  referred   to.  During  labour,  when  there  waj 
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  stimulating  enemata  of  a  strong  infusion  of 
ergot,  or  the  hypodermic  injection  of  ergotine,  in 
the  second  stage  ;  and  a  firm  unremitting  manual 
pressure  over  the  fundus  uteri,  from  the  time  the 
child's  head  escaped  from  the  vulva  until  the  com- 
pletion of  the  third  stage,  which  should  never  be 
hastened  by  traction  on  the  cord,  and  the  perma- 
nent contraction  of  the  uterus  was  secured.  In  nine- 
teen cases  of  flooding,  the  solution  of  perchloride 
of  iron  was  resorted  to  ;  in  eighteen  of  these  the 
hemorrhage  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  fundus  uteri — was  a  very 
hazardous  proceeding,  and  exposed  the  patient  to 
great  and  needless  twofold  danger  of  death  from 
embolism  or  from  peritonitis.     He,  therefore,  re- 
commended, instead,  the  direct  application  of  the 
strong  liquor  ferri  perchloridi  to  the  bleeding  ves- 
sels by  a  sponge  soaked  in  this  fluid,  and  carried 
up  by  the  hand  into  the  uterus,  and  retained  there 
until   a    firm   contraction   was   produced.     Some 
cases  were  referred  to  in  which  hemorrhage,  that 
had  resisted  all  other  treatment,  was  thus  arrested ; 
and  Dr.    Madden,   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  neces- 
sity.    Some  of  the  other  remedies  employed  in  the 
treatment   of  post-parium  hemorrhage,  including 
the  hypodermic  use  of  ergotine,  galvanism,  and 
cold  and  hot  injections,  were  referred  to. 

Dr.      William    Walter,    of    Manchester,     said 


hat  since  the  method  of  treating  postpartum 
hemorrhage  by  the  injection  of  hot  water  was 
brought  under  notice  by  Dr.  Atthill  early  in 
1878,  he  had  treated  in  this  way  eleven  cases 
in  the  Manchester  and  Salford  Lying-in  Hos- 
pital. The  temperature  of  the  water  used 
ranged  from  no"  to  120°  Fahr. ;  and  the  utmost 
care  was  taken  that  the  tube  (Hayes'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  given — led  Dr. 
Walter  to  the  conclusion  that  the  hot-water  treat- 
ment offered  some  advantages,  in  being  generally 
accessible  and  not  disagreeable  to  the  patient ;  but 
that,  as  a  means  of  contracting  the  uterus,  it  was, 
in  his  experience,  not  to  be  relied  on.  Neverthe- 
less, he  hoped  to  continue  the  method  ;  and  he  ad- 
vised that  the  temperature  of  the  water  should  be 
ascertained  by  the  thermometer  in  every  case.  The 
recent  researches  of  Dr.  Max  Runge  tended  to  show 
that,  if  success  was  to  follow  the  hot-water  treat- 
ment oipost-partum  hemorrhage,  the  temperature 
of  the  water  must  not  be  so  high  as  it  was  in  his 
(Dr.  Walter's)  cases.  In  all  the  cases  but  one,  the 
injection  was  followed  by  relaxation  and  dilatation 
of  the  entire  uterus ;  if  contraction  occurred,  it  was 
but  temporary;  but,  when  the  temperature  of  the 
water  did  not  exceed  104"  F.,  the  uterus  con=- 
tracted  without  being  afterwards  paralyzed.  No  ap- 
preciable effect  was  produced  on  the  pulse  and 
general  condition  of  the  system.  After  the  failure 
of  the  injection,  the  application  of  the  induced 
current  was  succcessful  in  several  of  the  cases. 

Dr.  Atthill,  of  Dublin,  confined  his  remarks  to 
the  use  of  the  four  principal  agents  used  for  the 
arrest  oi post-partwn  hemorrhage  ;  namely,  ergot, 
cold  water,  warm  water,  and  the  perchloride  of  iron. 
Ergot  was  most  unreliable  :  it  took  time  to  act,  and, 
though  valuable  if  administered  to  anticipate 
hemorrhage,  was  nearly  useless  at  the  time,  even 
if  injected  under  the  skin.  Cold  was  perhaps  the 
most  efiicient  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  ad- 
vantage, not  to  supersede  the  use  of  cold.  Dr.  Wal- 
ter recorded  cases  in  which  it  failed,  or  did  actual 
harm;  but  he  used  it  too  hot,  namely,  at  1 20°  instead 
of  100° ;  and  the  experiments  referred  to  at  the  con- 
clusion of  his  paper  showed  that  hot  water  was  effi- 
cient in  causing  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  unnecet^sary.  Perchloride  of  iron  was  in 
some  cases  absolutely  demanded,  and  was  the  most 
certain  means  of  checking/t?^/-/d/'///;«  hemorrhage. 
It  had,  in  Dr.  Atthill's  hands,  saved  several  lives  ; 
but,  like  all  other  remedies,   it  was  not  absolutely 


112 


THE    CANADA    MEDICAL    RECORD. 


safe.  He  knew  of  one  case  in  which  il  seemed  to 
cause  instantaneous  death ;  but  he  had  known 
death  to  follow  in  a  few  moments  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  ? 

PILOCARriN  IN  THECFDEMA  OF  PREGNAhXY. 

Dr.  Bidder  related  {Si.  Petersburg  Med.  Woch., 
Aug.  1 6)  at  the  St.  Petersburg  Society  of  Physi- 
cians the  following  case,  which  he  treated  in  the 
way  described,  having  from  previous  e.xperience 
assured  himself  that  pilocarpin  does  not  induce 
pains  during  labour :  A  primipara,  aged  twenty- 
five,  was  admitted  into  the  lying-in  hospital  in  her 
eighth  month  of  pregnancy,  suffering  fiom  consider- 
able oeiJema  of  the  face,  extremities,  and  external 
genitals — the  small  labia  forming  shining  tumours 
as  large  as  a  fist.  The  urine  contained  a  consider- 
able quantity  of  albumen.  Various  remedies  hav- 
ing been  tried  in  vain,  and  one  of  the  labia  threat- 
ening to  become  gangrenous,  a  Pravaz  syringeful 
of  a  solution  (20  per  cent.)  of  pilocarpin  was  in- 
jected twice  on  the  first  of  the  month,  salivation 
following  shortly  after,  and  somewhat  later  profuse 
sweating.  The  oedema  had  already  become  much 
less  by  the  next  day,  and  on  the  third  another  in- 
jection was  employed.  By  the  12th  all  oedema 
had  disappeared,  and  the  albumen  of  the  urine 
had  greatly  diminished.  No  uterine  pains  were 
induced  during  this  treatment,  and  when  her  full 
time  arrived  the  woman  had  an  easy  delivery  of  a 
large  child. — Medical  Times  and   Gazette. 

MURIATE  OF  PILOCARPINE  IN  ECLAMPSIA. 

Dr.  Braun  relates,  in  the  Berlin.  Klin.  Wochen- 
schrift  iox  ]\iut  i6th,  acase  of  puerperal  convul- 
sions successfully  treated  by  subcutaneous  injec- 
tions of  pilocarpine.  The  patient  was  a  robust, 
healthy  young  woman,  who  had  been  recently  de- 
livered of  her  first  child.  About  an  hour  after  the 
child's  birth,  violent  convulsions  set  in,  and  were 
frequently  repeated.  When  seen  by  the  author, 
five  hours  after  delivery,  she  presented  all  the 
symptoms  of  a  severe  attack  of  eclampsia.  The 
convulsions  followed  each  other  rapidly,  and 
during  the  intervals  the  patient  was  insensible. 
The  bladder  was  empty  ;  no  urine  had  been  pass- 
ed since  her  delivery.  Large  doses  of  chloral- 
hydrate  were  prescribed,  and  a  subcutaneous  in- 
jection of  two  centigrammes  of  morphia  made  ;  but 
without  effect.  During  the  next  twenty-four  hours 
the  patient's  state  assumed  almost  a  hopeless  as- 
y»ect ;  when  it  occurred  to  Dr.  Braun  that,  as  the 
eclampsia  of  peuri:)eral  women  is  caused  by  urremic 
intoxication,  a  diaphoretic  drug  would  diminish  the 
tension  in  the  arterial  system  and  free  the  blood 
of  toxic  matter.  He  accordingly  made  a  hypoder- 
mic injection  of  three  centigrammes  of  muriate  of 
pilocarpine.  This  was  followed  bv  "ery  profuse 
perspiration  and  salivation.  During  the  next  lialf- 
hour,  the  muscles  of  the  e)  e  and  the  face  twitched 


a  few  times.     No  more  eclamptic  fits  came  on,  and 
the  patient  recovered  quickly.— //r;/.  Mcd.Journ. 

AUSCULTATION  IN  UTERINE   HEMORRHAGE. 

Prof  Depaul,  in  clinical  lecture  {Gaz.  des  Hop., 
Aug.  26).  observes  that  when  hemorrhage  occurs 
during  labour,  it  will  generally  be  found  to  arise 
from  partial  detachment  of  the  placenta,  the  cord 
being  too  short.  •'  I  remember,"  he  said,  '•  the 
case  of  a  young  woman  whose  delivery  had  gone 
on  very  well,  when,  as  the  head  was  approaching 
the  vulva,  two  or  three  spoonfuls  of  blood  sudden- 
ly appeared  between  her  thighs.  I  immediately 
practised  auscultation,  and  found  the  foetal  heart 
beating  irregularly.  It  was  evident  that  the  infant 
was  suffering,  and  that  it  was  dangerous  to  await 
the  natural  termination  of  the  labour,  which  might 
last  two  or  three  hours  longer.  Dilatation  was  com- 
■  plete  ;  and  easily  persuading  the  mother  of  the  ne- 
cessity of  terminating  the  labour  rapidly,  I  appHed 
the  forceps.  Immediately  after  the  child  was  extract- 
ed there  followed  five  or  six  enormous  clots, 
weighing  about  a  couple  of  pounds.  The  child 
was  born  respiring  with  difficulty,  but  soon  quite 
recovered.  Never  forget,  then,  whenever  you 
meet  with  a  dow  of  blood,  to  assure  yourself  by 
auscultation  as  to  the  state  of  the  infant,  and  when 
dilatation  has  taken  place,  hasten  to  interfere  when- 
ever life  seems  in  danger." — M^d.  Times  and  Gaz. 

ERGOT  IN    THE    TREATMENT    OF    FIBROID   TUMOURS 
OF   THE    UTERUS. 

Dr.  William  H.  Byford  of  Chicago,  in  a  paper 
read  at  the  late  meeting  of  the  British  Medical 
Association  {British  Med.  Journal.)  laid  down 
the  following  propositions,  and  offered  argu- 
ments in  support  of  them.  i.  When  properly 
administered,  ergot  frequently  very  greatly  amelio- 
rates some  of  the  troublesome  and  even  dangerous 
conditions  of  fibroid  tumours  of  tlie  uterus,  e.  g  , 
hemorrhage  and  copious  leucorrhoea.  2.  It  often  ar- 
rests their  growth,  and  checks  hemorrhage.  3.  In 
many  instances  it  causes  the  absorption  of  the  tu- 
mour ;  occasionally  without  giving  the  patient  any 
inconvenience  ;  while,  at  other  times,  the  removal  of 
the  tumour  by  absorption  is  attended  by  painful 
contractions  and  tenderness  of  the  uterus.  4.  By 
inducing  uterine  contraction,  it  causes  the  expul- 
sion of  the  polypoid  variety  of  the  submucous 
tumour.  5.  In  the  same  way.  it  causes  the  disrup- 
tion and  discharge  of  the  intramural  tumour.  He 
said  that,  in  administering  ergot  in  cases  of  fibrous 
tumour,  the  action  of  tlie  drug  would  depend  on 
the  degree  of  development  of  the  fibres  of  the 
uterus,  and  on  the  position  of  the  tumour  with  re- 
ference to  the  serous  or  the  mucous  surfaces  :  the 
nearer  the  mucous  surface,  the  better  the  effect. 
A  good  result  might  be  expected  under  tlie  follow- 
ing conditions :  smoothness  of  contour  of  the 
tumour,  denoting  uniform  development  ;  hemor- 
rhage ;  a  lengthened  uterine  cavity  ;  and  elasticity  of 
the  tumour.  He  would  expect  large  fibro-cystic  tu- 
mours to  resist  the  action  of  ergot  ;  and  a  good 


THE    CANADA    MEDICAL    RECORD. 


113 


result  was  not  to  be  expected  in  cases  of  uneven 
nodulated  tumour,  absence  of  hemorrhage,  short- 
ness of  the  uterine  cavity,  and  hardness  of  the 
tumour.  It  was  not  essential  to  give  ergot  hypo- 
dermically,  though  this  was  a  very  efficacious  me- 
thod ;  it  might  be  given  by  the  mouth,  in  supposito- 
ries, etc.  If  the  object  were  to  cause  painless  absorp- 
tion of  the  tumour,  the  dose  should  be  moderate, 
and  not  too  frequently  repeated  ;  if  it  were  desired 
to  have  the  tumour  expelled,  full  and  increasing 
doses  should  be  given  often,  and  continued  till  the 
object  was  attained.  The  preparation  which  he 
used  was  Squibb's  fluid  extract  of  ergot.  He  sa.id, 
in  conclusion,  that  he  disclaimed  any  expectation 
that  ergot  would  supplant  all  other  modes  of  treat- 
ment. 

EXTIRPATION    OF    A   CANCEROUS    UTERUS. 

Dr.  Von  Massari  relates  a  case  of  extirpation  of 
the  cancerous  uterus  followed  by  a  fatal  result. 
The  patient  was  fifty-three  years  old,  the  mother  of 
nine  children.  Menstruation  had  ceased  at  the 
age  of  forty-three.  A  vaginal  discharge  had 
existed  for  two  years,  for  six  months  irregular 
hemorrhage  had  ocjurred,  and  the  discharge  had 
become  offensive.  There  was  no  pain,  and  the 
general  condition  was  good.  The  cancerous  cer- 
vix was  hollowed  out  into  an  ulcerated  cavity  which 
admitted  the  finger,  bled  readily  on  touching,  and 
from  which  a  scanty  offensive  discharge  flowed. 
The  uterus  was  quite  freely  movable,  and  no  trace 
of  the  disease  could  be  discovered  in  the  pelvis. 

The  operation  was  performed  on  February  i, 
1879,  i"  3.  room  disinfected  by  thymol  spray,  and 
the  patient  was  placed  with  her  head  towards  the 
window,  the  thighs  flexed  and  abducted.  A  mix- 
ture of  chloroform  100  parts,  ether  30,  and  alcohol 
20,  was  used  for  anaesthesia.  The  vagina  was 
syringed  with  5  per  cent,  solution  of  carbolic  acid. 
An  incision  having  been  made  from  umbilicus  to 
pubes,  the  author  succeeded  with  difficulty  in 
pressing  the  intestines  and  omentum  up  into  the 
upper  part  of  the  abdomen  by  means  of  com- 
presses dipped  in  warm  thymol  solution.  The 
edges  of  the  wound  were  then  held  apart  by  means 
of  a  kind  of  clamp  invented  by  the  author,  so  as 
to  allow  a  free  view  into  the  pelvis. 

The  operator  then  placed  himself  between  the 
patient's  knees,  and  introducing  the  left  hand  into 
the  vagina,  introduced  the  lowest  loop  of  the 
sutures  for  the  broad  ligament  at  each  side  in  a 
manner  similar  to  that  adopted  by  Freund.  the 
needle  being  inserted  at  a  point  i  cm.  from  the 
lateral  border  of  the  lip  of  the  cervix,  and  entering 
successively  the  anterior  and  posterior  pouches  of 
peritoneum  at  a  point  i  cm.  from  the  border  of 
the  uterus.  The  first  loop  at  each  side  inclosed 
the  lower  third  of  the  broad  ligament,  and  two 
more  loops  secured  its  middle  and  upper  thirds 
respectively,  the  uppermost  loop  being  placed  out- 
side the  ovary.  In  closing  the  wound  the  author 
adopted  a  different  method  from  that  of  Freund. 


Three  sutures  were  passed  from  the  vagina  into 
the  peritoneal  cavity,  between  bladder  and  uterus, 
and  a  similar  number  of  loops  were  passed  from 
vagina  into  pouch  of  Douglas,  intended  to  draw 
down  the  ends  of  the  sutures  after  removal  of  the 
uterus,  and  so  complete  the  loops,  to  be  tied  in 
the  vagina,  and  so  unite  the  anterior  and  posterior 
cut  surfaces.     Two  of  these  loops,  however,  were 
cut  in  separating  the  uterus,  and  the  two  corres- 
ponding sutures  had  afterwards  to  be  passed  by  a 
straight  needle  from  above  into  the  vagina.  During 
the  separation  of  the  uterus,  the  fundus  was  drawn- 
upwards,  or  to  the  side,  by  means  of  Luer's  forceps. 
As  soon  as  it  was  cut  away,  the  pelvis  filled  rapidly 
with  blood,  amd   the  uterine  and  some  smaller 
arteries  were  found  to  be  spirting,  and  to  require 
ligature.     The   cut   surfaces   were   then   brought 
together  by  the  sutures  before  mentioned,  and  in- 
termediate gut- sutures  were  inserted,  and  tied  on 
the  peritoneal  side.     The  peritoneal  cavity   was 
sponged  out,  and  four   drainage   tubes   inserted, 
antiseptic  dressings  being  applied.     The  operation 
lasted  an  hour  and  a  quarter,  and,  at  the  end  of 
it,  the  patient's  condition  was  good ;  pulse  96.  In 
the  evening  the  pulse  had  risen  to  118;  tempera- 
ture 38. 3  C,  and  vomiting  had  occurred  once.  On 
the  second  morning,  temperature  38.6  C,  pulse 
120;  evening,  temperature   39.3   C,    pulse   140. 
There  was  now  frequent  vomiting  of  watery  fluids 
and  the  features  had  become  drawn.     On  the  third 
evening,  temperature  had  risen  to  41   C,  pulse 
could   not   be   counted.     Death   occurred  about 
midnight. 

At  the  autopsy,  the  peritoneal  cavity  was  found 
to  contain  about  ten  c.  c.  of  semi-purulent  fluid, 
and  the  peritoneum  was  coated  thinly  with  lymph. 
The  right  ureter  was  found  to  have  been  cut  across 
about  three  cm  above  its  opening  into  the  bladder, 
and  its  upper  portion  was  included  in  one  of  the 
ligatures.  The  pelvis,  and  caiices  of  the  right 
kidney,  as  well  as  the  ureter,  were  slightly  dilated. 
In  the  removed  uterus  the  inner  two-thirds  of  the 
wall  of  the  cervical  canal  was  found  to  be  infil- 
trated with  medullary  carcinoma. 

To  avoid  the  risk  of  wounding  the  ureters,  the 
author  proposes,  in  future,  to  pass  bougies  into 
them,  :is  a  preliminary  to  the  operation,  lie  finds, 
however,  that  Simon's  method  of  sounding  the 
ureters  is  too  difficult  and  uncertain,  and  therefore 
proposes  to  dilate  the  urethra,  pass  into  the  blad- 
der Simon's  urethral  speculum,  and  by  its  aid  to 
sound  the  ureters.  In  one  trial,  he  has  found  this 
easy  to  accomplish  with  the  aid  of  an  ordinary 
lamp  light  and  reflector. — Centralblatt  fur 
Gyndk. 

Dr.  F.  J.  Kochs,  of  Bonn  in  the  Archiv  fur 
Gyndko/ogie,  B.  xiv.  H.  2,  relates  a  successful  case 
of  extirpation  of  the  cancerous  uterus.  The 
patient  was  thirty-nine  years  old,  the  mother  of 
two  children.  She  was  in  good  health,  and  men- 
struation was  regular  up  to  January,  1878.  After 
the  menstrual  period  of  that  month,  a  discharge 


lU 


THE    CANADA    MEDICAL    RECORD. 


commenced.  Occasional  hemorrhage,  but  not  to 
any  considerable  degree,  had  also  taken  place,  and 
but  little  p)ain  had  been  felt.  When  she  came 
under  the  author's  observation,  at  the  beginning  of 
the  following  April,  the  cervix  was  found  to  be 
hollowed  out  into  a  deep  crater,  and  enlarged  by 
malignant  growth,  whicli  reached  up  to  about  one 
cm.  frum  the  vaginal  insertion,  but  nowhere 
overpassed  that  boundary.  The  uterus  was  about 
as  much  enlarged  as  it  would  be  in  acute  metritis, 
and  was  movable,  although  not  quite  freely  so. 
Microscopic  examination  of  a  small  portion  of  the 
growth  showed  it  to  be  carcinoma.  The  tendency 
to  hemorrhage  was  considerable. 

Menstruation  came  on  on  April  19th,  lasting 
seven  days  ;  and  on  April  28th  the  operation  for 
extirpation  was  undertaken.  The  patient  was 
placed  with  her  head  towards  the  window,  and 
lower  than  the  pelvis.  The  anaesthetic  was  chlo- 
roform, given  by  Junker's  inhaler;  and  care  had 
been  taken  to  administer  purgatives  for  several 
days  previously.  Carbolic  spray  of  a  strength  of 
one  per  cent,  was  used  at  the  operation.  The  in- 
cision was  made  from  the  mons  veneris  to  about 
two  finger-breadths  above  the  umbilicus,  and  the 
edges  of  the  wound  were  held  apart  by  retractors. 
It  was  found  possible  to  hold  back  the  intestines 
in  the  upper  part  of  the  abdomen  by  means  of  a 
handkerchief  dipped  in  carbolic  solution. 

The  three  loops  of  strong  silk  ligature   were 
placed  on  the  broad  ligaments  at  each  side,  from 
above  downwards,  the  last  loop  entering  the  vagina. 
Each  loop  was  doubled,   so  that  the  innermost 
thread  was  close  to  the  uterus,  and  the  outer  one 
about  one  cm.  from  it.     The  threads  of  the  inner 
loops    were  cut    short.     A  simple    long,   slightly 
curved  needle  was  used  in  passing  all  the  ligature?. 
The  lowest  loops  became  slack  after  division  of  the 
upper  part  of  the  broad  ligaments,  and  had  to  be  re- 
placed. The  lowest  loop  on  the  left  side  had  again  to 
be  replaced  after  complete  separation  of  the  uterus 
from  the  right  broad  ligament,  and  from  the  bladder 
and  rectum.    In  passing  the  loops,  in  order  to  avoid 
lesion  of  the  bladder,  the  finger  was  passed  into 
that  viscus,  after  dilatation  of  the  urethra.     The 
ovaries  were  removed,  the  mes  ovaria  being  tied 
with  silk.     A  supplementary  ovary  was  noticed  on 
the  left  side,  situated  from  one  to  two  cm.  within 
the  left  ovary.     This  was  removed  in  like  manner. 
The  bladder  was  separated  from   the  uterus  by 
using  the  scalpel  from  above,  guided  by  the  finger 
within  the  bladder.     The  knife  was  also  used  to 
pierce  the  vagina  from  the  pouch  of  Douglas,  and 
the  opening  so  made  was  enlarged  to  either  side. 
The  ends  of  the  ligatures  were  drawn  down  into 
the  vagina,  after  Freund's  method,  and  the  wound 
of  the  peritoneum  was  brought  together  in  a  trans- 
verse line  by  six  fine  sutures.     The  vagina  was 
finally  washed  out  with  carbolic  solution,  but  no 
tampon  placed  in  it. 

Some  vomiting  occurred  the  same  evening,  and 
it"*  was  necessary  to  use  the  catheter  about  ten 
o'clock,  no  incontinence  of  urine  having  followed 


the  dilatation  of  the  urethra.  Temperature 
38  2°  C.  ;  pulse  120.  On  the  second  day,  tem- 
peiature  was  37°  ;  pulse  140.  The  same  evening 
the  pulse  rose  to  160,  but  after  this  improvement 
took  place,  although  vomiting  was  frequent  for 
several  days.  On  the  fifth  day  the  pulse  had  fallen 
to  96;  temperature  37  8°  C.  From  this  day  the 
vagina  was  washed  out  with  carbolic  solution  by 
means  of  a  speculum.  On  the  eighth  day,  on  the 
removal  of  one  of  the  sutures,  a  small  collection 
of  pus  was  evacuated  from  the  neighborhood  of 
the  puncture.  Convalescence  went  on  undisturbed 
till  May  24th,  the  twenty-.seventh  day,  when 
rigours  came  on,  followed  by  febrile  symptoms. 
On  the  26th,  a  considerable  discharge  of  pus  took 
place  by  the  vagina.  Recovery  was  steady  from 
this  time.  At  the  last  examination  reported,  which 
was  made  on  June  6th,  a  funnel-shaped  depression 
remained  at  the  summit  of  the  vagina,  with  some 
small  protuberances ;  but  these  did  not  show, 
microscopically,  any  sign  of  cancer.  There  had 
been  no  recurrence  of  menstrual  molimen. 

To  simplify  the  operation,  and  avoid  the  difficult 
process  of  placing  the  lowest  loops  of  the  sutures 
which  are  to  secure  the  uterine  arteries,  the  author 
proposes,  in  future,  before  placing  these  loops,  to 
separate  the  uterus  from  the  bladder  and  the 
pouch  of  Douglas,  which  will  not,  he  thinks,  cause 
much  bleeding.  The  loops  of  suture  can  then  be 
easily  carried  by  a  long,  strongly  curved  needle, 
like  an  aneurism-needle,  from  the  pouch  of  Doug- 
las in'.o  the  vagina,  and  thence  into  the  anterior 
pouch  of  peritoneum  through  the  opening  so 
made. — Obstetrical  Journal  of  Great  Britain, 
Sept,  1879. 


ON   VARIOUS   FORMS   OF   FUNCTIONAL 
CARDIAC  DISTURBANCES. 

By  Beverley  Robinson,  M.D.,  Lecturer  upon  Clinical 
Medicine  at  the  Bellevue  Hospital  Medical  College,  New 
York. 

Gentlemen  : — Functional  or  neurosal  condi- 
tions of  the  heart  differ  essentially  from  those 
which  are  organic  or  inflammatory  in  their  nature. 
In  the  one  case  we  have  no  evident  lesions  when 
the  heart  is  examined  post-mortem,  and  in  the 
others  we  have  usually,  if  not  always,  some  obvious 
change  in  valves,  or  orifices,  or  heart-walls. 
During  life  they  differ  also,  with  structural  diseases. 
Their  symptoms  are  more  variable,  more  painful 
and  distressing  frequently,  and  they  are  continually 
forcing  themselves  upon  the  patient's  attention. 
About  their  importance  no  one  can  doubt,  since 
they  are  frequently  confounded  ^v^th  permanent 
lesions,  and  yet  are  themselves  amenable  to  wise, 
careful,  judicious  treatment  Functional  trouble 
of  the  heart  may  be  temporary  and  passing,  or  it 
may  be  permanent  in  character.  It  may  be  part 
of  a  general  nervous  temperament,  or  it  may  be 
dominated  by  some  purely  accidental  circumstance. 
It  may  be  primary  and  essential  and  then,  so  far 


THE    CANADA    MEDICAL    RECORD. 


]15 


as  our  knowledge  to-day  extends,  seated  in  the 
cardiac  ganglia.     It  may  be   of  reflex  origin,  or 
dependent  upon  some  remote  disease  of  the  genito- 
urinary system,  especially  in  women.     Such  are 
those  cases  which  are  found  with  a  prolapsed  or 
displaced  womb,   or  with   an   ovary   the   seat  of 
chronic  inflammatory  change.     Further,  functional 
trouble  of  the   heart   may  be  closely   allied,    or 
connected    with,    all  those  different   pathological 
changes  as  they  effect  the  blood,  the  central  nervous 
system,  and  the  stomach.     Finally,  we  have  "   irri- 
table hearts  " — hearts   which  are  weary  and  worn, 
owing  to  the  cares  and  anxieties  of  life,  to  long 
night-vigils,  to  ovenvork,  both  mental  and  phy- 
sical.    In   this  latter  category  we  shall  have  to 
consider  the  hearts  which  have  become  irritable 
in  men  of  the  best  type — in  those  who  strive  and 
struggle  for  their  own  and  others'  rights  or  happi- 
ness, and  who  are  the  prey,  as  it  were,  of  their 
personal  self-abnegation  and  sacrifice :  such  an  one, 
at  times,  is  the  overworked  and  too  conscientious 
family  practitioner.       Functional  disturbance  of 
the  heart  is  marked  by  cardiac  palpitations.  These 
palpitations  may  be  violent  and  accompanied  with 
strong,  rapid  pulsations,   or  they  may  be  moder- 
ate and  conjoined  with  weak  and  slow  beats  of 
the  radials.     Almost  always  with  an  attack  of  car- 
diac palpitations,  we  have  a  lack  of  regularity  or 
proper  rhythmic  succession  in  the  cardiac  sounds. 
Palpitations  may  be  brought  on  by  more  or  less 
physical  exertion,  as  the  fact  of  going  upstairs,  or 
lifting  a  weight  of  some  magnitude.     Again,  they 
may  be  brought  on  by  an  incident  of  an  emotional 
character,  which  has  disturbed  greatly  the  nerves 
which  govern  the  heart's  normal  movements.     Too 
often  they  come  on  without  assignable  cause  and 
at  times  when  one  might  least  expect  them.     In 
the  middle  of  the    night  a  ]  atiant  is  frequently 
awakened  from  a  peaceful   deep  and  is  suddenly 
tormented  with  most  distressing  palpitations,  and  at 
the  same  time  very  gloomy  forebodings.     This  con- 
dition  is  encountered  particularly,  however,  with 
persons  passed  middle  life,  who  have  somewhat 
enlarged  hearts  and  atheromatous  arteries.     They 
have,  when  they  awake,  an  attack  of  true  cardiac 
asthma.     In  searching  for  the  proximate  cause, 
we  shall  be  able  at  times  to  affirm  that  it  lies  in  a 
dyspeptic  condition.     The  stomach  is  at  fault,  and 
when  its  deranged  digestion  is  quiet  and  better 
ordered,  the  attacks  of  cardiac  asthma  are  cured. 
You  all  know  of  the  disease  described  by  Graves 
and  Basedow — of  the  three   principal   classes  of 
symptoms :  first,  those  which  pertain  to  the  pro- 
minent eyes  ;  second,  those  belonging  to  the  en- 
larged thyroid  gland ;  third,  those  which  are  an- 
nexed to  the  overacting  heart.     In  such  patients 
there  is  no  counting  the  pulse  accurately  with  the 
fingers  at  times,  so  fast  does  it  go.     Well,  this  dis- 
ease is  by  some  located  in  the  sympathetic  system, 
and  it  is  this  location,  doubtless,  which  explains 
the  rapid  cardiac  contractions.       Of  course,  all 
heart  trouble  in  this  disease  is  not  purely  func- 
tional, for  we  find  in  its  advanced  stages  that  the 


heart  becomes  enlarged — how  much  owing  to  con- 
tinued overaction,   I  am  not  wholly  prepared  to 
say.      In  an  analogous    category  with  Graves's 
disease  come  those   murmurs  at    the  apex,  and 
rapid,  irregular  beats  of  the  heart  which  are  met 
with  in  chorea.     We  can  but  attribute  these  symp- 
toms to  the  want  of  synchronism  about  contraction 
of  the  intrinsic  cardiac  fibres,  and  particularly  of 
the  musculi  papillares.     And  now  I  wish  to  draw 
special  attention  to  the  condition  known  as  "  irrit- 
able heart."     This  name  was  first  given  to  it  in 
our  late  civil  war,  by  Prof.  Da  Costa,  of  Philadel- 
phia, and  to  those  who  wish  an  interesting  and 
highly  scientific  consideration  of  an  important  sub- 
ject, I  refer  them  with  strong  emphasis  to  his  wait- 
ings  in  the  United  States  Sanitary  Commission 
Reports,   1867,  in  the  Am.  Jour.  Med.  Sciences, 
187 1,  and  in  the  Toner  Lectures  for  1874. 

Such  reading  will  be  very  profitable,  for  it  will 
be  noted  and  acquired  that  what  was  a  frequent 
form  of  disease  in  the  army,  owing  to  overmarch- 
ing,  to  diarrhoea,  to  fevers,  is  also  becoming  fre- 
quent in  civil  life,  owing  to  tobacco,  tea-drinking, 
sexual  excesses,  and  inordinate  physical  exercise 
in   the   way   of  dancing,    rowing,   and   baseball. 
Under  this  name  is  included  what  Fothergill  has 
described  as  " hypergesthesia "  and  sub-paralysis" 
of  the  heart.     This  affection  is  marked  by  irregu- 
larity of  the  cardiac    rhythm,    overaction   of  its 
movement,  pain  in  the  precordial  region,  and  a 
feeling  of  faintness.       In  the  milder   forms  rest 
will,  in  a  brief  period,  greatly  ameliorate  this  con- 
dition.    In  aggravated  cases  it  renders  the  patient 
unfit  for  the  routine  duties  of  business  or  profes- 
sional life,  and  remedies  affect  it  favorably  only  by 
very  slow  degrees.     Upon  more  than  one  occa- 
sion hypertrophy  of  the  cardiac  walls  was  evident 
both  before  and  after  death.     Never  thus  far,  how- 
ever, have  either  the  muscular  or  nervous  fibres 
been  found  degenerated.     During  life  the  heart 
beats  very  rapidly,  the  impulse  is  more  diffuse, 
though  not  perhaps  increased  always  in  force,  and 
there  is  a  moderate  blowing  murmur  covering  the 
first  normal  sound,  and  heard  with  greatest  inten- 
sity at  the  apex.     This  is  not  invariably  true,  ho-vv- 
ever,  as  the   first   sound  is  at    times  only  more 
abrupt  than  usual,  but  is  wholly  free  from  the  pre- 
sence of  a  murmur. 

The  second  sound  is  clear,  but,  according  to 
Fothergill,  not  as  markedly  so  as  in  a  dilated  heart. 
There  is  almost  invariably  a  feeling  of  oppression 
around  the  precordia,  and  the  brain  is  apt  to  be 
attacked  with  vertiginous  sensations.  The  patients 
are  taken  occasionally  with  sudden  and  painful 
palpitations,  and  it  is  no  unusual  thing  for  this  to 
occur  in  the  middle  of  the  night.  Sleep  is  at  times 
much  disturbed,  and  these  patients  are  unusually 
restless.  They  cannot  lie  on  the  left  side  on  ac- 
count of  the  increased  pain  caused  by  this  decubi- 
tus. There  is  evidence  of  cardiac  debility  in  the 
very  frequent  and  depressible  pulse.  Often  upon 
the  slightest  exertion,  this,  from  relatively  quiet 
and  tranquil,  will  become  agitated  and  extremely 


116 


TIIK    CANADA   MEDICAL   RECORD. 


rapid,  and  it  is  not  remarkable  to  see  it  mount  to 
1 20  or  130  beats  per  minute. 

The  extremities  perspire  easily,  and  have  a  cold, 
clammy  feeling,  which  is  an  additional  proof  of 
general  nervous  prostration.  Tiicsc  patients  are 
at  times  affected  with  severe  dyspnoea ;  and  yet, 
when  we  count  the  numl)er  of  respirations,  we  do 
not  find  them  increased  so  as  to  be  above  the 
normal.  It  is  a  remarkable  circumstance  that  this 
affection  has  been  many  times  confounded  with 
pulmonary  phthisis.  I  can  understand  many 
reasons  why,  even  after  careful  research,  one  might 
properly  hesitate  between  it  and  hypertrophous 
dilation — tlie  more  too,  as  irritable  heart  is  often 
accompanied  with  or  followed  by  this  form  of 
organic  change.  But  it  appears  to  me  somewhat 
far-fetched,  with  the  signs  above  given,  that  any 
one  should  be  in  quest  of  consumptive  evidences. 
All  physical  signs,  moreover,  of  lung  disease  are 
absent ;  and  the  irritative  cough  present,  with  the 
slight  and  interrupted  spitting  of  small  pellets  of 
blood-stained  mucus,  are  not  sufficient  properly  to 
withdraw  one's  attention  from  the  heart. 

The  prognosis  of  irritable  heart  is  favorable  if  the 
whole  disease  consist  of  temporary  exhaustion  of 
the  sympathetic  ;  but  if,  in  consequence  of  repeat- 
ed over-exertion,  the  heart  becomes  organically 
affected,  then  we  have  to  do  with  an  affection 
which  is  almost  always  prolonged  and  sometimes 
serious.  Such  cases  are  reported  as  having  followed 
-an  affection  of  the  uterus,  and  also  the  inveterate 
use  of  tobacco.  Usually  the  signs  of  the  resultant 
lesion  are  similar,  viz :  there  is  extended  impulse 
and  increase  of  precordial  dullness  on  percussion 
— both  of  which  point  to  the  existence  of  an  en- 
larged heart.  An  analogous  form  of  heart  affection 
may  be  caused  in  individuals  who  have  undergone 
very  intense  exertion  without  having  previously 
*)een  in  training  for  it.  Such  an  example  is  that  of 
Clifford  Allbutt,  who  has  given  a  fail  account  of 
his  own  experience  in  an  article  upon  "  The  Effects 
of  Overwork  and  Strain  on  the  Heart,  etc.,"  in  St 
Geo.  Ho  p.  Reports,  vol.  v.,  p.  23.  Dr.  A.  had 
made  a  pretty  lofty  ascent,  and  was  about  to  go 
still  farther  and  higher  when  he  was  taken  sud- 
denly with  a  stifling  sensation  and  painful  cardiac 
pulsations  in  the  epigastric  region.  Unable  to 
proceed,  owing  to  the  distressing  sensations  from 
which  he  suffered,  he  lay  flat  on  his  back  for  a 
while,  and  then,  feeling  better,  attempted  once 
more  to  continue  his  ascent  on  foot.  The  same 
painful  feelings  returned  almost  immediately,  so 
that  he  was  compelled  to  delay  his  onward  march 
some  time  and  send  his  companion  in  advance 
to  secure  lodgings  for  them  during  the  night.  Fi- 
nally he  was  able  to  go  on.  When  he  again  reached 
level  ground  his  normal  feelings  returned,  and  that 
same  evening  he  was  able  to  eat  his  supper  with 
appetite  and  go,  without  discomfort,  to  bed. 

During  the  night,  after  several  hours  of  sound 
sleep,  he  awakened  with  similar  painful  sensations 
to  those  he  had  experienced  during  his  afternoon 
walk.     In  this  instance  there  had  evidently  been 


over-distention  and  temporary  debility  of  the  mus- 
cular walls  of  the  right  ventricle,  which  had  been 
brought  on  by  an  acute  strain  upon  the  heart 
strength.  Over-exertion,  without  preliminary  train- 
ing, here  occasioned  but  passing  dread,  with  in- 
tense oppression,  while  there  can  scarcely  be  a 
doubt  that,  under  like  circumstances,  rapid  death 
has  been  the  frequent  and  sad  result.  We  should 
bear  in  mind  an  example  like  this  whilst  remem- 
bering that  heart  disease  can  ordinarily  be  traced 
to  the  pre-existence  of  rheumatic  fever,  of  scarla- 
tina, typhoid,  typhus,  etc.  Still,  mechanical  causes 
are  at  times  equally  injurious,  and  affections  of  the 
orifices  or  cardiac  walls  may  thus  be  occasioned. 
It  is  a  singular  fact  that  but  little  emphasis  is  laid 
upon  these  causes  by  the  majority  of  English  and 
foreign  authorities.  Even  so  accurate  and  com- 
plete an  analyzer  as  Hope  barely  alludes  to  them, 
and  such  men  as  Jenner  write,  as  late  as  1869, 
only  to  deny  their  influence.  Doubtless,  as  re- 
marked by  Allbutt,  the  practice  of  this  distinguish- 
ed clinician  did  not  lead  him  in  the  way  of  en- 
countering many  such  cases.  In  the  view  of  Clif- 
ford Allbutt  it  is  regretable  that,  although  so  much 
has  been  published  in  regard  to  cardiac  pathology, 
the  character  and  mechanism  of  bruits,  the  thera- 
peutical bearings  of  numerous  cases,  this  equally 
important  subject  has  been  almost  completely  over- 
looked. And  yet  certain  occupations  do  undoubt- 
edly give  rise  to  organic  cardiac  disturbances. 
Heart  disease  among  soldiers  has  been  fully  des- 
cribed by  Myers  in  1870.  Peacock  mentions  it  in 
a  special  manner  as  existing  among  those  who 
work  in  tin  and  copper  mines,  and  Da  Costa 
among  those  who  make  excessive  expiratory  efforts, 
as  glass-blowers  and  comet-players.  Most  of  you 
saw  the  lad  I  presented  at  this  clinic  only  a  few 
weeks  since,  who  had  already  acquired  consider- 
able hypertrophy  of  heart,  with  obstinate  recurrent 
attacks  of  haemoptysis,  due  to  nothing  else  than 
the  continuous  fatigue  and  strain  in  his  trade.  The 
gist  of  this  matter  has  evidently  been  ascertained 
by  Da  Costa  with  that  clearness  and  correctness 
of  insight  which  stamp  his  observations.  He 
shows  conclusively,  in  his  monograph  on  this  sub- 
ject, that  it  is  not  so  much  ijiterruptcd  exercise 
which  does  damage  to  the  heart,  even  if  it  be  of 
violent  nature,  as  it  is  the  professions  in  which  the 
circulation  is  constantly  impeded  or  hurried.  Of 
course  it  is  not  affirmed  that  violent  games  will  not 
produce  both  functional  disturbance  and  occasional 
organic  difficulty — notably  hypertrophous  dilata- 
tion, for  examples  of  the  contrary  are  shown. 
Thus,  among  what  are  ordinary  amusements  with 
young  people,  such  as  dancing,  rowing,  base-ball, 
we  find  instances  of  functional  trouble  which 
finally  pass  into  organic  heart  disease. 

Still  when  these  latter  could  be  vouched  for, 
they  have  occurred  first  in  those  persons  who  were 
predisposed  to  have  irritable  heart,  and  second, 
among  persons  who  had  no  let-up  in  their  active 
amusements.  With  base-ball  players  Da  Costa 
cites  two  cases  of  hypertrophous  dilatation.     But 


THE   CANADA   MEDICAL   RECORD. 


IIT 


here  again  the  injurious  results  followed  almost 
continuous  play,  and  not  play  that  was  interrupted 
during  several  days  or  weeks  at  a  time. 

In  volume  xviii.   of  "  Ziemssen's  Cyclopaedia," 
Dr.  A.  Brayton  Ball,  of  this  city,  has  contributed 
an  excellent  article  on   "  Physical  Exercise,"  and 
under  the  division  of  "  Results  of  Over-exertion  " 
shows  that,  so  long  as  muscular  exertion  conforms 
to  the  law   of  rhythmic  action,   it  develops  the 
muscles  and  augments  their  strength  ;  but,  if  the 
exertion  become  continuous,  then  it  decreases  their 
power,  and  finally  leads  to  atrophy,  or,  worse  still, 
to  degeneration.     Applying  this  to  the  heart,  it  is 
not  difficult  to  appreciate  that  through  over-exertion 
we  shall  inevitably  diminish  the  duration  of  cardiac 
repose  by  encroaching  upon  diastole  through  in- 
creased rapidity  of  action.     Thus  we  approximate 
to  a  condition  of  almost  continuous  work  for  this 
organ,  which  must  occasion  the  same  detriment  to 
it  as  it  does  ultimately  to  any  one  of  the  purely 
voluntary  muscles  which  is  being  constantly  called 
upon  after  an  analogous  manner.      Doubtless  the 
heart  is  sooner  and  more  injuriously  affected  among 
those  who  are  poorly  fed,  breathe  an  impure  atmos- 
phere, and  are  victims  of  alcohol,  than  among  those 
who  suffer  from  no  such  pernicious  circumstances. 
Dr.  Ball  makes  a  few   forcible   remarks  against 
the  senseless  habit  of  long-distance  walking  which 
is  so  intensely  the  fashion  of  the  moment.     In  it 
he  finds  a  useless   expenditure   of  reserve   force, 
which  can  only  be  made  with  the  certainty  of  caus- 
ing future  permanent   injury   to   the   contestants. 
.  According  to  this  author,  the  best  way  probably  to 
prevent  bad  consequences  to  health  resulting  from 
active  physical  exercise  is  to  appoint  a  competent 
medical  man  in  each  one  of  our  large  institutions 
of  learning,  where  there  are  many  students,  and, 
therefore,  many  who   engage   in    outdoor   sports, 
whose  duty  it  shall  be  to  examine  each  young  man 
with  respect  to  his  physical  condition.     After  this 
examination  has  been  thoroughly  made,  only  those 
of  vigorous  build,  and  who  at  the  same  time  enjoy 
good  health,  shall  be  permitted  to  engage  in  games 
or  contests  for  which  just  these  attributes  are  essen- 
tial, so  that  harm  may  not  result  from  indulgence. 
In  regard  to  the  treatment  of  all  such  cases  of 
irritable  heart,  or  of  those  in  which  debility  has 
already  shown  itself  by   some   dilatation,  special 
importance  must  be  attached  to  rest  on  the  buck  ; 
and  with  "  heart-weary  "  people  it  is  a  great  point 
gained  to  have  them  avoid  just  those   professions 
which   are   calculated   to   increase   their  disease. 
Above  all,  let  the  thorough-going,  typical,  too  rapid 
American   be   perfectly    assured,    as    Da   Costa 
remarks,  that  constant  running  to  catch  a  boat  or 
a  train,  or  "  bolting  "  all  meals,  is  bound  to  injure 
his  heart  as  much  and  more  than  the  coats  of  his 
stomach.     Sexual   excesses   are   also   a   frequent 
cause  of  irritable  heart,  and  functional  disturbance 
thus  caused  is  not  the  price  paid  only  by  men  or 
women    of  profligate   habits.     Moral   men — men 
whose   duty  to  the   state  is  properly  shown  by  a 
vigorous  and  increasing  family — are  sufferers,  and 


have  become  so  by  an  apparent  ignorance  of  the 
fact  that  because  indulgence  is  not  socially  censur- 
able   it    is    individually    of  possii)le     injury    t& 
health.     Such    individuals    (clergymen,    farmers, 
lawyers,   etc.)    often   owe   their   general   lack   of 
energy  and  bodily  activity  to  irritable  hearts  thus 
occasioned.     We  all  know  many  of  the  disastrous 
consequences  which  are  the  immediate  outcome  of 
drinking  to  excess.     Among  these  none  are  more 
frequent  than  the  weakened  heart  and  soft,  weak, 
rapid  pulse  of  the  steady  drinker,  or  of  one  who 
frequently  "  makes  a  night  of  it."     To  some  per- 
sons tobacco  is  relatively  innocuous  ;  to  others  it 
is  a  poison,  even  in  mild  and  minute  doses.     To 
many,  mild  cigars  are   not   injurious,  but  strong 
tobacco  completely  unnerves   them.     How  many- 
young  men    suffer   cardiac   palpitation   which  are 
attributable  to  no  other  cause  ?     The  close  student 
is  often  just  the  one  who  is   thus  affected.     After 
the  excitement  of  examination  is   passed,  then  it 
commences  to  tell,   and   he  can   scarcely  walk  a 
block  at  a  rapid  pace  without  feeling  his  heart  leap 
into  his  mouth.     At   night   he   hears   his  arteries 
throb,  his  heart  beats  in  a  very  irregular  manner,, 
and  sleep  is  prevented  for  several  hours.     To  re- 
medy this,  whatever   else   be  done,   tobacco  must 
be  put  aside  for  several  months. 

The  green-tea  drinkers  of  our  mothers'  and  grand- 
mothers' days  were  certainly  more  numerous  than 
they  are  in  our  own  day,  and,  I  judge,  must  have 
had  very   irritable   hearts.     For   even   now,   and 
when  English  breakfa.st  tea  is  pre-eminently  a  lady's 
drink,  still  attacks  of  painful  palpitations  are  com- 
mon among  them,  and   to  remedy   them  we  must 
adopt  Fothergill's  plan  of  prescribing   cocoa  as  a 
beverage,  with  a  doubting  faith,  however,  lest  they 
soon  again   relapse   into   their  former  pernicious 
habit   of  excessive   tea-drinking.     To   show    the 
influence  of  the  mind  over  the  action  of  the  heart, 
Fothergill  cites  the  case  of  a  medical  student  who,^ 
when  asked  a  question,  the   answer  to  which  re- 
quired thought,  had  immediately  a  changed  cardiac 
rhythm  and  intermissions  of  the  pulse-beat.  When- 
ever the  answer  was   given   without   thought,  the 
action  of  the  heart  remained  undisturbed.     We  are 
all  of  us  aware  how  much  our  heart-action  is  in- 
fluenced by  emotions  or  temporary  excitement,  but 
we  are  not  all  aware  how  much  control  of  the  car- 
diac centre  may  be  acquired  by  an  effort  of  will. 
The  accomplished  statesman  is,  however,  able  to 
control  every  utterance  which  indicates  emotion, 
and  this  is,  perhaps,  as  great  a  proof  of  regularising; 
heart-action  as   the  others  familiarly   cited  of  the 
finished  coquette  or  the  winner  at  Creedmoor. 

In  his  usual  brilliant  way,  Fothergill  touches  the 
keynote  of  this  matter  in  saying  there  are  "  stout- 
hearted "  and  "  faint-hearted  "  people — those  who 
can  be  relied  upon  in  an  emergency  and  those  who 
cannot — those,  in  other  words,  who  can  control 
their  hearts  under  circumstances  of  great  excite- 
ment or  impending  danger,  and  those  who  thea 
become  powerless  and  useless. 

There  are  many  other  causes  of  cardiac  palpi- 


118 


TUE   CANADA    MEDICAL    RECORD. 


tations  that  we  have  not  as  yd  alUided  to.  Among 
the  frecjuently  encountered  are  plethora,  anxmia, 
<lyspepsia,  and  gout.  We  have  already  seen  that 
an  overtaxed  heart  becomes  irritable.  So  in  a 
certain  way  do  we  fmd  the  heart  of  an  individual 
whose  blood  is  in  excess.  The  muscular  fibre  of 
the  heart  is  unduly  excited,  the  origins  of  the 
])neumogastric  trunks  receive  too  much  blood,  and 
there  are  frequent  and  violent  pali)itations  as  a 
result  of  the  preceding  conditions.  These  symp- 
toms are  apt  to  occur  among  individuals  who,  for 
one  reason  or  another,  have  abandoned  active  and 
abstemious  habits  of  life  for  those  of  ease  and  self- 
indulgence.  There  is  no  more  prolific  source  of 
functional  heart  trouble  than  an  anaemic  state.  We 
are  constantly  encountering  it  in  city  practice. 
Numerous  causes  may  be  assigned  for  the 
presence  of  anaemia,  but  once  present  it  will 
often  become  the  source  not  only  of  cardiac 
palpitations,  but  also  of  many  secondary  pheno- 
mena, which  indeed  appear  to  be  very  similar  to 
those  we  find  in  connection  with  organic  heart 
disease.  The  prognosis  and  treatment  being  so 
very  different  in  these  two  conditions,  it  should 
make  us  very  cautious  in  affirming  our  diagnosis. 
Usually,  functional  heart  di.sorder,  due  to  annemia, 
is  accompanied  by  numerous  other  symptoms 
which  fully  establish  its  etiology.  Such  are  head- 
ache, intercostal  neuralgia,  cold  extremities,  leu- 
corrhcea,  etc.  Palpitations  are  often  aggravated, 
if  not  directly  occasioned,  by  the  presence  of 
atonic  dyspepsia.  Wind  accumulates  in  the  over- 
distended  stomach  after  a  meal,  and  soon  the  heart 
is  pushed  aside  and  its  circulation  is  directly  inter- 
fered with  and  becomes  markedly  laborious.  This 
same  mechanism  will  account  for  cardialgia  which 
is  so  apt  to  show  itself  in  hysterical  women  during 
a  paroxysm.  In  both  cases  the  immediate  exhibi- 
tion of  a  carminative,  such  as  the  rornpoMnd  tinc- 
ture of  lavender,  aromatic  spirits  of  ammonia,  or 
melissa  water,  will,  by  bringing  up  the  wind  from 
the  stomach  or  causing  it  to  be  belched,  give 
almost  instantaneous  relief.  In  speaking  to  you 
at  a  previous  lecture  of  the  effects  of  gout  upon  the 
capillary  system,  I  pointed  out  to  you  how  sudden 
palpitations  might  be  produced  in  a  wholly  unex- 
pected manner,  owing  to  spasm  of  the  arterioles. 
Formerly  this  effect  upon  the  rhythmic  beats  of  the 
heart  was  presumably  due  to  an  accumulation  of 
lithic  acid  in  the  blood,  and  even  in  the  last  edi- 
tion of  the  work  of  your  eminent  Professor  of  Prac- 
tice it  is  thus  described.  But  within  a  few  years, 
thanks  to  the  distinguished  researches  of  Sutton 
and  Sir  William  Gull,  but  more  especially  of  George 
Johnson,  of  King's  College,  London,  it  is  now 
accurately  determined  that  there  is  hypertrophy  of 
the  muscular  fibres  in  some  cases,  of  the  fibrous 
tissue  of  the  walls  of  the  arterioles  in  more  nume- 
rous instances,  and  of  a  combination  of  both 
changes  in  a  very  limited  number  of  examples, 
which  accounts  for  gout  palpitations.  Doubtless 
uric  acid  is  still  to  be  found  in  excess  in  the  blood, 
but  it  does  not  seem  to  be  the  proximate  factor  in 


causing  spasm  throughout  the  capillar)'  system. 
This  once  again  is  due  to  an  evident,  detennined 
pathological  lesion.  Why  it  is  that  gouty  palpita- 
tions come  on  during  the  night  particularly  I  am 
not  prepared  to  say.  After  all,  in  the  considera- 
tion of  cardiac  palpitations,  we  must  not  lose  sight 
of  the  fact  that  cardiac  excitability  varies  very 
much  with  different  individuals :  some  there  are 
whose  heart  palpitates  from  even  the  slightest 
emotions  ;  others  bear  with  the  greatest  stoici.sm, 
or  rather  most  perfectly  calm,  quiet  circulation,  all 
sorts  of  sudden  shocks  or  dreadful  occurrences. 
All  the  causes  which  affect  merely  the  rapidity  and 
force  of  the  cardiac  action,  influence  it  through  the 
symjiathetic  system ;  those  which  act  through  the 
pneumogastric  alter  the  rhythm  of  cardiac  move- 
ments. This  is  distinctly  shown  by  the  results  of 
the  experiments  of  sectioning  these  nerves. 

While  we  can  separate  in  our  experiments  the 
control  which  belongs  to  each  system  of  nerves, 
this  is  not  always  possible  with  certain  morbific 
agencies.  The  symptoms  present  often  show  con- 
clusively that  they  have  acted  through  both  systems. 
While  the  nervous  trunks  no  doubt  usually  carry 
the  impressions  and  modifying  stimulus  to  the 
heart,  it  is  often  true  that  the  nerve-centres  them- 
selves are  primarily  disturbed. 

Apart  from  the  symptoms  which  can  be  local- 
ized, and,  therefore,  attributed  to  the  heart  directly 
without  much  reason  for  uncertainty,  there  are 
many  general  symptoms  which  manifestly  must 
differ  according  to  the  different  cause  or  patholo- 
gical relations  of  the  cardiac  disturbance. 

{ To  be  cojitinueJ.) 


DIABETES  INSIPIDUS  TREATED  WITH 
ERGOT. 

In  the  British  Med.  Journal,  Dec.  25,  1875, 
is  recorded  the  case  of  a  man  who  suffered 
from  diabetes  insipidus,  and  was  successfully 
treated  with  ergot,  after  the  failure  of  jaborandi 
and  other  remedies.  Half  a  drachm  of  the  liquid 
extract  of  ergot,  every  three  hours,  reduced  the 
urine  in  twenty-four  days  from  twenty  pints  to  a 
pint  and  a  half,  increased  its  specificgravity  from 
1,002  to  1,017,  and  removed  the  excessive  thirst 
and  other  distressing  symptoms  from  which  he  had 
suffered  for  two  years.  A  few  days  ago  the  repor- 
ter of  the  case,  Dr.  Murrell,  accidentally  met  the  pa- 
tient and  was  told  that  he  had  never  had  a  day's  ill- 
ness since  he  left  the  hospital,  four  and  a  half  years 
ago.  His  urine  was  normal  in  quantity  and  he  did 
not  suffer  from  thirst.  He  was  strong  and  well  in 
every  way,  and  able  to  do  a  good  day's  work.  The 
ergot  cured  him  completely,  and  Dr.  Murrell  adds 
that  it  is  to  be  regretted  that  this  mode  of  treat- 
ment is  not  more  commonly  employed  in  these 
cases.— r/!^  Brit.  Med.  Journ.,  May  8,  1880. 


THE   CANADA    MEDICAL    RECORD. 


11^ 


SURGICAL   TREATMENT  OF  EPISTAXIS 

Dr.  Edward  Hamilton,  in  a  communication  to 
the  British  Medical  Journal  (vol.  i.,  1880,  p.  691), 
denounces  the  ordinary  Bellocq's  canula  as  a  fre- 
quently useless  and  sometimes  pernicious  instru- 
ment.    He  himself  takes  a  strip  of  linen  material 
three  feet  long,  with  a  width  in  proportion  to  the 
fineness  of  the  texture,  perhaps  an   inch   on    the 
average.     This  may  be  soaked  in  some  domestic 
astringent  at    hand, — tea,    alum-water,  saturnine 
solutions  ;   oil   may  be    used,    but    it  should   be 
sparingly,  for,  although  it   greatly  facilitates  the 
introduction  of  the  material,  yet  it  interferes  with 
the  imbibition  of  moisture,  and  thus  prevents  the 
subsequent  expansion  of  the  plug,  which  is  useful 
in  checking  the  escape  of  blood  by  its  compressing 
effect.     The  best  of   all  fluids,  if  at  hand,  is  a 
saturated  solution  of  gallic  acid  in  glycerine,  which 
may  be   kept   for     the    purpose.     This    has    the 
advantage   of  combining  astringency  and  ^styptic 
quality  with  lubrication.     This  strip  of  linen  should 
be  regarded  as  consisliag  of  three  parts,  each  intend- 
ed for  its  own  special  position  in  the  nostril.      The 
end  of  the  first  portion  should  be  grasped  in  the 
blades  of  a  dressing-forceps,  and  conveyed  along 
the  floor  of  the  nostril  to  the  posterior  termination 
of   that   cavity  ;   the  remainder,  about  one    foot, 
should  be  rapidly  "  paid  ''  by  the  finger  and  thumb 
into  the  cavity  of   the  nostril.     The  soHd     mass 
thus  formed  should  be  forced  along  the  floor  of 
the  nose,  first  with  the  little  finger  and  then  with  the 
dressing-forceps  or  a  pencil,  until  it  is  found    to 
occupy  the  posterior  nostril,  and  distinctly  felt   in 
it  by  the  finger,  hooked  round  the  soft  palate.      This 
is  far    the   most   important    part    of   the     entire 
proceeding,  being  as  it  were,  the  basis  of  operations. 
The  second  portion  should  now  be  paid    into  the 
nostril  in  the  same  way,  and  pressed  by  the    finger 
and  forceps  into  its  position, — the  roof  of  the  nose. 
The  third  and  last  portion  should  be  pushed  into 
the  nostril  so  as  to  occupy  a  position  in  front   of 
and  below  the  other  two,  and,  being  caught  within 
the  edge  of  the  alar  cartilage,  will  usually  retain  its 
position  without  trouble.     Dr.  Hamilton  thinks  it 
desirable  that  the  material  should  not  be  cut,  but 
retained  as  one  continuous   piece  for   facility    of 
subsequent  removal ;    but  too'much  care  cannto 
be  taken  in  disposing  of  the  first  portion.      The 
nostril  being  thus  perfectly  and  thoroughly  packed, 
every  portion  of  the  lining  membrane  is  steadily  and 
firmly  compressed,  and  the  escape  of  blood  is  ren- 
dered physically  impossible.  In  the  course  of  about 
forty-eight  hours  the    plug  begins  to    loosen,  the 
end  falling  from  the  nostril.     Directions  should  be 
given    to  the  nurse    or  attendant  on  no    account 
to  pull  it,  but  simply  to  cut  the  projecting  part  on 
a  level  with  the  nostril  according  as  it  drops,  until 
the  entire  plug  comes  away.     There  is  little    fear 
of  the  plug  remaining  too  long  as,  when  the  natural 
secretion  is  restored,  it  becomes  quickly  loosened 
and  unpacked,  and  falls  away  through  the  anterior 
nostril. 


TONDON  CORRESPONDENCE. 

The  age  of  miracles  is  not  yet  over  it  appears. 
A  gang  of  thieves  was  brought  up  at  one  of  our 
chief  pohce  courts  in  the  metropolis  a  short  time 
since,  charged  with  breaking  into  a  house  and 
ill-using  the  only  inmate,  a  lad  of  seventeen,  who 
had  been  dumb  from  birth,  but  who  was  so 
frightened  at  their  treatment  that  he,  I  was  going 
to  say  recovered,  but  at  all  events  he  found  his 
speech  !  and  I  beheve,  on  good  authority,  that  there 
is  no  doubt  about  the  fact. 

A  case  was  tried   at  the  Mar>'lebone  County- 
Court  the  other  day  of  considerable  interest  to  the 
medical  profession.     The  defendant,  apparently  a 
member  of  the  Hebrew  persuasion,  was  sued  by  his 
medical  attendant  for  a  sum  of  money  for  various 
visits    to  his  wife    after    her  confinement.      The 
defendant  contended,  first,  that  the  plaintiff  had 
agreed   to  atteud   his  wife  in  her  accouchement,- 
and  for   a  month  !    after,    for    the    sum  of    four 
guineas ;  and,  secondly,  that  the  after-illness  was 
caused  by  the  doctor's  neglect  and  want  of  skill,, 
in  not  having  ascertained   that   the  patient   had 
passed  no  water  for  four  days,   which  for  several 
days  after  necessitated  the    use    of  the  catheter 
twice   daily.     The  judge  promptly  sat  upon  the 
attempt  to   disparage  the    plaintiffs   professional 
skill,  and  gave  him  a  verdict  on  the  ground  that 
the  after-attendance  was,  as  he  observed,  outside  the 
original  contract,  and  that  no  man  in   his  senses 
would    undertake   to    attend    a   woman    in   her 
accouchement  for  a  month  for  four  guineas.     (Of 
course  the  plaintiff  utterly  denied  this  part  of  the 
compact.)     But  it  rather  appears  to  me  as  though 
this  case  is  another  illustration  of  "  if  you  want  a 
thing  done  well,  do  it  yourself,"  in  other  words  never 
trust  too  implicitly  to  the  statements  of  the  nurse. 
Talking  of  nursing,  the  lamentable  state  of  affairs 
still     continues    at    Guy's     Hospital,     and    has 
culminated  in  the  resignation  of  the  senior  Physi- 
cian and  Surgeon,  and  one  of  our  oldest  and  most 
useful  institutions  in  this  huge  overgrown  city  is 
rendered  well-nigh  incapable  of  carrying  out  the 
benevolent  intentions  of  its  founder.     More  than 
one    inquest    lately    has    demonstrated    the   im- 
potcncy  and  incapability  of  the  present  system. 
The  affair  seems  to  me  to  lie  in  a  nutshell,  are  the 
nurses  to  obey  the  doctors  or  not?     In  private 
practice,  a  nurse    who  choses  to  disobey    orders 
would  very  promptly  be  sent  to  the— well,  home  to 
her  mother. 


120 


THE   CANADA    MEDICAL    RECORD. 


The     fact    that   the   revenue    in    this   country 
•derives  more  than  two  hundred   thousand  pounds 
per  annum  from  the  stamps  for  the  sale  of  patent 
medicines  deserves  more  than  a  passing  mention, 
and   more  than   a  passing  thought.     England  is 
the  best  quacked  country  in  the  world,  and  the 
colossal  fortunes   that  have  been  and  are   being 
amassed  by  the   vendors   of  pills,  and  ointments, 
and  blood  mixtures,  surpass  all  belief     When  men 
can  afford  to  spend  many  thousands  per  annum  in 
advertising   alone,  their  profits   must  be  immense 
indeed.    I'he  endowment  of  hospitals,  &c.,  &c.,  in 
latter  life   from   some   of   the    huge    sums   made 
carries  one  back   in  thought  to  the  times  of  and 
prior  to  the  middle  ages,  when   the  robber  barons 
of  those   days,  after   during    nearly   their   whole 
existence  leading  a  life  of  robbery,  murder,  viola- 
tion, and  of  committing  every  vile  thing  they  could 
do  on  the  face  of  this  beautiful  earth,  would  on 
their  deathbeds  think   to  make  their  peace  with 
Heaven  by  building   a   church  !   or   endowing  a 
monastery.     Verily   "  History  repeats  itself,  and 
there  is  nothing  new  under  the   sun."     English 
Physicians  and   Surgeons    are,  it    is    universally 
admitted,  second  to  none  ;  the  examinations  they 
have  to  pass  are  as,  if  not  more,  stringent  than  any 
under  the  sun.     The  expense  of  acquiring  their 
diplomas    is    very    great,    and    when   they    have 
obtained  them,  what  does  a  munificent  state  and  a 
beneficent  country  do  for  them?     Mulcts  them  in 
a  fee  of  five  guineas  for  a  registration  sham,  sneers 
and  jeers   and    ridicules    them    (even    the    Poet 
Laureate  has  no  better  taste  than  to  have  a  fling^ 
and  state  what  a   moment's   consideration   must 
have  shown  him  to  be  a  monstrous  untruth),  allows 
any  fool  who  can  scrape  a   few  coppers  together 
to  Hood  the  country  with  advertisements   of  his 
wretched   nostrums,    which   when   they    do    any 
good  are,  as  in  one  notable  instance,  filched  from  a 
physician's  prescription.      The   munificent    state 
also  allows  any  booby  (either  with  or  without  a 
bogus  diploma),  who  can  get  a  qualified  man  (and 
I  am  sorry  to  say  there  are  many  unscrupulous 
enough  to  do  so)  to   "  cover  "  him,  to  drench  the 
unfortunate  gulls,  and  trust  to  luck  to  carry  them 
through.     Within  a    few   yards    of  where   I   am 
•writing,    there  are   two   of    these   so-called    Dis- 
pensaries doing  a  flourishing  business.     London  is 
full   of  quacks  and   impostors,   who   openly  and 
unblushingly  carry  on  their  nefarious  trades.     The 
public   suffer  equally   or  more  so   than  regularly 
qualified  and  registered  practitioners,  and  the  law 


seems  powerless  to  protect  either  the  one  or  the 
other.  Truly  they  "  manage  these  things  better  in 
France."  There  neither  nostrum  nor  quack,  nor 
unqualified  practitioner  is  allowed  to  flourish. 

We  are  as  far  off  as  ever  apparently  from  find- 
ing a  specific  for  the  cure  of  cancer.  The  much- 
vaunted  chian  turyientine,  which  was  introduced 
with  such  a  flourish  of  trumpets,  appears  to  have 
most  ignominiously  failed,  after  having  been  given 
a  fair  and  lengthened  trial  in  several  cases.  I  am 
sorry  to  confess  that  in  my  practice  it  has  com- 
pletely failed  to  do  what  it  was  asserted  80  con- 
fidently it  would  do— cure  cancer. 

LoKDON,  8th  December,  1880. 


The  Midwinter  (February)  Scribner  has 
always  been  a  special  number,  as  rich  as  the 
choicest  literary  matter  and  the  most  beautiful 
wood  engravings  can  make  it.  Of  last  year's  mid- 
winter number  the  London  Times  said  :  'It  is  a 
really  magnificent  triumph  of  American  pictorial 
art  and  literary  genius."  The  English  publisher 
of  Scribner  \iz.%  telegraphed  for  17,000  copies  of 
the  present  number, — an  advance  of  6,000  upon 
his  orders  last  year,  and  the  largest  edition  of  an 
American  magazine  ever  sent  to  England  : — in  fact, 
it  is  said  to  be  larger  than  the  monthly  sales  of  any 
Eyiglish  Magazine.  The  American  edition  of 
Scribner  has  grown  during  1880  about  20,000 
copies. 


Since  1878  the  sales  of  Wyeth's  Beef,  Iron  and 
Wine  have  quite  doubled  in  amount,  owing  to  the 
appreciation  by  Physicians  of  its  claim  that  the  pre. 
paration  really  deserves  the  preference  on  account 
of  the  Purity  of  the  Wine,  the  Fresh  Beef  used,  to- 
gether with  the  fact  that  the  Iron  is  held  in  solution, 
c  condition  to  insure  ready  assimilation.  If  Physi- 
cians will  test  it  by  simple  taste,  they  will  find  an 
entire  freedom  from  the  mawkishness  tliat  must 
characterize  it  if  made  from  Extract  of  Beef,  re- 
sulting in  a  disagreement  with  the  delicate  and 
sensitive  stomachs  of  the  class  of  patients  for 
whom  this  combination  is  specially  indicated. 

We  have  no  hesitation  in  stating  that,  as  a 
Tonic,  Stimulant  and  Roborant,  Beef,  Iron  and 
Wine,  properly  prepared,  has  proven  more  uni- 
formly beneficial  than  any  combination. 


THE  CANADA  MEDICAL  RECORD. 


Vol.   IX. 


MONTREAL,  FEBRUARY,  1881. 


No.   5. 


O  Ol^TEIsTTS. 


PROGRESSOFMEDICALSCIENCE 

Explosive  combinations  in  Pharmacy, 
121 — On  various  forms  of  Func- 
tional Cardiac  disturbances,  122 — 
Tetanus :  Study  of  four  hundred 
and  fifteen  cases,  123 — Suberine  in 
Excoriated  Nipples,  123 — Aching 
Kidney,  by  J.  M.  Duncan,  M.D., 
124 — Probable  value  of  Chloride 
of  Barium  in  Internal  Aneurism, 
124 — Treatment  of  Epilepsy,  126 
— Aids  to  Diseases  of  Women,  127 
— Ovarian  Dyspepsia,  129— Treat- 


ment of  Sterility,  129 — Sulphide 
of  Calcium  in  the  treatment  ot  sup- 
purating Buboes,  130 — Manage- 
ment of  deep  Abscesses,  131 — On 
Glycerin  in  Flatulence,  Acidity  and 
Pyrosis,  131 — Treatment  of  Acute 
Rheumatism,  132 — Treatment  in 
cases  of  Fxcessive  Lochial  Dis- 
charges,132— Treatment  of  Chorea, 
133 — Cases  of  Abnormally  high 
Temperature,  133  —  Official  ac- 
count of  Typhoid  outbreaks  at 
Lennoxville,  134 — Rules  for  In- 
jection in  Gonorrhoea,   138 — Hints 


on  Sea-bathing,  139— The  origin 
of  Tetanus,  140 — Bilious  Head- 
aches, 140 — Oxalate  of  Cerium  as 
a  Cough  remedy,  141 — Gastric 
Ulcer,  by  Herbert  W.  Little, 
M.D.,  141 — Why  we  eat  Oysters 
raw,  142 — Ice  to  the  Abdomen  in 
Typhoid  Fever '43 

EDITORIAL. 

Lawton's  Absorbent  Cotton,  143 — 
Administration  of  Ergot  in  Labor, 
144 — Obituary,    144— Death 144 


3^r^odmi'S  afjftedkui  Smtwe. 


EXPLOSIVE 


COMBINATIONS    IN 
MACY. 


PHAR- 


We  select  the  following  items  from  an  interesting 
article  on  dispensing  in  the  London  Chemisfs  and 
Druggisfs  Abnaiiac  for  1880  : 

Chloride  or  iodide  of  nitrogen  is  formed  by  the 
addition  of  chlorine  or  a  chloride,  or  iodine  or  an 
iodide,  to  ammonia  ;  and  this  compound  is  liable 
to  violent  explosion  on  coming  in  contact  with 
phosphorus,  iodine,  arsenic,  olive  or  cod-liver  oil, 
turpentine,  etc. 

Tincture  of  iodine  and  ammonia  are  often  pres- 
cribed together,  and  iodide  of  nitrogen  is  neces- 
sarily produced.  The  rarity  of  accidents  is  due 
to  the  fact  that  the  iodide  is  not  free  from  water. 

Mr.  Rice,  in  New  Eefnedies,  mentions  an  explo- 
sion resulting  from  the  preparation  of  the  following 
prescription^  iodide  of  nitrogen  being  evidently 
the  cause  : 

5:  lodinii,  gr.  xv  ; 
Lin.  camph.  co-, 
Lin.  saponis  co.,  a  a  gr.  Ix. 
A  concentrated  solution  of  iodine  and  iodide  of 
potassium  was  filtered  through  paper.     The  next 
day  the  filter  was  touched  to  be  removed,  when 
the  paper  and  funnel  broke  into  atoms  with  a  loud 
explosion. 

Concentrated  solutions  of  permanganate  of 
potash  in  alcohol  are  liable  to  explosion,  and 
bichromate  of  potash  in  alcohol  may  ignite  the 
latter.  Aqua  regia  will  also  often  cause  an  explo- 
sion with  alcoholates  or  essences. 

Chlorate  of  potash  mixed  dry  with  tannin  is 


dangerous,  and  an  explosion  has  resulted  from  its 
mixture  with  muriate  of  morphia.  The  followmg 
prescription  was  presented  at  a  pharmacy  in  New 
York  :  it  cannot  be  prepared  without  an  explosion  : 
5  Lactis  sulphuris,  gr.  iij ; 

Antimon.  sulph.  aurant.,  gr.  iij ; 
Zinci  valerian.,  gr.  i ; 
Potass,  chlorat.,  gr.  ij. 
The  addition  of  nitrate  of  silver  to  essence  of 
bitter  almonds  to  remove  the  hydrocyanic  acid  has 
been  followed  by  ignition. 

The   following   compounds   have    at    different 
times  caused  more  or  less  serious  accidents : 
5  Calcis  hypophosphitis,  gr.  viij  ; 
Potassae  chloratis,  gr.  xij ; 
Ferri  lactatis,  gr.  v. 
The  trituration  of  hypophosphite  of  lime  alone 
has  sometimes  resulted  in  an  explosion.     A  man 
was  killed  at  Erfurt  while  drying  one  kilogramme 
of  the  salt  in  a  sand-bath.     It  is  said  to  be  most 
dangerous  if  quite  pure. 

5  Glycerini,  f  3  ij  ; 
Acidi  chromici,  3  i. 
This  mixture  can  be  made  by  adding  the  acid 
to  the  glycerin  by  very  slow  degrees. 

A  mixture  containing  chlorate  of  potash,  tincture 
of  perchloride  of  iron,  and  glycerin  once  burst  in 
the  pocket  of  a  patient. 

Pills  containing  oxide  of  silver  are  liable  to 
inflame  if  they  become  warm.  They  have  taken 
fire  in  the  pocket  of  a  customer,  causing  severe 

burns.  .   ^  ,     . 

Other  compounds  liable  to  inflame  during  or 
after  preparation  are  permanganate  of  potash  and 
extract  of  milfoil,  permanganate  of  potash  and 
reduced  iron  in  pills,  golden  sulphuret  of  antimony 
and  chlorate  of  soda  in  pills. 

It  is  always  dangerous  to  associate  glycerin  Qf, 


P2 


THE   CANADA    MEDICAL    RECORD. 


in  general,  any  deoxidizer  with  easily-reducible 
compounds,  such  as  the  permanganates,  chromic 
acid,  the  chlorates,  and  some  organic  ai;ids. — Bos- 
ton Jourfuil  of  Chemistry. 


ON    VARIOUS    FORMS   OF   FUNCTIONAL 
CARDIAC  DISTURBANCES. 

By  Bkvfri.ey  Robinson,  M.U.,  I>ccturer  upon  Clinical 
Medicine  .it  tlie  Bellevue  Ilosjjital  Mciiical  College,  New 
York. 

{Continued from  our  last  number.) 

Physical    investigation    discovers    clearly    two 
facts:  I st,  that  there   is   no  evidence  of   structural 
lesion.     2d,  the  presence  of  signs  which  enable  us 
to  affirm   that    the   heart's   walls   and  orifices  are 
sound.     If  we  bring   percussion    to   our  help,  we 
find  the  heart  has  its  usual  size,     ^^'henever  func- 
tional trouble  is   conjoined  with    organic  trouble, 
ordinarily  the  heart  is,  without  question,  more  or 
less   enlarged.     Palpation  of  a  heart   functionally 
disturbed  finds  the  apex  at  its  normal  seat ;   does 
not  recognize  such  increased  power  as  one  would 
expect  to  find  if  the  organ  were  hypertrophicd,  and 
seldom  has   a    sensation    approximating  that  of  a 
'•  thrill."     If  auscultation    be  employed,  there  are 
usually  no  murmurs,  and  the  heart-sounds,  barring 
what  is  due  to  excitability,   are   healthy.     If  mur- 
murs exist  they  indicate  the  accompanying  blood 
condition,  and  this  is  indicated  more  by  their  seat 
and  time  of  greatest  intensity  than  by  anything  in 
the  actual  tone  of  the  murmurs  themselves.     We 
have  had  great  reason  to  believe,    during  the  last 
few  years,  that    many   cardiac  murmurs,  once  as- 
sumed to  be  evidence  of  organic  trouble  at  the  ori- 
fices, are  only  due  after  all  to  what  should  be  con- 
sidered functional  trouble.     And  in  the  same  line 
of  reasoning  I  would  now  hold  that,  even  with  very 
pronounced  disorder   of  cardiac  action,  it  is  not 
correct  to  infer  the  existence  of  either  dilatation  os 
fatty  degeneration  of  cardiac  fibre.     The   causer 
mentioned  above  are  usually  the  origin  of  all  the 
symptoms,  and  once  they  are  effectually  removed, 
the  heart  will  come  right  of  itself.     The  first  sound 
of  the  heart  affected  with  functional  disturbance  is 
sometimes   accompanied   with  a   clearly  distinct 
metallic  tinnitus,  which  is  due,  oftentimes,  not  as 
Hope  affirms,  to  the  noise  of  the  cardiac  impulse 
against  the  sixth  rib,  but  simj^ly  to  a  stomach  in- 
flated with  the  gases  of  imi)erfect  and  ])rolonged 
digestion.      I  have  seen   this   symptom  persist  for 
many  weeks,  and  then  quietly  subside  under  the 
influence  of  a  well-systematized  treatment  direct- 
ed  against    the    dyspepsia.     In    the    diagnosis  of 
functional  trouble  of  the  heart,  the  fust  and  most 
important  matter  is  to  determine  that  no  organic 
heart  affection  exists.     Afterward  we  must  endea- 
vor to  determine  to  what   extent  the  signs  i)resenl 
are  occasioned  by  complicating  symptoms  of  func- 
tional nature.     This   we  are  unable  accurately  to 
aflirm  in  a  certain  number  of  cases,  after  a  single 
examination,    no  matter   how   carefully  and  accu- 
rately made.     Upon  weighing  fairly  all  symptoms 


present,  the  age  and  circumstances  of  the  patient, 
his  preceding  history,  his  hereditary  tendencies, 
the  nature  of  his  employment,  etc.,  we  are  still 
obliged  to  apply  the  touchstone  of  treatment  in 
order  to  reach  the  exact  truth.  Even  physical 
examination,  so  sure  at  times  in  the  results  afforded, 
will  occasionally  leave  the  mind  uncertain  as  to 
the  correct  interpretation  of  the  signs  it  makes 
known.  The  normal  sounds  of  the  heart  are  so 
much  obscured  by  rapidity  and  irregularity  of 
action,  and  so  many  general  phenomena  are  pre- 
sent which  may,  at  first,  be  attributable  to  organic 
disease,  that  we  are  forced  to  suspend  judgment 
for  a  time.  True  it  is  that  the  varying  degree  of 
painful  symptoms,  their  lack  of  permanency  parti- 
cularly, and  the  absence  of  grave  disturbance,  such 
as  dropsy,  hemorrhage,  paralysis,  etc.,  all  point 
more  directly  to  functional  disorder  than  to  struc- 
tural disease. 

But  how  many  examples  of  the  latter  kind  remain 
for  a  long  period  ignored,  owing  to  the  simple, 
though  not  always  recognized  fact,  that  they  are 
covered  up,  or  concealed  from  view,  as  it  were,  by 
the  presence  of  a  complicating  neurosal  affection, 
only  those  who  practice  frequent  auscultation  can 
be  aware.  Now  it  is  just  this  very  troublesome 
element  of  disease,  the  nervous  one,  which  it  is 
important  to  eliminate  by  judicious  treatment,  and 
to  do  this  quickly  and  effectually  we  must  rely,  to 
a  certain  extent,  upon  the  proper  use  of  well- 
selected  therapeutical  means,  but  we  should  also 
rely  greatly  upon  more  power.  If  the  physician 
consulted  be  thoroughly  conversant  with  the  com- 
plex nature  of  the  affection  he  is  called  upon  to 
treat,  and  yet  feels  confidence  in  his  own  resources, 
he  will  take  positive  ground  by  affirming  in  the  be- 
ginning that  many,  if  not  all  of  the  distressing 
symptoms  experienced  by  the  patient  are  the 
sequelae  of  a  deranged  nervous  system.  He  is 
abundantly  justified  in  so  doing,  first,  because  in 
the  majority  of  instances  the  future  will  prove  the 
truth  of  his  statements,  and  in  the  few  instances 
in  which  he  may,  perhaps,  be  partly  in  error,  the 
immense  moral  weight  obtained  from  the  start  is 
of  incalculable  advantage  to  the  patient.  And 
even  supposing,  what  is  only  rarely  true,  that  there 
is  in  reality  present  an  advanced  stage  of  organic 
cardiac  disease,  we  know  well,  by  daily  contact 
with  hosjntal  i)atients,  that  freedom  from  emotional 
excitement,  perfect  rest  and  tranquility,  good 
food,  hrematinics,  and  the  moderate  use  of  digitalis, 
strychnine,  and  carbonate  of  ammonia,  will  work 
wonderful  results.  Make  such  a  patient  despair 
by  telling  him  he  has  incurable  or  real  cardiac 
disease,  and  soon  the  onward  and  downward  ten- 
dency of  his  disease  will  be  so  marked,  in  spite  of 
all  our  efforts,  that  we  shall  have  to  deplore  rapidly 
fatal  cases  in  which,  by  a  justifiable  deceit,  there 
was  the  possibility  of  several  years  of  life.  Of 
course  such  a  line  of  conduct  as  I  have  traced 
would  not  be  permissible  where  sudden  death 
might  be  anticipated  or  major  interests  of  great 
moment  are  at  stake.     And  look  for  a  moment  at 


THE   CANADA    MEDICAL    RECORD. 


123 


V 


a  sad,  though  usual  example,  of  daily  occurrence  : 
Take  a  young  fellow,  like  one  among  yourselves, 
who  is  simply  run  down  temporarily  in  bodily  vigor 
by  too  great  sedentary  occupation,  combined  with 
mental  strain,  and,  perhaps,  abuse  of  tobacco  and 
coffee.  He  commences  to  be  troubled  with  dis- 
agreeable, or  even  painful  cardiac  sensations.  He 
cannot  sleep  comfortably  at  night,  and  after  a  half- 
dozen  whiffs  of  a  cigar,  or  a  rapid  walk  of  short 
duration,  his  heart  seems  suddenly  to  stop,  or  to 
beat  forcibly  and  rapidly  for  a  few  moments,  and 
then  give  intermittent  and  irregular  shocks,  which 
make  him  believe  that  all  his  internal  machinery 
is  out  of  gear.  Under  these  circumstances  he 
consults  some  experienced  physician,  who  informs 
him  solemnly  that  he  has  heart  disease.  What  is 
— what  can  be  the  result — but  gloomy  forebodings, 
and  a  restless,  irritable  feeling  which  forbids  all 
steady,  honest  work,  and  makes  him  for  months 
and  years  the  victim  of  groundless  fears  ?  'T  Better 
far  that  the  examination  had  never  been  made,  or 
the  medical  man  consulted,  for  after  a  time,  with 
improved  hygienic  surroundings,  and  more  sleep 
and  leisure,  such  cases  might  often  come  out  all 
right.  If  not,  abandonment  for  a  time  of  tea, 
coffee,  and  tobacco,  and  the  use  of  moderate  doses 
of  henbane,  chloral,  or  aconite,  with  the  local  appli- 
cation of  a  belladonna  plaster  in  the  precordial 
region,  will  get  the  heart  soon  in  good  working 
order.  During  a  painful  attack  of  cardiac  palpita- 
tions it  may  be  advisable  to  give  an  opiate  or  an 
antispasmodic  remedy.  Tincture  of  lavender, 
aromatic  spirits  of  ammonia,  chloric  ether,  elixir  of 
valerianate  of  ammonia,  etc.,  are  all  good,  and 
may  be  severally  employed  with  advantage  to  the 
patient  in  reheving  his  distress.  For  several  years 
past  it  has  been  my  habit  to  combine  the  three 
first  in  equal  quantities  with  an  amount  of  syrup 
equal  to  the  three  in  bulk.  Of  this  mixture  I  give 
a  teaspoonful  in  a  little  water  every  hour,  until  the 
painful  feelings  are  notably  relieved.  Alcohohc 
stimulants  are  not  debarred  by  this  method  of 
treatment,  especially  if  the  patient  be  weak  and 
complain  of  fainting  sensations. 

There  are  numerous  examples,  however,  in 
which  the  functional  trouble  accompanies  a  mode- 
rate degree  of  organic  cardiac  trouble,  and  so  soon 
as  the  former  is  relieved,  the  latter  remains  inno- 
cuous with  a  little  judicious ^care  for  a  long  series 
of  years.  The  functional  trouble  may  be  depen- 
dent upon  the  condition  of  the  blood,  the  stomach, 
or  the  gouty  diathesis,  or  what  is  still  tolerably 
frequent — a  combination  of  different  pathological 
conditions.  Manifestly,  in  all  such  cases,  while 
carminatives,  small  doses  of  digitalis,  or  the  reme- 
dies already  indicated, m  ay  be  usefully  employed 
to  relieve  occasional  disturbance,  paroxysmal  in 
character,  permanent  relief  can  only  be  obtained 
by  remedies  directed  against  the  causal  agencies 
at  work.  If  a  plethoric  state  be  present,  use  mild 
depletory  measures,  such  as  small,  repeated  doses 
of  the  neutral  salts  :  if  anaemia  be  the  underlying 
difficulty,  iron,  gen^r^u?  diet,  and  life  in  the  open 


air,  are  mainly  to  be  relied  upon  ;  for  relief  of 
dyspeptic  trouble,  regular  meals,  riding  on  horse- 
back, and  rationally  formulated  stomachics,  varied 
according  to  prominent  indications,  should  be  per- 
sistently insisted  upon ;  as  for  gout,  potash  and 
lithia  salts  are  our  sheet  anchors,  and  soon  an  im- 
provement of  the  cardiac  condition  will  follow  their 
exhibition.  If  the  indications  be  complex,  our  for- 
mulae should  be  made,  so  far  as  possible,  to  meet 
the  requirements  of  the  individual  cases. — N.  Y. 
Medical  Record. 


TETANUS:  STUDY  OF   FOUR  HUNDRED 
AND  FIFTEEN  CASES. 

Dr.  D.  W.  Yandell  {The  Brain)  reports  his 
study  of  four  hundred  and  fifteen  cases  of  tetanus. 
This  study  points  to  the  following  conclusions  : 
(i)  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)  Where  tetanus 
continues  fourteen  days,  recovery  is  the  rule  and 
death  the  exception,  apparently  independent  of 
the  treatment.  (5)  Tetanus  arising  during  the 
puerperal  state  is  the  most  fatal  form  of  the  disease. 
(6)  Chloroform  has,  up  to  this  time,  yielded  the 
largest  percentage  of  cures  in  acute  tetanus.  (7) 
The  true  test  of  a  remedy  for  tetanus  is  its  influ- 
ence on  the  history  of  disease,  {a)  Does  it  cure 
cases  in  which  the  disease  occurred  prior  to  the 
ninth  day  after  the  injury?  (b)  Does  it  fail  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. 


SUBERINE  IN  EXCORIATED  NIPPLES. 

(Lyo?i  Medical.) 

The  treatment  advised  by  Dr.  Brochard  for 
sore  and  excoriated  nipples  is  so  simple  that  it 
deserves  publicity  : 

"  As  soon  as  an  excoriation  or  a  crack,  no 
matter  how  small,  appears  upon  the  breast  of  a 
nursing  woman,  the  nipple  and  areola  should  be 
washed  with  pure  water,  and,  after  drying, 
powdered  with  suberine,  or  impalpable  powder  of 
cork.  Suberine,  which  I  always  use  for  infants,  is 
far  preferable  to  lycopodium,  which  is  an  inert 
powder,  because  it  contains  tannin,  and  is  exceed- 
ingly cheap,  an  important  consideration  with  many 
mothers.  After  applying  the  powder,  the  nipple 
is  covered  with  a  piece  of  gold-beater's  skin,  cut 
star-shaped,  and  pierced  in  the  centre  Avith  several 
holes  made  with  a  very  fine  needle. 

"  Whenever  the  child  is  to  be  put  to  the  breast, 
the  suberine  should  be  washed  off  with  water,  and 
the  gold-beater's  skin  placed  over  the  nipple,  thus 
allowing  the  babe  to  suck  without  causing  pain  to 
the  nurse.  After  the  infant  has  finished  its  meal, 
the  nipple  is  again  wa,shed,  powdered  and  covere(3t," 


124 


THE    CANADA    MEDICAL    RECORD. 


ACHING  KIDNEY. 

6t  J.   Matthews  Duncan,    M.D.,    LL.D.,    in    Medical 
Times  and  Gatette. 

This  disease  is  sometimes,  both  in  men  and 
women,  very  easily  recognized.  There  are  achings 
in  cases  of  what  is  called  floating  kidney.  The 
patient  can  put  her  hand  on  the  lump,  and  say, 
"  Here  is  the  pain,"  and  there  is  no  difficulty  in 
recognizing  the  disease.  But  there  are  some  cases 
in  which  the  disease  is  very  diflicult  to  identify. 
In  pregnancy,  for  instance,  right  or  left  hypochon- 
driac pain  is  very  frequent.  In  many  cases  I  have 
been  able  to  be  quite  sure,  from  the  history  before 
and  after  pregnancy,  that  the  disease  was  not  to 
be  classified  in  the  vague  way  that  is  implied  in 
giving  it  the  name  of  hypochondriac  pain,  but 
that  it  was  really  a  case  of  aching  kidney.  In  preg- 
nancy you  have  the  very  opposite  conditions  to 
those  in  floating  kidney.  If  pregnancy  is  advanced, 
you  can  not  get  at  the  kidney  to  feel  it  and  identify 
its  position.  Here  I  may  remark  that,  while  the 
disease  often  occurs  in  pregnancy,  yet  some  wo- 
men who  are  liable  to  it  do  not  suffer  while  in  that 
condition. 

The  disease  in  women  is  not  a  rare  one,  and  its 
characters  are  the  following  :  One  or  other  kidney 
is  the  seat  of  pain.     It  is  not  a  neuralgic  pain  ;  it 
is  a  heavy,  wearing  pain  deep  in  the  side.     It  is 
in  the  region  of  the  kidney  ;  and  in  many  cases,  as 
I  shall  presently  tell  you,  you  can  easily  identify 
it  as  being  in  the  kidney  itself.     It  is  not  generally 
that  kidney-pain  which  is  a  familiar  symptom  of 
calculus.     In  such  cases  the  pain  is  the  pain  of 
the  pelvis  of  the  kidney.     You  have  in  the  region 
of  the  small   ribs  a   boring  or  a  nail-like  pain. 
Patients  with  aching  kidney  generally  point  to  the 
hypochondriac  region,  not  to  the  back,  as  they 
often  do  in  cases  of  calculus  in  the  kidney.     This 
pain  is   frequently  accompanied  by  pain   in  the 
corresponding  lower  limb,  referred  most  frequently 
to  the  course  of  the  sciatic  nerve,  sometimes  to 
the  course  of  the  anterior   crural.     The  pain  is 
often  accompanied  (and  you  will  find  this  of  im- 
portance throughout  all  the  subjects  of  this  lec- 
ture) by  irritability — I  do  not  say  disease — of  the 
bladder  ;  and  it  is  frequently  accompanied  by  pain 
in  the  region  of  the  ureter  corresponding  to  the 
kidney  affected.     This  pain  is  not  rarely  present 
only  during  the  monthly  periods.     When  it  is  pre- 
sent only  during  the  monthly  periods  it  may  be 
classed  with  that  disease,  which  is  very  ill-defined, 
called  dysmenorrhea.     It  should  never  be  placed 
there  unless  you  wish  to  use  the  word  dysmenor- 
rhea in  a  very  wide  sense.      If  we  use  the  word  as 
including  aching  kidney,  we  might  as  well  use  it 
as  including  headache — a  use  whic  h  would  be  in 
accordance    with    what    is    extensively    done    by 
writers.     This  disease,  however,  often  eludes  the 
examination  of  the  physician,  because  it  occurs  in 
many  cases  only  during  the  monthly  periods.     In 
all  cases  it  is  then  aggravated.     I  do  not  think  I 
have  ever  seen  a  case  in  which  the  patient  did  not 


volunteer  the  statement  that  the  pain  was  worse 
at  the  monthly  time. 

It  is  not  usual  to  find  both  kidneys  aching  ; 
and  I  guess — I  can  use  no  stronger  word — that 
the  left  kidney  is  much  more  frequently  the  seat 
of  disease  than  the  right  one.  You  are  not  left 
in  your  diagnosis  in  all  cases  merely  to  identifica- 
tion of  the  seat  of  the  pain,  although  that  may  be 
sufficient.  Frequently  in  the  region  of  the  pain 
you  can  find  distinct  fulness  ;  that  is  a  very  impor- 
tant condition  that  I  have  not  time  to  explain  to 
you.  It  can  scarcely  be  made  out  in  a  fat  woman  ; 
but  in  many  cases  this  condition  of  fulness  over 
the  affected  kidney  is  easily  recognized.  In  addi- 
tion, swelling  of  the  kidney  or  of  the  suet,  or  of 
both,  is  not  rarely  to  be  made  out.  The  physical 
examination  of  the  kidney  is  too  much  neglected. 
It  is  not  in  floating  kidney  only  that  you  can  feel 
the  organ.  In  many  women  who  are  not  nervous, 
yielding  themselves  freely  to  examination,  and  who 
are  not  fat,  you  can  feel  the  kidney  with  distinct- 
ness ;  and  in  cases  of  this  kind  you  can  frequently 
make  out,  as  I  have  said,  that  there  is  a  swelling 
of  the  kidney  or  of  the  suet,  or  of  both.  There 
is  also  generally  tenderness,  sometimes  great  ten- 
derness. 

The  treatment  is  to  be  conducted  on  the  general 
principles  applicable  to  the  therapeutics  of  neu- 
ralgia or  slight  hypersemia ;  and  these  two  condi- 
tions are  not  so  very  remote  from  one  another  as 
may  at  first  sight  appear.  A  neuralgia  sounds  as 
if  it  were  something  quite  different  from  a  hyperae- 
mic  condition  ;  but  that  has  to  be  proved.  The  reme- 
dies I  have  found  of  most  service  in  simple  cases 
of  this  kind  are  tonic  regimen  and  tonic  medicines, 
especially  iron  in  the  form  of  the  tincture  of  the 
perchloride  combined  with  mild  diuretics  in  small 
quantity,  and  especially  the  common  sweet  spirits 
of  niter. 


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 
efhcacy  in  the  treatment  of  some  varieties  of  inter- 
nal 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  philanthropic 
work,  that  she  perpetually  overtaxed  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  mani- 
fested  symptoms  of  inherited   gout,  and   a   near 


l*aE   CANADA   MEDICAL    RECORO. 


125 


relation   gives  indications  of  having  divided   the 
inherit ance  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  attendant,  and 
fulfilled  her  usual  social  and  domestic  duties  until 
she  was,  one  day  in  February,  1878,  attacked  with 
severe  shivering,  and  a  sense  of  severe  malaise. 
On  the  following  morning  I  found  her  temperature 
io2'''4,  and  on  searching  for  the  cause  of  the 
pyrxfia  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  vertebral  column  on  the  left 
side ;  pressure  on  both  external  iliacs  greatly 
increased  the  pulsation,  and  so  distressed  the 
patient  that  I  received  a  decided  impression  that 
it  would  not  be  advisable  to  repeat  the  experi- 
ment ;  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  con- 
siderable degree  of  tension,  and  it  had  the  same 
character  in  the  carotids  and  iliacs.  There  was  a 
moderate  degree  of  anaemia,  and  a  worn,  dis- 
tressed 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  independently  by  Mr.  J.  W.  Teale 
of  this  town  ;  they  all  agree  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  ex- 
amination ;  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 
occasionally  rose  to  10 1*,  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  carried  out  by  the  patient  and  attend- 
ant most  conscientiously  and  rigidly,  there  was 
no  improvement  in  any  way ;  the  tension  of  the 
pulse  remained  the  same,  and  the  throbbing  of  the 


tumor  had  rather  increased,  so  that  under  any  ex- 
citement, as,  for  instance,  during  a  thunderstorm, 
it  quite  shook  the  bed ;  the  sensations  of  the 
patient  and  my  own  observations  began  to  pre- 
pare me  to  expect  the  worst. 

There  were  reasons  for  abstaining  from  the  use 
of  large  doses  of  iodide  of  potassium,  so  I  did  not 
try  it.  After  careful  consideration  I  selected 
chloride  of  barium  as  a  probably  useful  remedy, 
and  began  to  give  it  in  doses  of  one-fifth  of  a  grain 
three  tunes  a  day  ;  after  three  or  four  weeks  I 
increased  the  dose  to  two-fifths  of  a  grain,  and, 
w.ih  ihe  e\cei)tion  of  a  very  short  trial  of  three 
quarters  of  a  grain,  I  kept  to  two-fifths  of  a  grain 
uuring  the  remainder  of  its  administration.  With- 
in 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  ob- 
servation ;  after  fiv^  weeks  use  of  it  the  patient 
was  able  to  bear  the  removal  of  a  necrosed  molar 
tooth  (which  had  for  a  few  days  given  rise  to  neu- 
ralgia 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  chloride  :  and  after  nearly  five  months  con- 
tinued 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  the 
present  time,  four  or  five  months  since  the  discon- 
tinuance 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  unnat- 
ural tension. 

Mr.  J.  W.  Teale  has  recently  seen  the  case 
again,  and  he  expressed  himself  highly  gratified 
With  the  change  in  the  patient's  state.  So  that 
testimony  can  be  borne  by  an  independent  trust- 
worthy practitioner  to  the  accuracy  of  the  diag- 
nosis in  the  first  place,  and  to  the  reliability  of 
the  improvement. 

It  will  now  be  interesting  to  e.xamine  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  over- 
whelming doses  paralyse  the  heart  and  blood-ves- 
sels ;  but  that  in  more  moderated  doses  they  stimu- 
late 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  chlo- 
ride is  half  a  grain  ;  Ringer  puts  the  dose  at 
from  half  a  grain  to  a  quarter  of  a  grain,  but 
in  the  edition  I  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  I  suppose.  I 
have  myself  taken  about  one  grain  three  times  a 
day  for  several  weeks  with  a  very  marked  stimu- 
lant effect.  So  that  I  should  expect  the  stimulant 
dose  to  be  somewhere  near  one  grain,  and  the 
paralysing  dose  nearer  two  drachms.     The  dose  I 


126 


tflE   CANADA   MEDICAL   RECORD. 


selected  was  under  that  which  I  siippose  could 
produce  a  decided  stimulating  effect  ;  and,  as  a 
most  essential  imi^rovement  occurred  at  the  begin- 
ning of  the  use  of  the  salt,  when  I  was  giving 
onc-fifth  of  a  grain,  I  should  not  be  surprised  to 
learn  that  I  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  paralysing  influence  of  the 
drug  on  the  heart.  I  regret  that  I  had  not  in  my 
possession  a  sphygmograph,  and  that  1  cannot, 
therefore,  give  any  sphygmographic  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  por- 
tion of  the  arterial  coat,  and  thus  gave  rise  to 
consolidation  of  the  weakened  arterial  M'all.  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  barium 
causes  an  increase  in  the  blood  pressure  it  is  not 
reasonable  to  expect  that  it  should  do  anything 
but  hami  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  Therapeutics),  will  be 
deterred  by  the  facts  mentioned  above  from  giving 
the  chloride  of  barium  in  aneurism  in  an  appro- 
priate dose.  Of  course  it  may  be  asserted  that  the 
improvement  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  appear  to  me  at  all  probable. 

The  question  of  the  value  of  the  drug  in  aneu- 
rism can  only  be  decided  by  repeated  trial  ;  and  1 
report  my  case  as  fully  as  I  have  done,  that  it 
may  be  tried  by  others  in  suitable  cases. 

In  my  opinion  preference  should  be  given  to 
the  chloride  of  barium  in  fusiform  aneurisms  which 
have  hitherto  not  been  very  amenable  to  treat- 
ment also  in  the  aneurisms  of  advanced  age  ;  and 
it  might  also  be  tried  in  any  case  in  which  iodide 
of  potassium  is  inadmissable,  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  pos- 
sible during  the  use  of  the  drug.  By  F.  Flint, 
M. D. —  The  Practitioner. 


TREATMENT  OF  EPILEPSY. 

Extracts  from  a  clinical  lecture  of  Prof  E.  C. 
Seguin,  M.D.,  in  the  Pliila.  Med.  Times. 

Brown-S^quard  has  shown  that  counter-irrita- 
tion at  the  seat  of  the  aura   is  often  of  the  greatest 


benefit  in  addition  to  them.  This  serves  to 
transmit  to  the  seat  of  disease  in  the  encephalon 
a  sensation  which  may  counteract  the  one  proceed- 
ing from  the  latter.  Blisters,  setons,  and  the  tourni- 
quet or  other  species  of  ligature  are  the  forms  of 
counter-irritation  employed.  The  aura  acts  as  a 
flag  or  signal  to  show  us  the  location  of  the  trouble 
in  the  brain,  and  it  often  enables  us  to  designate 
this  with  considerable  exactness.  It  is  supposed 
by  the  public  (and  by  a  large  number  of  the  pro- 
fession) to  be  the  starting-point  of  the  epileptic 
seizure  ;  the  truth  is  the  irritation  starts  in  the  brain, 
at  the  seat  of  the  lesion  present,  and  travels  along 
some  sensory  tract  to  the  point  where  the  fibres 
constituting  the  latter  terminate  in  the  periphery. 
I  therefore  prescribe  frequent  blistering  of  the 
groin.  The  blisters  employed  should  be  small 
(say  as  large  as  the  end  of  the  finger),  and  should 
be  repeated  every  second  or  third  day. 

In  the  general  treatment  of  epilepsy  I  use  only 
one  formula  in  order  that  I  may  keep  an  exact 
record  of  the  quantity  of  the  bromides  that  is 
taken  in  each  case.  This  gives  a  standard  for  all, 
and  enables  me  to  compare  readily  the  quantity 
taken  by  different  patients.  My  first  solution  is  : 
I^  Ammonii  bromidi,  §  ss  ;  potassi  bromidi,  "%  j ; 
aquae,  fl.  3  vij.  M.  My  experience  shows  that 
simple  water  is  best  for  bromide  solutions.  I 
never  employ  elixirs  or  syrups,  for  patients  soon 
tire  of  them,  and,  as  a  rule,  prefer  the  saltish  taste 
to  salt  mixed  with  sweet.  In  my  second  solution 
I  substitute  bromide  of  sodium  for  bromide  of 
potassium,  as  it  seems  to  suit  some  patients  better 
than  the  latter.  In  my  third  solution,  which  I  have 
used  during  the  past  two  years  only,  I  substitute 
chloral  of  bromide  of  ammonium  in  the  above,  and 
this  prescription  I  find  is  excellent  for  a  certain 
class  of  cases.  Allowing  seven  teaspoonfuls  to 
the  ounce,  it  is  seen  that  in  the  first  mixture  one 
teaspoonful  contains  ten  grains  of  bromide  of 
potassium  and  five  grains  of  bromide  of  ammo- 
nium ;  in  the  second,  ten  grains  of  bromide  of 
sodium  and  five  grains  of  bromide  of  ammonium  ; 
and  in  the  third,  ten  grains  of  bromide  of  potas- 
sium or  sodium  and  five  grains  of  chloral ;  that  is, 
in  every  instance,  one  teaspoonful  of  the  mixture 
contains  fifteen  grains  of  the  "anti-epileptic."  It 
is  generally  necessary  to  produce  mild  bromism ; 
but  severe  bromism  is  very  injurious.  It  is  always 
a  delicate  matter  to  steer  between  the  two  extremes 
of  too  little  and  too  much  bromide,  and  it  ordin- 
arily takes  me  from  one  to  three  months  to  fix 
upon  the  proper  dose  in  any  given  case.  Hence  I 
invariably  refuse  to  treat  out-of-town  patients  for 
epilepsy  unless  they  consent  to  remain  in  New  York 
for  at  least  a  month  after  the  treatment  is  com- 
menced. You  will  find  marked  difference  in  in- 
dividuals as  to  the  toleration  of  the  bromides.  Thus 
in  a  lady  thirty  grains  a  day  produced  a  most  pro- 
found effect ;  on  the  Oiher  hand,  I  have  known  a 
baby  a  few  months  old  take  seventy  grains  a  day 
and  e.xhibit  no  signs  of  bromism.  At  present 
there  is  a  gentleman  under  my  care  who  is  taking 


THE   CANADA   MEDICAL   RECORD. 


127 


I 


one  hundred  and  sixty  grains  of  bromides  in  the 
twenty-four  hours  without  the  slightest  inconve- 
nience. In  order  to  determine  the  effect  of  the 
bromides  we  must  observe  :  (i)  whether  the  intel- 
lectual faculties  show  a  tendency  to  become  sluggish 
and  dull,  and  (2)  whether  the  muscles  have  lost 
tone,  which  produces  a  change  in  the  physiognomy. 
A  delicate  test  of  bromism  is  that  discovered  by 
Voisin,  viz.,  the  irritation  of  the  fauces  and  soft 
palate  with  a  spatula  or  brush,  as  the  disappear- 
ance of  this  reflex  is  a  very  constant  sign  of 
bromism.  It  should  never  be  omitted.  Voisin 
claimed  that  when  this  point  was  reached  we  need 
go  no  farther ;  and  this  is  a  good  general  rule, 
though  it  lias  its  exceptions.  In  some  cases  the 
attacks  return  from  time  to  time,  notwithstanding 
this  evidence  of  bromism. 

The  eruption  of  acne  is  looked  upon  by  the 
patient  and  friends  as  a  very  important  sign  of 
bromism,  but  not  by  the  physician.  It  is  really 
due  to  some  peculiarity  of  the  individual  when  it 
occurs,  and  varies  very  greatly  in  severity  and  in 
location  in  different  patients.  The  shoulders,  neck, 
and  face  are  most  apt  to  be  affected.  In  some 
cases  the  acne  becomes  troublesome  long  before 
doses  sufficiently  large  to  control  the  epilepsy  are 
reached ;  but  the  gentleman  who  is  taking  one 
hundred  and  sixty  grains  of  bromides  a  day  scarcely 
suffers  at  all  from  it.  More  serious  effects  of 
bromism  are  those  such  as  paresis  and  impairment 
of  intellect  ;  but  it  is  never  necessary  to  push  the 
remedies  to  this  excess.  It  is  very  seldom  that 
morbid  bromism  is  produced  if  proper  caution  is 
observed. 

The  time  necessary  to  continue  the  drugs  is 
still  under  discussion.  Some  authorities  are  con- 
tent with  one  year.  I  hold  that  the  patient  should 
not  give  up  their  use  until  he  has  been  three  years 
without  any  epileptiform  manifestation,  however 
slight.  Brown-Sequard  and  Voisin  place  the  limij 
at  three  to  five  years.  I  have  seen  patients  who 
had  left  off"  the  medicine  at  the  end  of  two  years, 
and  then  had  a  return  of  the  trouble.  You  will 
often  be  importuned  by  the  patient  and  his  friends 
to  allow  him~  to  give  up,  but  you  must  be  firm  in 
insisting  upon  the  continuance  of  the  treatment. 
It  is  seldom,  however,  that  we  can  prevail  upon 
patients  to  keep  it  up  three  years  after  the  attacks 
have  entirely  ceased. 

The  time  in  the  day  for  the  administration  of 
the  bromides  is  an  important  factor  in  success  in 
treatment.  For  a  time  I  followed  Brown-Sequard 
in  his  practice  of  giving  the  greater  part  of  the 
necessary  quantity  at  bedtime,  because  in  the  im- 
mense majority  of  instances  the  attacks  occurred 
between  bedtime  and  8  or  9  a.m.  My  plan  is  now 
to  give  the  greatest  amount  just  before  the  time 
that  the  attacks  are  wont  to  occur.  In  the  case 
now  before  us  we  can  go  upon  Brown-Sequard's 
old  rule,  and  I  propose,  indeed,  to  order  only  one 
dose  of  the  bromide  mixture  in  the  twenty-four 
hours,  for  the  reason  that  the  patient  never  has 
any  fits  now  except  early  in  the  morning.  At  first  he 


should  take  two  teaspoonfuls  at  bedtime,  and  the 
dose  should  then  be  gradually  increased  until  a 
small  amount  of  bromism  is  produced.  It  is  best 
to  give  it  on  an  empty  stomach,  and  I  think  we 
are  much  less  likely  to  have  acne  produced  if  we 
use  alkaline  instead  of  simple  water  for  our  mix- 
ture. I  employ  Vichy  with  those  who  can  afford 
it,  and  a  solution  of  bicarbonate  of  sodium  among 
the  poor. 

In  conclusion  1  will  mention  the  manner  of  giv- 
ing the  bromides  in  different  cases,  it  being  under- 
stood that  the  patient  in  each  instance  is  an  adult : 

1.  When  the  attacks  occur  at  night  or  early  in 
the  morning  we  might  give  one  teaspoonful  of  the 
mixture  before  each  meal,  and  then  at  bedtime. 

2.  When  the  attacks  vary  as  to  time  we  might 
give  two  teaspoonfuls  in  the  morning,  one  before 
supper,  and  two  or  three  at  bedtime. 

3.  ^^'hen  the  attacks  are  more  liable  to  occur  in 
the  daytime  we  might  give  three  or  four  teaspoon- 
fuls in  the  morning,  one  before  supper,  and  two 
or  three  at  bedtime. 

4.  In  the  nocturnal  form  we  would  give  three  or 
four  teaspoonfuls,  at  one  dose,  either  at  bedtime 
or  early  in  the  evening.  The  gentleman  who  is 
using  one  hundred  and  sixty  grains  of  bromides  a 
day  takes  six  teaspoonfuls  in  the  morning  and  five 
at  night. 

AIDS  TO  DISEASES  OF  WOMEN. 

By  J.  J.  Reynolds,  M.R.C.S.  Eng. 

I.EUCORRHCEA, 

commonly  called  the  "  Whites/'  signifies  any 
whitish  discharge  from  the  vagina,  and  includes,  in 
fact,  all  the  non-hsemorrhagic  vaginal  discharges. 

There  are  four  varieties  : — 

I.  Uterine.  2.  Cervical.  3.  Vaginal.  4.  Vul- 
var. 

Uterine  Leucorrhoea  occurs  especially  in  mid- 
dle and  old  age,  and  consists  of  whitish  mucus  and 
epithelial  debris.  It  is  alkaline  in  reaction,  and  is 
often  attended  with  a  certain  degree  of  pain. 

Cervical  Leucorrhoea  occurs  more  especially 
during  the  childbearing  period,  and  consists  of 
transparent,  thick,  tenacious  mucus,  resembling 
unboiled  white  of  egg.  This  is  also  alkaline  in 
reaction.  Cervical  leucorrhoea  prevents  pregnancy. 

Vaginal  Leucorrhoea  is  met  with  more  common- 
ly in  young  women,  and  is  generally  light-coloured 
and  creamy,  and  consists  almost  entirely  of 
epithelium  and  oil-globules.  It  is  acid  in  reaction. 

Vulvar  Leucorrhoea  is  the  form  generally  met 
with  in  children. 

Causes. — They  are — (tz)  General  (^)  Local. 

The  general  causes  are  : — 

1.  Debility  of  the  system,  as  from  prolonged 
lactation,  acute  or  chronic  diseases  (phthisis), 
&c. 

2.  Haemorrhages,  as  menorrhagia  or  metrorrha- 
gia, producing  anaemia. 


128 


THt:   CANADA   MEDICAL   RECORt). 


3.  The  strumous  and  syphilitic  diathesis. 

4.  Anti-hygienic  conditions,  as  bad  air,  scanty 
diet,  unhealthy  occui)afions,  &c.,  producing  a 
general  state  of  ill-health. 

5.  Residence  in  hot  countries,  bringing  on  a 
feeble,  relaxed  state  of  health. 

The  local  causes  are: — 

1.  Inflammations  of  the  vagina  or  vulva. 

2.  Morbid  states  of  the  uterus,  as  congestion, 
acute  or  chronic  inflammation,  new  growths,  ii:c. 

3.  Morbid  conditions  of  the  cervical  c;inal. 

4.  Local  irritation,  as  from  a  pessary  or  exces- 
sive coitus,  and,  in  children  (especially  the  stru- 
mous and  ill-fed),  from  worms  and  want  of  cleanli- 
ness. 

5.  Urethral  haemorrhoids. 

6.  Masturbation. 

It  must  be  remembered  that  leucorrhoea  is  nor- 
mally present  at  certain  times.  It  precedes  and 
follows  menstruation,  and  it  is  often,  if  not  always, 
present  during  pregnancy. 

Treatme?ii. — i.   Improve  the  general  health. 

2.  Remove  any  local  condition  causing  the 
leucorrhoea. 

3.  Check  the  discharge  with  astringent  lotions  ; 
alum,  sulphate  of  zinc,  and  acetate  of  lead,  are 
good  astringents. 

The  treatment  of  the  general  health  must  de- 
pend upon  the  constitutional  condition  present. 
In  stnmia,  cod-liver  oil,  iron,  and  residence  at  the 
sea-side  will  be  very  beneficial. 

Diseases  of  the  Uterus. — Displacements  of 
THE  Uterus. 

Inversion  of  the  Uterus  exists  when  the  uterus 
is  turned  inside  out.  The  inversion  niay  occur  in 
various  degrees,  but  three  are  usually  described. 

1.  Depression  :  the  fundus  falls  inwards,  pro- 
ducing a  cup-shaped  depression. 

2.  Introversion  :  Depression  greater,  and  the 
inverted  portion  may  project  through  the  os  in  the 
form  of  a  round  ball,  not  unlike  the  body  of  the 
polypus. 

3.  Perversion  :  This  is  very  rare.  The  whole  of 
the  cervix,  as  well  as  the  body  of  the  uterus,  is 
completely  inverted.  Inversion  may  be  acute  or 
chronic. 

Causes — Acute  version  is  generally  the  result  of 
parturition,  being  caused  cither  by  traction  on  the 
cord  to  remove  the  placenta,  or  by  improperly 
applied  pressure  over  the  fundus  uteri.  It  some- 
times occurs  spontaneously.  Partial  and  irregular 
contraction  of  an  enlarged  uterus  is  generally 
thought  to  be  a  cause,  the  upper  part  of  the  uterus 
probab.'y  being  relaxed  and  the  lower  part  con- 
tracted. Apart  from  child-birth,  it  is  chiefly  caused 
by  a  fibroid  polypus,  or  a  submucous  fibroid  ;  but 
inversion  of  the  uterus  under  any  condition  is 
rare. 

Symptoms. — In  recent  inversion  they  are  gener- 
ally well  marked,  but  vary  much  with  the  degree 
of  inversion.  If  the  inversion  is  great  there  will  be 


severe  nervous  depression  and  generally  free  haemor- 
rhage. Occasionally  severe  abdominal  pain  and 
cramps  are  present.  On  vaginal  examination,  the 
uterus  will  be  felt  in  the  vagina,  or  may  even  be  seen 
outside  the  vulva.  In  slight  cases  there  may  be  no 
synii>toms.  and  in  cases  of  the  first  degree,  the  cup- 
shaped  depression  of  the  fundus  may  be  felt  through 
the  abdominal  walls.  In  chronic  cases  there  is  gener- 
ally haemorrhage  and  often  leucorrhcea  as  well, which 
is  caused  by  the  inverted  mucous  membrane  of  the 
uterus  getting  irritated  and  inflamed.  From  the 
pressure  of  the  displaced  uterus,  bladder  and  rectal 
irritation  are  often  set  up. 

Prognosis. —  It  is  very  grave.  Cross  states  that 
about  one-third  of  all  cases  are  fatal, either  very  soon 
or  within  a  month.  Death  may  be  due  to  slough- 
ing, or  gangrene  of  the  inverted  portion,  haemor- 
rhage, or  gradual  exhaustion.  The  shock  alone  is 
sometimes  so  great  as  to  quickly  cause  death. 

Diagnosis. — Inversion  has  to  be  distinguished 
from  a  polypus  or  fibroid  tumor,  and  prolapse  of 
the  uterus  and  vagina.  The  following  are  the 
chief  signs  of  distinguishing  inversion  from  a  poly- 
pus : — 

1.  I'he  history  of  the  case.  In  recent  inversion 
this  is  very  important.  The  sudden  shock,  and 
hfemorrhage  following  labor  point  to  the  nature 
of  the  disease. 

2.  By  manipulation  from  the  rectum,  and 
through  the  abdominal  wall,  the  fundus  uteri  will 
be  found  absent  from  its  normal  position  in  inver- 
sion, or  a  funnel-shaped  depression  may  be  felt. 
In  polypus  the  fundus  will  be  in  sitQ. 

3.  On  vaginal  examination  in  inversion,  a  round- 
ed tumor  will  be  felt,  soft  or  hard,  very  vascular, 
with  a  velvety  surface,  and  bleeding  on  slight 
manipulation.  It  will  be  painful  to  the  touch, 
and  its  size  will  vary  from  alternate  contraction 
and  dilatation.  A  polypus  is  not  sensitive  ;  it  does 
not  change  its  size,  and  is  not  so  vascular. 

The  diagnosis  from  prolapse  of  the  uterus  and 
vagina  can  easily  be  made  by  means  of  the  sound. 
Its  admittance  for  a  distance  of  twoanda  half 
inches  or  more  at  once  proves  the  existence  of 
prolapsus. 

Treat jneni. — An  inverted  uterus  may  cure  itself 
in  one  of  three  ways  : — 

1.  Spontanous  re-inversion  may  take  place. 

2.  The  uterus  may  separat.e  by  gangrene,  and  a 
cure  take  place. 

3.  Cases  are  related  where  the  uterus  has  been 
torn  away  and  recovery  followed. 

In  recent  cases  the  taxis  is  generally  successful, 
the  part  last  inverted  being  returned  first. 

In  chronic  inversion,  taxis  is  dangerous, — then 
gradual,  continuous,  and  long-sustained  pressure  on 
the  tumour  is  required,  either  by  means  of  an  air 
pessary,  or  an  elastic  pressure.  If  these  means 
fail,  a  repositor  svill  be  necessary,  and,  as  a  last 
resort,  amputation  of  the  inverted  uterus  may  be 
required,  but  it  must  be  remembered  that,  at  times, 
jDversions  exist  for  years  without  injury  to  health. 


THE   CANADA   MEDICAL    RECORD. 


129 


OVARIAN  DYSPEPSIA. 

J.  Milner  Fothergill,  M.D.,  (American  Journal 
of  Obstetrics)  describes  "  a  form  of  dyspepsia  in- 
duced and  kept  up  by  irritation  arising  from  the 
ovary."  The  irritation,  of  course,  must  be  reflex. 
The  condition  of  the  ovary  affects  the  stomach 
very  much,  as  the  impregnated  uterus  may  be  said 
to  do.  It  was  noticed  that  patients  Avho  pre- 
sented themselves  at  the  City  of  London  Hospital 
for  diseases  of  the  chest,  with  the  usual  symptoms 
of  phthisis,  had  a  good  family  history.  The 
patient  also  frequently  had  a  good  physique. 
Closer  investigation  showed  that  the  two  marked 
features  in  these  cases  were  dyspepsia,  with  leucorr- 
hoea  and  menorrhagia.  These  conditions  unite  a 
defective  nutrition  with  excessive  waste,  and  pro- 
duce a  condition  exceedingly  favorable  to  the 
of  tubercle. 

The  condition  of  the  ovary  was  found  to  be  the 
prime  cause  of  this  mischief — a  state  of  vascular 
excitement  in  one  or  both  ovaries,  usually  the  left. 

This  condition  Barnes  calls  "  cophoria." 
Patients  suffer  more  or  less  pain  in  the  iliac  fossa 
much  aggravated  during  the  menstrual  periods,  at 
which  time  there  is  a  more  or  less  severe  genito- 
crural  neuralgia.  Pressure  over  the  affected  ovary 
induces  acute  pain  during  the  excitement  of  the 
menstrual  flow,  and,  at  other  times,  in  a  less  degree, 
while  the  patient  "  feels  queer,"  as  if  about  to  faint. 
We  have,  in  this  condition,  an  important  though 
small  organ  morbidly  excited,  and  capable  of 
giving  off  from  its  nerve  centres  waves  of  nerve 
perturbation,  which  will  be  felt  in  distant  organs. 
These  waves  may  break  at  different  points.  In  one 
case  the  stomach  may  be  affected,  in  another  inter- 
costal neuralgia  may  be  the  prominent  symptom. 
Uterine  disturbance  is  excited — there  is  frequently 
menorrhagia  present,  and  always  leucorrhoea. 
Sometimes  there  is  diminished  menstrual  flow,  but 
then  there  will  be  more  profuse  leucorrhoea.  A 
distressing  orgasm,  recurring  oftenest  during  sleep, 
makes  the  patient  still  more  uncomfortable.  This 
recurrent  orgasm  affects  the  bladder  through  the 
nerve  centres  of  that  organ,  and  adds  incontinence 
of  urine  to  the  already  too  complicated  affection 
in  a  certain  proportion  of  the  cases.  Then,  also, 
the  ovary,  or  ovaries  as  the  case  may  be,  keep  the 
uterus  in  a  constant  state  of  erection,  and  high 
vascularity,  so  that  it  is  not  strange  that  such 
patients  suffer  from  leucorrhoea  and  menorrhagia  ; 
V  or,  if  instead  of  menorrhagia,  there  is  an  increased 
leucorrhoea,  then  the  starved,  overtaxed  organism 
may  prove  unequal  to  the  periodic  hemorrhage. 

As  for  the  stomach,  which  also  contains  sympa- 
thetic nerve  fibers,  isolated  nerve  ganglia,  and  some 
fibers  of  the  pneumogastric,  the  case  is  different. 
As  has  been  fully  proved  by  M.  Bernard,  as  well 
as  by  later  experimenters,  the  effects  of  a  stimulus 
applied  to  the  sympathetic  nerves  of  the  stomach, 
is  to  cause  a  diminution,  or  even  complete  arrest, 
of  secretion.  As  is  well  known,  the  action  of  the 
sympathetic  nerve   filarnents   is   to   contract   the 


arteries  and  arterioles,  while  the  pneumo-gastric 
filaments  dilate  them.  Hence,  it  is  easy  to  under- 
stand the  effect  of  a  nerve  current  from  the  ovary, 
which,  traversing  the  sympathetic  nerve  fibrils, 
arrests  the  flow  of  gastric  juice,  more  or  less 
thoroughly,  and  dyspepsia  is  the  consequence. 

The  etiology  of  these  cases  is  involved  in  doubt. 
Inquiries  seem  to  elicit  the  facts  that  a  miscarriage, 
in  a  few  cases  marriage  ;  in  others  who  were  mid- 
dle-aged women,  nearing  the  end  of  their  repro- 
ductive life —  a  confinement,  were  the  beginnings 
of  the  trouble.  A  few  were  made  thus  miserable 
by  the  excessive  excitement  due  to  the  changes  at 
puberty,  and  quite  a  number  of  the  patients  attri- 
buted their  trouble  to  the  excitement  set  up  by  the 
working  of  the  treadle  sewing  machines. 

The  treatment  for  this  class  of  evils  is,  first,  to 
unload  the  bowels  with  a  saline,  such  as  sulphate  of 
magnesia ;  bromide  of  potassium  to  control  the 
conductivity  in  the  nerves,  and  a  blister  over  the 
region  of  the  ovary.  If  the  stomach  is  too  intol- 
erant of  food  and  medicines  they  may  be  given 
per  enema.  Also,  astringent  vaginal  injections, 
hip  baths,  etc.,  are  important. 

The  menorrhagia  is  treated  during  the  flow  by 
quietude,  cooling  drinks  and  unstimulating  food. 
The  irritable  stomach  should  be  supplied  "with 
small  quantities  of  food  at  regular  short  intervals. 

To  treat  the  stomach  as  the  offending  organ 
does  no  good  in  these  cases,  therefore  the  author 
begins  the  treatment ,  of  dyspepsia  by  ehminating 
the  ovarian  factor  in  all  females  before  treating  the 
stomach. 


TREATMENT  OF  STERILITY. 

At  the  meeting  of  the  St.  Louis  Medical  So- 
ciety, held  March  13th,  a  very  interesting  paper, 
illustrated  by  drawings,  upon  the  treatment  of 
sterility  dependent  upon  endocervicitis  and  en- 
dometritis was  read  by  Dr.  A.  C  Bernays.  The 
treatment  which  is  advocated  he  attributed  to  Dr. 
G.  Simon.  The  reader  held  that  sterility,  and  the 
dysmenorrhoea  depending  upon  it,  belonged  as 
much  to  the  domain  of  surgery  as  stricture  of  the 
urethra  or  fissure  of  the  anus  ;  that  the  swollen 
condition  of  the  mucous  membrane  of  the  cervix 
caused  a  stricture  of  the  neck,  and  this  stricture 
was  the  cause  of  dysmenorrhoea  and  sterility. 

The  operation  by  which  he  proposed  to  cure 
this  stricture  is  as  follows  :  The  patient  is  placed 
in  the  lithotomy  position  ;  the  neck  is  split  by  in- 
cisions similar  to  those  made  in  Sims'  bilateral 
incisions.  Now,  it  has  been  found  that  this  pro- 
cedure temporarily  cures  the  leucorrhoea,  but  that 
the  cut  surfaces  reunite,  and  the  condition  of  the 
patient  becomes  worse  than  it  was  before.  In 
order  to  prevent  this,  another  step  is  necessary, 
namely,  a  wedge-shaped  piece  is  cut  from  the 
anterior  and  posterior  vaginal  surfaces  of  the  neck, 
the  cuts  running  at  right  angles  to  the  long  axis 
of  the   uterus,  and  the  base  of  the  wedge  being 


130 


THE    CANADA    MEDICAL    RECORD. 


external :  the  surfaces  of  these  wedge  like  cuts  are 
brought  together  by  sutures,  thus  prying  open  the 
split  cervix  and  exposing  to  view  the  internal  os. 

Dr.  Bemays  has  performed  the  operation  seven- 
teen times.  Up  to  December,  1879,  he  had  treat- 
ed fourteen  cases  in  this  way,  and  in  regard  to 
these  was  ready  to  give  results  :  Five  of  the  patients 
became  pregnant,  and  three  of  them  had  been 
delivered.  Of  these  five,  two  had  been  barren 
between  six  and  seven  years,  one  five  years,  and  the 
other  two  between  three  and  four  years.  The  nine 
others,  though  they  remain  barren,  have  been 
relieved  of  their  leucorrhcea. — Boston  Medical  and 
Surgica/ /out  rial,  .\])ril  1. 


SULPHIDE  OF  CALCIUM  IN  THE  TREAT- 
MENT OF   SUPPURATING  BUBOES. 

My  attention  was  first  called  to  the  value  of  the 
sulphide  of  calcium  in  arresting  processes  of  sup- 
puration through  an  article  in  The  Lancet  of 
February  21,  1874,  by  Sydney  Ringer,  M.D.  Dr. 
Ringer  claimed  that,  when  the  product  of  suppura- 
tion in  scrofulous  sores  was  thin  and  ichorous,  the 
administration  of  small  doses  of  the  sulphide  of 
potassium  or  of  calcium  promptly  changed  the 
purulent  fluid  to  one  of  a  more  healthy  character, 
and  that  the  healing  of  the  sore  was  promoted. 
He  also  claimed  that  the  formation  of  boils  and 
abscesses  was  prevented  by  a  timely  administration 
of  small  doses  of  the  sulphides,  and  that,  when  sup- 
puration had  already  occurred  in  such  cases,  the 
suppurative  process  was  quickly  arrested  through 
the  influence  of  these  remedies.  Opportunity  for 
a  practical  test  of  these  claims  soon  occurred,  and 
resulted  in  my  own  personal  conviction  of  their 
entire  correctness,  and  I  have  now  for  the  last  five 
years  habitually  prescribed  the  sulphide  of  calcium 
in  cases  of  threatened  suppuration  in  phlegmonous 
swelling  from  various  causes,  and,  as  a  rule,  with 
very  gratifying  results.  The  manner  of  its  use  was 
practically  the  same  as  advised  by  Dr.  Ringer,  viz  : 
I -1 2  grain  of  the  sulphide  of  calcium  every  two 
hours,  or  1-20  every  hour,  during  the  day  and  up 
to  the  time  of  retiring.  Especially  have  I  found 
small  doses  of  the  sulphide  of  calcium  useful  in 
arresting  the  progress  of  furuncular  swellings  and 
abscesses,  and  in  preventing  their  occurrence  when 
threatening.  On  the  other  hand,  I  have  repeatedly 
tested  the  influence  of  this  drug  upon  the  suppura- 
tive processes  in  mucous  membranes,  as  in  gonorr- 
hoea, gleet,  leucorrhoea,  etc.,  without  being  able  to 
discover  that  it  influenced  or  modified  the  suj^pura- 
tive  process  in  such  cases  in  the  least  degree. 

Among  the  cases  in  my  private  practice  where 
promj)t  arrest  of  suppuration  was  quickly  followed 
by  absorption  of  pus  already  formed  and  resolution 
of  tumor,  and  apparently  from  the  use  of  the  sul- 
phide of  calcium,  were  several  inguinal  buboes 
associated  with  chancroid.  The  simple  fact  that 
resolution  occurred  in  these  cases  was  (in  accord 


ance  with  the  popular  teaching)  accepted  as  procf 
that  the  buboes  were  of  sympathetic  and  not  of 
chancroidal  origin. 

Authorities  have  long  taught  that,  once  the  virus 
from  a  chancroid  has  been  carried  along  a  lympha- 
tic vessel  and  deposited  in  the  adjacent  lymphatic 
gland,  inflammation  is  at  once  set  up  in  the  sub- 
stance of  the  gland.  This,  it  is  claimed,  goes 
steadily  on  in  spite  of  all  and  any  treatment  until 
an  abscess  is  formed.  This  must,  sooner  or  later, 
through  advance  of  the  suppurative  agency  or  by 
surgical  interference,  result  in  an  open  ulcer,  the 
pus  of  which  will  possess  the  same  vicious  character 
as  the  chancroid  from  which  it  was  derived.  This 
variety  of  bubo  is  known  as  the  virulent  or  chan- 
croidal bubo.  The  suppuration  of  such  buboes 
has  been  considered  inei'itahle,  and  all  buboes  not 
pursuing  this  course  have  been  set  down  as  not  of 
true  chancroidal  but  of  simple  or  sympathetic 
origin.  Inflammatory  lymphatic  enlargements 
associated  with  chancroid  are  very  naturally  dreaded 
as  most  likely  to  prove  by  results  to  be  of  chan- 
croidal origin,  and  usually,  after  a  few  feeble 
attempts  at  treatment  with  a  view  to  their  resolution, 
glands  affected  are  encouraged  to  suppurate,  and 
prompt  incision  and  evacuation  of  pus  are  advised 
as  soon  as  the  slightest  true  fluctuation  is  recog- 
nized. If  suppuration  is  indeed  inevitable,  un- 
doubtedly it  is  wise  to  encourage  it,  to  evacuate 
the  virulent  product  at  the  earliest  moment,  and 
thus  afford  access  for  efficient  treatment  for  the 
destruction  of  this  new-formed  chancroid.  For 
this  reason  I  had  been  an  earnest  advocate  for 
early  incision  into  suppurating  buboes  associated 
with  chancroid.  My  experience  in  the  few  cases 
above  alluded  to,  however,  made  me  inchne  to  the 
belief  that  a  thorough  and  extended  trial  of  the 
calcium  sulphide  in  cases  of  inflammatory  buboes 
associated  with  chancroid  might  give  such  results  as 
to  make  its  use  imperative  in  every  such  case. 

In  order  to  gain  further  light  on  this  important 
matter  a  systematic  use  of  the  calcium  sulphide  was 
made,  in  my  service  at  Charity  Hospital,  in  eighteen 
consecutive  cases  of  inflammatory  bubo  occurring 
with,  or  as  the  immediate  sequel  of,  well-pro- 
nounced chancroid.  All  the  facts  considered  of 
importance  were  noted  by  myself  and  under  my 
direction  by  Dr.  Johnston,  my  House  Surgeon,  and 
are  truly  confirmatory. 

Thus  it  will  be  seen  that,  out  of  eighteen  cases  of 
inflammatory  bubo  presenting  the  rational  evidences 
of  chancroidal  origin,  and  treated  systematically  by 
the  use  of  small  doses  of  the  sulphide  of  calcium, 
resolution  occurred  in  fifteen,  and  that  in  only 
three  cases  was  incision  ultimately  required. 

If  we  apply  to  these  cases  the  usual  rule  that 
chancroidal  buboes  always  eventuate  in  chancroidal 
abscesses,  always  suppurate  and  require  evacuation 
by  natural  means  or  surgical  procedure,  then  we 
must  hold  that  only  three  out  of  fifteen  cases  of 
inflammatory  buboes  associated  with  chancroid 
were  the  result  of  transference  of  the  suppurative 
process  from  the  chancroid   to  the  adjacent  lyii^ 


THE    CANADA    MEDICAL   RECORD. 


131 


phatic  gland.  It  is  just  possible,  however,  that  the 
influence  of  the  sulphide  of  calcium  may,  in  arrest- 
ing suppuration,  extend  to  the  true  chancroidal 
bubo.  The  apparent  successful  use  of  this  drug 
in  the  series  of  cases  herewith  presented  at  least 
suggests  and  invites  a  trial  of  its  efficacy  in  all 
instances  of  threatened  glandular  suppuration, 
whether  associated  with  chancroid  or  of  puryle 
Sympathetic  origin. — Fcssendcn  N.  Otis,  M.D.,  in 
New  York  Medical  Record. 


MANAGEMENT  OF  DEEP  ABSCESSES. 

J.  T.  Kent,  M.D.,  in  discussing  the  management 
of  deep-seated  chronic  abscesses,  says  :  Perfect 
evacuation  and  coaptation  of  the  walls  of  the  ab- 
scess cavity  seem  to  be  the  points  to  be  constantly 
held  in  view.  *  *  *  The  surgeon  is  too  apt  to 
open  the  cavity  in  its  most  accessible  locality,  when 
the  floor  is  the  only  possible  place  to  secure  perfect 
drainage.  The  floor  of  an  abscess  will  be  also 
changed  as  the  patient  changes  his  attitude  from 
the  walking  to  the  recumbent  position  ;  therefore 
an  abscess  upon  a  patient  walking  about  should 
be  sometimes  opened  in  a  different  locality  from 
one  in  bed.  *  *  By  perfect  evacuation  we  obtain 
perfect  coaptation,  which  is  imperative ;  rest  is 
therefore  the  only  means  of  cure,  as  it  permits 
nature  to  do  her  work  in  her  own  good  way. 

Superficial  abscesses  are  of  little  importance 
compared  with  the  deep-seated  cavities  involving 
important  structures ;  therefore,  not  so  much 
knowledge  and  judgment  are  required  in  the 
management  of  them.  Another  important  feature 
of  deep  abscess  is  the  change  that  occurs  in  the 
anatomical  relations  of  the  part.  No  anatomist 
will  pretend  to  be  able  to  give  the  relations  of 
arteries,  veins,  muscles  and  nerves  in  deep-seated 
abscess  of  any  proportions,  *  *  but  might  say,  as 
I  was  once  known  to  say,  "  plunge  in  the  knife.  " 
This  is  not  my  practice  now.  To  make  an  opening 
in  a  deep-seated  abscess  at  its  most  depending  part 
is  at  times  a  most  difficult  undertaking,  hence  it 
becomes  necessary  to  perform  tie  operation  with 
as  little  risk  as  possible.  *  *  I  am  in  the  habit, 
according  to  Hilton's  method,  of  making  an  incision 
with  my  scalpel  through  the  skin  at  the  most 
depending  point,  then,  with  my  groove-director,  I 
force  an  opening  to  the  supposed  cavity.  If  I  have 
entered  an  abscess  a  small  drop  of  pus  will  appear 
in  the  groove  of  my  director,  then  with  my  dressing 
forceps  I  follow  the  groove  in  the  director  to  the 
cavity,  and,  by  separating  my  fingers,  I  force  an 
opening  which  may  be  enlarged  at  will,  and  with 
perfect  safety. 

These  hints  are  not  given  to  frighten  the  timid 
from  making  their  usual  free  incision  in  superficial 
and  ordinary  abscesses,  but  to  encourage  precaution 
in  the  very  rarely  met  with  deep-seated  formations 
of  pus  in  dangerous  localities,  as  sub-muscular 
abscess  of  the  thigh,  submammary,  gluteal,  cervical 
^ncj  post-pharyngeal  abscesses.    Injections  in  large 


abscess  cavities  are,  as  a  rule,  of  little  use,  and 
often  dangerous.  Perfect  rest  must  be  procured. 
If  it  cannot  be  obtainedby  the  recumbent  position, 
it  must  be  had  by  strapping,  bandaging  or  com- 
pressing. The  means  will  readily  suggest  them- 
selves to  the  competent  anatomist  of  procuring  rest 
and  coaptation,  which  is  the  all-important  issue  to 
be  uppermost  in  the  mind  of  the  surgeon  after  the 
evacuation  has  been  completed. 

Any  treatment  directed  to  a  permanent  cure 
must  be  conducted  in  accordance  with  the  history 
and  etiology  of  each  respective  case.  Internal 
remedies  are  often  demanded,  so-called  alteratives 
and  tonics  are  commonly  resorted  to  by  nearly  all 
surgeons.  Then,  with  a  thorough  knowledge  of 
the  most  potent  of  all  remedies,  rest  will  crown  the 
surgeon's  labor  with  a  fair  degree  of  success  and 
satisfaction. 


ON  GLYCERIN  IN  FLATULENCE,  ACIDITY 
AND  PYROSIS. 

Sydney  Ringkr,  M.D,,  and  William  Murrel,  in  the 

Lancet. 

An  old  gentleman,  who  for  many  years  suffered 
from  distressing  acidity,  read  in  a  daily  paper 
that  glycerin  added  to  milk  prevents  its  souring, 
and  he  reasoned  thus  :  "  If  glycerin  prevents  milk 
turning  sour,  why  should  it  not  prevent  me  turning 
sour  ?  "  and  he  resolved  to  try  the  efficacy  of 
glycerin  for  his  acidity.  The  success  of  his  experi- 
ment was  complete,  and  whenever  tormented  by 
his  old  malady  he  cures  himself  by  a  recourse  to 
glycerin.  Indeed  he  can  now  take  articles  of  food 
from  which  he  was  previously  compelled  to  abstain, 
provided  always  that  he  takes  a  dram  of  glycerin 
immediately  before,  with  or  directly  after  his  food. 

He  recommended  this  treatment  to  many  of  his 
friends  (sufferers  like  himself),  and  one  of  these 
mentioned  the  above  circumstances  to  us. 

We  have  since  largely  employed  glycerin,  and 
find  it  not  only  very  useful  in  acidity,  but  also  in 
flatulence  and  pyrosis,  and  that  it  sometimes  reheves 
pain,  ^^'e  meet  with  cases  where  flatulence,  or 
acidity,  or  pyrosis  is  the  only  symptom,  but  more 
frequently  these  symptoms  are  combined.  Some 
patients  rift  up  huge  quantities  of  wind  without  any 
other  symptoms  than  depression  of  spirits  ;  in 
others  we  get  flatulence  and  acidity,  one  or  other 
predominating  ;  and  we  meet  with  others  who  suf- 
fer from  acidity,  flatulence,  and  also  pyrosis.  In 
all  these  various  forms  we  find  glycerin  useful,  and 
in  the  great  majority  of  cases  very  useful.  We  do 
not  mean  to  say  that  in  all  cases  it  is  superior  to 
other  remedies  for  these  complaints  ;  indeed  in 
several  instances  it  has  only  partially  succeeded, 
where  other  remedies  at  once  cured.  On  the  other 
hand,  in  some  cases  glycerin  speedily  and  com 
pletely  succeeded,  where  the  commonly-used  reme 
dies  for  acidity  and  flatulence  completely  failed 
We  do  not  pretend  to  estimate  its  relative  vali| 


132 


THE    CANADA    MEDICAL    RECORD. 


to  other  remedies  ;  we  are  only  anxious   to  draw 
attention  to  its  virtues. 

Gas  is  in  some  instances  formed  in  the  stomach, 
in  others  in  the  large  intestine,  in  some  patients  in 
both.  Our  observations  were  made  on  stomach 
flatulence,  and  as  glycerin  is  so  readily  absorbed 
we  should  hardly  e.xpect  that  it  would  influence  the 
formation  of  wind  in  the  colon,  except  given  in 
large  doses,  and  when  it  acts  as  a  slight  laxative, 
and  so  expels  the  putrefying  mass  which  forms  the 
wind. 

In  some  cases  it  removes  pain  and  vomiting, 
probably  like  charcoal,  by  preventing  the  formation 
of  acrid  acids,  which  irritate  delicate  and  irritable 
stomachs. 

We  suggest  that  it  acts  by  retarding  or  j)revent- 
ing  some  forms  of  fermentation  and  of  putrefaction. 
J.  Mekulics  (Archiv.  /.  Klin.  Chir.)  shows  that 
glycerin  prevents  putrefaction  of  nitrogenous  sub- 
stances, as  of  blood  diluted  with  water,  wliich  speed- 
ily decomposes  at  the  ordinary  temperature  of  the 
air.  Two  per  cent,  of  glycerin  retarded  decompo- 
sition for  twenty-four  hours  ;  ten  per  cent,  for  five 
days.  If  the  fluid  were  placed  in  the  hatching-oven, 
then  two  per  cent,  retarded  decomposition  for 
several  hours,  ten  per  cent,  for  forty-eight  hours, 
and  twenty  per  cent,  altogether  prevented  putre- 
faction. He  also  proves  that  glycerin  destroys 
bacteria  and  prevents  the  formation  of  septic  poison, 
though  it  will  dissolve  and  preserve  the  septic 
poison  itself. 


TREATMENT  OF  ACUTE  RHEUMATISM. 

Dr.  Alfred  Stille,  Medical  Record,  in  referringtto 
blisters  and  alkalies,  in  the  treatment  of  acute 
articular  rheumatism,  remarks  as  follows  :  It  may 
be  difficult  to  see  the  connection  between  these 
two  classes  of  remedies  in  their  power  to  influence 
the  course  of  acute  articular  rheumatism,  and  yet 
it  is  certain  that  they  do  so  influence  it,  and  in  the 
same  way,  /.  <?.,  by  altering  the  condition  of  the 
blood  from  acid  to  akaline.  If  you  ask  me  to 
explain  to  you  how  blisters  act  in  this  way,  I  am 
obliged  to  confess  my  ignorance.  To  produce 
this  effect,  they  must  be  applied  over  all  the  affected 
joints.  Experience,  if  not  science,  has  decided 
conclusively  in  their  favor.  They  do  produce  a 
cessation  of  local  symptoms,  render  the  urine 
alkaline  and  diminish  the  fibrin  in  the  blood. 

This  brings  us  to  a  consideration  of  the  use  of 
alkalies.  Alkalies  neutralize  the  acids,  act  as 
diuretics,  and  eliminate  the  materies  tnorbi.  Alone, 
and  in  small  doses,  they  are  unable  to  cure ;  but 
when  given  in  very  large  doses,  their  effects  are 
marvelous  ;  the  pulse  falls,  the  urine  is  increased 
in  quantity  and  becomes  alkaline,  and  the 
inflammation  subsides.  The  symptoms  of  the 
disease  are  moderated,  the  duration  of  the  attack 
is  shortened,  and  the  cardiac  complications  are 
prevented. 
Jhe  dose  of  the  alkalies  must  be  increased  until 


the  acid  secretions  are  neutralized.     A  very  good 
combination  of  these  remedies  is  the  following: 

\\  Sodae  bicarb 3   iss 

Potas.  acetatis 3  ss 

Acid,  cit 3  s  s 

Aqiue :  f-  3  ij 

S. —  This  dose  should  be  repeated  every  three  or 
four  hours  until  the  urine  becomes  alkaline.  On 
the  subsidence  of  the  active  symptoms,  two  grains 
of  quinia  may  be  added,  with  advantage,  to  each 
dose.  The  alkalies  must  be  gradually  discontinued, 
but  the  quinia  continued. 

The  diet  should  consist  of  beef-tea  or  broth,  with 
bread  and  milk  ;  no  solid  food  should  be  allowed. 
Woolen  cloths,  moistened  with  alkaline  solutions, 
may  with  advantage  be  api)lied  to  the  affected 
joints.  To  these  laudanum  may  be  added  for  its 
anodyne  effect. 

The  patient  must  be  sedulously  protected  from 
vicissitudes  of  temjierature.  and  lie  in  bed  between 
blankets.  The  alkaline  treatment  relieves  the  pain, 
abates  the  fever,  and  saves  the  heart  by  lessening 
the  amount  of  fibrin  in  the  blood. 

A  long  time  ago  Dr.  Owen  Rees,  of  London, 
introduced  the  use  of  lemon-juice.  This  remedy 
was  thought  to  convert  uric  acid  into  urea,  and  so 
to  help  elimination.  Though  the  treatment  is 
practically  right,  the  theory  of  it  is  wrong.  Lemon- 
juice  does  good  in  mild  cases,  but  cannot  be 
relied  upon  in  severe  attacks. 

During  the  febrile  stage  of  acute  articular  rheu- 
matism the  diet  should  consist  mainly  of  farinaceous 
and  mucilaginous  preparations,  with  lemonade  and 
carbonic  acid  water  as  a  drink.  The  cloths  applied 
to  the  joints  should  be  changed  when  they  become 
saturated  with  sweat,  and  in  changing  them  the 
patient  should  be  protected  from  the  air. 

The  sweating  may  be  controlled  by  small  doses 
of  atropia,  from  one-sixtieth  to  one-thirteenth  of 
a  grain.  To  prevent  subsequent  stiffness,  the  joints 
should  be  bathed  with  warm  oil  and  chloroform, 
and  wrapped  in  flannel  cloths.  In  the  proper 
season  this  condition  is  very  well  treated  by  sea- 
bathing. There  is  no  specific  plan  of  treatment  in 
acute  articular  rheumatism.  The  treatment  must 
vary  according  to  the  intensity  of  the  inflammation, 
and  the  peculiarities  of  the  patient. 


TREATMENT   IN  CASES    OF   EXCESSIVE 
LOCHIAL  DISCHARGES. 

Dr.  Hugh  Miller,  in  a  clinical  lecture  delivered  at 
Glasgow,  recommends  the  following  prescription  in 
cases  in  which  there  is  an  excessive  discharge, 
accompanied  by  a  relaxed  condition  of  the  uterus. 
He  administers  one  drachm  doses  of  liquid  extract 
of  ergot  repeated  every  three  or  four  hours,  and 

5   QuiniK  sulph., 3  ss 

Acidi  hydrobrom, 3  vj 

Aquam  ad.,     .     • 5  ij 

Dose,  one  drachm  in  aq.  ter.  in  die. 


THE    CANADA    MEDICAL   RECORD. 


133 


By  this  method  large  doses  of  quinia  may  be 
given  without  causing  headache.  In  septic  cases 
Dr.  Miller  advises  the  employment  of  sulpho- 
carbolate  of  potash,  in  the  form  of  powders,  in  doses 
of  ten  to  fifteen  grains  internally  three  times  a  day. 

When  the  discharge  is  suspended,  the  treatment 
consists  of  turpentine  stupes  applied  over  the  lower 
part  of  the  abdomen,  with  the  addition  of  warm 
moist  cloths,  or  of  sponges,  pressed  out  of  hot 
water,  and  applied  to  the  external  parts.  In 
special  cases,  which  require  an  antiseptic  plan  of 
treatment,  Dr.  Miller  makes  use  of  a  solution  of 
thymol,  one  part  to  five  hundred  parts  of  water, 
or,  better,  three  grains  of  thymol  to  an  ounce  of  eau 
de  Cologne.  This  mixture,  which  has  a  pleasant 
and  rather  refreshing  odor,  is  simply  sprinkled 
over  the  napkins  before  they  are  used.  In  severe 
cases,  with  a  putrid  odor,  a  solution  of  permanganate 
of  potash,  injected  with  Higginson's  syringe, 
provided  with  a  vaginal  portion,  is  made  use  of; 
the  injection  of  the  fluid  is  continued  till  it  returns 
unaltered  in  color.  In  all  cases  where  the  discharge 
is  excessive,  tincture  of  arnica  is  employed  ;  the 
tinture  is  used  in  the  proportion  of  one  teaspoonful 
to  a  cupful  of  water  ;  it  acts  as  a  mild  astringent 
and  disinfectant. —  Practitioner. 


TREATMENT  OF  CHOREA. 

Dr.  Thomas  B.  Peacock,  in  the  recently  issued 
volume  of  St.  Thomas's  Hospital  Reports,  in  the 
concluding  portion  of  a  report  on  cases  of  chorea, 
thus  speaks  of  the  treatment  of  the  disease  : 

In  a  large  proportion  of  cases  of  chorea  there  is 
evidence  of  disorder  of  the  general  health  and  of 
the  digestive  organs,  the  tongue  being  furred  and 
the  bowels  confined.  When  this  was  the  case  a 
purgative  was  usually  first  prescribed,  such  as  a 
calomel  and  rhubarb  powder,  or  some  blue  pill 
and  rhubarb,  and  this  was  combined  with  the 
stomachic  mixture  (a  cold  infusion  of  rhubarb  and 
gentian  with  soda  and  ginger)and  this  treatment  was 
continued  till  the  symptoms  of  disorder  of  the  diges- 
tive organs  subsided.  In  some  cases  under  this 
treatment, the  choreic  movements  almost  wholly  dis- 
appeared. In  others  they  were  greatly  relieved,  and 
the  patient  was  then  put  upon  a  tonic  course  of 
treatment,  quinia  and  iron  with  cod-liver  oil  and  a 
nutritious  diet,  and  an  allowance  of  wine.  In 
others,  when  the  tongue  became  clean,  but  the 
choreic  movements  still  continued,  nervine  tonics 
were  used  ;  if  the  patient  was  pallid  and  anemic 
the  chalybeate  remedies  were  generally  first  em- 
ployed, preference  being  given  to  the  saccharine 
carbonate  of  iron,  in  doses  of  five,  ten,  or  twenty 
grains,  three  times  daily.  In  other  cases  citrate 
or  sulphate  of  iron  was  given.  If,  after' a  fair 
trial  of  this,  there  was  Httle  or  no  obvious  improve- 
ment in  the  state  of  the  patient,  sulphate  of  zinc 
was  prescribed,  in  doses  of  one  or  two  grains, 
three  times  daily,  and  the  dose  was  increased  by 
one  or  two  grains  twice  a  week,  till  sickness  or  nau- 


sea was  produced,  or  till  the  symptoms  subsided.* 
Not  unfrequently  the  zinc  was  first  given,  and 
either  remedy  was  replaced  by  the  other,  or  by 
the  liq.  arsenicalis,  if  no  satisfactory  improvement 
was  seen  at  the  end  of  a  week  or  fortnight.  The 
amendment  is  often  very  gradual,  and  seems  rather 
to  accord  with  the  improvement  in  the  general 
health  of  the  patient  than  to  follow  quickly  after 
the  use  of  the  remedy.  A  very  good  test  of  the 
advantage  of  the  treatment  is  afforded  by  the  state 
of  the  pupil ;  generally,  when  the  symptoms  are 
very  active,  it  is  large,  and  shows  little  or  no  action 
under  the  stimulus  of  light,  but,  as  the  symptoms 
subside,  it  diminishes  in  size,  and  is  much  more 
readily  affected  by  light. 

The  movements  are  occasionally  so  constant 
and  severe  that  the  patient  gets  little  or  no  rest  at 
night,  and  so  becomes  rapidly  exhausted,  and  the 
back  is  apt  to  chafe  and  bed-sores  to  form,  and 
indeed  it  is  in  this  way  that  the  cases  generally 
prove  fatal.  It  becomes,  therefore,  of  great  im- 
portance that  the  patient  should  be  quieted,  and 
anodynes  are  required  for  this  purpose.  I  have 
generally  preferred  to  give  Dover's  powder,  fre- 
quently in  combination  with  henbane,  either  at  night 
or  at  intervals  during  the  day.  Sometimes  morphia 
has  been  used  in  a  similar  way,  and  occasionally 
it  has  been  employed  hypodermically  ;  and  more 
recently  chloral  has  not  unfrequently  been  given 
at  night. 

The  use  of  the  shower  bath,  either  cold  or  tepid  ; 
or,  when  the  patient  is  timid,  of  ablution  with 
tepid  or  cold  water,  is  often  of  use  in  effecting  a 
complete  cure  after  the  active  symptoms  have  sub- 
sided ;  and  when  the  patient  becomes  prostrated 
nutritious  food  and  wine  must  be  given  ;  and  I 
have  sometimes  seen  great  advantage  from  the 
use  of  nutritive  enemata  with  wine,  where  the 
patient  was  becoming  rapidly  exhausted  and  could 
not  take  an  adequate  amount  of  food  by  the 
mouth.  In  one  very  severe  case,  in  which  the 
skin  was  excessively  dry  and  harsh,  great  relief 
was  obtained  by  the  use  of  the  warm  bath,  followed 
by  the  inunction  of  warm  oil. 

CASES  OF  ABNORMALLY  HIGH 
TEMPERATURE. 

A  late  number  of  the  British  Medical  Journal 
contains  a  report  by  Dr.  Donkin  of  eight  cases  of 
abnormally  high  temperature,  all  but  one  in  females, 
and  none  proving  fatal.  Pain  was  a  prominent  sym- 
pton  in  all.    An  abbreviated  statement  is  subjoined. 

No.   1,  111.6°;  convalescing  from  enteric  fever. 

No.   2,  io8°;  no  organic  lesions  ;  ovarian  pain. 
No.  3,11 5.8°;great  abdominal  pain  and  excitement. 

No.  4,  111°;  convalescing  from  enteric  fever. 

No.  5,  113°;  enteric  fever  and  double  pneumonia. 

No.   6,  1 1 2°;  synovitis.     This  was  the  only  male. 

No.  7,  112°;  painful  stump,  with  necrosis. 

No.  8,  117°;  pyonephrosis. — Buffalo  Medical 
and  Surgical  Journal. 

*  The  zinc  appears  to  be  more  efficacious  when  the  dose 
is  rapidly  raised; 


134 


THE    CANADA    MEDICAL    RECORD. 


OFFICIAL   ACCOUNT  OF  TYPHOID  OUT- 
BREAKS AT  LENNOX VI LLE. 

The  local  Committee  of  Management  of  Bishop's 
College,  Lennoxville,  in  publishing  the  following 
report  of  the  Medical  Commission,  appointed  to 
examine  into  the  causes  of  the  recent  outbreak 
of  tyhoid  fever,  deem  it  right  to  give  a  short  state- 
ment of  the  first  and  subsequent  appearances  of 
the  disease,  and  the  steps  taken  by  them  in  the 
emergency. 

Early  in  the  spring  term  of  1880  two  boys  from 
the  United  States  were  taken  down  with  pneumonia, 
the  disease  having  shown  itself  almost  immediately 
after  their  arrival  at  school.  These  boys  were  at- 
tended by  Dr.  Austin,  the  medical  officer  of  the 
school,  and  by  a  physician  from  the  United  States. 
iThey  recovered  after  a  protracted  and  dangerous 
cilness.  No  other  cases  of  illness  occurred  in  either 
ollege  or  school  during  the  whole  of  the  first  term 
f  1880. 

In  the  month  of  May  a  bad  smell  was  noticed 
byDr.  Lobley,  the  Principal  of  the  College,  in  the 
College  building — which  was  found  to  emanate 
from  the  drain  of  the  night  water  closet — and  was 
caused  by  an  inflow  of  water  from  outside  of  the 
building.  An  examination  disclosed  the  fact  that 
this  drain  discharged  into  the  ground  some  few 
feet  from  the  main  barrel  drain  or  sewer.  Repairs 
were  instantly  made  and  disinfectants  in  large 
quantity  applied,  and  the  whole  work,  which  took 
only  a  very  few  days  to  complete,  was  finished  by 
the  22nd  May. 

It  should  be  here  stated  that  the  rebuilding  of 
the  college  after  the  fire,  when  the  night  water  closet 
was  constnicted,was  under  the  supervision  of  a  com- 
petent architect,  Mr.  Nelson  of  Montreal,  and  that 
a  clerk  of  works  of  good  reputation,  Mr.  Richard 
Richards,  was  employed  to  oversee  the  work. 
Had  Mr.  Richards  done  his  duty  this  gross 
neglect  on  the  part  of  the  contractor  could  not  have 
occurred.  At  the  end  of  May  one  of  the  boys  in 
the  school  was  taken  ill  during  a  time  of  intensely 
hot  weather.  Dr.  Austin  reported  the  case  as  one 
of  sunstroke,  not  severe.  When  the  boy  was  re- 
covering he  was  called  into  Montreal  by  his  father, 
and  the  medical  man  there  discovered  symptoms 
of  typhoid  fever  about  the  case.  The  Committee 
was,  however,  not  informed  of  it.  and  even  if  they 
had  been,  it  would  presumably  not  have  created 
any  anxiety  in  their  minds  as  it  was  deemed  a 
very  mild  case.  On  the  21st  June  Mr.  Cook,  a 
student  in  the  College,  exhibited  feverish  symp- 
toms and  went  home,  but  in  his  correspondence 
with  Dr.  Lobley  he  made  no  allusion  to  typhoid 
fever.  On  the  24th  June  the  college  and  school 
broke  up  for  the  holidays,  and  with  the  exception 
of  the  cases  mentioned  all,  both  students  and 
boys,  appeared  to  enjoy  robust  health.  The 
usual  games  had  gone  on,  and  the  severe  mental 
strain  of  the  examinations  had  passed  off  with- 
out any  appearance  of  illness. 

Somewhere  about  the  ipth  July  news  came  of 


the  illness  of  Mr.  Gibb,  a  student  of  the  college, 
suffering  from  typhoid  fever,  and  soon  afterwards 
his  death  was  announced.  Almost  simultaneously 
news  of  the  illness  of  several  school  boys  and  one 
or  two  of  the  students  reached  the  college.  Alarm 
was  felt  at  once,  and  the  Committee  was  called 
together  without  delay.  On  the  advice  of  Dr. 
Austin  it  was  determined  to  reconstruct  the  whole 
drainage  system,  which  on  examination  was  found 
to  be  defective,  and  the  advice  and  active  assist- 
ance of  Mr.  Walter  Shanly,  C  E.,  was  sought  for 
and  freely  given.  At  the  request  of  the  corpor- 
ation of  the  college,  which  was  called  together  in 
the  emergency.  Dr.  Godfrey,  of  Montreal,  who 
hapj)ened  to  be  in  the  neighborhood,  made  an  in- 
spection of  the  drainage  system,  and  suggested 
some  modifications,  which  were  adopted.  Dr. 
Godfrey  was  assisted  in  his  investigation  by  Dr. 
Robertson,  of  Lennoxville,  at  the  request  of  Prin- 
cipal Lobley.  At  the  time  of  the  reconstruction  of 
the  drains,  the  prevalent  idea  was  that  the 
trouble  was  due  to  the  defective  drain  above  men- 
tioned, but  the  Committee  found  great  difficulty  in 
coming  to  any  conclusion  on  the  subject  owing  to 
a  difference  of  opinion  amongst  medical  men,  some 
of  whom  declared  that  the  disease  might  be 
dormant  in  the  system  during  three  or  four  weeks 
at  a  maximum,  whilst  others  said  that  as  many 
months  might  pass  before  it  would  be  developed. 

During  the  progress  of  the  drainage  work  the 
Committee  determined  on  the  removal  of  the 
wood-sheds  and  latrines  from  the  centre  of  the 
great  college  yard,  where  they  had  long  been  an 
eye-sore,  and  it  was  on  this  ground  alone  that  they 
were  removed.  This  involved  the  fiUing  up  of  the 
cesspit,  which  was  very  thorouiihly  done,  new 
earth  and  disinfectants  being  thrown  into  the 
space.  About  the  same  time  the  Chairman  of 
Trustees  urged  that  the  well  water  should  be  sent 
to  Montreal  for  analysis.  This  water  was  freely 
used  by  the  whole  institution.* 

The  following  gives  the  result  of  the  analysis  by 
Dr.  Baker  Edwards  :  — 

Beaver  Hall  Hill,  Montreal,  Aug.  19,  1880. 
Ed.  Chapman,  Esq.,  M.A., 

Bishop's  College  University,  Lennoxville. 

Sir, — I  hereby  certify  that  I  have  analyzed  the 
sample  of  water  which  you  forwarded  to  me  from 
the  well  supplying  the  college  and  school,  and 
that  I  have  very  carefully  examined  the  water, 
both  chemically  and  microscopically,  for  any  dele- 


I 


*In  an  article  published  in  the  January  number  of  the 
Caitdda  Medical  and  Surgical  Jourtial,  signed  by  Dr. 
Worthington,  it  is  stated  that  he  some  years  ago  was  one 
of  a  commission,  consisting  of  Dr.  Johnston,  of  iiherbrooke, 
Dr.  Robertson,  of  Lennoxville,  and  himself,  to  examine 
the  sanitary  condition  of  the  then  school,  and  that  he  at 
that  time  condemned  this  well.  The  report  of  this  Com- 
mission contains  no  allusion  whatever  either  to  this  well  or 
to  any  water  supply. 

In  this  respect,  as  in  many  others,  the  doctor  has  drawp 
on  his  imagination. 


THE   CANADA   MEDICAL   RECORD. 


135 


terious  matter,  and  find  xtperfedly  pure  and  whole- 
some, and  well  adapted  for  drinking  purposes. 
The  water  contains  per  Imperial  gallon  : — 8.4 
grains  of  total  solid  matter ;  of  which  7.7  grains  are 
mineral;    0.7  grains  are  organic. 

The  mineral  matter  consists  of  carbonate  of 
lime  and  magnesia,  with  a  trace  of  iron  and 
alumina  and  the  usual  saline  chlorides  of  sodium 
and  potassium. 

The  hardness  of  the  water  (as  indicated  by 
"Clarke's  test  ")  is  s'^,  which  ranks  the  spring  as 
a  "  soft  water." 

The  organic  matter  present  is  of  a  simple  vege- 
table character,  and  free  albu/ninous,  7iitrogen  and 
nitrates. 

On  the  whole  you  may  be  satisfied  that  your 
water  supply  is  not  only  pure  but  excellent. 

I  have  the  honour  to  be. 
Your  obedient  servant, 

J.  Baker  Edwards,  D.C.L.,  F.C.S., 

Professor  Practical  Chemistry  and  Public  Analyst, 
&c. 

This  analysis  satisfied  the  Committee,  who,  not 
being  scientific  chemists,  did  not  know  then  that 
strong  doubts  existed  as  to  whether  the  origin  of 
typhoid  fever  could  be  detected  by  analysis.* 
Under  these  circumstances  with  a  new  drainage 
system  supposed  to  be  perfect,  and  with  the  water 
in  use  pronounced  by  a  scientific  analyst  to  be 
"not  only  pure  but  excellent",  the  college  and 
school  re-opened  in  September. 

In  October,  owing  to  the  unprecedented  drought, 
this  well,  which  had  never  been  known  to  fail,  al- 
though used  for  over  twenty-five  years,  ran  dry. 
The  water,  however,  soon  came  in  again,  on  the 
setting  in  of  the  rains  of  autumn.  In  the  begin- 
ning of  November  the  pump  at  the  well  was  frDzen, 
and  thenceforward  the  use  of  the  water  ceased. 

During  the  whole  of  this  time  the  health  of  the 
college  and  school  seemed  excellent,  and  the  ath- 
letic games,  principally  foot-ball,  were  vigorously 
prosecuted.  In  the  end  of  November  several 
cases  of  typhoid  fever  made  their  appearance. 
The  Committee  were  startled,  and  again  sought  ad- 
vice.  The  water  was  again  sent  in  for  analysis, 
and  this  time  not  the  well  water  only  but  that 
used  for  culinary  purposes,  obtained  from  a  reser- 
voir in  the  woods,  as  well  as  the  water  used  by  the 
cows  at  the  farm  houses  whence  the  milk  was  ob- 
tained. 

The  following  is  the  second  analysis  of  Dr- 
Baker  Edwards  : 


*After  the  completion  of  the  work  it  came  to  the  know- 
ledge of  the  Principal  that  the  results  of  Dr.  Baker  Ed- 
wards' analysis  were  called  in  question  by  Dr.  Worthing- 
ton,  and  that  he  had  expressed  an  opinion  that  the  well 
ought  to  be  closed.  But  so  much  reliance  did  the  Principal 
place  upon  the  report  of  the  Public' Analyst  that  he  took 
po  action  upon  this. 


(copy.) 
Montreal,  12th  December,  1880. 
R.  White,  Esq. 

Dear  Sir, — I  have  carefully  examined  the  three 
samples  of  water  from  Lennoxville  as  minutely  as 
the  limited  quantity  permitted,  and  can  safely  say 
that  none  of  these  are  polluted  by  sewage  or 
organic  germs  likely  to  cause  sickness.  No.  i  is 
the  least  pure  and  contains  much  suspended  mat- 
ter, and  I  should  not  consider  it  fit  f  jr  drinking 
purposes,  unless  filtered.  No  2  is  a  good  spring 
water,  free  from  organic  nitrogen,  and  containing 
8.40  grains  of  solid  mineral  matter  to  the  Imperial 
gallon,  this  corresponds  with  the  water  I  analyzed 
in  August  last,  and  it  is  in  every  respect  an  excel- 
lent drinking  water.  Sample  No.  3  is  less  pure, 
but  is  a  perfectly  wholesome  water,  and  sample 
No.  4,  town  supply,  shows  more  organic  matter 
than  either  of  the  other  samples.  If  the  sample 
No.  I  is  in  use  I  should  like  to  examine  a  larger 
quantity,  say  one  gallon,  as,  from  the  presence  of  a 
rat's  hair,  possibly  the  bottle  was  not  clean,  this 
water  is  also  turbid  with  suspended  clay. 

No.  I.  Sample  taken  from  tank  in  stable  at 
Lunden's  farm.  No.  2.  Sample  taken  from  well 
in  court  yard.  No.  3.  Sample  taken  from  tank 
in  school  from  spring,  brought  in  by  gravitation. 
No.  4.  Sample  is  the  supply  used  in  the  city  of 
Montreal  from  the  Water  Works. 

I  am,  yours  most  truly, 

(Signed.)  J.  Baker  Edwards,  D.C.L., 

Public  Analyst,  Montreal. 

Being  completely  puzzled  at  tlie  cause  of  this 
second  outbreak,  the  Chairman  of  Trustees  visited 
Montreal,  and  called  a  meeting  of  gentlemen 
friendly  to  the  college,  amongst  whom  were  the  me- 
dical men  who  kindly  accepted  the  duty  of  examin- 
ing and  reporting  on  the  whole  matter.  The 
thanks  of  all  who  take  an  interest  in  Bishop's  Col- 
lege and  school  are  due  to  these  gentlemen  for 
their  patient  investigation  of  the  case,  and  the 
Committee,  while  regretting  that  this  investigation 
has  failed  in  discovering  the  origin  of  the  outbreak, 
have  yet  scrupulously  followed  the  suggestions 
made  from  time  to  time  by  the  Medical  Commission, 
as  well  as  the  direction  of  the  Sanitary  and  Drain 
Inspectors  of  Montreal,  who  also  kindly  lent  their 
valuable  assistance. 

It  is  because  these  suggestions  cannot  be  fully 
carried  into  effect  until  the  summer  that  it  has 
been  found  necessary  to  open  the  school  tempor- 
arily at  Magog,  whilst  the  work  of  the  college  is 
going  on  as  usual  at  the  Village  of  Lennoxville  in 
other  buildings  away  from  the  college. 

The  annexed  report  of  the  jNIedical  Commission 
is  now  published  at  the  earUest  possible  date  after 
its  receipt.  The  delay  in  furnishing  this  report 
is  attributable  to  the  desire  to  leave  no  stone  un- 
turned in  the    investigation  of  this  case. 

In    conclusion,   the    Comniittee    of   Manage- 


136 


THE    CANADA    MEDICAL    RECORD. 


mcnt  helicvc  that  the  sympathies  of  all  right-mind- 
ed men  will  he  with  them  in  this  trying  emergency. 
The  Trust  whic  h  they  have  undertaken — that  of 
carrying  on  a  College  and  School — at  great  per- 
sonal sarrit'i"  e  of  time  and  money, with  the  sole  de- 
sire of  doing  their  duly  to  the  country  in  which  they 
live,  and  to  the  Church  of  which  they  arc  mem- 
bers, has  been  an  arduous  one,  albeit  a  "  labour  of 
love,"  and  they  cannot  but  express  their  deep  regret 
that  the  editors  of  a  Scientific  Journal  should  have 
been  led  to  form  one-sided  conclusions,  when  they 
at  the  same  time  acknowledge  that  they  have  had 
only  an  cx-partc  statement  before  them. 

J.  A.  LoBLEV,  D.C.L.,  Principal, 
A.  C.  ScARTH,  M.A.,  Prof.  Educ'l.  History, 
R.  W.  Heneker,  D.C.L.,  Chairman  of  Trus- 
tees, 
Ed.  Chap.man,  M.A.,  Bursar, 
Henry  Roe,  M.A.,  Professor  of  Divinity, 
Members  of  the  Committee  of  Management. 

NB. — The  name  of  the  Rector  of  the  School  is 
omitted  on  account  of  his  necessary  attendance 
at  Magog. 

To  the  Chancellor  and  Corporation  of  the  Uni- 
versity of  Bishop's  College,  Lennoxville. 

Gentlemen, — We  the  undersigned,  having 
been  appointed  a  commission  to  inquire  into  the 
origin  and  spread  of  an  outbreak  of  typhoid  lever 
which  occurred  during  the  summer  and  autumn  of 
1880  at  Bishop's  College  and  Grammar  School  in 
Lennoxville,  beg  to  summit  the  following  report : — 

We  personally  inspected  the  Institution  on  the 
19th  and  20th  December  last,  and  at  our  request 
the  College  authorities  invited  Mr.  Radford,  the 
Health  Inspector,  and  Mr.  Lowe,  the  Drain  In- 
spector, of  the  City  of  Montreal,  to  carefully  ex- 
amine the  drainage  and  ventilation  of  the  premises. 
These  gentlemen  have  kindly  complied  with  the 
request,  and  have  submitted  to  us  an  elaborate 
statement  of  their  investigations,  together  with  a 
number  of  valuable  suggestions,  which  we  have 
embodied  in  this  report. 

For  the  sake  of  brevity  and  convenience,  the 
subject  will  be  considered  in  sections,  as  follows  : 

Situation. — The  School  and  College  buildings 
stand  upon  an  eminence  at  the  junction  of  the 
Massiiiwippi  and  St.  Francis  Rivers,  near  the  vil- 
lage of  Lennoxville.  The  soil  is  generally  light 
and  gravelly,  the  situation  open  and  airy,  and  ad- 
mirably adapted  for  a  large  public  institution. 

Medical  history  of  the  Institution  in  reference 
to  Typhoid  Fez'cr. —  We  are  informed  that  ten  or 
twelve  years  ago  a  boy  contracted  typhoid  while  at 
school,  but  no  other  cases  occurred  ;  fr<jni  thai  time 
to  the  re  opening  of  the  College  and  School  after 
the  Christmas  vacation  in  January,  1880,  we  do 
not  tind  anything  in  this  connection  calling  for 
special  comment,  beyond  the  fact  that  in  the  sum- 
mer vacation  of  1875  one  of  the  boys  died  of  typ- 
hoid fever  in  Lennoxville,  but  the  disease  was  evi- 


dently contracted  after  leaving  school,  in  the  house 
where  he  was  visiting.  In  February,  1880,  shortly 
after  the  re-oj)ening  of  the  School,  two  cases  of  ill- 
ness of  a  somewhat  suspicious  character  occurred, 
in  both  instances  the  boys  were  ailing  when  they 
returned  to  school,  and  one  of  them  continued  ill 
for  about  two  months ;  unfortunately,  we  have 
been  unable  to  come  to  a  positive  conclusion  with 
reference  to  the  precise  nature  of  these  cases.  On 
the  1 8th  of  May  a  drain  in  the  quadrangle  was 
open  for  repairs  ;  one  of  the  boys  descended  into 
it,  and  shortly  afterwards  he  developed  typhoid 
fever  at  his  home  in  Montreal.  In  July,  after  the 
School  and  College  had  closed,  reports  began  to 
come  in  of  other  cases.  Altogether,  we  have  been 
able  to  trace  twelve  cases  in  this  epidemic — five 
from  the  College  and  seven  from  the  School. 
During  the  months  of  August  and  September,  the 
sanitary  condition  of  the  Institution  was  investiga- 
ted, and  found  to  be  very  unsatisfactory.  A  new 
system  of  drainage  was  substituted,  new  latrines 
built,  and  many  improvements  made  under  the 
directions  of  a  competent  engineer.  The  reason- 
able hope  was  entertained  that  no  further  trouble 
would  occur.  On  September  22nd  the  School  re- 
assembled. During  October  and  the  early  part  of 
November  the  health  of  the  pupils  was  excellent, 
but  towards  the  end  of  the  month  six  boys  and 
one  resident  student  were  taken  ill  with  the  fever. 
About  the  middle  of  December,  a  servant  boy 
employed  about  the  kitchen  and  dining-room  was 
also  attacked.  Two  other  cases  that  developed 
the  fever  at  their  own  homes  have  been  reported, 
making  in  all  10  cases  during  the  second  epidemic. 
There  was  nothing  in  the  distribution  of  the  cases 
through  the  College  and  School  which  could  favor 
the  idea  that  the  disease  originated  in  any  special 
quarter  of  the  Institution. 

Internal  Economy  and  Commissariat. — The 
boys  and  students  take  their  meals  together  in  the 
dining-hall ;  in  other  respects  the  institutions  are 
separate  and  distinct. 

Milk  Supply. — We  visited  and  inspected  the 
dairy  farm,  and  while  we  found  no  reason  to  ascribe 
the  outbreaks  of  typhoid  to  any  contamination 
of  the  milk,  we  would  draw  attention  to  the  dan- 
gerous proximity  of  the  well,  privy  and  stable 
and  to  the  faulty  position  of  the  tank,  which  is  at 
j)resent  below  the  level  of  the  stable  floor. 
These  conditions,  in  the  event  of  any  cases  of 
typhoid  occurring  at  the  farm-house,  would  prove  a 
ready  means  of  spreading  the  disease. 

Water  Supply. — The  water  supply  of  the  Insti- 
tution is  derived  from  (i)  a  well  in  the  quadrangle, 
19  feet  in  dei)th,  and,  at  the  time  of  our  visit,  con- 
taining 2ft.  4in.  of  water.  On  account  of  its  sup- 
posed purity,  this  water  was  used  almost  exclusively 
for  drinking  purposes.  During  the  exceptional 
drought  of  last  season  this  well  ran  dry,  and  was  not 
not  available  for  general  use  until  some  time  after  the 
oi)ening  of  the  School.  The  well  is  situated  at  the 
lower  part  of  the  quadrangle,  at  a  distance  of  90  feet 


•rHfi   CJANADA   MEDICAL   RECORD. 


137 


from  the  old  latrines,  the  soil  between  being  of  a 
light  gravelly  nature,  and  the  dip  being  towards 
the  well.  (2)  A  spring  in  the  Beaver  Meadow, 
the  water  of  which,  after  passing  along  in  an  open 
stream  for  some  distance,  is  collected  in  a  tank 
and  conveyed  thence  through  perforated  logs  to  a 
large  reservoir  in  the  School  building,  whence  it  is 
distributed  to  the  various  parts  of  the  establish- 
ment. 

Analysis  of  Water. — The  analysis  of  water  was 
made  by  Professor  Croft  of  Toronto  ;  the  follow- 
is  a  copy  of  his  report : 

Report  OH   Three  Waters  from  Lennoxville. 

No.  I,  water  from  cistern  in  school. 
No.  2,  water  from  well  in  quadrangle. 
No.  3,  water  from  Duffield's  well. 

It  did  not  seem  requisite  or  desirable  to  make 
an  accurate  quantitative  analysis  of  each  specime.i, 
as  the  mineral  constituents,  unless  present  in  ab- 
normal quantities,  could  have  little  or  no  effect  on 
their  medicinal  properties,  and  no  chemical  test 
can  recognize  typhoid  germs.  It  appeared  desir- 
able to  test  the  waters  qualitatively  as  to  their 
constitution,  as  to  presence  of  ammonia  or  am- 
moniacal  salts,  chlorides,  and  organic  matters,  also 
for  magnesia.  By  an  accident  from  frost  and 
other  causes,  the  first  analyses  of  No.  i  were 
untrustworthy,  and  had  to   be  repeated. 

Ammonia. — Each  test  was  repeated  two  or  three 
times  so  as  to  avoid  error,  and  in  cases  of  distilla- 
tion, a  quantity  of  pure  water  was  first  distilled  to 
wash  out  all  ammonia  from  the  vessels,  and  in 
neither  of  the  waters  could  ammonia  be  detected  di- 
rectly— I.e.,  in  the  water  as  taken  from  the  bottles. 
In  first  products  of  distillation — No.  i,  faintest 
trace  ;  No.  2,  decided  trace;  No.  3,  less  decided 
trace.    In  no  case  very  large  ;  most  so  in  No.  2. 

Chlorine. — Probably  as  chloride  of  sodium — 
No.  I,  scarcely  perceptible  trace  ;  No.  2,  decided, 
so  much  so  as  to  induce  rough  determination, 
about  12  grains  per  gallon  of  chloride  of  sodium  ; 
No.  3,  decided,  but  less  than  in  No.  2. 

Sodium. —  Probably  as  chloride — No.  i,  faint 
trace;  No.  2,  very  decided;  No.  3,  decided. 

Sulphtcric  Acid. — As  probably  sulphate  of  lime 
was  present — No.  i,  very  faint  trace;  No.  2,  de- 
cided, but  not  large  ;  No.  3,  about  the  same 
as  No.   2. 

Lime. — As  for  above. 

Magnesia. — No.  i,  scarcely  perceptible;  Nos. 
2  and  3,  rather  more,  about  equal. 

All  waters  gave  a  very  slight  precipitate  on 
boiling,  consisting  of  carbonates  of  lime  and 
magnesia,  with  an  infinitesimal  trace  of  iron. 

Solid  contents.  5,000  grs.     70,000  grs.  i  gal. 

No,  I,  first  experiment, 6.1        ...      85.4 

No.  2,  "  6.2     ....      86.8 

No.  3,  "  6,6     92.4 


These  experiments  were  repeated,  and  the  num- 
bers assigned  represent  the  mean  of  several  exper- 
iments. They  (the  lesidues)  all  became  blacken- 
ed very  much  on  heating,  Nos.  2  and  3  especially 
shewing  presence  of  much  organic  matter,  I 
have  not  been  able  to  ascertain  the  exact  quanti- 
ties, but  may  say  that  2  and  3  are  very  ob- 
jectionable, from  the  presence  of  organic  matter. 

I  have  a  letter  from  Dr.  Baker  Edwards,  who 
analysed  one  of  these  waters  and  found  only  8.4 
grains  in  a  gallon  of  70,000  grains.  That  cannot 
have  been  one  of  the  waters  submitted  to  me,  un- 
less in  the  hurry  of  writing  Dr.  E.  has  placed 
the  decimal  point  wrongly.  The  8.4  corresponds 
closely  with  my  85.4.  Can  there  be  a  mistake 
here? 

I  think  the  waters  are  all  bad,  as  containing 
too  much  organic  matter.  I  have  had  several 
cases  of  similar  waters  to  examine  in  Yorkville  and 
Toronto,  in  or  from  houses  where  sickness  pre- 
vailed— one  case  bad  typhoid.  They  all  exhibited 
the  same  properties — chlorides  in  excess,  magnesia, 
traces  of  ammonia,  and  organic  matter.  In  one 
exceptional  case  I  denounced  the  well  water. 
There  has  been  no  illness  to  speak  of  in  the  School 
since  the  change. 

Your  obedient  servant,       Henry  H.  Croft. 

P.S.  —  I  have  other  confirmatory  experiments 
going  on,  but  send  this  as  report  on  results  ob- 
tained up  to  this. time.  The  numbers  obtained 
by  analysis  made  in  a  hurry  may  not  be  absolutely 
correct ;  moreover,  an  error  in  5,000  grains  has 
to  be  multiplied  or  divided  by  14  for  70,000. 

H.  H.  C. 

Suggestions  with  regard  to  the  water  supply  : — 

I. — That  the  well  in  the  quadrangle  be  closed. 

2. — That  iron  distributing  pipes  replace  the 
wooden  logs  in  the  quadrangle. 

3. — That,  if  possible,  the  large  receiving  tank  be 
removed  from  its  present  position  and  lo- 
cated at  the  spring,  and  that  the  water  be 
conveyed  thence  to  the  school  reservoir 
through  iron  pipes, 

4. — That  the  connection  at  present  existing  be- 
tween the  reservoir  and  the  School  drain 
(flush-pipe)  be  cut  off,  and  that  the  reser- 
voir be  regularly  cleaned  and  inspected. 

Privies. — About  the  centre  of  the  quadrangle 
the  old  latrine  was  situated;  it  was  a  square  pit 
about  4  feet  in  depth,  lined  with  unmortised 
planks,  which  permitted  the  liquid  portion  of  the 
fcecal  matters  to  ooze  iVeely  into  the  surrrounding 
soil.  In  August  last  the  latrine  was  abolished, 
the  contents  were  carted  away,  and  the  pit  filled 
with  earth  and  lime.  A  few  feet  from  the  latrine, 
between  it  and  the  well,  we  caused  a  pit  to  be  dug 
a  depth  of  six  feet,  and  we  found  the  loose  gravel- 
ly soil  to  be  impregnated  at  various  depths  with 
organic  matter.  To  replace  the  latrine,  closets 
were  constructed  behind  the  gymnasium,  but  not 


138 


THE   CANADA   MEDICAL   RECORD. 


upon  a  plan  which  could  prove  to  be  cither   efTec- 
tual  or  satisfactory. 

Suggestions  with  regard  to  the  privies  : — 

1. — That  the  closets  he  removed  from  such  close 
proximity  to  the  gymnasium. 

2. — As  we  are  of  opinion  that  for  outside  privies 
the  earth  system,  if  properly  carried  out, 
would  be  preferable  to  any  other,  we  would 
suggest  that  every  precaution  be  taken  to 
secure  its  thorough  and  systematic  applica- 
tion. 

Drainage. — The  old  barrel  drain  which  passed 
under  the  corner  of  the  school  and  chapel  was 
imperfect  in  construction,  and  ill-adapted  for  the 
purposes  required  ;  it  was  removed  in  August,  and 
replaced  by  two  i  2  inch  vitrified  tile  drains,  one 
for  the  College  and  the  other  for  the  School, 
These  drains  united  below  the  College  building, 
and  emptied  into  the  Massawippi,  well  out  in  the 
stream.  The  river. below  this  point  is  consequently 
contaminated  with  sewage.  The  ventilation  pro- 
vided for  these  drains  is  insufficient  and  unsuit- 
able, and  in  addition  to  the  recommendations  con- 
tained in  the  report  of  Messrs.  Lowe  and  Radford, 
we  would  suggest  the  construction  of  a  proper 
ventilating  shaft  in  the  main  drain,  near  the  junc- 
tion. We  append  the  careful  and  minute  report 
of  these  gentlemen,  and  concur  in  their  recom- 
mendations. 

Subsoil  Dra'nage. — Owing  to  the  faulty  con- 
struction of  the  old  barrel  drain  and  the  latrine, 
the  soil  of  the  quadrangle  must  have  become  con- 
taminated with  thier  fluid  contents.  In  order 
effectually  to  purify  this  quadrangle,  we  would 
recommend  that  a  thorough  system  of  subsoil 
drainage  be  adopted.  The  present  well,  which 
probably  drains  a  considerable  portion  of  the 
quadrangle,  should  be  utilized  by  carrying  a  tile 
drain  from  the  bottom. 

It  is  a  well-known  scientific  fact  that  the  atmos- 
pheric air  penetrates  the  soil,  according  to  its 
character,  to  an  indefinite  depth,  and  circulates  in 
every  direction  with  a  rapidity  of  motion  depen- 
dent upon  various  surrounding  conditions,  one  of 
the  chief  of  which  is  variation  of  temperature. 
This  air  is  known  as  ground  air.  The  temper- 
ature of  the  cellars  and  basements,  especially  where 
furnaces  are  used,  is  considerably  higher  in  cold 
weather  than  that  of  the  outside  soil,  consequently 
the  flow  of  ground  air  will  then  be  directed  to- 
wards these  cellars  and  basements.  Vi  the  soil  be 
contaminated  in  any  way,  so  will  be,  to  a  greater 
or  less  extent,  the  ground  air  contained  in  it.  In 
this  way  it  is  very  probable  that  polluted  ground 
air  from  the  quadrangle  is  drawn  up  through  the 
imperfect  floor  of  the  basement  and  circulated 
throughout  the  building.  In  order  to  prevent,  as 
far  as  possible,  the  entrance  of  this  air,  we  would 
recommend  a  thorough  covering  of  the  cellar 
and  basement  floors  with  some  suitable  imper- 
vious material,  such  as  concrete  or  asphalt.     The 


walls,  as  high  as  the  level  of  the  soil,  should  be 
protected  in  a  similar  manner. 

It  is  now  held  by  the  best  authorities  that  im- 
perfect sanitary  conditions  cannot  of  themselves 
originate  the  typhoid  jioison,  but  when  once  the 
specific  germ  has  gained  access  to  a  soil  suitable 
for  its  develojjment,  it  spreads  and  multiplies  with 
great  rapidity.  The  conditions  most  favorable 
for  its  development  are  chiefly  those  produced  by 
defective  drainage  and  ventilation.  In  this  in- 
stance, whence  the  poison  came,  or  by  whom  in- 
troduced, we  have  been  unable  definitely  to  ascer- 
tain ;  but,  whatever  may  have  been  the  precise 
origin  of  the  disease,  the  condition  of  the  drainage 
and  water  supply  during  the  latter  part  of  May 
was  most  favorable  for  the  development  and 
diffusion  of  the  typhoid  poison.  The  close  prox- 
imity of  the  well  to  the  latrines  favored  the  con- 
tamination of  the  drinking  water  ;  and  to  the  use 
of  this  water,  more  than  to  any  other  single  cause, 
we  attribute  the  spread  of  the  disease.  In  this 
opinion  we  are  strengthened  by  the  result  of  Pro- 
fessoi  Croft's  analysis. 

From  the  foregoing  it  must  be  evident  that,  in 
order  to  eradicate  the  disease,  it  is  absolutely 
necessary  to  secure  for  the  institution  thorough 
ventilation,  perfect  drainage,  and  a  pure  water  sup- 
ply. 

We  cannot  conclude  this  report  without  bearing 
our  testimony  to  the  courtesy  and  willing  assis- 
tance rendered  us  at  all  times  by  the  School  and 
College  officials  during  the  prosecution  of  our  in- 
vestigations, and  to  the  evident  desire  on  the  part 
of  the  authorities  to  carry  out  all  reasonable  and 
necessary  reforms. 

We  have  the  honor  to  remain, 
Gentlemen, 

Your  obedient  servants, 

T.  Simpson,  M.D. 

W^M.  OSLER,  M.D. 

J.  C,  Cameron,  M.D. 
Montreal.  21st  January,  1881. 


RULES  FOR  INJECTION  IN  GONORRHEA. 

In  acute  gonorrhea  before  all  things  we  must 
insist  u|)on  the  patient  wearing  a  suspensory  in 
order  to  prevent  traction  on  the  testes.  He 
should  take  no  beer  or  champagne  or  any  drink 
which  contains  much  carbonic  acid  in  the  nascent 
state,  as  this  gives  rise  to  dysuria.  Meat  in  the 
evening  and  late  meals  should  be  avoided,  as  favor- 
ing the  occurrence  of  nocturnal  pollutions,  aggra- 
vating the  patient's  condition.  The  same  may  be 
said  of  the  sitz-bath  taken  late  in  the  evening. 
During  the  acute  stage,  if  there  still  exist  severe 
pain,  especially  after  passing  urine,  and  stabbing 
pains  at  the  posterior  part  of  the  urethra — one  of 
the  earliest  symptoms  of  gonorrhea — we  may  con- 
fidently begin  the  treatment  by  the  injection  of  a 


¥Ht:   CANADA    MEDlCAt    REOORD. 


131) 


very  weak  solution  of  an  astringent  metallic  salt. 
After  the  first  effective  injections  the  pains  are 
considerably  diminished,  the  urine  is  passed  more 
easily,  and  the  slight  fever  which  is  often  present 
disappears.  The  relief  of  the  pain  may  also  be 
hastened  by  tepid  sitz-baths.  It  is  an  interesting 
fact  that  the  patient,  who  at  the  beginning  of  the 
gonorrhea  can  only  pass  urine  amidst  the  severest 
pain,  is  able  to  empty  the  bladder  while  in  the  bath 
with  the  greatest  ease  and  comfort.  With  regard 
to  the  injections  they  should  at  first  be  as  weak 
as  possible,  so  that  they  may  never  act  as  caustics, 
but  only  as  astringents.  The  substance  from  which 
Prof.  Zeissl  has  derived  the  best  results  is  the 
permanganate  of  potash,  of  which  he  prescribes  two 
centigrammes  in  200  grammes  of  distilled  water, 
thrown  in  four  times  daily  by  means  of  a  caoutchouc 
syringe,  care  being  taken  to  prevent  the  entrance 
of  air,  the  presence  of  even  a  small  quantity  of  which 
in  the  urethra  suffices  to  induce  severe  dysuria.  If 
this  occur,  or  pains  arise  in  the  testes,  the  injections 
must  be  suspended,  and  the  symptoms  suitably 
treated.  As  already  stated,  it  often  happens 
that  after  a  few  injections  the  pain  diminishes,  and 
all  traces  of  the  gonorrhcea  frequently  disap- 
pear after  only  a  week's  employment  of  the  per- 
manganate. If  however,  after  using  this  very 
weak  solution  for  a  week,  no  essential  improvement 
has  taken  place,  it  may  be  strengthened  by  a  centi- 
gramme ;  but  Prof.  Zeissl  never  goes  beyond 
fifteen  centigrammes  in  the  200  grammes  of  water. 
A  rule  to  be  observed  is  not  to  continue  the  same 
injection  for  too  long  a  time,  as  the  urethra  becomes 
accustomed  to  the  presence  of  the  medical  agent, 
the  further  employment  of  which  is  then  useless, 
and  a  weak  solution  (thirty  centigrammes  to  200 
grammes)  of  sulphate  of  zinc  should  be  substituted, 
gradually  increasing  the  strength  to  five  deci- 
grammes. If  this  does  not  succeed,  Prof.  Zeissl 
then  resorts  to  the  employment  of  insoluble  bodies, 
such  as  bismuth,  kaolin,  or  the  acetate  of  lead. 
Injections  containing  these  suspended  bodies  must 
be  well  shaken,  so  as  to  cause  a  uniform  distribu- 
tion of  the  precipitate  in  the  urethra.  This  powder 
may  remain  in  the  urethra  for  a  long  period — and 
at  all  events  until  the  next  discharge  of  the  urine ; 
and  when  it  is  forced  into  the  glandular  orifices  of 
the  prostate  it  often  remains  there  for  a  fortnight 
longer.  This  circumstance  explains  the  beneficial 
action  of  these  suspended  substances,  as  they 
remain  in  close  and  prolonged  contact  with  the 
membranous  and  prostatic  portions  of  the  urethra 
and  with  the  prostate  itself — the  parts  in  which 
the  catarrh  exhibits  the  greatest  obstinacy. — 
Weitier  Med.  Woch — Lea's  Abstract. 


HINTS  ON  SEA-BATHING. 

August  is  the  month  for  sea-bathing,  which,  if 
properly  managed,  is  one  of  the  most  healthful 
and  invigorating  of  exercises,  though  its  good 
effects  are  often  neutralized  through  ignorance  or 


carelessness.  The  following  extracts  from  Dr.  J. 
H.  Packard's  Sea-Air  and  Sea-Bathing  (one  of 
the  "  American  Health  Primers  ")  furnish  a  very 
good  summary  of  rules  for  the  guidance  of  the 
unprofessional  reader  in  this  matter  : — 

Ho7i.i  Long  to  Bathe. — It  is  quite  absurd  to  lay 
down  positive  rules  as  to  the  time  people  should 
remain  in  the  water,  since  they  do  not  carry 
watches  in  with  them.  And  any  day's  experience 
on  the  beach  in  the  season  will  show  a  great  many 
bathers  sporting  in  the  water  for  half  an  hour  or 
an  hour,  and  even  longer,  without  any  perceptible 
ill  effect.  It  is  quite  a  common  practice  among 
the  young  to  go  in,  take  a  bath,  come  out  and  lie 
on  the  sand,  and  go  in  again,  perhaps  a  number 
of  times.  The  powers  of  endurance  vary  greatly  ; 
and  it  is  well  known  that  swimmers  have  some- 
times remained  in  the  water  for  many  consecu- 
tive hours  without  harm. 

There  can,  however,  be  no  question  that  for 
sanitary  purposes,  and  as  a  matter  of  prudence,  it 
is  better  to  take  the  bath,  and  then  to  leave  the 
water  for  the  day. 

What  is  wanted  in  ordinary  sea  bathing  is  to 
carry  the  chilling  of  the  body  only  so  far  as  to 
promote  the  subsequent  reaction.  The  first  sense 
of  cold  on  entering  the  water  is  soon  followed  by 
ihe  feeling  of  returning  warmth  ;  and  this  continues 
for  some  little  time,  to  be  again  succeeded  by  a 
sense  of  chilliness  This  second  cooling  is  accom- 
panied by  a  diminution  in  the  activity  of  the  cir- 
culation, shown  especially  by  blueness  of  the  lips 
or  finger  nails  ;  and  this  should  invariably  be  re- 
garded as  a  signal  for  leaving  the  water  at  once. 
To  wait  until  the  teeth  chatter,  and  the  skin  of 
the  fingers  becomes  shriveled  like  those  of  a 
washerwoman,  is  in  a  very  high  degree  imprudent. 

For  those  who  have  young  children  or  invalids 
under  their  charge,  and  who  are  able  to  observe 
and  regulate  the  exact  time  of  their  stay  in  the 
bath,  it  may  be  said  that  this  may  be  according 
to  the  condition  of  the  skin,  somewhere  between 
two  and  fifteen  minutes.  It  is  always  safe  to  err 
on  the  side  of  prudence,  and  to  cut  the  bath  need- 
lessly short  rather  than  to  prolong  it  at  any  risk. 

Perhaps  it  need  hardly  be  said  that  the  colder 
the  water  is  the  less  time  should  be  spent  in  it. 
When  the  air  and  the  water  are  both  cold,  the 
duration  of  the  bath  should  be  correspondingly 
diminished.  This  condition  of  things  increases 
the  danger  of  shock  and  of  insufficient  reaction. 

One  should  enter  a  sea  bath  comfortably  warm, 
and  exercise  actively  during  the  stay  in  the  water. 
The  temporary  chilling  of  the  surface  will  then 
give  place  quickly  to  a  glow,  which  may  be  kept  up 
or  even  increased  by  thorough  rubbing. 

How  to  Bathe. — There  is  very  seldom  oppor- 
tunity for  diving  into  the  sea,  and  only  a  very 
small  number  of  bathers  are  expert  enough  to  doit. 
The  best  plan  is  to  walk  or  run  rapidly  into  the 
water,  wading  out  at  once  far  enough  either  to  dip 
the  whole  person  head  and  all,  or  to  allow  a  wave 
to  break  over   the   bather.     Some  like  to  have  a 


140 


The   CANADA    MEDICAL    RECORD. 


bucket  of  sea  water  dashed  over  them  before 
going  in.  Once  in  the  water,  and  thoroughly  wet, 
"one  need  only  keep  moving,  occasionally  going 
under  a  wave,  as  long  as  the  water  is  agreeable, 
and  there  is  no  sense  of  chilliness. 


IHE  ORIGIN   OF  TETANUS. 

The  Brain,  for  January,   1880,  contains  an  art'- 
cle  by  Surgeon  Major  J.  J.  L.  Ratton,  in  which  he 
enunciates  the  proposition  that  tenanus  is  a  single 
disease  ;  that  it   begins   in    persistent  ])eripheral 
nerve   irritation,  and    ends   in  organic  molecular 
and  functional  disturbance  of  the  medulla.     The 
peripheral    nerve  irritation    may   or  may   not   be 
traumatic,    but  is  invariably  the    cause  of  the  dis- 
ease ;  so  that  the  term    idiopatliic  tetanus  should 
be  disused.     The  above  conclusion  is  arrived  at 
after  exhaustive  arguments  have  been  adduced  in 
proof  of  the  five   following   points:   i.  Peripheral 
nerve  irritation  is  a  cause   of    tetanus.     2.    Peri- 
pheral nerve  irritation  is  present  in  all  cases  of  the 
disease.     3.  It  produces  eventually  the  group  of 
symptoms    know  as  tetanus.     4.  It  explains  the 
facts  of  the  morbid  anatomy  of  the  disease.     5.   It 
guides  the  treatment  of  the  disease,  and  is  proved 
by  its  success.     The  great  bulk  of  cases  of  so-called 
idiopathic  tetanus  are  either  puerperal,  menstrual, 
or  the  result  of  worms.     That  case  of  idiopathic 
tetanus  in  which  peripheral   nerve  irritation  could 
be  excluded  as  the  cause  must  be  absolutely  free 
from  disease  ;  the  author  cannot  imagine  that  such 
a  case  ever  existed.     His  view  of  the  pathology  of 
tetanus  is   that    in  the    first  stage   of  the   disease 
(that  of  continued  nerve  irritation    reacting   upon 
the  medulla  and  originating  tonic  spasms),  up  to  a 
certain  point  there  is  no  morbid  change  in  the  cord, 
and   consequently  there  would  be  no  evidence  of 
disease.     At  this  period  division  of  the  afferent 
nerve,    by    cutting   off  the    source   of  irritation, 
arrests  the  symptoms.     Aftenvard,  continued  irrita- 
tion, exciting  the  reflex  function  to  an  inordinate 
degree,  causes  hypertemia  with  molecular  changes, 
and  frequently  inflammation.     Here  there  may  or 
may  not  be  visible  changes,  but  these  will  be  hid- 
den by  molecular  changes.     Pathological  facts  fit 
in  exactly  with  these  views.     Sometimes  no  changes 
are  found,  sometimes  microscopical  changes,  and 
sometimes    evidences    of    inflammation     of    the 
medulla  and   upper  part  of  the  cord.     The  treat- 
ment  by   amputation,  or  section  of  the  afferent 
nerve  is  only  eflicient  up  to  a  certain  point ;  when 
molecular  changes  have  taken  place  in  the  medulla 
it  is  useless.     Division  of  the  nerve  in  the  second 
stage  may  help,    but  does  not  cure  the  disease. 
Something  more  is  wanted — some  powerfiil  wrench 
to  the  nervous  system  that  will  alter  the  morbid 
molecular   arrangement  of  the  i)arts,  or  act  as  a 
revulsive  or   counter-irritant.     Stretching  a  large 
nerve  trunk  (e.g.,  the  sciatic j,  and  making  traction 
on  the  cord,  have    been    tried    and    followed   by 
marked    success.     The    drugs    used,    and    which 


have  justified  their  use  in  this  disease,  are  just 
those  which  are  known  to  diminish  the  reflex  irri- 
tability of  the  cord.  The  ice  bag  to  the  spine 
leeches,  blisters,  and  plasters,  to  the  same,  all 
testify  to  the  universal  opinion  acted  upon,  if  not 
avowed.  The  tetanus  is  a  disturbance  disease  of 
threflex  unctio  nf  e  ofthe  cord. 


BILIOUS  HEADACHES. 

AV'hen  patients  are  very  bihous,  and  a  conjunctivae 
yellow  a  good  cholagogue  purgative  will  excite 
the  action  of  the  liver,  and  drain  away  a  copious 
quantity  of  bile.     Form: 

ft.       Hydr.  subchlorid, gr- "ij 

Pil.  coloc.  CO.,.  ...  gr.  vj 

Ext.  hyoscyami,       ....       gr.  ij 
Misce  et  divide    in  pilulas  ij.     To  be  taken  at 
bed-time  occasionally. 

A  mixture  of  soda  and  bismuth  with  sal  volatile 
will  be  useful  to  relieve  flatulency  and  acidity. 
Form  : 

y .       Sodae  bicarb., 

Bismuth  subcarb  , 

Pulv.  acacias,     .     .     .     .     aa  3J 

Spt.  amm.  arom.,      ....  3  ij 

Syr.  zingib.,  3  iij 

Aquae  purae,  ad.,         .     .     .     .  |  viij 

Misce.  Two  tablespoonsful  three  times  a  day, 
half  hour  before  food. 

If  the  headache  is  accompanied  with  atonic 
dyspepsia,  and  there  is  a  clean  tongue  with  weight 
and  oppression  at  the  epigastrium,  the  nitro- 
muriatic  acid  will  be  found  serviceable,  before 
meals  or  three  times  a  day.     Form  : 

3.       Tine.  nuc.  vom., jj 

Acid.  nitr.  dil.,  ....       3J 

Acid,  hydrochl.  dil.,    .     .     .     •    3  ij 

Tine,  aurant., 3  vj 

Aquae  purae,  ad.,         .     .     .     •    3  vj 

Misce.      A  tablespoonful    in  a  wineglassful  of 
water  three  times  a  day. 

If  flatulence  is  very  troublesome,  bismuth  with 
nux  vomica,  and,  if  there  is  constipation,  a  morning 
pill  of  aloes,  nux  vomica,  and  belladonna,  or  one 
consisting  of  aloes,  capsicum,  quinine,  and  ipeca- 
cuanha, are  indicated.     Forms  : 

3.       Ext.  aloes,  barb,         ....  gr. '^ 
Pulv.  ipecac,  ....      gr.  j 

Pil.  rhei  comp.,  .     .     .     .    gr.  iij. 

Misce  et  fiat  pilula.  To  be  taken  daily  before 
dinner. 

\\       Quiniae  sulph., 

Ext.  aloes  aciuos aa  gr.  xij 

Pulv.  capsici, 

Pulv.  ipecac,  .     .     .     .    aa  gr  vj 

Glycerini,         •     .  q.  s. 

Ut  fiant  pilulae  xij.  One  to  be  taken  daily 
before  food  at  midday. 

— Dr.  Day  on  Headaches. 


THE    CANADA   MEDICAL    RfeCORD. 


141 


OXALATE  OF  CERIUM  AS  A  COUGH 
REMEDY. 

Dr.  Andrew  H.  Smith,  chairman  of  the  Com- 
mittee on  Restoratives,  New  York  The  rapeutical 
Society,  at  the  meeting  held  April  9th.  1880,  report- 
ed cases  illustrating  the  different  degrees  of  suc- 
cess 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  obser- 
vers. 

Dr.  Cheesman  had  used  the  remedy  in  hospital 
practice  from  July  ist  to  November  ist,  1879, 
allowing  it  to  take  the  place  of  all  sedatives,  includ- 
ing opium,  in  the  daily  average  oiphthisis  patients. 
It  was  uniformly  administered  in  the  form  of  dry 
powder,  and  notes  were  taken  in  69  trials.  In 
39,  marked  relief  followed ;  in  19,  the  cough  was 
moderately  relieved,  and  in  11  no  relief  whatso- 
ever 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  reliev- 
ed 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  he  had  experienced  benefit 
from  its  use  in  whooping-cough.  It  produced  no 
bad  effects  on  the  stomach. 

The  conclusions  reached  by  the  committee  were 
the  following  : 

1.  Oxalate  of  cerium  could  be  safely  administer- 
ed 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  remedy  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  valua- 
ble agent  to  be  employed  in  alternation  with  other 
remedies. 

7.  It  did  not  disturb  the  stomach  :  on  the  con- 
trary, 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. — 
Medical  Record' 


GASTRIC  ULCER. 

By  Herbert  W.  Little,  M.D.,  New  York. 

.A.S  ulcers  of  the  stomach,  which  give  definite  ■ 
symptoms  during  life,  are  not  of  common  occur- 
rence, with  the  exception  of  perforating  ulcers,  of 
which  the  termination  is  fatal,  it  will  be  interesting, 
perhaps,  to  read  the  case  given  below.  This  is 
presented  for  the  following  reasons,  viz.  :  firsts  on 
account  of  the  great  obstinacy  of  the  case  ;  second, 
the  controlling  influence  of  ingluvin  ;  third,  the  to- 
lerance of  rectal  alimentation. 

The  obstinacy  of  the  case  will  be  perceptible 
farther  on. 

As  far  as  the  beneficial  effect  of  ingluvin  in  this 
instance  went,  it  certainly  was,  apparently,  very 
satisfactory  ;  but,  whether  or  not  the  ulcer  was 
cicatrizing  at  the  time  it  was  administered,  and 
the  improvement  was  a  mere  coincidence  with  its 
administration,  or  whether  or  not  the  improvement 
was  due  directly  to  the  effect  of  the  remedy,  is 
hard  to  say.  In  either  case,  improvement  promptly 
followed  the  use  of  the  remedy. 

The  patient  was  supported  exclusively  by  rectal 
alimentation  for  three  consecutive  months,  proving 
the  tolerance  and  absorption  of  enemata,  the 
rectum  acting  as  a  second  stomach.  This  would 
seem  to  show  the  fallacy  of  Dr.  Tully's  statement 
that,  inasmuch  as  there  are  no  lacteals  in  the  colon 
and  in  the  rectum,  the  idea  of  introducing  nourish- 
ment into  the  system  by  means  of  enemata  nutri- 
entia  is  a  perfect  chimera.  It  seems,  as  Boden- 
hamer  says,  that  the  nutritious  elements  are  taken 
up  by  the  absorbents,  and  conveyed  by  them  to 
\ht  receptacu/u7ti  chyli  or  reservoir  of  Pecquet,  and 
thus  soon  find  their  way  into  the  economy,  and 
produce  their  assimilative  and  nutritive  effect. 
Bodenhamer,  in  his  excellent  treatise  on  rectal 
medication,  further  states  that  there  are  lacteals 
both  in  the  colon  and  rectum,  and  that  the  late 
and  lamented  Prof.  Horner,  of  Philadelphia,  stated, 
from  minute  researches,  that  the  ofiice  of  the 
follicles  of  Lieberkiihn  is  that  of  absorption,  and 
not  secretion.  Therefore,  absorption  takes  place 
principally  through  the  lacteals  and  follicles  of 
Lieberkiihn.  In  my  position  as  house  physician 
at  the  Presbyterian  Hospital,  I  have  had  oppor- 
tunity to  test  the  tolerance  and  absorptive  powers 
of  the  rectum  and  colon  to  a  considerable-extent, 
both  for  food  and  for  medicine,  and  have  great 
confidence  as  regards  their  efficacy ;  and,  moreover, 
am  safe  in  saying  that  in  a  number  of  instances  I 
have  seen  life  saved  by  resorting  to  rectal-colonic 
alimentation. 

The  patient,  a  female,  aged  ^d,  unmarried,  and 
a  seamstress  by  occupation,  came  under  my  ob- 
servation October  i,  1879,  with  ^^'hat  was  supposed 
to  be  gastric  ulcer.  She  stated  that  she  had  always 
been  stout  and  healthy,  with  the  exception  of  a 
general  peritonitis,  which  she  had  two  years  ago. 
Her  weight  when  in  health  was  about  160  lbs. 

The  present  trouble  began  eight  months  ago  with 
nausea  and  vomiting   after  eating;   at  times  she 


14! 


THE    CANADA    MKDICAL    RECORD. 


vomited  a  little  blood.  The  vomiting  had  in- 
creased so  much  that  for  the  last  two  months  it  had 
been  almost  continuous,  being  excited  by  the  in- 
gestion of  food.  She  knew  of  no  cause  for  her 
ailment.  She  had  been  from  the  first  under  medi- 
cal care,  but  had  derived  no  benefit.  Almost  all 
the  remedies  in  the  materia  medica  employed  for 
that  purpose  had  been  used  to  check  her  vomiting, 
but  without  avail — ipecac,  opium,  pepsin,  bismuth, 
soda,  oxalate  of  cerium,  hydrocyanic  acid,  euca- 
lyptus, carbolic  acid,  calomel,  salicylic  acid,  nitrate 
of  silver,  Carlsbad  water,  ice,  etc.  She  was  gra- 
dually getting  worse,  having  lost  twenty-five 
pounds  since  the  inception  of  the  trouble,  and  the 
vomiting  still  increasing. 

When  she  came  under  observation  she  was  ema- 
ciated and  feeble  ;  had  not  had  her  menses  since 
July  last ;  bowels  constipated ;  vomited  everything 
shortly  after  being  ingested,  not  being  able  to  retain 
either  solid  or  fluid  food,  although  coarse  and  solid 
food  gave  her  more  distress  than  fluid  ;  threw  up  a 
little  blood  three  or  four  times.  Always  felt  relieved 
after  emesis  had  taken  place.  Complained  of  ten- 
derness, confined  to  the  centre  of  the  epigastric 
region,  and  a  burning  pain  (coming  on  soon  after 
eating)  in  the  same  location.  At  times  she  would 
complain  of  a  dorsal  pain  or  cardialgia.  No  tumor 
was  felt  through  the  abdominal  walls.  The  diag- 
nosis of  gastric  ulcer  was  founded  on  the  following 
symptoms  :  great  tenderness  at  a  localized  point 
in  the  epigastrium ;  a  burning  pain  in  the  same 
location ;  vomiting  of  both  solid  and  liquid  food, 
and  always  experiencing  relief  after  emesis.  As  the 
nausea  and  vomiting  was  more  severe  in  an  hour 
or  so  after  eating,  it  seemed  to  point  to  the  pyloric 
end  of  the  stomach  as  the  seat  of  the  disease. 

She  was  given  a  liquid  diet  consisting  of  milk 
with  lime-water  and  beef-tea,  occasionally  chewing 
rare  pieces  of  beef  and  swallowing  the  juice.     To 
control   the  vomiting,   powders  of    subnitrate   of 
bismuth    and   morphia  were  administered.     This 
plan  of  treatment  was  kept  up  for  five  days  with- 
out any  beneficial  result,  the  milk  being  thrown  off 
as   well  as  the  beef-tea.     Various  remedies  were 
then  tried,  but  still  she  vomited  and  retched  until 
everything  was  thrown  off  her  stomach—  even  bile, 
blood,  and  mucus  being  expelled.     A  whitish  dis- 
charge which   had  been   vomited  occasionally  was 
examined  microscopically,  and  found  to  consist  of 
squamous  epithelium  and  blood-corpuscles,  with 
mucus  and  extraneous  matter.     She  was  then  put 
on   enemata   of  milk,  beef-tea,   and   defibrinated 
blood.     Ice,  soda,  and  subcarbonate  of  bismuth  in 
twenty    grain    doses,    with    blistering    over    the 
stomach,  were  all  employed  to  relieve  the  retching, 
but  with  no  amelioration.     In  fact,  all  the  symp- 
toms were  aggravated.     The  burning   pain    was 
getting  more  intense,  the  tenderness  and  vomiting 
increasing,  and   now  insatiable   thirst   tormented 
her,  but  everything  she  took  to  relieve   this  only 
aggravated  the  emesis.     As  a  last  resort,  ingluvin 
was   employed,  to  be   given  three   times  a  day. 
Within  a  week  she  felt  better.     The  vomiting  was 
greatly  relieved,  now  occurring  but  twice  a  day. 


whereas  formerly  it  was  almost  continuous.  The 
burning,  gnawing  pain  was  gradually  eased.  Im- 
provement rapidly  progressed  ;  in  ten  days  the 
vomiting  had  entirely  disappeared,  the  tenderness 
and  burning  diminishing.  The  enemata  were  now 
discontinued  (having  been  used  three  months). 
The  patient  got  out  of  bed,  and  thereafter  ate 
three  meals  a  day  without  any  inconvenience. 
She  began  immediately  to  gain  flesh,  and  her 
menses  again  appeared.  Shortly  after  she  went 
home  in  excellent  condition,  with  the  ulcer  pro- 
bably cicatrized. 

As  mentioned  above,  this  case  is  interesting, 
partly  on  account  of  the  long-continued  use  of 
rectal  injections,  showing  the  value  of  them  in  pro- 
longing and  saving  life.  They  are  of  service  after 
operations  on  and  in  diseases  of  the  tongue, 
pharynx,  oesophagus,  and  stomach  ;  after  removal 
of  cancer  of  the  tongue,  of  tumors  of  the  jaw,  and 
in  cases  of  diphtheria,  tumors  of  the  pharynx, 
stricture  or  obstruction  in  the  oesophagus,  tumors 
of  the  larynx,  pressing  upon  the  oesophagus,  or  in 
any  disease  interfering  with  deglutition  ;  also  in 
cancer  or  ulcer  of  the  stomach,  gastritis,  and  in 
marasmus  of  children.  Of  the  latter,  Dr.  G.  M. 
Smith,  of  this  city,  had  a  case,  the  subject  of  which 
was  a  little  girl  in  a  deplorable  condition.  She 
was  supported  entirely  by  rectal  injections,  until 
gradually  she  was  restored  to  perfect  health. 

These  injections  may  be  used  almost  without 
limit,  although  there  is  a  prejudice  against  them 
on  the  part  of  the  patient.  Dr.  Austin  Flint,  in 
his  "  Practice  of  Medicine,"  mentions  three  cases 
which  were  supported  by  nutritious  enemata. 
The  first  was  sustained  three  weeks,  the  second 
one  month,  and  the  third  and  longest  three  months. 
— iVew  York  Medical  Record. 


Why   We  Eat    Oysters  R.\w. — Dr.    William 
Roberts,  in  his  interesting  lectures  on  the  digestive 
ferments,  states  that  our  practice  in  regard  to  the 
oyster  is  quite  exceptional,  and  furnishes  a  striking 
example  of  a  general  correctness  of  the  popular 
judgment   on  dietetic  questions.     The  oyster    is 
almost  the   only  animal  substance   which  we  eat 
habitually  and  by  preference,  in  the    raw  or  un- 
cooked state  ;  and   it  is  interesting  to  know  that 
there  is  a  sound  physiological  reason  at  the  bottom 
of  this  preference.     The  fawn  colored  mass  which 
constitutes  the  dainty  of  the  oyster  is  its  liver,  and 
this  is  little  else  than  a  heap  of  glycogen.  Associated 
with  the  glycogen,  but  withheld  from  actual  contact 
with  it  during  life,  is  its  approjiriate  digestive  fer- 
ment— the  hepatic  diastase.     The  mere  crushing 
of  the  dainty  between  the  teeth  brings  these  two 
bodies    together,    and  the    glycogen   is    at  once 
digested  without  other  help  by   its  own  diastase. 
The    oyster   in   the   uncooked    state,   or    merely 
warmed,  is,  in  fact,  self-digestive.     But  the  advan- 
tage of  this  provision  is  wholly  lost  by  cooking,  for 
the  heat  employed  immediately  destroys  the  asso- 
ciated ferment,    and  a   cooked  oyster  has  to  be 
digested,  like  any  other  food,  by  the  eater's  own 
digestive  powers. — J^ondon  Medical  Record, 


THE    CANADA    MEDICAL    RECORD. 


143 


ICE   TO    THE    ABDOMEN    IN    TYPHOID 

FEVER. 

At  a  recent  seance  of  the  Societe  Medicale  des 
Hopitaux,  M.  Labbe  called  attention  to  the  effi- 
cacy of  ice  applications  to  the  abdomen  in  typhoid 
fever,  complicated  or  not.  He  related  the  case 
of  a  young  girl  attacked  with  typhoid,  whose 
temperature  exceeded  104°.  and  who  appeared  at 
the  last  extremity,  who,  under  the  influence  of  this 
treatment,  was  perfectly  cured.  M.  Labbe  claims 
for  this  procedure  a  considerable  lowering  of  the 
temperature  and  a  notable  amelioration  of  all  the 
other  symptoms. 


The  Canada  Medical  Record, 

SI  i«ontJ)Ii»  Sournal  of  ittcOtciJic  aiiir  iSIjarmac)) 

HDITOK,  : 
FKANCIS  W.  CAMPBELL,  MA.,  M.D.,L.K.C. I  .LOND 

ASSISTANT  SDITOKB  : 

R.  A.  KENNEDY,  M.A.,  M.D. 

JAMES  PEERIGO,  M.D.,  M.R.C.S.  Eng. 

KDITOK  OF  PHABMACEDTICAL  DEPARTMENT: 

ALEX.  H.  KOLLMYER,  M.A.,  M.D. 

SUBSCRIPTION  TWO  DOLLARB  PER  ANMM  . 

Afl  communications  and  Exchavgei  must  be  addressed  to 
the  Editor,  Drawer  3o6,  Post  Office,  Montreal. 

MONTREAL.  FEBRUARY,  188L 

Look  at  your  address  labels,  and  pay  up  if  you 
are  in  arrears. 


At  a  late  meeting  of  the  Medico-Chirurgical 
Society,  Dr.  Hingston  mentioned  a  case  of  very 
rare  occurrence.  In  May,  1867,  he  had  been  called 
by  the  late  Dr.  .Smallwood  to  see  a  French  Cana- 
dian lady,  then  aged  63  years,  the  subject  of  a  large 
ovarian  tumour.  He  proposed  ovariotomy,  but 
the  patient  declined,  but  consented  to  emptying 
the  cyst.  This  was  first  done  on  13th  May,  1867  '> 
the  quantity  removed  was  four  gallons.  From  that 
date  to  the  loth  March,  1876,  the  operation  was 
repeated  forty-three  times,  with  an  average  of  four 
gallons  each  time.  From  March,  1876,  to  .-August, 
1880,  she  was  not  operated'upon  ;  on  13th  August, 
1880,3^  gallons  were  removed,  and  on  25th  Janu- 
ary, 1 88 1,  the  last  time,  six  gallons  were  removed. 
She  died  from  an  attack  of  indigestion,  after  eating 
a  very  hearty  supper,  on  30th  January,  at  the  age 
of  81  years.  The  patient  continued  in  perfect  health 
until  the  day  of  her  sudden  death,  and  was  able  to 
walk  several  miles.  The  total  number  of  operations 
was  46,  and  the  quantity  removed  was  186  gallons. 


Three  smaller  cysts,  Aveighing  in  all  about  20 
pounds,  and  which  had  grown  within  the  past  three 
years,  were  not  interfered  with. 


At  the  recent  meeting  of  the  Medico-Chirurgical 
Society  of  Montreal,  Dr.  Bessey  presented  for 
final  inspection  the  case  of  Psoriasis  Lepraformis 
of  18  years'  standing,  treated  solely  by  bovine 
vaccination.  The  patient  appeared  to  be  perfectly 
cured,  the  disease  having  entirely  disappeared, 
traces  in  the  form  of  skin  marks  only  remaining  of 
what  was  at  first  a  most  inveterate  and  disagreeable 
looking  case.  The  patient  expressed  herself  well- 
pleased  with  the  result. 

By  the  result  of  this  case  Dr.  Bessey  has  estab- 
lished the  value  of  vaccination  as  a  valuable  agent 
in  the  treatment  of  chronic  skin  diseases. 

LAWTON'S  ABSORBENT  COTTON. 

Upon  the  first  introduction,  a  year  or  two  since,  of 
absorbent  cotton,  the  new  article  attracted  much 
attention,  and  was  eagerly  received,  especially  by 
Surgeons  and  Gynaecologists.  It  was  found  to 
answer  admirably  many  of  the  purposes  for  which 
patent  lint  was  formerly  employed,  in  the  dressing 
of  wounds,  in  applying  medicated  lotions,  in  soaking 
up  discharges,  etc.,  etc. 

By  soaking  the  absorbent  cotton  in  medicated 
solutions,  and  subsequently  drying  it,  we  may . 
obtain  the  effects  of  many  local  remedies.  Thus 
we  may,  by  using  carbolic,  boracic  or  salicylic  acid, 
or  Labarraque's  solution,  make  it  antiseptic.  By 
saturating  it  with  astringents,  we  may  give  it  this 
property  in  any  degree,  even  carrying  it  so  far  as  to 
obtain  a  most  powerful  styptic.  The  article  fur- 
nished by  Wyeth  of  Philadelphia  will  be  found  very 
fine,  on  account  of  the  facilities  they  possess  for 
the  manufacture,  and  the  care  taken  at  every  step 
of  the  process. 


"The  Medical  Faculty  in  Missouri  are  taking 
measures  to  rid  the  state  of  Quacks,  with  whom 
it  is  over-run." 

"  Three  bills  have  been  prepared  for  legislative 
action — one  providing  for  the  creation  of  a  state 
board  of  health  ;  another  for  regulating  the  prac- 
tice of  medicine,  and  the  third  for  the  registra- 
tion of  births,  deaths  and  marriages." 

"Owing  to  the  enactment  of  stringent  laws 
regulating  medical  practice  in  Illinois  and  Kansas, 
Missouri  has  been  crushed  with  9.n  immigration 


144 


THE    CANADA    MEDICAL    RECORD. 


"  of  irregulars,  which  she  now    finds    it  expedient 
"  to  get  rid  of." 

{Frank    Leslie  s    Illustrated    Paper,  February 
5th,  1881). 


ADMINISTRATION   OF   ERGOT   IN 
LABOR. 

A  writer  in  the  Dublin  Journal  of  Medical 
Science  remarks  that  there  is  no  doubt  that  the 
judicious  administration  of  ergot  will  often  save  a 
woman  from  the  necessity  of  a  forceps  delivery. 
If  there  is  reason  to  fear  postpartum  haemorrhage, 
ergot  should  be  given  always  before  the  child  is 
bom.  The  fifteen  to  thirty  minim  range  of  the 
Pharmacopaeial  liquid  extract  is  practically  useless, 
but  there  is  a  limit  to  the  dose  which  it  is  desir- 
able to  give.  Two  fluid  drams  may  be  cited  as  a 
maximum,  but  occasionally  it  is  justifiable  to  re- 
peat this  quantity.  Ergot  should  never  be  admin- 
istered until  the  labor  is  so  far  advanced  that  it 
could,  if  necessary,  be  easily  finished  with  forceps. 
In  cases  where  tonic  uterine  contraction  follows, 
threatening  the  life  of  the  child,  but  not  terminating 
the  labor,  recourse  may  then  be  had  to  the  for- 
ceps. If  the  placenta  should  happen  to  be  mor 
bidly  adherent,  the  danger  of  the  complication 
may  be  greatly  augmented  by  postpartum  increased 
uterine  contraction,  due  to  the  influence  of  the 
ergot  administered. 


Small-pox  has  broken  out  in  the  Fort  Madison 
penitentiary,  lona,  creating  great  excitement  and 
panic. 

Diphtheria  and  small-pox  are  said  to  be  increas- 
ing in  Chicago,  and  a  case  has  been  discovered  in 
a  tenement  house  there  where  six  persons  had  the 
latter  di.sease,  and  were  without  medical  attendance 
for  five  days. 


William  Dewart,  of  Rochester,  N.Y.,  has 
patented  a  device  for  ventilating  houses,  by  using 
the  well-known  facts  that  plants  give  offozone  and 
oxygen,  and  absorb  and  use  carbonic  acid  in  their 
growth.  His  invention  consists  of  a  small  conser- 
vatory, from  which  pipes  issue  to  every  room  of 
the  house,  intended  to  convey  the  necessary 
oxygen. 


Dr.  McLaren,  of  Edinburgh,  Scotland,  states  that 
the  types  of  insanity  have  changed  with  modern 
times,     For  instance,  acute  delirious  mania  is  now 


comparatively  rare,  but  mental  enfeeblement, 
attended  with  paralysis,  is  becoming  more  and 
more  common,  and  is  the  result  of  the  over-work 
and  worry  of  the  struggle  for  existence  at  the 
present  day. 


Dr.  Wilkins,  Professor  of  Physiology  and  Patho- 
logy, University  of  Bishop's  College,  has  been  ap- 
pointed examiner  in  these  subjects  at  the  Univer- 
sity of  Toronto. 


We  direct  attention  to  the  advertisements  re- 
garding the  preliminary  examination  of  the  College 
of  Physicians  and  Surgeons  of  Quebec,  and  the 
half-yearly  meeting  of  the  Governors. 


OBITUARY. 

We  record  with  much  regret  this  month  the 
death  of  Dr.  Robert  F.  Godfrey,  of  Montreal,  son 
of  our  much  respected  confrere.  Dr.  Robert  T. 
Godfrey.  The  deceased  began  his  medical  studies 
at  McGill  University,  concluding  them  at  the 
University  of  Bishop's  College,  from  which  Uni- 
versity he  graduated  with  honors  in  1873.  He 
commenced  the  practice  of  his  profession  and  bid 
fair  soon  to  have  around  him  an  extensive  practice 
but  failing  health  warned  him  to  desist.  He  pro- 
ceeded to  Colorado,  where  he  remained  some 
time  ;  returning  he  occupied  a  farm  in  a  beautiful 
section  of  the  Eastern  Townships,  devoting  him- 
self to  agricultural  pursuits.  All  was  unavailing, 
the  disease,  phthisis,  continued  its  onward  pro- 
gress, and  he  returned  to  the  parental  roof,  where, 
surrounded  by  his  friends,  he  passed  to  his  rest  at 
the  early  age  of  30  years.  Young  Dr.  Godfrey 
was  a  man  of  singularly  amiable  disposition,  and 
among  his  college  mates  was  a  universal  favorite. 
His  abilities  were  of  a  high  order,  and  had  life  and 
strength  been  spared  to  him  he  would  have  made 
his  mark  as  a  medical  man.  We  extend  to  his 
parents  our  deep  sympathy. 

January  28th,  1881,  at  Richmond,  Virginia,  Dr. 
Henry  S- Jaynes,  LL.D.,  aged  62  years,  one  of 
the  most  prominent  physicians  in  Virginia,  and  a 
large  contributor  to  professional  literature. 

Dr.  Alva  Curtis,  of  Cincinnati,  aged  83,  on  25th 
January,  1 88 1. 


DIED. 


In  Montreal,  on  the  24th   February,  Robert  F.  CJodfrey, 
C,M.,  M.D.,  aged  jo  years, 


THE  CANADA  MEDICAL  RECORD. 


Vol.  IX. 


MONTREAL,  MARCH,  1881. 


No.  6. 


C  OlsTTEHSTTS. 


ORIGINAL  COMMUNICATIONS. 


Some  Ri  marks  on  "  Haeckel  on  the 
EvoiuMon  ot  Man,"  and  on  so-called 
Blood-Poisoning 145 

j 

PROGRESS  OF  MEDICAL  SCI ENCe| 

tment     ot  Seminal     Emissions,     j 
4 — On  the  Treatment  ot  Tuber- 


cular Consumption,  155 — Aids  to 
^Diseases  of  Women,  158— The  Treat- 
ment of  Post-Nasal  Catarrh,  161  — 
Tooth-caries  of  Pregnancy,  163 — 
Treatment  of  Scarlatina  in  Child- 
ren, 164— The  Treatment  of  Ranula, 
165 — Treatment  of  Glandular  Sore 

Throat 165 

EDITORIAL. 
Proposed  Protestant  Lunatic  Asylum, 


166— Wyeth's  Fluid  Extract  of 
Ergot,  167 — College  of  Physicians 
and  Surgeons,  P.  Q.,  167 — Prelimi- 
nary Examination  College  Physi- 
cians and  Surgeons,  P.  Q.,  167 — 
Personal,  167 — A  Novel  Prescrip- 
tion, 167 — Annual  Report  of  the 
Woman's  Hospital  of  the  City  of 
Montreal,  167— Died 168 


0r44mui  Bo'mmimimUon& . 


SOME  REMARKS  ON  "  HAECKEL  ON  THE 
EVOLUTION  OF  MAN,"  AND  ON  SO- 
CALLED  BLOOD-POISONING. 

By  Henry  Howard,  M.D.,  M.R.C.S.  Eng. 

Read  before   the  Medico-Chirurgical  Society  of    Montreal 
January  2ist,  i88i. 

Mr.  President  and  Gentlemen, — A  few  weeks 
after  I  had  read  my  paper  on  Man's  Two  Natures 
and  Evolution,  a  friend  loaned  me  the  last  edition 
of  •'  Haeckelon  the  Evolution  of  Man."  It  is  hardly 
necessary  for  me  to  say  that  I  found  it  to  be  just 
such  a  profound  and  learned  work  as  we  would 
expect  from  such  a  naturalist. 

The  great  object  of  the  writer  seems  to  have 
been  to  prove  the  truth  of  the  Darwinian  theory 
of  evolution.  I  need  not  tell  those  who  heard,  or 
read,  my  previous  lecture  that,  as  to  the  simple 
question  of  the  modus  operandi  by  which  God 
created  man,  I  am  entirely  in  accord  with  Mr. 
Haeckel,  that  is,  that  God,  by  his  natural  laws, 
evolved  an  ovum  from  the  earth,  from  which  ovum 
man  was  evolved,  in  virtue  of  the  potentiality  or 
latent  power  existing  in  all  matter;  (Mr.  Haecke 
calls  it  an  atom),  and  I  based  my  theory  upon 
the  fact  that,  as  the  whole  human  race  is  evolved 
fromovums,  so  is  it  the  most  probable  way  by 
which  God  called    into  existence  the  first  man. 


I  don't,  however,  consider  because  that  I  accept 
the  theory  as  true  ^of  man  being  evolved  from 
an  ovum,  that  I  am  bound  to  accept  Mr.  Haeckel's 
conclusions,  that  the  last  act  of  evolution  was  for 
man  to  be  evolved  from  an  ape  ;  not,  as  I  have 
heretofore  stated,  that,  if  such  were  the  case,  do 
I  consider  it  would  take  anything  from  God's 
honor  and  glory,  or  make  man  anything  more  or 
less  than  what  he  is,  the  highest  order  of  animal, 
and  rendered  human  because  God  endowed  him 
with  a  human  nature. 

And  most  certainly  I  am  in  no  way  bound  to 
accept  Mr.  Haeckel's  conclusion  that,  because  there 
are  natural  laws,  God  did  not  create  them,  or  that 
they  were  not  his  established  laws,  by  which  he 
created  all  things.  I  see  no  proof,  but  the  contrary, 
that  anything  happens  by  chance  or  accident,  or 
that  there  can  be  effect  without  cause.  What  men 
call  accident  is  simply  natural  laws.  Fish  cast 
their  ovums  upon  the  sea,  but  the  male  and  female 
cells  don't  come  together  by  chance,  but  by  what 
Mivart  calls  an  innate  law  modified  by  the  sub- 
ordinate action  of  natural  selection,  so  that  but  few 
of  the  many  female  ovums  are  fertilized  ;  and  in 
this  nature  shows  her  wisdom,  for  naturalists  tell 
us  that,  if  all  the  fish  ovums  were  fertilized,  there 
would  not  be  room  in  the  sea  for  all  the  fish  that 
would  be  propagated,  notwithstanding  the  number 
of  young  fish  that  perish  by  becoming  food  f  r 
others. 

And  let  us  see  how  perfect  is  the  law  of  nature 


146 


THE    CANADA    MEDICAL    RECORD. 


with  regard  to  the  procreation  of  man.  Rarely  is 
there  more  tlian  one  female  ovum  fertilized  by  the 
male  sperm  cell,  and  why  is  this?  but  simply  for  the 
protection  of  the  mother,  for  in  the  woman  the 
evolution  from  the  fertilized  ovum  to  the  perfect 
child  takes  place  in  the  uterus  and  within  the 
abdominal  cavity,  and  whenever  there  happens  to 
bean  exception  to  this  rule,  and  there  is  a  plurality 
of  fertilized  ovums,  nature,  as  it  were  to  be  revenged, 
either  destroys  the  mother  or  part  of  the  offspring. 
Here  then  again  we  observe  the  natural  law  of  selec- 
tion ;  one  ovum  is  fertilized,  the  others  peri.sh. 

It  is  different,  however,  with  fouls  whose  off- 
spring are  evolved  outside  the  uterus,  and  outside 
of  the  abdomen.  Wild  fowls,  as  a  rule,  only  lay  a 
certain  number  of  ovums  for  the  purpose  of  pro- 
creation, and  as  their  young  all  come  out  on  or  about 
the  same  time  we  have  a  right  to  suppose  that  all  of 
the  female  ovums  are  incubated  by  the  male  sperm 
cell  at  one  and  the  same  time.  If  this  were  not 
the  case,  the  first  laid  egg  would  produce  its  young 
before  the  last  laid  egg,  five  or  six  days  according 
to  the  number  of  eggs,  which  would  be  very 
inconvenient  to  the  parent  fowl,  and  in  some  degree 
dangerous  to  the  life  of  her  young. 

We  know  that  these  fowls  hatch  their  eggs  for 
a  certain  number  of  days,  but  the  commencement 
of  the  existence  of  the  new  creature  is  from  the 
very  moment  that  the  cell  of  the  female  ovum  is 
fertilized  by  the  cell  of  the  male  sperm  ;  therefore, 
if  the  different  female  ovums  were  fertilized  at 
different  periods  of  time,  we  would  naturally  expect 
that  there  would  be  just  that  time  between  what 
we  might  call  the  birth  of  each  of  the  young. 

Let  us  suppose,  then,  a  wild  water  fowl,  say  a 
duck,  lays  twelve  eggs,  one  each  day  ;  if  all  these 
ovums  were  not  incubated  at  the  same  time, 
there  should  be  a  difference  of  twelve  days  between 
the  appearance  of  the  first  and  last  duckling,  so 
that  the  first  duckling  would  starve  before  the  last 
made  its  appearance,  for  while  one  remained  in  the 
shell  the  mother  would  not  forsake  her  nest.  This 
fertilization,  or  incubation,  of  many  ovums  at  the 
same  time  is  the  natural  law  where  the  young  are 
reproduced  outside  of  the  abdominal  cavity  ;  for 
example,  it  is  a  well-known  fact  to  naturalists  that 
the  queen  bee  leaves  the  hive  six  days  after  her 
birth  for  the  act  of  copulation,  when  she  is  fecun- 
dated for  her  lifetime,  which  lasts  about  three 
years,  and  in  the  height  of  her  season  she  will  lay 
three  thousand  eggs  in  twenty-four  hours,  all  of 
which  reproduce.     These  naturalists  who  give  us 


this  information  add  that,  as  soon  as  the  drone  or 
male  bee  fertilizes  the  queen,  it  immediately  dies. 
We  can  understand  this  when  we  remember  that 
the  male  or  drone  neither  works  nor  makes  honey 
like  the  working  bee,  and  that  he  only  exists  for  the 
one  single  purpose  of  procreation,  and  when  he 
performs  that  act  his  usefulness  is  finished.  For 
him  to  live  would  simply  be  to  be  a  burthen  to  his 
community,  so  nature  kills  him  off  when  his  work 
is  done.  Does  nature  do  the  same  with  the 
placenta  mammalia?  Let  us  hope  so,  let  us  hope 
that  none  live  longer  than  is  necessary  for  the 
accomplishing  of  their  work. 

But,  you  may  ask,  why  is  it  not  with  the  domestic 
fowls  as  with  the  wild  fowls,  the  chick,  for  example, 
that  lays  a  greater  number  ©f  eggs  than  she  can 
possibly  hatch  ?  First,  because  that  we  have  forced 
the  hen  to  break  natural  laws  to  provide  ourselves, 
with  food.  But,  notwithstanding  this,  we  find  that 
after  the  hen  has  rejected  a  certain  number  of 
ovums  she  determines  to  hatch  her  eggs  and  bring 
forth  her  young,  and  the  careful  guardian  of  the 
hen,  from  the  notice  she  gives,  will  save  up  a 
certain  number  of  her  last  eggs,  and  set  them,  and 
in  doing  so  will  be  sure  to  be  recompensed  by  a 
full  clutch  of  healthy  chicks  ;  whereas  the  guardian 
who  does  not  observe  these  natural  laws,  but  pur- 
chases eggs  in  the  market  or  elsewhere,  and  sets 
them  under  the  sitting  hen,  with  the  impression  that 
that  is  all  he  has  to  do  to  secure  a  clutch  of  chicks 
finds  himself  grievously  disappointed  and  out  in 
his  calculation,  so  that  we  see  one  farmer  having  a 
hen  with  twelve  chicks,  another  with  a  hen  and 
two,  or  even  one  ;  so  we  can  easily  see  who  is  the 
intelligent  farmer,  in  the  very  number  of  his  barn- 
door fowls.  And  I  have  learned  lately  from  good 
authority  that  fowls  that  get  their  food  too  easily — 
those  fowls  that  don't  work  for  their  food  that  their 
eggs  when  set  don't  bring  forth  chicks,  consequent- 
ly there  is  a  custom  now  amongst  those  who  keep 
fowls  to  throw  the  grain  amongst  straw,  or  sand  to 
compel  the  fowls  to  scratch  for  and  search  for  their 
food.  I  can  only  explain  this  seemingly  extraor- 
dinary foct  on  the  physiological  supposition  that  the 
production  of  healthy  semen  in  the  male  and  ovula- 
tion in  the  female  is  dependent  upon  the  spinal 
cord,  and  that  this  scratching  labour  of  the  fowls  is, 
through  the  sensory  nerves,  a  stimulus  to  the  spinal 
cord,  which  reacts  upon  the  male  and  female  organs 
of  generation,  through  their  special  nerves.  You 
may  say  that  art  has  found  a  means  of  hatching 
the  eggs.     Yes,  but  art  or  the  hen  herself  will  not 


THE   CANADA    MEDICAL    RECORD. 


147 


produce  a  chick  from  an  egg  that  has  not  in 
it  the  male  and  female  cell.  There  may  be  some 
excuse  for  Mr.  Haeckel,  but,  for  the  sake  of  scien- 
tific truth,  it  is  a  great  pity  that  he  should  have 
gone  out  of  his  way  to  attack  religion.  In  so  doing 
he  has  not  only  done  an  injury  to  science,  but  he 
has  not  done  justice  to  himself  as  a  man,  in  that 
he  has  shown  his  profound  ignorance  of  the  mat- 
ter he  wrote  on. 

In  Vol.  I,  page  169,  speaking  of  sudden  vari- 
ations in  animals  he  says  :  "  This  is  equally  true 
of  individual  and  phlyctic  evolution.  This  is  also 
the  explanation  of  a  process  of  evolution  which, 
above  all  others,  is  usually  put  under  mystical  veil 
as  though  it  were  a  supernatural  wonder,  this  is  thg 
process  of  fertilization  or  sexual  generation.  In 
all  the  higher  plants  and  animals  this  constitutes 
the  first  act  in  which  the  evolution  of  the  new 
individual  begins.  But  it  must  be  noted  here  that 
this  important  process  is  by  no  means  as  univer- 
sally distributed  throughout  the  animal  and  vege- 
table world  as  is  commonly  supposed  ;  on  the  con. 
trary,  there  are  very  many  low  organisms  which 
always  multiply  assexually,  the  aemeba,  etc.  In  these 
cases  there  is  no  form  of  impregnation,  the  multi- 
plication of  individuals  and  the  preservation  of 
species  depend  here  simply  on  assexual  generation 
under  the  form  of  fission,  propagation  by  buds  or  by 
germ-cells  ;  on  the  other  hand,  in  the  case  of  ah 
higher  plant  and  animal  organisms,  sexual  propa- 
gation is  the  general  law  and  assexual  generation 
never,  or  but  seldom,  occurs  ;  among  vertebrates  in 
particular,  '  virginal  generation '  (Parthenogene. 
sis)  never  occurs.  This  we  must  explicitly  affirm 
in  the  face  of  the  celebrated  doctrine  of  the  im- 
maculate conception.  Immaculate  conception  has 
never  been  observed  either  in  man  or  any  other 
vertebrate." 

I  have  not  read  for  you  this  quotation  simply 
for  the  sake  of  explaining  to  you  the  dogma  of  the 
immaculate  conception,  but  to  show  you  that  even 
so  clever  a  naturalise  as  Mr.  Haeckel,  when  he 
allows  his  reason  and  judgment  to  be  clouded  by 
prejudice  and  fanaticism,  will  write  the  most  absurd 
and  ridiculous  folly.  Mr.  Haeckel,  or  any  othe^ 
man,  if  he  so  pleases,  has  a  perfect  right  to  pro- 
test against  this  dogma  or  any  other  religious 
dogma,  but  then  he  should  know  what  he  is  writ- 
ing about,  and  not  leave  it  in  the  power  of  any 
school-boy  to  show  he  did  not.  Mr.  Haeckel 
assumed  that  the  dogma  meant  that  the  Blessed 
Virgin  Mary  had  no   father,  but   was   procreated 


assexually  by  her  mother.  Never  was  there  such 
an  absurdity.  The  dogma  simply  means  that  God 
exempted  her  from  the  stain  of  original  sin  that 
she  might  be  an  immaculate  mother  for  Christ, 
who  was  to  obtain,  through  her.  His  human  nature. 
As  I  have  already  said,  I  have  only  drawn  your 
attention  to  this  absurd  statement  of  Haeckel's  to 
show  you  what  a  dangerous  thing  is  prejudice, 
and  how  it  will  blind  otherwise  wise  and  well-mean- 
ing men,  making  them  state  the  most  unfounded 
falsehoods  with  unblushing  effrontery.  Such  men 
never  can  learn  from  nature  her  great  truths  which 
she  so  willingly  unfolds  to  those  who  humbly  seek 
for  truth  for  truth's  sake. 

Mr.  Haeckel  avows  himself  an  atheist :  if  he  be 
such,  which  I  very  much  doubt,  I  am  sorry  for 
him  ;  it  is  however  his  own  affair,  not  mine.  I  am 
not  afraid  that  God  will  hold  me  responsible  for 
the  religion  or  non-religion  of  Mr.  Haeckel,  and, 
seeing  that  I  claim  the  right  to  my  own  religious 
opinions,  why,  I  let  Mr.  Haeckel  hold  his.  But, 
for  the  sake  of  science,  I  regret  that  he  should  con- 
sider it  necessary  to  make  such  a  declaration,  for 
by  so  doing  he  has  put  a  weapon  into  the  hands 
of  the  bigots  and  fanatics,  who  try  to  impress,  all 
who  will  listen  to  them,  with  the  false  idea  that  the 
Science  of  Evolution  leads  to  infidelity  and 
Atheism. 

It  is  very  possible  that  Mr.  Haeckel  is  so  con- 
stituted that  he  cannot  believe,  nay,  cannot  assent, 
to  anything  above  his  reason,  but  I  deny  he  is  an 
atheist  in  virtue  of  his  science  ;  but  in  spite  of  it, 
according  to  my  idea,  the  more  a  man  knows  of 
natural  science  the  nearer  is  he  to  the  Supernatu- 
ral Creator. 

Mr.  Haeckel  shows  us  by  his  beautiful  attested 
plates  taken  from  nature  that  in  the  early  period 
of  gestation  in  the  different  species  of  placental 
mammalia,  hog,  calf,  rabbit,  man,  it  is  impos- 
sible to  see  the  slightest  difference  between  the  dif- 
ferent embryo,  and,  as  I  said  in  my  former  paper, 
the  first  stage  resembles  more  a  small  worm  than 
anything  else,  then  a  fish,  then  a  fowl,  then  a 
quadruped,  and  finally  each  embryo  assumes  its 
own  peculiar  shape,  so  that  in  the  last  stage  of 
evolution  we  can  distinguish,  but  not  very  dis- 
tinctly, which  is  which.  We  distinguish  the  em- 
bryo of  the  woman,  however,  from  all  others, 
because  that  in  the  latter  stage  it  looses  its  tail,  an 
appendage  which  all  the  others  retain  even  after 
birth. 

I  have   been   told  that,  after  having  read  my 


148 


THE    CANADA    MEDICAL    RECORD. 


former  paper,  the  question  was  aslced  of  me,  which 
i  certainly  did    not   hear,   if  that   Adam   had  an 
umbilHcus.     If  he  was  evolved  I  would  say  he  had, 
because  in  all  placental  mammalia  there  must  be  a 
placental  circulation  before  a  breathing  one  ;  if  he 
was  not  evolved,  but  made  after  the  manner  that  the 
image  maker  makes  images,  primary  creation,  which 
I  believe  is  the    theory  held  by  many,  creation 
of  substantial  form,  then  an  umbillicus  would  not 
be  necessary,  although  he  might  have  one.     As  I 
conceive  he  was  evolved  from  an  ovum,  I  believe 
that  like  unto  his  offspring  he  had  an  umbillicus ; 
no  man,  however,  knows  positively,  or  perhaps 
ever  will  know,  how  God  created  the  first  man, 
that  is,  the  modus  operandihy  which  he  was  made, 
therefore  it   is  a   lawful   subject    for    discussion. 
Evolution  appears  to    me    the    more    reasonable 
theory,  because  it  is   in  accordance  with  existing 
natural  laws  ;  the  question  to  me,  howe  ver,  is  only 
interesting  as  bearing  on  the  s  cience  of  develop- 
ment, and  fortunately   we  have  not  to  go   back 
to  the  first  man  for  that,  seeing  that  we  who  are 
procreated  attain  all  our  animal  and    vegetative 
organs  by  the  process  of  evolution,  and  that  this 
evolution  is  taking  place   in  us  all  as  long  as  we 
have  a  living  existence.     Indeed,  evolution  con- 
tinues in  our  material  bodies  even  after  death,  for 
that  which  once  is  may  undergo  change,  but  cannot 
be  annihilated  ;  it  always  remains  in  one  form  or 
another,  always    perpetual    evolution.       As    Dr. 
Buckniil,  in  his  criticism  of  M  ickle  on  the  General 
Paralysis  of  the  Insane,  says  :  "  We  may  reflect,  as 
Hamlet  did,  how  that  a  man  may  eat  of  the  fish, 
that  had   fed  of  that  worm,    that  had  eat  of    a 
king,  to  show   that  a  king  may  go  a    progress 
through  the  guts  of  a  beggar."     Not  a  very  choice 
but   a   very  expressive  expression,    proving    t  he 
indestructibility  of  matter,  and  continual  evolution. 

I  shall  now  quote  for  you  what  I  consider  the 
most  interesting  passages  of  Mr.  Haeckel's  work, 
interesting  because  the  most  practical ;  before  doing 
so,  however,  I  will  give  you  the  meaning  of  the 
many  terms  he  uses,  for  certainly  there  are  very 
many  of  them  by  no  means  familiar  terms,  or 
household  words  : 

"  Phlyciic,"  impregnation  by  the  male. 

"  Parthenogenesis,"  virginal  generation. 

"  Oniogony,''  germ  history. 

"  Biogony"  evolution  of  organisms,  life. 

"  Embryology"  germ  science. 

"  JViy/ogony"  tribal  history. 

"  Paiengencsii,'^  new  birth  inheritance. 


"  Morphology,"  science  of  forms. 

"  Physiology,"  science  of  the  functions  of  forms. 

'^Physiology,"    )  united,   forms   the  science  of 

''  Morphology,"  \     biology. 

"  Biology,"  the  science  of  organisms,  or  science 
of  life. 

I  confess  to  you  on  the  first  reading  of  Mr* 
Haeckel's  book  1  was  puzzled  as  to  the  meaning  of 
terms,  but  when,  I  came  to  comprehend  them,  I 
was  satisfied  that  each  term  represented  a 
science,  and,  moreover,  that  the  knowledge 
of  each  and  all  of  these  sciences  was  necessary 
to  the  perfect  comprehension  of  the  sciences  of 
anatomy,  physiology  and  pathology. 

Mr.  Haeckel,  after  giving  a  sketch  of  the  life  of 
Baer,  says  :  "  Baer  especially  perfected  the  fun' 
damental  theory  of  germ  layers  as  a  whole,  as  well 
as  in  detail,  so  clearly  and  completely  that  his 
dea  of  it  yet  forms  the  safest  basis  of  our  know- 
edge    of  ontogony. 

•'  He  showed  that  in  man  and  the  other  animals, 
as  in  the  chick — in  short  as  in  all  vertebrate? — first 
two,  and  then  four,  germ-layers  are  formed,  always 
in  the  same  manner,  and  that  the  modification  of 
these  into  tubes  gives  rise  to  the  first  fundamen- 
tal organs  of  the  body.  According  to  Baer  the  first 
rudiment  of  the  body  of  the  vertebrate,  as  it  ap- 
pears in  the  globular  }elk  of  the  fertilized  egg,  is 
an  oblong  disc,  which  first  separates  into  two  leaves 
or  layers.  From  the  upper  or  animal  layer  evolve 
all  the  organs  which  produce  the  phenomena  of 
animal  life  ;  the  functions  of  sensation,  of  motion 
and  the  covering  of  the  body.  From  the  lower  or 
vegetative  layer  proceed  all  the  organs  which 
bring  about  the  growth  of  the  body :  the  vital 
functions  of  nutrition,  digestion,  blood-making, 
breathing,  secretion,  reproduction,  and  the  like. 
Each  of  these  two  original  germ  layers  separates 
again  into  two  thinner  layers,  or  lamellae,  one 
lying  above  the  other.  First  the  animal  layer 
separates  into  two,  which  Baer  calls  the  skin  or 
dermal  layer,  and  the  flesh  or  muscular  layer.  From 
the  uppermost  of  these  two  lamella,  the  skin  layer, 
are  formed  the  outer  skin,  the  covering  of  the  body, 
and  the  central  nervous  system,  the  spinal  cords 
the  brain,  and  the  organs  of  sensation.  From  the 
lower,  or  flesh  layer,  the  muscles,  or  fleshy  parts, 
the  internal  or  bony  skeleton — in  short,  the  organ, 
of  motion — arise.  Secondly,  the  lower,  or  vegeta- 
tive, germ-layer,  parts  in  the  same  way  into  two 
lamellae,  which  Baer  distinguishes  as  the  vascular 
and  mucous  layer.     From  the  outer  of  the  two,  the 


THE   CANADA   MEDICAL    RECORD. 


149 


vascular  layer,  proceed  the  heart  and  the  blood- 
vessels, the  spleen,  and  other  so-called  blood-vessel 
glands,  the  kidneys  and  the  sexual  glands.  Finally? 
from  the  lowest  and  fourth,  or  mucous,  layer,  arises 
the  inner  alimentary  membrane  of  the  intestinal 
canal,  with  all  its  appendages,  liver,  lungs, 
salivary  glands.  Baer  traced  the  transformation 
of  these  four  secondary  germ-layers  into  tube" 
shaped  fundamental  organs  as  ingeniously  as 
he  had  successfully  determined  their  import  and 
their  formation  in  pairs  by  the  segmentation  of 
the  two  primary  germ-layers.  He  was  the  first  to 
solve  the  difficult  problem  as  to  the  process  by 
which  the  entirely  different  body  of  the  vertebrate 
developes  from  this  flat,  leaf-shaped,  four-layered 
original  germ,  the  process  was  the  transformation 
of  the  layers  into  tubes.  In  accordance  with  cer- 
tain laws  of  growth,  the  flat  layers  bend  and  be- 
come arched  ;  the  edges  grow  towards  each  other, 
so  that  the  distance  between  them  is  continually 
decreased ;  finally,  they  unite  at  the  point  o 
contact.  By  this  process  the  flat  intestinal  layer 
changes  into  a  hollow  intestinal  tube  ;  the  flat 
spinal  layer  becomes  a  hollow  spinal  tube ;  the 
skin  layer  becomes  a  skin  tube,  etc." 

Again,  speaking  of  Baer,  he  says  :  "  yet  the  ova  of 
man  and  other  mammals  were  not  actually  known 
till  the  yeir  1827,  for  the  egg  is  exc  eed 
small,  a  spherical  vesicle  or  bladder  of  only  one- 
tenth  of  a  line  in  diameter,  which  can  be  seen  with 
the  naked  eye  only  under  very  favourable  circum" 
stances.  This  spherical  vesicle,  when  in  the  ovary 
of  the  mother,  is  enclosed  in  a  number  of  peculiar 
spherical  vesicles  of  much  larger  size,  called  Graaf- 
fian  follicles,  after  their  discoverer  "  Graff,"  and 
these  were  formerly  universally  regarded  as  the 
actual  eggs.  It  was  not  until  the  year  1827,  not 
fifty  years  ago,  that  Baer  proved  that  these  Graaf- 
fian  follicles  are  not  the  actual  eggs,  which  are  much 
smaller,  and  only  imbedded  in  the  GraaflSan 
foUicles.  Baer  was  also  the  first  to  observe  the 
so-called  germinal  vesicle  of  mammals,  that  is,  the 
little  spherical  bladder  which  is  first  developed 
from   the   impregnated  and  the  thin  wall  of 

which  consists  of  a  single   layer  of  uniform  phylo- 
ginal  cells." 

"  Another  discovery  of  Baer's,  of  great  impor- 
tance in  understanding  the  types  of  the  lineage  of 
the  vertebrates  and  the  characteristic  organizations 
of  this  group  of  animals,  in  which  man  is  included, 
was  that  of  the  chorda  dorsalis.  This  is  a  long, 
thin, cylindrical,  cartilagenous  cord,   which  in  all 


vertebrates  passes  lengthwise  through  the  whole 
body  of  the  embryo.  It  is  developed  at  a  very 
early  stage,  and  is  the  first  formation  of  the  spine, 
the  firm  axis  of  vertebrates."  So  much  for  Baer.  I 
will  now  quote  Mr  Haeckel's  own  statements  on 
the  brain  of  the  mammalias.  He  says  "  Though 
in  general  features  of  growth  the  brain  of  the 
mammals  correspond  with  those  of  birds  and  rep- 
tiles, yet  striking  differences  very  soon  appear 
between  the  two.  In  birds  and  reptiles  the  mid 
brain  and  the  central  part  of  the  hind  brain  develop 
considerably.  In  mammals,  on  the  other  hand, 
these  parts  remain  small,  and,  instead,  the  fore-brain 
begins  to  grow  so  rapidly  that  it  covers  the  other 
bladders  from  in  front  and  above.  As  it  constantly 
grows  further  back,  it  eventually  covers  the  whole 
of  the  rest  of  the  brain  above,  and  also  encloses 
the  central  part  from  the  sides.  This  process  is  of 
the  greatest  importance,  because  this  fore-brain  is 
the  organ  of  the  higher  mental  activities — because 
in  it  are  accomplished  those  functions  of  the  nerve 
cells,  the  sum  of  which  is  generally  designated  as 
the  mind,  or  the  *  spirit '  in  the  narrower  sense. 
The  highest  activity  of  the  animal  body,  the  won- 
derful manifestations  of  consciousness,  the  com- 
plex phenomena  of  the  activities  of  thought,  have 
their  seat  in  the  fore-brain.  It  is  possible  to  remove 
the  great  hemispheres  of  a  mammal,  piece  by  piece, 
without  killing  the  animal,  thus  proving  that  the 
higher  mental  activities,  consciousness  and  thought, 
conscious  volition  and  sensation,  may  be  destroyed 
one  by  one,  and  finally  entirely  annihilated.  If 
the  animal  thus  treated  is  artificially  fed,  it  may  be 
kept  alive  for  a  long  time,  for  the  nourishment  of 
the  entire  body,  digestion,  respiration,  the  circula- 
tion of  the  blood,  secretion,  in  short,  the  vegetative 
functions,  are  in  no  way  destroyed  by  this  destruc- 
tion of  the  most  important  mental  organs. 

Conscious  sensation  and  voluntary  motion,  the 
capacity  for  thought  and  the  combination  of  the 
various  higher  mental  activities,  have  alone  been 
lost.' "  The  extremely  complex  and  perfect  ac- 
tive phenomena  within  the  nerve  cells,  summed  up 
the  word  '  mental  life,'  can  no  more  exist  without 
their  organs  in  the  vertebrate,  including  man,  than 
can  the  circulation  of  the  blood  without  a  heart 
or  blood.  As,  however,  the  central  marrow  of  man 
has  developed  from  the  same  medullary  tube  as 
in  all  other  vertebrates,  so  also  must  the  mental 
life  of  man  have  had  the  same  origin.  All  this  is, 
of  course,  true  of  the  conductive  marrow  or  the  so- 
called   'peripheric   nervous  system.'      This   con- 


150 


TUE   CANADA    MEDICAL    KECORD. 


sists  of  the  sensa/ivtrnervons  fibres  which  convey 
the  impressions  of  sensation  from  the  skin  and  the 
organs  of  the  senses  in  a  centripetal  direction  to 
the  central  marrow,  in  a  centrifugal  direction  to 
the  muscles.  By  far  the  greater  part  of  these 
peripheric  conductive  nerves  originates  from  the 
skin-fibrous  layer,  by  peculiar  local  differentiation 
of  the  rows  of  cells  into  the  respective  organs. 

"  The  membranous  coverings  and  blood-vessels 
of  the  central  marrow  are  identiail  in  origin  with 
the  greater  part  of  the  conductive  marrow  ;  these 
membranous  coverings  are  the  inner  membrane 
(pia  mater),  the  central  membrane  ( incninx  arach- 
noidcs),  and  the  outer  membrane  (dura  mater).  All 
these  parts  are  developed  from  the  skin-fibrous 
layer." 

"  Important   as    is  the  vascular  system  in  the 
more  highly  developed  and  differentiated  animal 
body,  it  is  not,  however,  an  apparatus  as  indispen- 
sable to  animal  life  as  is  generally   supposed.     In 
the  older  theory  of  medicine  the  blood  was  regard- 
ed as  the  real  source  of  life,  and  humoral  pathology 
referred   most  diseases  to  corrupt  blood-mixture. 
Similarly  the  blood  plays  the  most  important  part 
in  the  prevailing  obscure  conception  of  heredity. 
Just  as  half-blood,  pure  blood,  etc.,  are  yet  common 
phrases,   so  it  is  widely  believed  that  the  trans- 
mission by  heredity  of  definite  morphological  and 
physiological  characters  from  the  parent    to  the 
child  lies  in  the  blood.      That     this   customary 
notion  is  entirely  false,  is  easily  seen  from  the  fact 
that  neither  in  the  act  of  procreation  is  the    blood 
of  the  parents  directly  transmitted  to  the  procre- 
ated germ,  nor  does  the  embryo  acquire  blood  a 
an  early  period.     As  we  have  already  seen,   no 
only  the  separation  of  the  four    secondary   germ 
layers,   but   also   the   beginning    of  the  most  im 
portant  organs,  takes  place  in  the  embryos  of  all 
vertebrates  before  the  rudiment  of  the  vascular 
systems  of  the  heart  and  blood   is   formed.      In 
accordance  with   this   ontogenetic  fact,   we  must, 
from  a  phylogenetic  point  of  view,  regard  the  vascu. 
lar   system    as   the    most    recent,    the    intestinal 
system,  on  the  contrary,  as  the  oldest  formation  of 
the  animal  body.     The  origin  of  the  vascular  sys" 
tem  is,  at  least,  much  later  than  that  of  the  intes. 
tinal  system.     If  the  fundamental  law  of  biogony 
is    rightly    appreciated,    it    is    possible,  from  the 
ontogenetic  sequence  in  which  the  various  organs 
of  the  ;  n  mal  body  consecutively  originate  in  the 
embryo,  approximately    to  mfer  the  phylogenetic 
sequence,  in  which  these  organs  gradually  develop- 


ed one  after  the  other  in  the  ancestral   order  of 
animals." 

The  organ  system  may  be  arranged,  according 
to  age,  in  something  like  the  following  order  :  Firsty 
the  skin  system  and  intestinal  system.  Second,  the 
nerve  and  muscular  system.  Third,  the  kidney 
system.  Fourth,  the  vascular  system.  Fifth,  the 
skeleton  system.     Sixth,  the  sexual  system. 

We  have  now,  gentlemen,  gone  through  Baer's 
germ  history  as  set  forth  and  approved  of  by 
Haeckel.and  I  can  conceive  nothing  more  clear  and 
distinct.  Every  step  in  embryology  is  gradually  and 
distinctly  traced  from  the  moment  the  female  ovum 
is  fertilized  by  the  cell  of  the  male  sperm  till  the 
formation  by  evolution  of  the  perfect  animal  child- 
I  say  animal  because  it  is  only  as  such  Mr.  Haeckel 
speaks  of  him  pure  and  simple,  differing  from  all 
other  animals  only  in  degree.  He  does  not  recognize, 
what  I  do,  that  man  has  a  human  nature,  in  virtue 
of  which  he  differs  also  from  all  other  animals 
in  kind  as  well  as  in  degree.  You  who  have  heard 
my  first  paper  know  that,  while  I  accept  the  evolu- 
tion theory  as  I  have  described  it,  I  do  not  accept 
the  monistic  hypothesis  as  set  forth,  nor  yet  the 
dualistic  hypothesis  as  it  is  generally  understood. 

From  Mr.  Haeckel's  book  we  learn  many  very 
important  facts,  which  not  only  explain  to  us  many 
physical  phenomena,  but  which  must  be  of  great 
practical  utility  in  the  treatment  of  disease.  First, 
we  learn  that  heredity  is  not  through  the  blood 
but  nervous  system,  hereditary  syphilis,  insanity, 
imbecility,  phthisis,  gout,  cancer,  intemperance,etc., 
and  is  it  not  of  the  greatest  importance  to  know  that 
in  the  treament  of  these  diseases  it  is  not  the  blood 
we  have  to  deal  with,  but  with  the  nervous  system 
— not  with  a  reproductive  fluid,  but  living  organ- 
isms. You  may  say  that  Mr.  Haeckel  did  not  say 
heredity  was  through  the  nervous  system,  but 
that  it  was  not  through  the  blood.  Very  true,  but 
have  we  not  a  right  to  conclude  it  is  through  the 
nervous  system  when  it  is  not  through  the 
blood.  Physiological  heredity  always  exhibits 
itself  in  the  nervous  system,  let  it  be  good  or  bad, 
as  in  hereditary  insanity  or  atrophy,  as  exhibited 
to  us  by  Dr.  Osier,  in  the  case  of  the  Farr  family 
of  Vermont. 

Then  what  are  the  phenomena  of  animal  life  ? 
Sensation,  thought,  perception,  or  consciousness, 
and  motion.  From  whence  come  these  phenomena  ? 
From  the  nervous  system,  that  imparts  animal  life 
and  with  it  all  its  phenomena  to  the  male  and  female 
cells  to  the  male  sperm  cell  that  fertilizes  the  cell  in 


THE   CANADA    MEDICAL    RECORD. 


151 


the  female  ovum,  from  which  is  generated  the  little 
spherical  bladder  described  by  Baer  as  the  first 
development  from  the  impregnated  egg.  Of  course, 
if  these  cells  were  not  living  germs  they  never  could 
evolve  into  living  animals,  for  life  does  not  come 
from  death  but  from  life  ;  moreover,  if  they  were 
dead  germs  they  would  be  a  foreign  body  in  the 
Graaffian  follicles,  and  be  rejected  from  them  ;  or, 
remaining,  would  be  a  source  of  irritation  and  a 
cause  of  disease. 

Again,  according  to  Erb,  it  is  a  pretty  well 
established  physiological  fact  that  the  production 
of  semen,  and  ovulation  are  dependent  upon  the 
spinal  cord. 

I  therefore  assume  that  not  only  is  heredity  but 
animal  life  transmitted  from  the  parent  to  the  off- 
spring by  means  of  the  nervous  system.  From 
these  facts  are  we  not  forced  to  raise. the  question  : 
is  there  such  a  thing  at  all  as  blood-poison,  as  is 
generally  understood  by  that  term  ?  Or,  if  poisoned) 
is  it  not  only  in  common  with  the  rest  of  our  organ- 
ization, and  not  as  the  medium  through  which  a 
poison  is  conveyed.  Why  should  we  not  recognize 
that  all  poisons  are  conveyed  to  and  from  the  liv. 
in  centre  by  means  of  the  centripetal  and  centri- 
fugal sensory  nerves  that  originate  in  the  skin  ;  and 
when  we  have  a  case  of  so  called  blood-poison,  is 
it  not  the  nervous  system  that  first  gives  symptoms 
of  poisoning,  and  is  it  not  hard  to  understand  why 
we  have  attributed  delirium  in  certain  diseases  to 
blood-poisoning,  when  it  is  so  much  easier  to 
account  for  it  through  the  medium  of  the  peripheral 
sensory  nerves.  I  am  not  speaking  of  these  cases 
when  the  blood  has  an  increase  or  decrease  of  its 
chemical  properties.  I  speak  of  when  the  system 
is  poisoned  from  an  animal,  a  vegetable,  or  mineral 
poison.  Has  any  analyst,  when  called  upon  to  say 
whether  or  not  a  person  died  from  the  effects  of 
poison,  given  his  attention  more  to  the  blood  than 
to  any  other  part  of  the  animal  economy,  and,  if  so, 
has  the  blood  shown  from  such  an  analysis  that  it 
contained  a  greater  quantity  of  poison  than  any  other 

part  of  the  system.  It  is  a  mere  assumption,  and 
a  most  unjustifiable  one,  that  the  system  is  poison- 
ed through  the  blood,  or  that  the  blood  undergoes 
some  chemical  change  which  poisons  the  whole 
system.  Our  very  treatment  for  what  we  classify  as 
septic  diseases  is  a  contradiction  to  such  a  theory, 
for  the  drugs  we  administer  are  those  that  we  know 
have  a  specific  action  upon  the  nervous  system, 
such  as  quinine,  salicylic  acid,  morphine, 
atropine.     If  a  person  is  poisoned  by   opium  we 


administer  atropine  or  give  injections  of  strong 
infusion  of  tea,  as  recommended  by  Dr.  Sewell,  of 
Quebec  ;  if  poisoned  by  atropine  we  give  opium  ; 
if  by  strychnine,  tobacco, — recognizing  by  our  treat- 
ment in  all  that  it  is  the  nervous  system,  not  the 
reproductive  fluid,  that  is  poisoned. 

It  will  not  do  to  point  out  that  in  some  cases  of 
mechaniail  obstruction  from  embolism  or  throm- 
bus, such  as  has  been  so  frequently  exhibited  to 
the  Society  by  Dr.  Osier,  that  pus  is  found  in  the 
blood-vessels,  nor  to  say  that  in  cases  of  pyaemia 
pus  is  found  in  the  blood,  unless  it  can  be  shown 
that  pus  is  found  in  no  other  organ  or  tissue,  or 
that  it  can  be  shewn  that  the  blood  itself  under- 
went a  chemical  change  which  converted  it  into 
pus,  and  that  the  pus  was  a  cause,  not  the  conse- 
quence, of  a  poison  from  which  the  whole  system, 
as  well  as  the  blood,  suffered.  To  my  mind  there 
has  never  been  sufficient  proof  adduced  that  there 
was  such  a  thing,  properly  speaking,  as  blood-poi- 
son, that  is,  that  the  blood  from  some  cause  under- 
went some  chemical  change  by  which  it  became  a 
poison  to  the  rest  of  the  system,  nor  have  I  seen 
any  proof  that  the  blood  was  the  medium  through 
which  the  vital  organs  were  poisoned. 

Because  in  all  cases  of  inflammation,  whether 
in  organs  or  tissues,  we  find  congestion  of  the 
capillaries,  we  assume  that  the  blood  is  the  im- 
mediate cause  of  the  inflammation,  whereas  it  is 
only  the  secondary.  The  cause  of  the  congestion 
is  not  due  to  the  blood,  but  to  the  blood  vessels,  ■ 
which  lose  their  normal  contracting  and  dilating 
powers  or  force,  in  virtue  of  some  disordered  state 
of  the  vaso-motor  nerves, — a  want  of  co-ordinate 
action  between  the  vaso-contractor  and  its  inhi- 
bitory nerve,  the  vaso-dilator,  brought  about  by 
irritation  of  some  nerve  centre,  acting  upon  the 
sympathetic  nerve,  which  is  the  great  vaso-motor 
of  the  body,  controlling  organic  or  vegetative  life, 
as  the  cerebral  and  spinal  nerves  do  animal  life. 
I  do  not  myself  believe  that  there  is  any  such 
thing  as  idiopathic  inflammation.  I  believe  all 
inflammations  are  traumatic,  that  is,  that  there  is 
some  injury  (although  we  cannot  always  see  it)  to 
a  nerve  centre,  from  either  objective  or  subjective 
cause,  to  produce  the  effect,  inflammation,  which 
in  all  cases  is  preceded  by  either  venous  or  arte- 
rial congestion  of  the  capillaries.  Holding  this 
to  be  the  true  theory  of  inflammation  of  a  part, 
no  matter  whether  of  organs,  membranes,  or 
tissues,  you  will  not  be  surprised  when  I  tell  you 
that,  in  my  treatment  of  inflammations,  I  direct 


152 


THE    CANADA    MEDICAL    RECORD. 


my  attention  more  particularly  to  restoring  the 
vaso-motor  nerves  to  their  normal  state  ;  and  the 
drugs  I  have  found,  as  yet,  most  useful  to  this  end 
have  been  the  various  preparations  of  ergot,  bella- 
donna, hyoscyamus,  digitalis,  aconite,  bromide  of 
potass,  etc.,  all  medicines  known  to  have  a  specific 
action  upon  the  vaso-motor  nerves.  Of  course  you 
must  understand  that  I  am  speaking  of  inflamma- 
tion, not  of  its  consequences,  neither  am  I  speak- 
ing of  inflammation,  the  result  of  specific  poisons, 
uch  as  .<5yphilis,  gonorrhoea,  etc.  Although  I 
maintain  that,  even  in  these  inflammations,  they 
are  directly  due  to  the  vaso-motor  nerves,  al- 
though indirectly  to  the  irritation  of  a  nerve  centre 
from  the  specific  poison.  Of  course  if  I  know  of 
anything  that  is  acting  traumatically  in  a  nerve 
centre  through  the  peripheral  nerves,  I  use  my 
best  efibrts  to  remove  that  cause  of  irritation. 

Recognising,  as  I  do,  the  success  of  Mr.  Tindal's 
experiments  in  proof  of  atmospheric  germ,  bacte- 
ria, and  believing  that  animal,  vegetable,  and  min- 
eral poisons  are  carried  through  the  air  from  a 
thousand  different  sources,  I  am  a  firm  believer 
in  antiseptic  surgery,  of  Lesterism  as  now  well 
understood ;  but  I  don't  believe  that  the  danger 
from  exposing  a  cut  surface  to  the  atmospheric  air 
is  due  to  the  blood  vessels,  which,  by  the  way,  are 
usually  tied  up  as  quick  as  possible, — even  veins, 
as  Dr.  Roddick  has  shown  us,  can  be  tied  with  as 
little  impunity  as  arteries.  I  say  the  danger  is  not 
from  exposing  blood  vessels,  but  the  cut  ends  of 
the  numerous  peripheral  nerves. 

Mr.  Haeckel  has  clearly  demonstrated  that  there 
is  no  animal  life  without  a  nervous  system,  and  he 
has  equally  demonstrated  that  there  is  animal  life 
witho  a  circulating  or  blood  system.  There- 
fore, according  to  his  views,  I  was  correct,  when, 
in  my  previous  paper,  I  said  that  the  properties 
of  animal  life  were  in  the  nervous  system.  This  is 
also  evident  from  the  fact  that  consciousness  of 
the  objective  is  the  result  of  perception,  and 
sensation  is  necessary  to  perception,  sensation  is 
even  necessary  to  subjective  consciousness ;  for 
although  sensation  can  exist  without  self-con- 
sciousness (for  as  all  matter  has  in  it  potentiality, 
so  all  matter  has  sensation  but  not  consciousness), 
yet  self-consciousness  cannot  exist  without  sensa- 
tion, and  Mr.  Haeckel  has  clearly  demonstrated 
that  sensation  is  imparted  to  our  consciousness 
through  the  sensory  nerves,  which  take  their  origin 
from  the  skin  that  envelopes  our  bodies. 

This  physiology  of  the  skin  explains  to  us  the 


modus  operandi  of  blisters,  plasters,  baths,  counter- 
irritants,  rubefacients,  anaesthetics,  hypnoti.sm, 
electro-magnetism  and  metallotheropy,  and  sug- 
gests to  us  that  perhaps  much  more  could  be  done 
through  the  skin  for  the  successful  treatment  of 
disease  than  has  been  hitherto  done,  in  fact,  as 
much  as  has  been  hitherto  done  through  the 
mucous-membrane  of  our  stomachs,  which,  after 
all,  is  only  part  of  the  skin  that  envelopes  our 
bodies — a  skin  so  closely  allied  to  our  brains  and 
spinal  cord  as  that  we  might  properly  define  them 
to  be  one. 

In  the  October  number  of  Brain  there  is  an 
article  by  Tschirieu  which  has  a  practical  bearing 
on  this  question.  It  is  a  case  of  lesion  of  the 
spinal  cord  and  skin  of  anaesthetic  leprosy.  After 
a  microscopical  examination  of  the  spinal  cord 
and  skin,  and  finding  the  same  disease  in  both 
parts,  he  thus  concludes  :  "  What  relation  there  is 
between  the  degeneration  of  the  cells  in  the  grey 
matter  and  the  connection  between  these  and  the 
phenomena  of  anaesthetic  leprosy,  are  all  questions 
which  it  will  be  for  future  research  to  decide 
definitively." 

It  appears  to  me  that  if  Tschirieu  had  been 
aware  of  the  intimate  union  that  exists  between 
the  skin  and  spinal  cord,  he  would  have  seen  that 
the  question  is  already  settled.  Nothangal  found 
that  irritation  of  the  skin  of  children,  even  in 
remote  parts  of  the  body,  caused  fluxinary  hyper- 
emia, by  first  causing  through  the  vasomotor 
nerves  sudden  contraction  of  the  arteries  from 
irritation  of  the  centripetal  sensory  nerves,  which 
sudden  contraction  Eber  says  is  always  followed 
by  sudden  relaxation  of  the  vessels,  hence  the 
hyperemia.  But  Eber  did  not  then  know  what  is 
now  so  well  established,  that  the  relaxation  was 
due  to  the  vaso-relaxer,  which  is  an  inhibitory 
nerve  to  the  vaso -contractor.  I  suppose  there 
are  but  few  medical  men  who  have  not  seen 
inflammation  of  the  lungs  from  scalds  on  the 
thorax,  and  I  see  a  case  lately  recorded  of  ulcer- 
ation and  perforation  of  the  small  intestines  from 
a  scald  of  the  nalies  and  legs,  and  it  is  an  oft-told 
tale,  how  flogging  on  the  back  has  produced 
pleuritis  and  pneumonia,  yet  moralists  tell  us  to 
spare  the  rod  and  spoil  the  child.  I  say,  use  the 
rod  and  destroy  the  child's  mental  organization,  if 
not  his  life,  and  here  I  remark  with  pleasure  that 
I  perceive  England  is  at  last  about  to  abolish 
that  remnant  of  barbarism,  flogging  in  the  army 


THE   CANADA    MEDICAL    RECORD. 


153 


and  nav)' ;   this   improvement  is  due  to  men  of 
science. 

I  think  I  hear  you  say  I  am  making  the  skin  of 
too  much  importance  in  the  animal  economy — this 
I  conceive  to  be  impossible,  when  we  remember 
that  it  is  the  medium  through  its  peripheral  sensory 
nerves  between  all  things  objective  and  our  whole 
material  organization,  not  only  animal,  but  vegeta- 
tive.    Through  the  skin   the  sensorium  is  made 
cognisant  of  cold,  heat,  pressure,  painful  and  plea- 
surable sensations,  and  through  it  we  communi- 
cate our  thoughts  by  emotional  language,  for  you 
must  remember  that  man  differs  so  much  in  degree 
from  all  other  animals  that  he  possesses  what  no 
other  animal  does — a  power  of  communicating  his 
thoughts  and  ideas  to  his  fellow  by  oral  speech. 
But  man  has,  in  common  with  all  oher  animals,  an 
emotional  language  by  which  we  communicate  our 
thoughts  and  desires  through  the  sensory  nerves. 
This  is  the  language  made  much  more  use  of  than 
oral  by  the  opposite  sexes  when  either  wish  to 
excite  the  sexual  desire  in  the  other,  and  render 
a  natural  desire  morbid,  so  that  desire  gives  place 
to  ungovernable  passion,  and  will  looses  its  in- 
fluence to  guide  it.     It  is  well-known  that  certain 
irritation  of  the  skin  excites  in  different  persons 
more  or  less  generalized  reflex  spinal  action,  excit- 
ing the  sexual  organs  in  male  and  female.     Some 
there  are  that,  by  a  powerful  effort  of  the  will,  can 
excite  in  the  cerebrum  irritations  of  an  inhibitory 
nerve  centre,  and  thus  control  the  sexual  desire, 
but  such  persons  are  few  and  far  between  ;  every 
man  and  woman  knows  the  truth  of  this  pheno- 
mena, but  none  care  to  admit  it.  All  would  wish  it  to 
be  believed  that  they  are  exceptions  to  this  natur- 
al law,  but  there  are  no  exceptions  ;  all  have  sen- 
sory nerves  which  take  their  origin  from  the  skin, 
and  whose   centripetal  branches  pierce  the  spinal 
marrow  from  whence  the  reflex  action  comes,  and 
although  men  and  women  laugh  and  ridicule  those 
who  condemn  close  intimacy  between  the  sexes, 
particularly  that  intimacy  when  touch  is  permitted, 
as  dangerous  to  morals,  yet   those  very  people 
know  well  the  danger,  but  don't  wish  to  admit  it. 

Knowing,  as  we  now  do,  the  physiology  of  the 
skin  and  sensory  nerves,  and  this  emotional 
language,  will  we  not,  as  medical  men,  feel  it  our 
duty,  when  mothers  consult  us  about  the  health  of 
their  hysterical  daughters,  to  warn  them  not  to 
allow  any  intimacy  between  their  daughters  and 
one  of  the  opposite  sex,  or  to  partake  of  any 
amusement  where  touch  is  permitted.      I  am  no 


speaking  as  a  moralist,  but  as  a  medical  man,  as 
one  who  has  seen  too  many  young  men  and 
maidens  find  their  way  into  an  insane  asylum  or 
an  early  grave,  or  drag  out  a  miserable  existence 
from  uncontrollable  ungratified  sexual  desire.  We 
can  have  no  feeling  for  such  but  the  greatest  pity, 
whatever  may  be  the  feelings  we  have  towards  the 
parents,  who  have  so  grossly  neglected  to  perform 
their  duty  towards  their  children.  Can  there  be 
a  more  pitiable  sight  than  to  see  these  poor  hysteri- 
cal girls  rushing  about  from  one  thing  to  another, 
and  finding  no  rest,  no  satisfaction  only  in  the 
excitement  of  the  moment,  sometimes  seeking 
causes  of  excitement  the  very  opposite  to  each 
other,  and,  when  there  is  no  longer  excitement, 
then,  sickness  and  suffering. 

I  don't  believe  in  the  doctrine  of  all  work  and 
no  play,  I  believe  it  to  be  a  most  cruel  and  unna- 
tural doctrine,  a  breach  of  all  natural  laws  ;  I  like 
cheerfulness  because  it  shows  a  normal  consti- 
tution, but  I  don't  like  to  see  abnormal  desires 
take  possession  of  male  or  female,  and,  above  all 
things,  I  wish  to  see  all  men  and  women  know 
thoroughly  their  duty  in  whatever  their  position 
in  life  may  be,  and  to  let  that  duty  be  their  first 
consideration  before  all  other  things.  When 
people  act  thus  we  may  expect  to  see  a  normal 
healthy  state  of  society  very  different  from  what  it 
is  at  present.  And  I  consider  it  the  duty  of  every 
medical  man  to  use  his  best  efforts  to  bring  about 
such  a  healthy  state  of  society  by  not  only  treat- 
ing his  patients  when  sick,  but  by  teaching  them 
how  to  live  that  they  might  enjoy  a  sound  mind 
in  a  sound  body,  for  they  cannot  have  one  with- 
out the  other,  and  the  physiolog}'  we  have  learned 
from  Mr.  Haeckel  must  aid  him  in  his  efforts. 
This  is  what  Mivart  would  call  "  rational  mater- 
ialism "  founded  upon  physiological  and  pathologi- 
cal science.  Who  is  Mivart  ?  In  beginning  this 
paper  I  told  you  a  friend  loaned  me  Haeckel ;  be- 
fore concluding  it  I  must  tell  you  that  another 
friend  loaned  me  another  book,  "  Lessons  from 
Nature,  by  St.  George  Mivart,  Ph.D.,  F.R.S., 
Professor  of  Biology  at  University  College,  Kens- 
ington, and  Lecturer  on  Zoology  and  Comparative 
Anatomy  at  St.  Mary's  Hospital," — that  is  who 
Mivart  is,  and  I  read  his  book  with  just  as  great, 
if  not  a  greater,  interest  as  I  read  Haeckel,  and 
I  was  delighted  to  find  that  my  views  upon  man's 
two  natures  were  so  similar  to  such  an  authority, 
He,  however,  while  admitting  that,  zoologically, 
man  and  ape  were  of  the  same  order  of  mammalia. 


154 


TlIK    CAN'ADA    MEDICAL    RECORD. 


stemly  opposes  that  man  was  evolved  from  the 
ape.  He  says:  "The  lessons,  then,  concerning 
man,  which  we  seem  to  gather  from  nature  as 
revealed  to  us  in  our  own  consciousness,  and  as 
externally  obsencd,  is  that  man  differs  fundamen- 
tally from  every  other  creature  which  presents 
itself  to  our  senses.  That  he  differs  absolutely 
and,  therefore,  differs  in  origin  also.  Although  a 
strict  unity,  one  material  whole,  with  one  form  or 
force  (not  made  by  two  parts  mutually  acting 
according  to  the  vulgar  notion  of  soul  and  body), 
yet  he  is  seen  to  be  a  compound  unity  in  which 
two  distant  orders  of  being  unite.  He  is  mani- 
festly animal,  with  the  reflex  functions,  feelings 
desires,  and  emotions  of  an  animal,  yet  equally 
manifest  is  it  that  he  has  a  special  nature,  looking 
before  and  after,  which  constitutes  him  rational,  rul- 
ing, comprehending,  interpreting  and  completing 
much  in  nature.  ^Ve  also  see  in  him  that  which  mani- 
festly points  above  nature.  We  see  this  since  we 
know  that  he  can  conceive  minds  indefinitely  aug- 
mented in  power  and  devoid  of  those  limitations 
and  imperfections  it  exhibits  in  him.  Manifestly 
a  contem])lation  of  nature  must  be  fertile  indeed 
which  neglects  to  ponder  on  these  ideas  of  power, 
wisdom,  puqjose,  goodness  and  will,  which  are 
revealed  to  him  in  and  by  his  own  nature  as  he 
knows  it  to  exist,  and,  therefore,  as  conceivably 
existing  in  a  far  higher  form  in  that  vast  universe 
of  being  of  which  he  is  a  self-conscious  fragment." 
You  perceive  by  the  foregoing  quotation  that 
Mivart  recognizes  the  two  natures  in  man.  He, 
however,  appears  to  attribute  something  more  to 
our  human  nature  or  something  less  to  our  animal 
nature  than  I  have  done  in  my  previous  paper.  As 
I  have  already  said  I  recognize  that  man  has  a 
human  nature  given  to  him,  in  virtue  of  which  he 
has  an  Ego,  a  free  will,  and  an  immortal  soul ;  yet 
when  I  consider  the  anatomy  and  physiology  of 
man,  and  the  pathological  effects  of  disease  on 
man's  organization,  when  I  consider  the  nations 
of  savages  aye,  even  of  cannibals,  in  this  our  day  ; 
when  I  look  at  the  worse  than  barbarian  crimes  com- 
mitting every  day  by  all  peoples,  and  none  surpass- 
ing the  crimes  of  Christians,  I  cannot  help  but 
recognize  the  theory  of  development  or  evolution 
of  man,  in  so  far  as  the  intellectual,  rational  being 
is  concerned,  and  that  the  striking  difference 
between  individuals,  and  peoj)les — between  the 
humane  and  barbarous,  or  cruel,  man — is  in  virtue 
of  his  animal  and  not  his  human  nature  ;  the  latter 
I  consider,  in  virtue  of  its  source  to  be  equal  in 
all. 


In  bringing  before  you  this  evening  the  subjects 
of  heredity  of  blood-poison,  of  inflammation,  of 
the  physiology  of  the  skin,  and  sensory  and  vaso- 
motor nerves;  if  I  have  been  obliged  to  show 
that  neither  life  nor  heredity  was  in  the  blood, 
which  was  simply  the  reproductive  fluid  of  our 
whole  organization ;  if  I  have  been  obliged  to 
show  you  that,  properly  speaking,  there  was  no 
such  thing  as  blood-poi.son  ;  if  I  have  been  obliged 
to  give  you  a  different  definition  of  inflammation 
from  what  we  have  been  accustomed  to  consider 
it ;  if  I  have  largely  extended  my  remarks  upon 
the  physiology  of  the  skin  and  the  sensory  nerves  ; 
— it  was  not  merely  from  the  desire  to  break  down 
old-established  ideas,  and  replace  them  with  new  , 
it  was  because  I  long  had  my  doubts  that  these 
old  theories  were  based  upon  scientific  truths, 
"  and,  having  doubted,  I  had  no  rational  choice, 
but  was  in  duty  bound  to  reason  out  my  doubts 
to  the  end,"  and,  having  done  so,  making  use  of 
all  the  means  within  my  reach  to  assist  my  reason, 
I  have  offered  the  results  to  you,  such  as  they  are, 
that  you  may  be  led  to  the  careful  consideration 
of  these  questions,  and  see  what  claims  they 
possess,  or  whether  we  have  not  yet  much  to  learn 
in  the  theory  and  practice  of  medicine. 


J^f^o^J^eSSof  ^(edlcal  Science. 


TREATMENT   OF   SEMINAL    EMISSIONS. 

Bumstead  gives  the  following  prescription  for 
its  special  tonic  effect  upon  the  genital  organs  : 

Grams. 

Ix     Tr.  ferri  chloridi 3  iii     90 

Ext.  ergot,  fid.  (Squibb's)  iii     90 

M.   et.  sig  :    A  teaspoonful  in  water  aft 
meal.  er  each 

As  a  direct  means  of  diminishing  the  frequency 
of  the  emissions,  B.  recommends  : 

Grams.o 

rj,     Potass,  bromidi 3  i       3 

Tr.  ferri  chloridi  3  i      30 

Aqua; 3  iii     90 

M.  et  sig  :  From  one  to  two  teaspoonfuls  in 
water,  after  each  meal,  and  at  bed-time. 

The  avoidance  of  tobacco  in  all  its  forms,  clean- 
liness of  mind  and  body,  laxatives  when  needed, 
and,  in  a  word,  attention  to  the  rules  of  hygiene, 
are  to  be  strictly  enjoined. — American  Practi- 
tioner,  July,  1879. 


THE   CANADA    MEDICAL   RECORD. 


155 


ON  THE  TREATMENT  OF  TUBERCULAR 

CONSUMPTION. 

By  Carl  Both,  M.D.,  New  York. 

Some  time  ago  I  published  an  account  of  a  treat- 
ment of  turberculous  phthisis,  which  I  had  used 
with  good  success  for  twenty-two  years.  That 
treatment  consisted  m  first :  The  cleansing  of  the 
bronchi  of  mucus  and  pus;  and  afterward  the  nor- 
mal expansion  of  the  air-vesicles  by  means  of 
actively  exercising  the  respiratory  muscles  (see 
Medical  Record  of  July  21,  1877,  and  May  18, 
1878).  Second :  The  careful  study  of  the  needs  of 
the  system  for  certain  articles  of  food  containing 
lime  salts  ;  and  a  proper  appreciation  of  the 
necessity  of  getting  rid  of  excrementitious  sub- 
stances as  quickly  as  possible.  Third :  In  a 
medication  of  certain  minerals  in  organic  form, 
such  as  lime  and  silica,  for  the  purpose  of  aiding 
the  calcification  of  tubercles  ;  and  in  acids,  such 
as  citric,  which  contain  an  excess  of  oxygen,  and 
which  tend  to  help  the  oxidation  of  protein  sub- 
stances. Fourth  :  In  bringing  the  patient  in  such 
condition  of  life  that  his  nervous  system  is  not 
unnecessarily  over-taxed,  at  the  same  time  it  is  so 
employed  as  to  balance  nervous  force  and  stimu- 
late his  general  nutrition  as  much  as  possible. 

The  whole  object  of  this  method,  which  I  have 
called  that  of  the  "  artificial  calcification  of  tuber- 
cles," is  to  check  the  suppurative  processes  and 
arrest  the  softening  of  the  indurated  portions  of 
lung.  It  is  immaterial  how  this  effect  is  reached, 
whether  by  calcification  of  tubercles,  of  fatty  degen- 
eration, or  ossification,  or  cicatrization,  or  by 
solidification  of  fibrin,  or  any  other  pathological 
process,  so  long  as  we  reach  our  desired  object — 
namely,  of  drying  up,  so  to  speak,  the  softened  or 
infiltrated  portions  of  the  lung-tissue. 

I  well  know  how  settled  the  professional  mind 
is  on  the  incurability  of  phthisis,  especially  tuber- 
cular ;  and  it  is  not  without  a  feeling  of  misgiving 
that  I  venture  to  continue  my  assertions  regard- 
ing the  curability  of  phthisis.  I  am  aware  that 
such  assertions  will  be  charged  to  undue  enthusiasm 
in  a  pet  method,  or  to  misguided  judgment  regard- 
ing the  value  of  facts.  Still  I  feel  it  my  duty  to 
say  what  I  believe.  It  is  not  my  purpose  to 
theorize  on  the  relation  between  the  cause  and 
the  effect,  although  there  must  be  room  for  all 
theories. 

The  profession,  as  a  whole,  accepts  and  rejects 
views  as  it  sees  fit.  But  facts  are  stubborn  things, 
and  are  always  acceptable  to  the  profession,  no 
matter  what  their  particular  interpretation  may  be. 
With  this  view  a  short  description  of  some  of  the 
cases  treated  by  my  method  is  offered,  in  the  hope 
that  the  profession  may  become  convinced  of  its 
efficacy,  and  resort  to  it  accordingly.  I  claim  in 
no  way  perfection,  or  anything  wonderful,  but 
unless  my  judgment  is  utterly  defective,  these 
cases  must  convince  the  most  conservative  skeptic, 
that  tuberculosis  of  the  lungs  can  be  arrested  to  a 


degree  heretofore  considered  absolutely  impossi- 
ble. 

It  may  be  well  to  state  beforehand,  that  all  the 
cases  reported  were  more  or  less  desperate  ones  ; 
that  to  manage  such  patients  is  very  difficult, 
sometimes  impossible;  and  that  even  with  the 
utmost  caution  these  patients,  especially  the 
recovering  ones,  will  commit  follies  almost  incom- 
prehensible, and  utterly  beyond  the  control  of 
the  medical  adviser.  But  it  will  be  seen  that  the 
effect  of  my  treatment  is  uniform,  regardless  of  the 
final  result,  the  same  in  each  case,  and  excluding 
any  accidental  improvements  which  are  so  common 
in  these  cases. 

Mr.  W.  H ,  merchant  in  New  York  ;  native 

of  Yonkers  ;  twenty-eight  years  of  age  ;  lost  a  bro- 
ther and  sister  of  consumption  in  1876  ;  had  been 
sick  for  ten,  and  was  compelled  to  give  up  busi- 
ness for  two  years.  Had  tried  Colorado,  Minne- 
sota, and  the  South,  outdoor  tent-living,  with 
injurious  results;  had  been  examined  by  Drs.  C-  P. 
Tucker,  A.  Clarlc,  and  A.  Flint. 

Examination  denoted  decided  dullness  at  both 
summits  ;  right  side,  comprising  both  upper  lobes, 
with  bruit  de  pot  file  ;  lower  portion  of  right  chest, 
absolute  dullness  to  about  the  nipple.  Auscultation 
on  right  side  bronchial,  with  strong  gurgling 
sound  indicating  a  cavity  of  four  by  two  inches  ; 
middle  portion,  broncho  vesicular  ;  lower  portion 
of  chest,  absence  of  sound  ;  right  upper  lobe,  sub- 
crepitant  rales  with  bronchial  respiration.  Pulse 
124  and  variable.  Heart  well.  Digestion  fair. 
The  patient  came  under  my  treatment  in  October, 

1876.  In  August,  1877,  he  went  back  to  his 
business,  four  months  sooner  than  I  wished  him 
to.  His  condition  was  then  as  follows  :  Dullness 
of  percussion  nearly  the  same,  except  the  right 
lower  portion,  where  it  had  entirely  disappeared. 
Auscultation  :  The  gurgling  sounds  of  cavity  had 
disappeared  ;  cavernous  respiration  indicated  the 
cavity  smaller  on  summit,  but  had  extended  some- 
what downward,  caused  by  formation  of  a  new 
cavity;  respiration  around  it  broncho-vesicular. 
In  lower  portions  of  right  lung,  normal  vesicular 
respiration.  Left  upper  portion,  respiration  vesi- 
cular, with  a  very  slight  tubular  timbre  and  pro- 
longed expiration ;  lower  portion  normal  He 
was  at  that  time  re-examined  by  Dr.  A.  Clark. 

The  patient  has  remained  steadily  in  business, 
working  hard.  I  examined  him  again  in  January, 
1879,  when  he  had  neglected  himself  somewhat.  I 
then  heard  bronchial  rales  and  moist  crepitation 
on  left  side.  It  soon  subsided,  and  he  was  hard 
at  work  when  I  last  saw  him  in  June,  1879.  He 
is  at  present  travelling  in  Europe.     From  August, 

1877,  to  June,  1879,  he  had  not  missed  a  day  in 
his  business  in  the  city,  while  he  lived  in  Yonkers. 
Considering  the  large  cavities,  which  of  course 
cannot  heal  on  account  of  the  pyogenic  mem- 
brane, and  cause  him  to  cough  on  exertion,  he 
appears  perfectly  well  from  his  looks  and  actions. 

Mr.  Herm.  B .  merchant,  in  51  New  Street, 

New  York  j  native  of  Hamburg ;  twenty-two  years 


156 


TriK    CANADA    MEDICAL    RECORD. 


old ;   had    lost   a   brother   from   consumption  in 
Madeira  in  1871  ;  was  attacked  several  times  by 
haeuioptysis  in  1875  ;  ^^^  which  he  was  treated  by 
Dr.  Pregitzer,  of  Staten   Island.     Not  recovering, 
he   consulted    Dr.  Schmetter,  of  New  York,  who 
sent  him  to  Aiken,  S.  C,  from  where  he  returned 
much  reduced.     Dr.  S.  then  advised  him  to  go  at 
once  to  I'au  in  the  winter,  and  to  Davos,  Switzer- 
land, in  summer.     With  the  steamer  ticket  in  his 
pocket,  he   came   to  me   in  October,  1876.     His 
appearance  was  decidedly  hectic  :  had  night-sweats, 
and   a  pulse  of  135  at  rest.     Percussion  dull  on 
both  apices,  much  more  on  left  than  on  right  side, 
with  cracked-metal  resonance  between  third  and 
fourth   left  ribs,  and  pains  on  percussion.     Res- 
piration bronchial,  with  subcrepitant  rale,  on  both 
summits  on  left  side  down  to  fifth  rib,  with  caver- 
nous  whisper  between  third  and  fourth  ribs,  in- 
dicating a  cavity  of  the  size  of  a  large  walnut.    He 
was  not  able  to  walk  ten  blocks,  and  could  not 
retain  his  food.     He  was  under  my  treatment  from 
October,  1876,  to  June,  1877,  when  he  sailed  for 
Europe.      Before  he  sailed  Dr.  Lellmann,  physi- 
cian  to  St.  Francis'  Hospital,  New  York,  had  the 
kindness  to  examine  him,  and  although  he   was 
very  much  better  than  when   I  first  saw  him,  Dr. 
Lellmann  warned  me  not  to  be  sanguine  in  my 
expectation  of  his  recovery.     The  patient  returned 
to   New  York  in  October,    1877,  and  re-entered 
business.     He   is  a  well-known  member  of   the 
Produce  Exchange.     He  finally  became  careless 
of  himself,  when  an  attack  of  haemoptysis  fright- 
ened him,  and  gave  me  a  chance  to  perfect  his 
cure.     He  has  recovered  so  as  to  outwalk  me  at 
any  time,  dances  all  night,  eats  and  drinks  as  he 
pleases  ;  has  been  through  serious  business  excite- 
ments, and  broken  his  fibula,  which  confined  him 
four  weeks  on  his  bed.     He  looks  so  well,  and 
shows  such  vitality  that  he  is  laughed  at  by  his 
friends  when  he  says,   he   is  consumptive.     The 
condition  of  his  lungs  is  as  follows  :  Percussion  is 
moderately  dull  in  both  summits.     Auscultation 
denotes  a  somewhat  large  vesicular  respiration  in 
the  aff::cted  portions,  with   prolonged   expiration. 
The  signs  of  the  cavity  on   left  side  have  disap- 
peared, so  has  his  cough.     His  pulse  is  60  to  70  ; 
he   is  very  strong,  and  has    gained  considerable 
flesh.     His  chest  has  become  full  and  rounded, 
and  he  presents  as  perfect  a  recovery  as  can  be 
realized  only  by  the  most  san.i^uine  expectation. 
Still,  I  am  satisfied  he  would  have  died  had   not 
the  haemoptysis  brought  him  back  under  my  con- 
trol in  1877  ;  and  I  may  mention  that  when  I  took 
him  as   a   patient  with  the  view  of  curing  him,  I 
was  ridiculed  by  all  his  friends. 

Frank  VV.   T ,  M.D.,  practising  physician  of 

New  York,  came  to  me  in  March,  1877.  He  had 
been  examined  by  all  the  leading  specialists  of 
New  York,  and  had  been  treated  by  Drs.  Elsberg 
and  Lincoln  for  marked  aphonia  of  two  years' 
standing.  He  told  me  that  these  gentlemen  found 
two  tubercular  ulcers  upon  the  vocal  ligaments. 
Exammation  of  lung  denoted  marked  dullness  in 


both  summits  to  about  fourth  rib.  and  an  exuda- 
tion of  two  inches  in  right  pleura,  over  which 
auscultation,  denoted  a  soft  crepitation,  indicating 
a  not  fully  reabsorbed  pneumonia.  Respiration  in 
both  upper  ])ortions  bronchial,  with  mucous  and 
subcrepitant  rales.  Pulse  120,  digestion  ent  rely 
out  of  order,  very  weak,  and  short  of  breath.  Two 
weeks  after  I  treated  him  his  aphonia  left  him, 
when  he  failed  to  appear.  I  found  him  in  his 
office  very  sick.  He  had  taken  nitrous  oxide  gas 
and  morphia.  I  managed  to  get  him  out  again, 
but  he  was  a  very  irregular  patient,  and  I  lost 
sight  of  him  until  September,  1877,  when  he  came 
back  much  reduced  and  weaker.  He  then  began 
treatment  in  earnest,  and  improved  steadily,  so 
that  he  could  walk  daily  to  my  office  during  the 
whole  winter  which  he  could  not  do  previously. 
In  June,  1878,  he  went  to  spend  the  summer  on 
a  farm,  with  the  direction  to  return  in  September 
to  complete  his  recovery.  That  was  the  last  I  saw 
of  him.  I  am  fearful  that  he  feels  so  well  that  he 
considers  no  further  treatment  necessary. 

John  M  ,  architect,  a  patient  of  Drs.  John 

L.  Campbell  and  James  L.  Little,  presented  at 
case  of  pleuritic  exudation  of  about  four  inches  in  lef 
pleura,  dullness  over  whole  left  lung,  on  right  side 
to  fourth  rib.  Auscultation  showed  the  varieties  from 
cavernous  gurgling  to  dry,  moist  mucous  and  me- 
tailic  rales.  Both  tympani  were  destroyed  by  tuber- 
cular ulceration,  with  ulcers  on  tongue  and  pharynx. 
He  had  also  three  fistulae-in-ano,  from  which  he 
suffered  very  much.  I  treated  the  case,  by  spe- 
cial request  of  Dr.  Campbell,  from  September, 
1877,  to  March,  1878.  The  patient  made  such 
favorable  progress  that  Dr.  Little  sent  me  a  note 
of  congratulation.  An  also  ;ss  in  the  lungs  broke 
on  the  loth  of  December.  This  completely  upset 
him  ;  still  he  rallied  again,  wilked  over  three  miles 
per  day,  until  February,  when  another  abscess 
broke,  and  two  weeks  af  er  that  another,  which 
completely  exhausted  him.  He  died  very  easy. 
Post-mortem  was  decidedly  refused.  This  case 
was  an  utterly  desperate  one,  with  no  chance  at 
all,  but  it  showed  the  effect  of  treatment,  neverthe- 
less, as  the  medical  gentlemen  mentioned  above 
can  testify. 

Mr.  C  A.  M.,  merchant  of  New  York,  22  years 
of  age,  had  been  treated  some  time  by  a  French 
physician  when  he  was  examined  by  Dr.  A.  Clark, 
who  pronounced  his  lungs  affected,  and  recom- 
mended the  South.  He  was  also  examined  by  Dr. 
Metcalf,  who  concurred  in  the  same  opinion.  The 
patient,  therefore,  went  to  Asheville,  N.C.  This 
was  1877-78.  He  returned  very  much  sicker.  I 
saw  him  in  May,  1878.  Percussion  was  dull, 
more  or  less,  over  the  whole  of  left  lung  front — 
moderately  dull  m  right  summit  to  about  third  rib 
— resonance  on  back  about  even  on  both  under 
portions.  Auscultation  denoted  bronchi  of  caver- 
nous character  front  and  back  on  left  side — some 
portion  aimost  entirely  devoid  of  any  respiratory 
murmur,  while  portions  between  them  gave  bron- 
chial rales,  and  subcrepitant  rales  over  the  whole 


Till-:    CANADA    MEDICAL   RECORD. 


157 


of  left  portion  in  front.     There  was  some  vesicular 
murmur  audible  on  lower  portion  of  back,  but  of  a 
moist  character.     Left   upper    side    subcrepitant 
rales  on  summit,  lower  portion  normal  ;  expiration 
a    little   sharper.     Pulse    128  at   rest;  decidedly 
hectic ;   parents    both    healthy    and    living,  but 
several  brothers  delicate.     Patient  could  walk  but 
very  slow  and  with  difficulty.     As  the   case  was 
decidedly  a  desperate  one,  and  liable  to  die  at 
any  time,  I  took  the  precautionary  measure  to  have 
him  re-examined  by  one  of  the  most  distinguished 
physicians  of  New  York,  who  gave  his  opinion  that 
the  patient  was  beyond  the  hope  of  any  possible 
recovery.     I  then  treated  the  case  with  the  follow- 
ing result :  for  the   first  two  months  he   made  no 
perceptible  progress,  except  that  he  obtained  better 
sleep  and  became  livelier.    In  September  his  pulse 
began  to  fall,  and  he  improved  visibly.     In  order 
to  reach  my  office  daily,  he  had  to  travel  twenty- 
four  miles  by  railroad  and  a  mile  to  walk.     He 
improved'  so  that  he  walked  three  or  four  miles 
daily  when  at  home,  besides  his  thoracic  exercises. 
His  pulse  began  to  fall  from  76-78.     In  February 
it  began  to  rise  somewhat,  and  the  patient  com- 
plaining of  soreness   in  his  left  thorax,  made  me 
suspect  an  abscess  ready  to  open,  and  he  removed 
temporarily  to  the  Windsor  Hotel.     After  a  few 
days  the  abscess  opened,    and  he  discharged  a 
large  quantity  of  pus.     To  my  surprise  this  did  not 
affect  him  so  seriously  as  it  generally  does,  but  he 
soon  felt  so  much  better  that  I   permitted  him  to 
go  home  again.     Pulse  back  again  to  78.     The 
large  cavity  left  could  easily  be  diagnosed,  which, 
with  the  already  existing  smaller  cavities,  comprised 
an  area  from  the  clavicle  down  to  the  nipple.  The 
tissues  existing  between  these  cavities  I  hoped  to 
save  for  cicatrization.     The  patient,  meanwhile,  re- 
mained about  the  same,  not  well  enough  to  do 
business  and  too  smart  to  do  nothing ;  the  right 
lung  progressing  well  all  the  time.     Spending  the 
summer  with  me  in  Nantucket,  Mass.,  he  left  a 
week  in  August  for  New  York  City  to  meet  his 
father,  who  had  just  returned  from  Europe,  and  to 
have   a   good   time   generally.     He   returned   to 
Nantucket  somewhat  used  up,  but  still  his  physi- 
cal signs  were  about  the  same  ;  pulse  96.     Think- 
ing that  I  could  make  a  change  for  the  better  I 
allowed  him  to  travel  over  the  White  Mountains, 
regardless  of  weather,  which  he  did  in  September, 
consuming  about  three  weeks.     He  enjoyed  his 
trip  very  much,  but  returned  changed  for  the  worse. 
His  lips  and   nails,  which  were   rosy  and  bright, 
looked  bluish;   his   pulse    112,  and  very    feeble. 
Examination  showed  that  the  cavities  in  the  left 
lung  had  coalesced.     Right  lung  in  perfect  order  ; 
respiration  vesicular  throughout  and  dry ;  only  in 
upper  portion  respiration  prolonged  and  audible. 
The  patient  travelled  his  twenty-four  miles  every 
day  to   reach  my  office  ;  his  pulse  is  80  in  bed  ; 
104-112  in  day-time  ;  appetite  and  digestion  per- 
fect. The  case  is  an  extremely  painful  one,  demon- 
strating the  good  effect  of  treatment  in  one  lung 
and  its  utter  helplessness  in  the  other  one.     This 
patient  finally  succumbed  to  the  disease. 


Mr.  Alex.  W ,  bookkeeper  in  Bank  of  Lan- 

singburgh,  26  years  old.     1  saw  the  patient  while 
in  Albany.     He  had  been  sick  about  two  years, 
trying  in  vain  different  modes  of  treatment.  Besides 
being  lung-sick,  he  had  chills  and  fever  for  two 
months,  for  which  he  had  been  in  Brooklyn,  but 
failed  to  get  rid  of  them.  I  saw  him  in  May,  1878. 
Examination  showed  the  left  upper  lung  very  dull 
on  percussion.  Respiration  bronchial,  with  mucous 
rales.     Subcrepitant  rales  in  lower  left  lung.    Right 
lung  less  dull   on   percussion,  with  some  mucous 
rales,  but  with  subcrepitant  rales  in  both  upper 
lobes.     Pulse  145  ;  very  weak.     Epigastrium  pain- 
ful, abdomen  hard  and  dull,  digestion  completely 
out   of  order,    severe    night-sweats ;   hectic,   with 
bluish  lips  and  nails.    I  ordered  a  dose  of  sulphate 
of  soda,  followed  next  day  by  a  dose  of  the  juice 
of  twenty  lemons,  with  hot-water  sheets  applied  an 
hour  previous  to  the  chill.     This  arrested  his  fever 
and  chills  at  once,  and  he  came  to   New  York. 
His  pulse  was  140,  and  he  was  so  weak  that  he 
was  unable  to  walk  four  blocks.     His  cough  and 
looks  alarmed  the  guests  and  landlord  at  the  hotel 
in  Nantucket,  who  thought  he  had  been  brought 
there  to  die.     He  soon  picked  up,  however,  and  in 
February,    1879,    ^^    walked     over    200    miles. 
Although  not  quite  well  he  left  me   in  June,  with 
the  understanding  to  spend  the  summer  in  Nova 
Scotia,  at  the  seashore,  instead  of  which  he  remain- 
ed at  home  in  Lansingburgh,  doing  business.     The 
result  was  a  return  of  the  chills  and  fever,   for 
which  he  was  in  New  York  a  few  days  ago  to  con- 
sult me.    I  advised  him  to  go  home  again  to  apply 
the  hot  water  until  the  epigastric  pain  had  gone. 
Of  course,  he  does  not  look  so  well  as  he  did  in 
the  spring,  but,  with,  some  attention  on  his  side, 
he  will  soon  make  up  again.   His  pulse  has  been  all 
along  to  58  to  60,  when  quiet ;  since  the  fever,  it 
has,  of  course,  been   higher,  varying   from   80  to 
96. 

Mr.  Geo.  W.  Sh ,  from  Albany,  came  to  me 

through  Drs.  Bailey  and  Curtis,  in  June,  1878. 
Examination  showed  a  moderate  dullness  of  both 
summits  to  third  rib  on  right  and  fourth  rib  on  left 
side,  with  subcrepitant  rales.  Pulse  80 ;  no  compli- 
cations. This  case  made  very  rapid  progress,  gain- 
ing six  pounds  in  weight,  under  somewhat  severe 
exercise  in  two  months.  Instead  of  remaining 
with  me  until  Christmas,  when  I  promised  to  dis- 
miss him  as  cured,  he  felt  well  enough  to  dis- 
charge himself. 

Mr.  J.    Watson  A ,  30   years   of  age,  from 

Fishkill,  N.Y.,  a  merchant,  came  under  rny  treat- 
ment in  August,  1878.  He  had  a  very  moderate 
dullness  over  both  upper  lungs,  with  bronchial 
mucous  rales  and  moist  crepitation.  Pulse  76. 
This,  I  considered,  was  quite  a  curable  case.  He 
left  me  suddenly  after  two  months,  just  when  the 
case  worked  to  my  full  satisfaction.  I  did  not  see 
him  again  until  this  last  summer,  when  he  had 
apparently  failed  very  much.  Since  October  ist 
he  has  been  my  patient  again.  The  dullness  now 
is  quite  perceptible;  his  pulse  104  to  112,  and  I 
am  apprehensive  of  the  formation  of  an  abscess. 


158 


THE    CANADA    MEDICAL    RECORD. 


Auscultation  denotes  subcrepitant  rales  over  both 
upper  portions.  Respiration  decidedly  bronchial, 
with  occasional  mucous  rales.  I  shall  report  the 
result  of  my  treatment  hereafter. 

Miss    H ,  from  Brockport,  N.Y.,  aged  20, 

was  sent  to  mc  by  Dr.  Brannan,  in  August,  1878  ; 
marked  dullness  in  both  apices  as  low  as  fourth 
ribs,  with  bronchial  respiration  and  subcrepitant 
rales.  Not  able  to  retain  any  food  ;  very  feeble 
and  nervous  ;  pulse  over  100.  She  recovered  so 
quickly  that  she  could  walk  two  miles  without 
difficulty.  After  six  weeks  I  ordered  her  to  exer- 
cise her  respiratory  muscles  more  actively,  which 
resulted  in  serious  pains  in  back  and  abdomen.  I 
then  discovered  that  she  was  suffering  from  pro- 
lapsus uteri  with  antroversion,  and  which  she  had 
hidden  from  me  for  unknown  reasons.  As  this 
arrested  my  treatment,  and  she  preferred  her  bro- 
ther-in-law to  the  specialists  recommended  by  me, 
she  left  for  home.  I  have  heard  that  she  died  a 
few  months  since. 

Mr.  A.   R.  McM ,    merchant   and   banker, 

from  Toronto,  came  to  me  in  August,  1878,  through 
Dr.  Walsh,  of  Michigan.  Had  been  a  consump- 
tive invalid  for  ten  years,  under  treatment  of  Dr. 
Philipps,  of  London,  Eng.  Had  been  in  Egypt, 
Madeira,  Mentone,  and  Western  America,  with 
temporary  benefit,  but  had  failed  rapidly  for  the 
last  two  years  ;  fifty-two  years  of  age  ;  presented  a 
strongly  marked  hectic  habitus.  Examination,  left 
side,  denoted  decided  dullness  to  fourth  rib,  with 
bronchial  and  irregular  respiration  and  subcrepi- 
tant rales  ;  right  side,  marked  dullness  to  fifth  rib, 
with  bruit  depot  fele  under  clavicles,  which  stood 
out  higher  than  an  inch.  Auscultation  gave 
strongly-marked  cavernous  respiration  under  clavi- 
cle, surrounded  by  bronchial  and  irregular  respira- 
tion, with  wheezing  noises ;  occasional  mucous 
rales  ;  amphoric  voice  ;  pulse  intermittent  every 
fifth  or  seventh  beat— irregular,  but  not  higher  than 
72  to  76;  heart  appeared  normal.  Patient  was 
very  weak  ;  chest  sunk  and  flat.  After  three 
months  his  pulse  become  perfectly  regular.  He  left 
me  in  May  to  spend  the  summer  at  Rye  Beach. 
He  intended  to  return  to  business  this  fall,  but,  by 
my  advice  and  that  of  his  friends,  will  spend  this 
winter  still  under  my  observation.  His  condition 
is  now  :  Chest  full  and  developed  ;  walks  ten  miles 
up  and  down  hill  as  straight  as  an  arrow,  without 
unusual  fatigue  \  pulse  60  to  64.  Examination  of 
chest  denotes  moderate  dullness  on  both  summits. 
No  marked  signs  of  the  cavity  left.  Respiration 
established  evenly  in  both  points,  with  a  broncho- 
"esicular  character  and  prolongated  expiration.  No 
rales.  Since  August  he  has  occasional  spa.sms  of 
cough,  seemingly  caused  by  irritation  of  throat,  but 
may  be  due  to  reflex  irritation  also.  He  managed 
to  get  his  digestion  out  of  order  at  Rye  Beach, 
without  apparent  injury  to  his  system.  I  expect 
to  dismiss  him  in  the  spring  a  fully  recovered  case 
— which  he  is  nearly  now. 

This  necessarily  short  report  of  these  few  cases 
may  suffice  to  illustrate  the  nature  of  the  affections 


in  question.  It  will  be  seen  that  most  of  them 
have  been  examined  and  treated  by  the  most 
accredited  sjiecialists  in  the  country,  and  there  can 
be  hardly  any  doubt  as  to  the  seriousness  of  the 
cases,  none  of  which  had  any  chances  left  by  the 
usual  routine  treatment.  Even  if  I  had  lost  all 
these  cases,  which  fortunately  1  have  not,  a  uni- 
form effect  of  my  treatment  is  apparent  in  any  of 
them,  as  I  take  patients  as  they  come,  and  I  have 
to  bear  up  against  the  fact  that  the  quick  recover- 
ing ones  leave  me  before  I  get  a  chance  to  finish 
them,  while  the  failing  ones  invariably  remain  with 
me  until  death.  'I'his  fact  makes  my  full  recoveries 
less  than  they  would  be  otherwise. 

As  already  stated,  the  treatment  cannot  be  ex* 
pected  to  accomplish  miracles,  but  it  is  offered  as 
one  which  brings  about  gratifying  results.  The 
expansion  of  the  lungs  by  the  active  and  varied 
exercise  of  the  respiratory  muscles,  is  comparatively 
simple.  The  difficulty  is  in  keeping  it  up  in  a 
systematic  and  methodical  way,  with  a  determina- 
tion to  accomplish  the  ultimate  result.  It  requires 
the  utmost  patience  and  perseverance  on  the  part 
of  the  patient,  and  the  physician  should  have  him 
under  complete  control.  The  same  may  be  said 
regarding  diet,  but  in  a  much  greater  degree.  The 
patient's  diet  must  be  studied  day  by  day  ;  he 
must  keep  a  diary  of  his  meals,  and  give  a  daily 
account  from  his  written  record  of  the  time  of 
eating,  the  amount  and  variety  eaten,  and  of  any 
unusual  symptoms  which  may  be  referred  to  im- 
perfect indigestion.  Under  such  training,  the  sys- 
tem soon  makes  known  its  wants,  and  the  discri- 
minating physician  acts  accordingly.  But  this,  of 
course,  cannot  be  learned  except  by  a  study  of 
individual  cases  and  by  the  use  of  that  common 
sense  which  comes  of  extended  experience  and 
careful  observation. 

13  East  Thirtieth  Street. 


AIDS  TO  DISEASES  OF  WOMEN. 
By  J.  J.  Reynolds,  M.R.C.S.  Eng. 

Tumours  of  the  Uterus. 

Polypus  Uteri. — There  are  six  varieties  of  polypi, 
viz.  : — 


1.  The  Fibrous. 

2.  "      Mucous. 
X.     "     Granular. 


4.  The  Vascular. 

5.  "     Placental. 

6.  ''     Fibrinous. 


The  Fibrous  Polypus. — This  is  the  most  common 
variety  of  polypi.  They  usually  grow  from  the  fundu.s 
uteri,  and  have  their  origin  in  the  sub-mucous  tissue. 
They  are  firm,  usually  solitary  and  pedunculated, 
and  are  composed  of  fibro-cellular  tissue.  They 
cause  enlargement  of  the  uterus,  and  give  rise  to 
haemorrhage,  either  in  the  form  of  menorrhagia 
or  metrorrhagia,  leucorrh?ea,  and  pain  of  a  bearing- 
down  or  expulsive  character.  Bladder  and  rectal 
irritation  may  be  present,  or  the  polypus  may  set 


THE    CANADA    MEDICAL    RECORD. 


159 


up  ulceration  of  the  cervix  uteri,   metritis,  septi- 
caemia, or  peritonitis. 

It  must  be  remembered  that  a  polypus  may 
cause  abortion,  but,  as  a  rule,  they  prevent  preg- 
nancy. 

Treatment. — This  variety  is  best  treated  by  the 
ecraseur,  and  the  after  application  of  nitric  acid. 
There  is  generally  free  hemorrhage. 

The  Mucous  Polypus. — This  variety  generally 
grows  from  the  os  uteri.  They  are  usually  very 
vascular,  red  in  colour,  small,  soft,  and  peduncu- 
lated, and  are  made  up  chiefly  of  connective  tissue 
containing  one  or  more  mucous  follicles,  and  a  soft 
and  viscid  fluid,  the  whole  being  capped  with  a  very 
vascular  mucous  membrane. 

These  polyi  generally  produce  either  menor- 
rhagia  or  leucorrhcea,  and  at  times  dysmenorrhoea, 
There  may  be  no  symptoms. 

Treatment. — Torsion,  and  the  after  application 
of  nitric  acid,  or  the  cautery  or  the  wire  ecraseur 
maybe  used. 

The  Granular  or  Cystic  Polypi. — These  gen- 
erally occur  in  the  cervical  canal,  and  are  sessile 
and  multiple.  They  are  bluish-white  in  colour,  soft, 
and  seldom  larger  than  a  grape,  and  are  composed 
of  a  mucoid  fluid  enclosed  in  a  thin  membrane. 
They  cause  leucorrhcea  or  hcemorrhage. 

The  channelled  polypus  of  Oldham  belongs  to 
this  variety. 

Treatment. — They  may  be  treated  like  the  mu- 
cous polypi,  or  else  broken  up  by  being  seized  by 
the  forceps.  Thus  killed,  the  haemorrhage  gen- 
erally ceases,  but  the  cautery  had  better  be  applied 
to  the  spot  as  a  further  security. 

The  Placental  Polypus. — This  variety  is  not 
recognized  by  many  authorities.  It  is  formed  from 
a  retained  portion  of  the  placenta,  and  produces 
severe  bleeding. 

The  Fibrinous  Polypi. — These  polypi  always 
cause  profuse  menorrhagia,  and  are  thought  to  be 
the  result  of  an  abortion,  or  produced  from  retained 
menstrual  blood,  &c. 

Diagnosis. — A  polypus  which  has  emerged  from 
the  uterus  may  be  mistaken  for  inversion  of  the 
uterus  or  prolapse.  In  the  latter  the  os  uteri 
may  always  be  discovered  at  the  lowest  part  of  the 
tumour.  A  prolapsed  uterus  is  very  sensitive  to 
compression.  A  polypus  is  not  at  all  sensitive. 

Dr.  Barnes  says  complete  inversion  is  distin- 
guished by : — 

1.  The  absence  of  an  os  uteri  at  the  lowest 
part. 

2.  By  the  neck  of  the  tumour  being  continuous 
with  the  roof  the  vagina,  which  is  directly  reflected 
off"  from  it. 

3.  By  determining  the  absence  of  the  body  of 
the  uterus  from  its  normal  position,  &c. 

The  following  tests,  he  states,  will  commonly  dis- 
tinguish partial  inversion  (in  partial  inversion,  as  in 
polypus,  there  is  a  rounded  tumour  encircled  by  a 
ring,  permitting  a  sound  or  the  finger  to  pass  up 
between).  Tne  sound  will  not  run  more  than  an 
inch,  perhaps  less,  beyond  the  margin  of  the  encir- 


cling ring,  whereas,  in  the  case  of  polypus,  it  will 
generally  run  at  one  part  or  another  at  least  two 
and  a-half  inches,  &c.  Other  diagnostic  signs  will 
be  found  under  "  Inversion." 

Fibrous  Tumours. — These  tumours  vary  much 
in  size,  some  being  no  larger  than  a  small  pea, 
whilst  others  are  bigger  than  a  cocoa-nut.  They 
are  often  multiple,  but  may  occur  singly,  and 
they  are  formed  of  the  same  strictures  as  the 
uterine  walls — non-striated  muscular  tissue,  with 
a  varying  quantity  of  connective  tissue. 

The  amount  of  connective  tissue  present  depends 
on  the  age  of  the  tumour,  the  oldest  ones  contain- 
ing the  largest  amount,  while  those  newly-developed 
consist  almost  entirly  of  muscular  tissue. 

Fibrous  tumours  are  encapsuled,  and  occasionlly 
cysts  are  developed  in  their  interior — fibro-cystic 
tumours. 

There  are  three  varieties  : 

1.  The  sub-peritoneal  or  extra-uterine.  This 
variety  grows  from  the  peritoneal  surface  of  the 
uterus,  and  can  be  felt  through  the  abdominal 
walls. 

2.  The  sub-mucous  or  intra-uterine,  growing 
directly  beneath  the  mucous  membrane  and  pro- 
jecting internally. 

3.  The  intramural  or  interstitial.  These  grow 
within  the  substance  of  the  uterine  walls,  and  they 
become  converted  in  the  sub-peritoneal  and  sub- 
mucous varieties.  The  sub-peritoneal  variety  may 
be  solitary  or  multiple,  sessile  or  pedunculated. 
They  do  not  generally  cause  enlargement  of  the 
uterus,  nor  do  they  necessarily  influence  menstrua- 
tion or  cause  haemorrhage.  The  only  symptoms 
which  are  often  present  are  due  to  pressure.  By 
descending  into  the  pelvis,  bladder  and  rectal 
irritation  may  be  set  up.  If  pregnancy  should 
take  place,  abortion  would  probably  be  the  result, 
or  a  tedious  labour,  followed  by  post-partum 
haemorrhage. 

Pedunculated  tumours  floating  about  in  the  abdo- 
men may  interfere  with  respiration,  the  circulation, 
or  with  the  intestines. 

The  sub-mural  fibroids  are  verj^  common,  and 
they  cause  hypertrophy,  enlargement,  and  fre- 
quently distortion  of  the  whole  uterus.  They  nearly 
always'  produce  haemorrhage  and  leucorrhcea,  and 
often  dysmenorrhoea.  Local  pain  is  usually  present, 
and  it  is  generally  of  a  spasmodic  character.  Owing 
to  their  mechanical  pressure  various  other  symp- 
toms may  be  present,  and  they  are  often  largely 
influenced  by  menstruation  and  pregnancy.  At  any 
period  a  tumour  producing  no  discomfort  may 
become  greatly  enlarged,  and  very  painful.  Preg- 
nancy also  intensifies  the  symptoms  of  fibroids  ; 
while,  on  the  other  hand,  delivery  is  often  followed 
by  great  diminution  or  complete  disappearance  of 
a  fibroid.  Fibroid  tumours  are  often  the  cause  of 
sterility,  and,  if  impregnation  takes  place,  abortion 
is  very  liable  to  occur. 

Prognosis. — Fibroids  do  not,  as  a  rule,  cause 
death,  but  they  may  do  so  from  haemorrhage, 
asthenia,  peritonitis,  blood-poisoning,  metritis,  or 


160 


THE    CANADA    MEDICAL    RECORD. 


from  the  effects  of  pressure.  At  times  a  fibroid 
cures  itself.  There  are  four  ways  by  which  a  natu- 
ral cure  may  take  jilace  : 

1.  The  tumour  may  become  ab.sorl)ed. 
Fibroids  grow  very  slowly,  and  after  a  time  have 

a  tendency  to  cease  and  diminish.  Cases  of  absorp- 
tion are  not  very  rare,  esj)ecially  about  the  meno- 
pause, or  as  the  result  of  involution  after  delivery. 

2.  The  tumour  may  undergo  fatty  or  calcareous 
degeneration,  and  be  finally  sej^arated  and  cast 
off. 

3,  The  tumour  may  become  spontaneously 
detached  and  expelled. 

4,  The  tumour  may  become  gangrenous,  and 
slough  away  as  the  result  of  operation,  or  from  the 
effects  of  pressure. 

Dia^(^/iosis.—'lh\s  is  often  difficult.  The  large 
fibro-cystic  tumours  must  be  distinguished  from  an 
ovarian  tunioui. 

Dr.  Atthill,  in  his  work,  gives  the  following  tabu- 
lated form  of  the  differences  between  ovarian  cystic 
disease  and  uterine  fibro-cystic  disease.  He  states, 
however,  that  there  is  not  one  of  the  symptoms 
enumerated  which  is  not  liable  to  great  variation, 
and  that,  therefore,  the  most  extreme  caution  must 
be  exercised  in  forming  an  opinion  based  on 
them. 


Ovarian  Cystic  Disease. 

1.  May  occur  at  any 
age,  but  probably  more 
frequent  before  the  age 
of  36  than  after  it.  Of 
281  cases  recorded  by 
Mr.  Clay,  and  of  which 
the  ages  were  known, 
168  were  under  36  ;  68 
of  these  were  aged  be- 
tween 17  and  25. 

2.  Previous  history 
often  throws  light  on  the 
diagnosis,  a  tumour 
being  frequently  felt  at 
first  in  one  or  other  iliac 
region,  which  gradually 
extended  across  the 
abdomen. 

3.  Growth  of  tumour 
comparatively  rapid. 

4.  Menstruation  some- 
times normal,  but  fre- 
quently irregular,  and  as 
the  disease  progresses 
is  liable  to  be  sup- 
pressed ;  profuse  men- 
struation of  rare  occur- 
rence. 

5.  Uterus  of  its  nor- 
mal size,  frequently 
drawn  upwards  so  as  to 
be  difficult  to  reach, 
moveable  (unless  bound 


Uterine   Fibro-cystic 
Disease. 

1.  Rarely  met  with  in 
early  life.  Of  23  cases 
recorded  by  Mr.  Clay, 
in  which  the  operation 
was  abandoned  in  con- 
sequence of  the  disease 
being  extra-ovarian,  34 
was  the  age  of  the 
youngest  patient. 

2.  Such  a  history  un- 
likely to  occur ;  growth 
usually  more  central. 


3.  Growth  compara- 
tively slow. 

4.  Menstruation  pro- 
fuse, if  tumour  be  intra- 
mural or  sub-mucous  ; 
normal,  if  sub-peritoneal. 


5.  Uterus  elongated, 
if  tumour  be  in  its  sub- 
stance or  interior.  Sound 
often  pissing  for  a  con- 
siderable  distance   into 


down  by  adhesions),  and 
sometimes  anteflected. 

6.  Tumour  becomes 
softer  as  it  increases  in 
size. 

7.  Urine  voided  with 
difficulty. 


its  cavity.  When  tumour 
is  rotated,  sound  moves 
with  it. 

6.  Time  not  likely  to 
alter  consistence  of  tu- 
mour. 

7.  Diflficulty  in  pass- 
ing water  occasionally 
experienced,  from  pres- 
sure on  bladder  and 
urethra. 

8.    Generally    health         8.  General  health  does 
suffers,   more   or    less  ;     not  suffer,    unless  men- 
sometimes   to    a     great     orrhagia  be  present, 
degree. 

'i'he  diagnosis  from  ]iregnancy  is  generally  easy. 
In  pregnancy  the  enlargement  of  the  uterus  is  uni- 
form ;  in  fibroid  disease  the  contour  is  generally 
irregular.  The  history  of  the  two  cases  is  quite  differ- 
ent, while  the  presence  of  menstruation,  the  absence 
of  cervical  softening,  and  other  signs  of  pregnancy, 
will  prevent  any  error.  Displacements  of  the  uterus 
can  be  distinguished  by  the  sound.  When  the 
uterus  is  restored  to  its  normal  situation,  the  sup- 
posed tumour  will  have  disappeared.  It  must  be 
remembered  that  flexion  and  a  tumour  may  co- 
exist. 

The  other  diseases  which  may  similate  a  fibroid 
are,  retro  uterine  haematocele,  perimetric  inflam- 
mation and  malignant  growths  in  the  lumbar 
glands,  peritoneum,  or  intestines.  The  diagnosis 
of  these  diseases  can  generally  be  arrived  at  by 
careful  palpation,  the  sound,  the  history,  and  gen- 
eral symptoms  present. 

Treatment. — When  it  is  remembered  that 
fibroids  have  a  tendency  to  stop  growing  and  dimin- 
ish in  size  after  the  menopause,  it  is  obvious  that 
no  severe  operative  measures  for  their  removal 
should  be  thought  of.  A  natural  cure  also  is  not 
very  rare,  and  fibroids  often  produce  no  distress. 
Generally,  palliative  treatment  only  is  required. 
Haemorrhage  and  leucorrhoea  must  be  restrained. 
When  the  former  resists  minor  treatment,  it  will  be 
necessary  to  dilate  the  cervical  canal,  either  by 
mechanical  means  or  by  incision ;  and,  if  bleeding 
continues,  to  swab  the  interior  of  the  uterus 
with  fuming  nitric  acid  or  strong  perchloride  of 
iron. 

The  sub-mucous  pedunculated  fibrous  tumours 
may  be  treated,  like  the  ordinary  fibrous  polypi^ 
with  the  wire  ecraseur,  &c. 

When  palliative  measures  are  of  no  avail,  and  the 
condition  of  the  patient  is  becoming  serious,  more 
heroic  treatment  must  be  undertaken. 

The  different  operations  which  have  been  prac- 
tised are  : — 

1.  Incision  of  tumour. 

2.  Enucleation  of  tumour. 

3.  Incision  of  tumour,  and  destruction  of  its 
tissue,  or  gouging. 

4.  Avulsion,  or  tearing  away  the  tumour  from 
its  attachments. 

5.  Spaying,  or  normal  ovariotomy. 


THE   CANADA   MEDICAL    RECORD. 


161 


6.  Removal  of  tumour  by  gastrotomy,  with  or 
without  the  uterus. 

Incision  of  tumour  may  be  required,  in  intra- 
mural tumours,  when  haemorrhage  cannot  be 
checked  by  minor  treatment.  If  ergot  be  after- 
wards given,  the  tumour  may  be  protruded  through 
the  opening. 

Enucleation  of  tumor. — This  operation  always 
involves  a  great  risk  of  septicaemia  and  peritonitis. 

Avulsion. — This  treatment  is  appropriate  in 
those  cases  where  natural  enucleation  has  com- 
menced, or  to  assist  enucleation  which  has  been 
commenced. 

Spayifig. — The  object  of  this  operation  is  to 
bring  on  artificially  the  menopause,  and  it  may  be 
performed  when  the  symptoms  demand  such  a 
severe  operation. 

Gastrotomy. — Only  to  save  life  should  this 
operation  be  thought  of.  Of  course,  it  is  rarely 
called  for. 


THE 


TREATMENT    OF     POST-NASAL 
CATARRH. 


Read  before  the  Philadelphia  County  Medical  Society,  Septem- 
ber 24,  1879. 

By  Wm.  R.  D.  Blackwood,   M.D. 

Under  the  title  of  our  subject  this  evening  may 
properly  be  included  the  treatment  of  an  extensive 
series  of  disorders  of  the  naso-pharyngeal  space, 
evidencing  all  grades  of  severity,  from  the  simplest 
chronic  coryza,  of  little  account,  to  the  formidable 
ozena,  which,  in  its  destructive  ravages,  some- 
times threatens,  and  occasionally  destroys,  life 
itself. 

The  great  majority  of  cases  of  catarrh  are  not 
under  medical  treatment  of  any  kind,  and  the  ma- 
jority of  the  remainder  are  in  the  hands  of  adver- 
tising philanthropists,  retired  clergymen,  Indian, 
botanic,  eclectic,  homoeopathic,  and  such  like  illi- 
terate  quacks.      Thousands   of  cases  have  been 
treated  by  eminent  and  by  skillful  men,  without 
either   cure   or  appreciable  relief.     Sweeping  as 
this  assertion  may  seem,  let  gentlemen  only  inter- 
rogate families  under  their  charge,  many  of  whose 
members  suffer  from  catarrh  without  applying  for 
advice,  and  they  will  readily  discover  its  truth. 
The  natural  outcome  is  that  post-nasal  catarrh  is 
considered  an  incurable  disease,  and,  as  the  laity 
is  not  to  blame  for  its  mistaken  opinion,  would  it 
not  be  well  that  an  effort  be  made  to  undo  this 
error  by  paying  the  subject  more  attention  than  it 
apparently  receives,  and  which,  from  its  impor- 
tance,  it  undoubtedly  deserves  ?     It  is   singular 
that  so  much  study  has  been  given  to  some  dis- 
eases and  so  little  to  others,  and,  as  it  does  not 
always  follow  that  the  gravity  of  an  affection  deter- 
mines the  interest  felt  in  its  investigation  or  treat- 
ment, it  is  possible  that  in  this  way  the   subject 
under   consideration  may   have   been  unworthily 
neglected. 


Very  little  enquiry  will  elicit  the  reason  why  sa 
little  is  successfully  done  in  the  treatment  of 
catarrh.  Briefly  stated,  the  failure  consists  in  re- 
lying upon  general  constitutional  treatment,  which 
is  all  well  enough  as  an  auxiliary,  but  not  suffi- 
cient in  itself  To  cure  the  sufferer  demands  the 
persistent,  skillful,  personal  attention  of  his  medical 
adviser,  and  unless  this  course  is  strictly  and  con- 
scientiously followed  the  patient  will  receive 
little  benefit  and  his  physician  only  discredit. 

The  disagreeable  nature  of  the  service,  the  time 
and  trouble  involved,  and  the  diflficulty  in  some 
cases  of  mechanical  treatment,  have  deterred  the 
larger  part  of  the  profession  from  devoting  the  re- 
quisite personal  attention  to  their  patients,  and 
the  expense  attendant  upon  a  necessarily  extend- 
ed course  in  the  hands  of  most  specialists  has  pre- 
vented many  from  receiving  the  benefits  which 
would  accrue  from  their  services. 

I  do  not  intend  speaking  of  the  pathology  of 
naso-pharyngeal  catarrh,  there  being  too  much 
room  for  difference  of  theory,  and  too  little  time 
for  discussion.  The  vital  point  is  the  treatment  of 
our  patient.  What  is  to  be  done  ?  No  claim  of 
novelty  is  intended  in  this  paper,  but  it  may  be 
that  suggestions  thrown  out  as  the  result  of  suc- 
cessful management  might  be  elaborated  by  others, 
and  serve  a  useful  end  to  those  who  have  hitherta 
given  the  question  less  attention  than  it  of  right 
deserves. 

First,  then,   as  to   mechanical   treatment, — an 
essential  in  all  cases.     The  instruments  requisite 
are  few  and  simple  in  construction  andapplicaiion. 
At  their  head  stands  the  nasal  douche,  an  invaiu- 
able  and  indispensable  assistant,  not   to    be  re- 
placed by  any  other.     The  objections  to  its  use 
are   avoidable   by   simple  precautions.     Employ 
water  always  at  a  temperature  of  100°  F. ;  add  one 
drachm  of  common  table  salt  to  each  pint  of  water 
used,;  do  not  permit  the  patient  to  swallow  during 
the  flow  of  the  douche ;   hold   the   reservoir  no 
higher   than   the  eye  of  the  sufferer ;   incline   the 
head  slightly  forward  over  a  basin  ;   use  a  simple 
douche,  free  from  valves  or  complicated  mechan- 
ism ;   an  ordinary  tin  or  glass  funnel,  with  a  yard 
of  quarter-inch  rubber  tubing  and  a  conical  glass, 
wood,  or  porcelain  nozzle,   is   as  good  as  any,   is 
cheap,  durable,   and  easily  made.     Do  not  trust 
the  douche  in  the  hands  of  the  patient  until  its  use 
is  thoroughly  understood  and  accurately  managed. 
In  stupid,  perverse,  or  nervous  persons,  never 
trust  it  to  them  ;  always  apply  it  yourself.     I  have 
never  had  any  trouble  occur  through  the  use  of  the 
douche.     The  posterior-nares  syringe  is  a  valuable 
adjunct,  as  also  is  the   atomizer,  in  getting  at  the 
vault  of  the  pharynx,  which  they  do  in  many  cases 
much    more   effectually   than   does   the   anterior 
douche.     Although,  theoretically,  the  steam  atom- 
izer appears  preferable,  because  of  the  temperature 
being  readily  maintained,  yet  the  difficulty  of  di- 
recting the  spray  in   other  than  a  horizontal   line, 
and  the  view  of  the  parts  being  intercepted  by  the 
boiler,  render  the  hand-ball  apparatus  more  con- 


162 


THE   CANADA    MEDICAL    RECORD. 


venient,  especially  in  conjunction  with  simple  ad- 
justable tubes,  which  afford  a  lateral  or  vertical 
discharge  at  pleasure.  A  convenient  though  ex- 
pensive aj)paratus  is  the  compressed-air  mechan- 
ism of  Codman  &:  .Shurtleff,  by  means  of  which  a 
steady  flow  may  be  maintained  for  any  desired 
length  of  time.  In  common  with  those  applied 
by  the  douche,  all  atomized  solutions  should  be 
at  blood  heat  and  of  sufficient  density.  Caustic 
and  sjjonge-holders,  brushes  of  various  sizes,  an 
insufflator,  a  tenaculum  for  the  uvula,  a  tongue 
depressor,  an  anterior-nares  speculum,  and  a  rhino- 
scopic  mirror  are  requisite,'with  a  strong  light,  natur- 
al or  artificial,  in  the  management  of  which  nine- 
tenths  of  the  imposing  array  of  mechanism  usually 
encountered  may  be  disjjensed  with.  Each  pa- 
tient should  have  his  own  douche,  and  all  instru- 
ments employed  in  office  practice  must  be  kept 
thoroughly  clean.  Scrupulous  care  is  to  be  ob- 
served in  syphilitic  cases  that  the  ordinary  catarrh 
of  one  patient  is  not  complicated  by  specific 
inoculation  from  another. 

In  the  department  of  materia  medica  the  list  of 
necessary  agents  will  vary  with  the  taste  of  the 
physician,  some  drugs  developing  powers  in  the 
disease  under  consideration,  as  in  others,  accord- 
ing to  the  ability  shown  in  their  use  or  the  idio- 
syncrasy of  each  particular  case.  In  my  practice 
the  list  is  not  extensive.  The  first  point  in  treat- 
ment is  the  thorough  cleansing  of  the  parts  at 
least  twice  daily,  the  ordinary  solution  of  sodium 
chloride  being  a  satisfactory  one.  Occasional 
alternations  with  a  solution  of  potassium  biborate, 
which  I  prefer  to  the  sodium  biborate,  in  similar 
proportion,  will  prove  effectual  where  the  secretion 
is  free  and  the  posterior-nares  blocked.  The  ad- 
dition of  from  three  to  five  grains  of  potassium 
permanganate  in  solution,  when  the  wnsh  is  from 
one-half  to  three-quarters  expended,  will  modify 
the  fetor  and  render  the  subsequent  steps  much 
more  comfortable  to  the  medical  attendant.  The 
liquor  sodse  chlorinatse  replaces  the  permanganate 
satisfactorily,  especially  in  delicate  blondes.  Po- 
tassic  chlorate  may  also  be  added,  but  is  service- 
able only  from  its  local  effect,  no  constitutional 
impression  being  apparent  through  it  in  my  hands. 
The  use  of  from  one  half  to  one  ounce  of  the  dis- 
tilled extract  of  witch  hazel,  as  prepared  by  Mr. 
McKelway,  of  this  city,  is  frequently  efficacious, 
but  the  ordinary  fluid  extract  made  by  displace- 
ment is  not  reliable.  The  simple  or  compound 
tincture  of  benzoin  is  an  admirable  remedy,  both 
locally  and  internally.  The  quantity  of  water 
necessary  is  determined  by  the  amount  of  offen- 
sive secretion,  and  varies  from  one  pint  to  many, 
the  prime  object  being  the  removal  of  all  crusts, 
pus,  mucus,  or  blood,  without  which  subsequent 
medication  must  fail  from  the  remedy  not  reach- 
ing the  congested  or  abraded  tissue.  In  mild  or 
recent  cases  the  careful  cleansing,  as  described, 
of  the  parts  will  sometimes,  if  prolonged,  effect  a 
■cure  ;  but  such  success  is  uncommon  in  this  in- 
tractable disease. 


In  long-standing  and  stubborn  cases,  after  pre- 
]>aring  the  parts  as  suggestec',  a  number  of  astrin- 
gent  or  alterative  remedies  can  be  selected.  That 
chosen  may  be  employed  either  in  solution,  or,  as 
is  sometimes  more  efficacious,  in  dry  powder  pro- 
jected on  the  parts  of  the  insufflator.  Snuffing  the 
jjowder  from  the  hand  does  not  act  so  accurately, 
in  consequence  of  much  of  the  medicament  being 
either  detained  anteriorly  by  the  turbinated  bones, 
or,  having  passed  them,  being  drawn  into  the  lower 
pharynx.  Alum,  bismuth,  cubebs,  tannic  orgalHc 
acic,  with,  if  thought  proper,  ferric,  cupric,  or 
zincic  sulphate,  will  act  admirably  in  many  cases. 
Granulations  or  adenoid  tissue,  if  excessive,  may 
be  removed,  when  accessible,  by  the  curette  or 
galvano-cautery.  I  have  not  observed  distinct 
patches  of  ulceration  as  often  as  the  literature  of 
the  subject  would  imply  their  existence,  except  in 
caries  or  necrosis  of  the  bones  of  the  nasal  passages 
(^or  flues,  as  a  locomotive-building  patient  of  mine 
aptly  interprets  them),  any  apparent  abrasion  being 
generally  diffused  ;  but  should  examination  detect 
areas  thus  affected  they  should  be  stimulated  or 
cauterized,  as  required,  by  strong  solutions  of  the 
solid  silver  nitrate.  Glacial  acetic  acid  is  a  favo- 
rite with  nie  in  such  instances,  and  tincture  of 
iodine  frequently  acts  admirably.  Loose  portions 
of  bone  or  easily-detached  pieces  should  be  care- 
fully removed,  and  a  very  small  spicula  will,  if  over- 
looked, be  often  productive  of  continuous  dis- 
charge. I  have  not  performed  Rouge's  operation 
in  any  case  of  catarrh,  but  some  time  ago  in  assist- 
ing a  friend  in  an  operation  on  the  upper  maxillary 
the  feasibility  of  reaching  the  nares  by  that 
method  was  very  apparent,  and  in  a  second 
operation  on  the  same  patient  by  himself  I  re- 
moved another  part  of  the  superior  maxillary  and 
a  portion  of  the  vomer,  without  dividing  the  upper 
lip  or  cheek,  as  had  been  done  in  the  previous 
operation.  The  rapidity  of  union  without  any 
suppuration  was  remarkable,  and  the  freedom  from 
scar  or  deformity  by  this  method  is  invaluable. 

Attention  to  the  general  health  is  of  moment. 
The  secretions  of  the  alimentary  canal,  the  kidneys, 
and  the  skin  should  be  inquired  into,  and  placed 
in  proper  condition  if  defective.  I  have  found  the 
Turkish  bath  a  most  efficient  auxiliary  in  all  stub- 
born cases.  The  constitutional  remedies  employed 
will  vary  as  indicated  by  apparent  dyscrasia.  Mer- 
curic bichloride  is  notably  a  tonic  and  alterative  in 
many  cases,  even  where  syphilitic  complication  is 
not  evident.  I  usually  combine  the  alterative 
selected  with  compound  fluid  extract  of  stillingia, 
in  drachm  doses,  three  or  four  times  daily.  When 
well  borne,  copaiba,  long  continued,  is  of  great  ser- 
vice. Ferric  iodide,  with  or  without  potassium 
iodide,  and  sometimes  calcium  chloride,  are  excel- 
lent in  chronic  scrofulous  cases.  Iodoform  has  not 
been  of  much  use  in  my  hands,  either  locally  or 
constitutionally,  nor  has  carbolic  acid.  As  to  sali- 
cylic acid  or  its  salts  I  cannot  yet  form  an  opinion 
of  their  merit,  although,  as  a  detergent,  the  sodium 
salicylate  is  apparently  good. 


THE    CANADA    MEDICAL    RECORD. 


16a 


Of  all  therapeutic  remedies  I  value  none  more 
highly  than  electricity,  which  convinced  me  of  its 
value  through  the  importunities  of  a  patient  whom 
I  was  treating  at  the  time  for  myalgia,  and  who 
suffered  badly  from  post-nasal  catarrh.  He  in- 
sisted that  electricity  would  cure  his  catarrh  ;  and 
so  it  did,  contrary  to  my  opinion.  It  cannot,  of 
course,  be  relied  on  in  every  case,  but  it  is  a 
valuable  adjunct.  Either  the  galvanic  or  the 
faradic  current  may  be  necessary, — sometimes 
both, — but  the  induced  current  appears  to  be  the 
most  generally  applicable,  and  it  is  much  the  more 
easily  managed  of  the  two,  besides  being  less 
liable  to  produce  giddiness  in  those  highly  sus- 
ceptible. Care  must  be  exercised  in  galvanization, 
from  the  proximity  of  the  basilar  brain.  Extremely 
interesting  illustrations  might  be  given  in  this  cor.- 
nection  did  not  brevity  forbid. 

Diet  is  all-important.  It  should  be  nutritious, 
but  all  veal  and  pork  compounds  must  be  tabooed, 
with  all  indigestible  substances.  Tobacco  is  un- 
doubtedly highly  injurious.  The  so-called  grape- 
cure  acts  a  good  part,  especially  in  those  who  can 
afford  the  expense  of  living  at  the  vineyards. 

Much  more  might  be  said  and  many  particulars 
present  their  claims  upon  our  attention,  but  your 
patience  has  been  taxed  already.  Disagreeable  as 
such  patients  are  to  handle,  it  is  our  duty  to  exert 
our  utmost  ability  in  their  behalf,  not  only  for 
their  personal  welfare,  but  for  the  comfort  of  their 
families  and  society  at  large.  Other  formidable 
maladies  have  succumbed  to  medical  skill,  and 
why  not  that  under  consideration  ?  It  Hes  within 
the  power  of  gentlemen  such  as  compose  our 
Society  to  do  much  in  this  direction,  and  assuredly 
the  need  is  urgent. 

Although  I  purposely  refrained  from  touching 
the  causation  or  pathology  of  post-nasal  catarrh, 
one  point  which  has  interested  me  may  be  alluded 
to  in  closing,  which  is  the  belief  in  my  own  mind, 
from  close  observation,  that,  under  certain  condi- 
tions, the  disease  is  contagious,  even  when  posi- 
tively non-syphilitic.  I  have  repeatedly  seen  it 
occur  in  newly-married  persons,  and  where,  at 
school,  children  previously  entirely  heahhy  became 
affected  when  sleeping  together.  In  all  such  in- 
stances noted  no  hereditary  tendency  existed,  nor 
were  other  members  of  the  family  thus  diseased. 
I  have  not  heard  this  idea  expressed  by  others, 
and  many  whom  I  have  consulted  dissent  from  it, 
yet  through  indubitable  evidence  I  do  not  hesitate 
to  assert  my  opinion,  for,  if  it  is  correct,  we  should 
be  on  our  guard,  and  in  those  thus  exposed 
remember  that  "  prevention  is  better  than  cure." 


TOOTH-CARIES  OF  PREGNANCY. 

ITS  CAUSE  AND  TREATMENT. 

Extract  from  a  paper  by  Edward  C.  Kirk, 
D.D.S.,  in  Philadelphia  Medical  Times : 

It  is  well  known  that  during  pregnancy  women 
are  often  subject  to  annoyance  and  discomfort 
from  their  teeth.     This  may  vary  in  degree,  from 


a  slight  uneasiness,  a  mere  consciousness  of  the- 
presence  of  her  teeth  to  the  severest  form  of 
odontalgia.  The  frequent  occurrence  of  rapid  and. 
extensive  destruction  of  tooth-structure  during 
pregnancy  is  so  well  recognized  that  it  would  be 
useless  to  multiply  examples. 

In  cases  where  women  have  borne  children 
rapidly  it  is  the  common  story  that  up  to  the  time  of 
marriage  the  teeth  were  of  good  quality  and  gave 
but  little  trouble,  but  since  have  rapidly  failed. 

As  to  the  cause  of  this  degeneration  of  tooth- 
structure  during  pregnancy,  there  is  litde  reason 
to  doubt  the  accepted  explanation  that  an  exces- 
sive demand  is  made  upon  the  system  of  the  mother 
for  the  lime- salts  necessary  for  the  formation  of 
the  osseous  structures  of  the  fetus,  and  the  teeth 
of  the  mother  suffer,  along  with  her  osseous  sys- 
tem, in  meeting  this  demand  when  the  supply  of 
lime-salts  is  not  sufficiently  kept  up  in  the  mother's 
food. 

We  believe  that  much  can  be  done  to  avert  this^ 
wholesale  destruction  of  the  teeth,  the  loss  of  which 
details  so  much  disfigurement  and  physical  suffer- 
ing. If  the  cause  be  as  stated,  then  to  supply 
food  rich  in  lime  combinations  is  the  rational  in- 
dication. But  most  of  the  food  brought  to  our 
tables  is  not  rich  in  bone-forming  material,  and  it 
may  be  that  even  a  liberal  supply  of  lime-contain- 
ing food  would  not  meet  the  urgent  demands  made 
during  pregnancy  upon  a  system  already  poor  in 
lime-salts.  Certainly  the  judicious  use  of  some  of 
the  soluble  preparations  of  lime,  such  as  the  lacto- 
phosphate  or  hypophosphite,  would  be  of  benefit 
in  such  a  case,  not  only  in  maintaining  the  lime- 
standard  of  the  mother,  but  also  in  insuring  to  the 
fetus  a  well-developed  osseous  and  dental  organi- 
zation. We  have  every  reason  to  believe  that 
rickets  is  due  to  lime-starvation  upon  the  part  of 
the  mother  and  child ;  and  evidence  is  not  want- 
ing to  show  that  certain  malformations  of  the  jaws, 
and  consequent  irregulai  ities  of  the  teeth,  are  in  a 
measure  due  to  the  lack  of  sufficient  bone-forming 
material  during  fetal  development. 

A  fact  in  this  connection  which  I  have  had  occa- 
sion to  observe  more  than  once  is  that  in  a  large 
number  of  pregnant  women  the  morbid  craving,  so 
called,  for  unusual  articles  of  food — which  is  so 
often  present,  and  may  occasion  great  annoyance 
to  both  patient  and  physician — is  for  articles  of  a 
mineral  character,  such  as  chalk,  slate-pencils, 
lime,  plaster,  whiting,  etc. 

It  seems  reasonable  to  believe  that  this  craving 
is  nature's  method  of  expressing  the  need  for  lime 
when  from  pregnancy  or  other  causes  the  supply  is 
not  equl  to  the  demand,  and  the  system  is  poor  in 
lime  as  a  consequence.  I  say  from  other  causes, 
for  what  else  is  it  that  will  make  a  rapidly  growing, 
over-worked  school-girl  chew  her  slate-pencils  and 
lead-pencils  with  such  apparent  relish  ? 

If  this  be  true,  then  the  supplying  to  the  system 
all  the  lime  it  needs,  either  by  properly-selected 
food  or  by  the  administration  of  a  sufficient  quan- 
tity of  some  soluble  preparation  of  lime,  ought  to 


164 


THE    CANADA    MEDICAL    RECORD. 


do  much  toward  averting  the  destruction  of  the 
teeth  by  caries  during  pregnancy,  and  relieve  the 
distressing  cravings  for  unusual  kinds  of  food.  As 
having  bearing  on  the  subject,  and  showing  that 
an  increased  quantity  of  lime  is  demanded  by  the 
system  during  pregnancy,  I  may  cite  the  fondness 
which  birds  and  fowls  generally  have  for  lime, 
oyster-shells,  j)laster,  etc.,  during  the  egg-laying 
period.  Another  point  which  I  have  noted  is  that 
this  fondness  for  lime  is  displayed  on  the  part  of 
the  female  more  than  on  that  of  the  male.  Hens 
will  quarrel  for  the  possession  of  an  empty  egg- 
shell, and  the  cock  will  look  on  without  interest 
while  they  devour  it  greedily. 


TREATMENT  OF  SCARLATINA  IN 
CHILDREN. 

By  M.  Archambault, 

Of  the  Hopital  des  Enfants  Malades,  Paris. 

Translated  by  Hastings  Burroughs,  L.R.C.S.I.,  6r*c. 

We  have  just  observed  amongst  the  children  of 
our  service  five  cases  of  scarlatina,  each  of  which 
presented  something  abnormal.     At  No.  8  in  the 
St.  Louis  ward  is  a  child  who  entered  the  hospital 
with  bronchitis  ;  one  evening  he   was  taken  sud- 
denly with  high  fever,  and  a  scarlet  eruption  ap- 
peared over  the  whole  body.     There  was  no  sore 
throat  nor   vomiting.     7'he   next    day   the   fever 
abated,  and  the  eruption  disappeared.     It  was  one 
of  those  abnormal  scarlatinas  that  have  given  the 
idea  that  one  can  have  scarlatina  without  eruption. 
The  child  in  the  next  bed  was  stricken  with  the 
.same  malady  ten  days  afterwards,  and  presented 
the  same  symptoms,  but  the  eruption  remained  two 
days.     Eight  days  afterwards  another  child  occupy- 
ing the  same  ward  took  the  disease,  but  in  her 
case  the  symptoms  were  regular,  except  that  there 
was    no    vomiting.      Two    other   children    were 
similarly  affected  a  few  days  aftenvards.     You  see 
J)y  these  examples  that  scarlatina  can  present  con- 
siderable anomalies.     However,  you  must  not  for 
that  forget  the  type  of  which  I  am  going  to  speak. 
Scarlatina  is  remarkable  for  its  brusque  invasion, 
more  sudden,  I  believe,  than  that  of  pneumonia. 
It  commences  by  a  fever  which  is  very  intense  from 
the   outset.     The   first  day,  in  the   generality  of 
cases,  appear  vomiting  and  sore  throat.     A  child 
^oes  to  bed  in  perfect  health  ;  he  is  restless  during 
the  night,  and  is  sick  ;  the  next  day  the  eruption 
is  observed  ;  or  perhaps  it  is  a  child  who  gets  up, 
breakfasts,  goes  to  school,  and  suddenly  feels  him- 
self ill,  vomits,  complains  of  sore  throat ;  in  the 
evening  the  eruption  appears.     The  fever  is  always 
high — in    other    eruptive   diseases,    measles,    for 
example,    the   fever  is  remittant.     The   vomiting 
comes  on  immediately  on  taking  food.     As  for  the 
sore  throat,  there  are  two  things  to  be  observed — 
the  jjain  and  the  eruption.     'J'lic  patients  will  tell 
you  that  the  throat  is  not  sore  ;  look,  and  you  will 
find  redness  of  the  fauces.     The  eruption  appears 
twenty-four    or    thirty-six    hours    after    the    first 


symptoms  ;   if   it    appear   later  the    scarlatina  is 
abnormal.     Whilst  measles   and   small-pox   com- 
mence on  the  face,  the  eruption  of  scarlatina  com- 
mences often  on  the  neck,  chest,  or  back.     Very 
frequently   you  will  observe  at  the   same  time  a 
miliary  eruption,  small  vesicles,  and  sudamina  in 
the  inguinal  region.     The  fever  is  continuous  ;  in 
measles  the  fever  falls  on  the  appearance  of  the 
eruption.     The  eruption  lasts  two,  four,  five  days ; 
towards  the   fourth  or  sixth,   the  fever  falls  pro- 
gressively.    The  pulse  is  in  keeping  with  the  tem- 
perature, 140 — 160  in  the  minute.     They  say  that 
the    pulse  is   full  and  strong  ;  I  find  it,    on   the 
contrary,   very    small    at    the    outset.      Thus    I 
diagnosed   a  scarlatina  in   a  Russian    lady  who, 
taken  with  fever,  sore  throat,  and  vomiting  while 
railway  travelling,  was  thought  to  have  diphtheria. 
Having  felt  the  pulse  of  the  patient,  who  was  in  a 
dark  room,  I  suspected  scarlatina.     I  caused  the 
shutters  to  be  opened  and  drew  aside  the  curtain, 
when  I  found  the  eruption.     The  desquamation 
commences  towards  the  sixth  or  seventh  day  ;  it 
lasts  from  one  or  two  days   to  a  month.     I  hasten 
to  the  question  of  treatment.     There  is  a  certain 
class  of  infantile  diseases  for  which  it  is  not  at  all 
necessary   that  the  physician   should   display  his 
skill.     Scarlatina  is  one  of  these.     Put  the  patient 
to    bed   in   a   well-ventilated    chamber,    but    the 
windows    should   not  be    opened.     In    England, 
where  it  is   the  rule  to  thoroughly  ventilate  the 
room  of  a  scarlatina  patient  on  recueille  disastrous 
statistics  ;  the  temperature  of  the  chamber  should 
not  exceed  64°.     When  the  fever  falls,  the  temper- 
ature may  be  raised  a  little,  because  the  patients 
have  tendency  to  chills.     The  covering  should  be 
no  heavier  than  in  health.     How  long  would  you 
leave  a  patient  in  bed  ?     Some  say  that  he  might 
get  up  as  soon  as  the  fever  fell ;  others,  on  the  con- 
trary, exact  a  month  or  six  weeks.     Leave  him  a 
long   while   in    bed,   about    three   weeks.      The 
statistics  of  an  Engli.sh  doctor,   comprising  six  or 
seven   hundred    cases    of    scarlatina,    show    that 
nephritis  appeared  oftenest  from  the  fourteenth  to 
the  eighteenth   or  twenty-second   day.     If,  then, 
nephritis  is  due  to  cold,  as  I  believe,  it  will  be  well 
to  oblige  the  patients  to  keep  their  beds.     They 
might  sit  up  in   bed,  but  care  should  be  taken  to 
put  a  kerchief  around  the  neck,  for  secondary  sore 
throats  are  grave.     It  would  be  well  also  to  recom- 
mend mittens  on  the  wrists,  the  carpal  articulations 
being  the  most  subject  to  the  rheumatism  which  is 
frequent  after  this  disease.     The  patients  should 
not  go  out  before  the  thirty-fifth  or  fortieth  day  ; 
but  that  will  depend  again  on  the  gravity  of  the 
disease.     Barthez  has   told  me   that  he  did   not 
know  any  case  of  anasarca  after  scarlatina  since 
he  forced  his  patients  to  keep  the  bed  during  five 
or  six  weeks.     As  regards  the  medical  treatment, 
properly  so  called,    I  will  not  spend  much  time 
over  it,  as  I  consider  that  hygienic  precautions  are 
the  most  important.     Hot  drinks  should  not  be 
given  unless  the  eruption  does  not  come  out  pro- 
perly.     Refreshing    drinks,    such    as    lemonade, 


THE   CANADA   MEDICAL    RECORD. 


165 


gooseberry  wine,  &c.,  are  preferable.  To  aid  the 
eruption  I  have  often  given  the  acetate  of  ammonia. 
If  the  patient  is  constipated,  a  httle  rhubarb  or 
castor-oil  will  suffice.  If  the  nights  are  restless,  a 
little  bromide  of  potassium  I  have  found  of  great 
benefit.  The  mouth  must  be  washed  often,  but 
for  the  throat  caustics  are  seldom  necessary. 
Chlorate  of  potash,  or  alum  gargles  will  be  suffi- 
cient. If  the  patient  is  too  young  to  gargle,  one 
or  two  grammes  of  chlorate  of  potash  mixed  with 
five  or  six  grammes  of  white  powdered  sugar  may 
be  given.  Ought  baths  to  be  ordered  in  scar- 
latina? One  might  order  a  bath  if  the  fever  were 
very  high  and  the  eruption  abundant,  but  in 
ordinary  cases  it  would  be  better  to  dispense  with 
it.  This  practice  is  much  used  in  England  ;  it  is 
thought  hazardous  with  us.  Sometimes  the 
itching  is  very  great.  Some  German  doctors  con- 
ceived the  idea  of  rubbing  the  children  with  fresh 
lard,  but  to  this  procedure,  which  is  not  very  clean, 
I  prefer  the  English  method,  which  is  a  mixture  of 
glycerine  and  cold  cream.  As  regards  nourish- 
ment, it  is  evident  when  the  fever  is  high  a  light 
diet  should  be  prescribed  ;  when  the  fever  abates, 
a  stronger  nourishment  might  be  administered, 
but  with  caution. 

Such  is  the  treatment  that  will  suffice  in  scarla- 
tina; it  is  simple,  and  will  not  cover  you  with 
glory,  but  it  will  cure  your  patients  and  will  pre- 
vent, in  the  majority  of  cases,  complication.  Do 
not  neglect  above  all  hygienic  precautions,  for  I 
say,  in  closing,  there  is  not  a  case  of  scarlatina 
that  ought  to  be  neglected. — Dublin  Medical 
Press. 


THE  TREATMENT  OF  RANULA. 

Dr.  C.  Lovegrove  {British  Medical  Journal)  has 
found  the  following  plan  most  efficacious  :  Pass  a 
tenaculum  through  the  base  of  the  timior  and 
draw  the  part  somewhat  forward.  After  withdraw- 
ing the  thicker  part  of  the  tenaculum  a  little,  pass 
a  plain  gold  ring,  such  as  is  used  when  the  ears 
are  first  pierced,  by  the  side  of  the  tenaculum, 
through  both  holes,  then  clasp  it  securely,  and 
leave  in  situ  for  three  or  four  weeks,  then  remove. 
A  permanent  exit  for  the  mucus,  etc.,  will  then 
remain  and  all  trouble  cease. 

J.  E.  G.  has  found  the  following  plan  very  suc- 
cessful :  Thread  an  ordinary  curved  needle  with 
common  silk  suture  ;  make  a  double  thread  ;  pass 
the  needle  through  the  cyst,  tie  the  thread  suffi- 
ciently short,  so  that  the  loop  lies  within  the  teeth 
and  will  not  be  bitten  through  when  eating  ;  move 
the  thread  to  and  fro  every  other  day.  If  this  be 
kept  in  for  about  a  week  the  cyst  will  have  evacu- 
ated Itself  by  means  of  this  small  seton.  When 
the  patient  says  that  it  no  longer  discharges  re- 
move the  thread  (seton)  and  let  it  granulate  up. 
The  last  case  he  treated  in  this  way  (about  six 
nionths  ago)  is  still  quite  free  from  the  ranula. 
Since  that  case  he  had  another  ranula  in  an  old 
woman  about  seventy.     It  involved  the  whole  ex- 


tent of  her  teethless  lower  jaw,  and  pushed  her 
tongue  up  against  the  roof  of  her  mouth.  She 
could  not  speak  nor  swallow.  The  treatment 
adopted  in  this  case  was  to  make  several  punc- 
tures, at  least  half  a  dozen,  through  the  cyst 
with  a  sharp-pointed  bistoury.  He  gave  a  con- 
centrated solution  of  chlorate  of  potash  as  a  lotion 
to  wash  the  mouth  with,  and  also  gave  her  a  mix- 
ture of  chlorate  of  potash.  This  case  is  still  re- 
lieved by  the  above  treatment. 

Dr.  C.  D.  F  Phillips  recommends  gradual  dilata- 
tion of  the  salivary  duct  by  laminaria  tents.  After 
incising  and  clearing  out  the  ranula,  the  duct 
should  be  sought  for  and  a  piece  of  laminaria 
(which  may  require  to  be  as  fine  as  a  needle  and 
should  be  very  smooth)  be  inserted  as  far  as  possi- 
ble, and  left  in  for  one  or  two  hours  every  morn- 
ing or  evening.  The  size  of  the  tent  should  be  in- 
creased, but  very  gradually,  so  as  to  avoid  over- 
much irritation.  The  patient  himself  can  learn  to 
pass  it  after  a  little  instruction,  and  cure  should 
result  in  two  or  three  weeks.  In  some  cases  it 
may  be  necessary  to  leave  in  the  tent  longer,  and. 
then  a  perforated  one  should  be  used.  Some  years 
ago  Dr.  Phillips  came  across  several  cases  in  which 
the  duct,  as  well  as  the  ranula,  had  been  cut  away,, 
and  much  suffering  and  serious  swelling  of  the 
gland  had  resulted.  These  cases  were  cured  by 
simple  incision  and  keeping  open  the  artificial 
duct  by  laminaria. 

Mr.  W.  J.  Tivy  suggests  the  use  of  a  seton 
composed  of  three  or  four  threads  of  coarse  liga- 
ture silk,  which  he  has  found  invariably  success- 
ful. 


TREATMENT  OF  GLANDULAR  SORE 
THROAT. 

Glandular  sore  throat,  by  which  I  mean  catarrhal 
congestion  or  inflammation  in  and  around  the 
glandulae  of  the  mucous  membrane  of  the  pharynx 
and  larynx,  is  a  very  tedious  and  troublesome 
affection.  It  has  been  known  as  dysphonia  cleri- 
corum  ;  it  is,  in  fact,  the  chronic  sore  throat  to 
which  persons  are  liable  who  use  their  voices  exten- 
sively, especially  in  large  rooms  or  in  the  open  air. 
I  desire  to  draw  attention  to  the  usefulness  of  the 
topical  application  of  borax  in  its  treatment.  I 
order  a  saturated  aqueous  solution,  which  the 
patient  applies  to  his  throat  by  the  aid  of  Corbyn's 
throat  spray.  The  spray  should  be  employed  for 
several  minutes,  thrice,  or  more  frequently,  daily, 
and  midway  between  meals.  If  the  larynx  be 
much  implicated,  the  patient  should  inspire 
deeply  while  the  spray  is  playing  upon  his  throat. 
I  have  lately  found  this  very  simple  method  of 
treatment  of  striking  service.  The  cure  may  be 
expedited  by  the  appHcation  of  astringent  solutions 
to  the  pharynx  and  larynx  by  means  of  suitable 
brushes.  When  there  is  much  secretion,  extract 
of  eucalyptus  is  a  good  local  astringent,  which 
may  be  used  in  the  fonn  of  lozenge. — James 
Sawyer,  ^M.D.,  London. 


166 


THE    CANADA    MEDICAL   HECORD. 


The  Canada  Medical  Record, 

a  fHantfjl"  .TIouriT.il  of  fHcUiriiic  nnU  |)f)armarri 

EDITOR,  : 
Fa\NCIS  W.  CAMPBELL,  MA.,  M.D.,L.K.C.F.,LOND 

ASSISTANT  E11ITOI18  : 

S.  A.  KENNEDY,  MA,  M.D. 

JAMES  PERRIUO,  M.D.,  M.R.C.S.  Eng. 

KDITOR   iiy    rHARJ£  \CKUTICAL    OKPARTMENT: 

ALEX.  H.  KOLLMTES,  M.A.,  M.D- 

9DB8CRIPTI0N  TWO  DOLLARS  PIB  ANNTU  . 

All  eommunieations  and  Exchanges  mutt  be  addretsed  to 
the  Editor,  fJrawer  356,  Pout  Oj^ce,  Montreal. 

MONTREAL.  MARCH,  1881. 

PROPOSED  PROTESTANT  LUNATIC 
ASYLUM. 

We  believe  that  among  the  entire  body  of  Pro- 
testants in  the  Province  of  Quebec  there  is  a 
unanimity  of  feeling  that  the  system  of  farming  out 
lunatics  at  so  much  per  head,  adopted  by  our  Pro- 
vincial Government,  is  one  utterly  unworthy  of 
a  Province,  which  makes  any  pretension  to 
advanced  civilization.  They  object  to  it  upon 
various  grounds,  but  chiefly  because  it  is  not  in 
the  interest  of  the  contractors  to  cure  the  lunatics, 
and  they  therefore  feel  that  the  system  is  respon- 
sible for  placing  many  a  patient  permanently  upon 
the  Government  for  support.  They  would  rejoice, 
for  it  would  be  in  accordance  witli  the  views  they 
hold,  if  the  Government  of  the  Province  of 
Quebec  would  purchase  the  Asylums  at  Beauport 
and  Longue  Point,  and  convert  them  into  Pro- 
vincial Lunatic  Asylums,  where  patients,  quite 
irrespective  of  religion,  would  have  the  most 
scientific  treatment,  under  the  care  of  men  who 
have  si)ecially  devoted  themselves  to  its  study.  We 
are  pleased  to  know  that  these  views  are  held  by 
some  at  least  of  the  present  local  administration, 
and  we  hope  that  the  day  is  not  far  distant  when 
the  Province  of  Quebec  will  be  able  to  take  her 
place  among  her  sister  Provinces  in  the  scientific 
treatment  of  the  insane.  We  do  not  exaggerate 
when  we  say  that  at  present  her  position  in  this 
matter  is  not  to  her  credit  (to  put  it  mildly).  If 
the  Protestants  of  the  Province  of  Quebec  hold 
the  views  we  ascribe  to  them  it  may  be  asked  how 
is  it  that  they  are  at  this  moment  applicants  for 
a  charter  to  establish  an  asylum  under  Protestant 
management,  but  under  conditions  similar  to  those 
already  under    contract    with    the   Government? 


Simply   because    they   recognize  the   position  of 
affairs  as  at  i)resent  unalterable.  While  giving  every 
credit  for  gentle  and   humane    treatment  o/   all 
placed  under  the    charge  of  the  present  asylum 
contractors,  they  are  of  opinion  that  the  clerical 
character  of  both,   but  especially  of  one  asylum, 
is  such  as  to  prevent  the  free  mingling  of  the  Pro- 
testant clergy  with  the  patients.     They  also  feel 
that,  medically,  much  more  can  be  done  for  the 
Protestant  insane  than  is  being  done  ;  and,  if  they 
are  correct  in  this  idea,  that  it  is  t'leir  duty  to 
place  them  where  "  cure  "  will  be  the  prime  object. 
If  there  was  no  other  motive  than  this,  it  is  a  most 
laudable  one.     It  may  be  asked,  how  are  the  Pro- 
testant contractors,  for  such  in  truth  they  would 
be,  going  to    be  more  liberal  and  self-sacrificing 
than  their  Roman  Catholic  confreres.     Simply  and 
only  in  this  way  :  that,  as  the  asylum  would  be  con- 
ducted by  an  association  of  gentlemen,  every  one 
of  whose  voice  and  vote  would  be  equal,  and  its 
transactions  open  freely  to  public  scrutiny,  they, 
naturally,  would  be  constantly  exposed  to  public 
criticism — and  we  do  not  know  of  anything  more 
likely  to  keep  them  from  doing  wrong.     Beauport, 
which,  in  its  way,  is  a  good  asylum,  certainly  in  our 
opinion  the  best  we  have,  is  a  private  proprietor- 
ship, though,  of  course,  fully  open  to  Government 
Inspection      The  Longue  Pointe    Asylum    is  in 
the   hands  of  one   woman,   supreme   in   all  her 
authority,  as  to  internal  management,  though  also 
open  to  Government  Inspectorship,  and  having  a 
Government  visiting  physician,  whose  powers  and 
authority   the    Government  should   most   largely 
increase,  for  in  the  person  of  the  gentleman  who 
now  fills  that  position  they  have  the  very  best  medi- 
cal alienist  in  the  Province,  and  one  who  stands 
very  high  among  his  confreres  of  this  specialty  in 
the  Dominion.     It  is  but  fair  to  say  that  at  all  the 
meetings   which  have   been  held   to   further   the 
establishment   of  this    Protestant  asylum,  all  the 
speakers  have  borne  the  strongest  testimony  as  to 
the  kindness  and  the  humanity  of  the  sisters  at 
the    longue    Pointe   Asylum  ;    the    clergy    were 
especially  warm  in  bearing  testimony  to  this  fact, 
and  also  to  the  liberality  and  attention  which  they 
received  when  in  attendance  on  Protestants  in  that 
asylum.     Beyond  the   facts  we  have   stated,  the 
Protestants  make  no  complaints. 

We  object  strongly  to  the  term  "  asylum."  Its 
very  sound  seems  to  imply  prolonged  residence^ 
free  from  care.  The  word  "  Hospital  "  would,  we 
think,  be  more  appropriate.  It  is  suggestive  of  treat- 


THE   CANADA   MEDICAL   RECORD. 


167 


ment,  of  pills,  powders  and  potions  perhaps — but 
often  useful ;  and  then  it  is  also  suggestive  of  con- 
valescence, and  that  means  cure,  just  what  is 
wanted. 


WYETH'S    FLUID    EXTRACT  OF    ERGOT. 

The  menstruum  used  is  that  best  adapted  for  ex- 
tracting all  the  active  matter,  and  retaining  its  full 
power.  Each  minim  represents  one  grain  of  the 
freshly  powdered  drug.  It  is  entirely  free  from 
acid,  and  can  be  used  subcutaneously  without  irri- 
tation in  most  cases,  having  in  this  respect  a  great 
advantage  over  the  watery  solutions,  which  decom- 
pose very  rapidly.  The  menstruum  is  simply 
Water,  Alcohol  and  Glycerine,  no  heat  whatever 
is  used  in  its  manufacture.  Since  adopting  this 
formula,  a  number  of  valuable  papers  from  foreign 
authorities  have  endorsed  Wyeth's  views. 


COLLEGE    OF     PHYSICIANS    AND    SUR- 
GEONS P.  Q. 

Mr.  Lamirande,  the  gentleman  employed  by  the 
College,  as  its  Collector  and  Detective,  having  suc- 
cessfully devoted  considerable  attention  to  those 
holding  licenses,  who  had  not  complied  with  the 
last  Act,  has  now  turned  his  attention  to  the  irregu- 
lar practitioners.  We  hear  of  several  actions  having 
been  instituted  in  the  Eastern  Townships.  In 
Montreal,  during  the  present  month.  Judge  Jette 
gave  judgment  in  the  College  vs.  John  Roscoe,  a 
Herb  Doctor  as  he  styled  himself,  fining  the  defen- 
dant in  the  sum  of  $25.00. 


PRELIMINARY  EXAMINATION  COLLEGE 
PHYSICIANS  AND  SURGEONS,  P.  Q. 

We  direct  special  attention  to  the  advertise- 
ment giving  the  date  (May  5th)  of  this  examina- 
tion. By  error  an  incomplete  advertisement  giv- 
ing wrong  date  was  inserted  in  our  last  issue. 

The  meeting  of  the  Governors  of  the  College 
will  take  place  in  Montreal  on  the  nth  of  May, 
next.     See  Adv. 


PERSONAL. 

Dr.  Imrie,  House  Surgeon  of  the  Montreal 
General  Hospital,  who  has  been  exceedingly  ill  for 
the  past  two  months  with  Pyaemia,  is,  we  are  glad 
to  know,  quite  convalescent. 

Dr.  Sutherland  (McGill  College  1879),  of  Mont- 
real, is  to  about  to  visit  London,  England. 


Dr.  Costigan  (M.D.,  Bishop's,  1874)  of  Los 
Lunas,  New  Mexico,  has  been  elected  Coroner  for 
the  County.  He  was  also  about  the  commencement 
of  the  year  presented  by  his  friends  with  a  hand- 
some present  in  the  shape  of  a  number  of  Surgical 
Instruments  and  Medical  works. 


A  NOVEL  PRESCRIPTION. 

A  recent  number  of  Le  Praticien  reports  that  a 
physician  of  Chalons,  France,  was  sent  for  into  a 
village  in  the  neighborhood,  and,  having  examin- 
ed his  patient,  found  he  had  forgotten  his  pocket- 
book.  He  then  asked  for  a  pencil  and  paper  in 
order  to  write  his  prescription,  but  no  such 
objects  were  among  the  possessions  of  the  house- 
hold. Some  one  went  out  to  seek  for  the  required 
necessaries,  but  primary  education  seemed  to  have 
omitted  that  commune  altogether.  The  physician 
got  tired  of  waiting,  and  at  last  wrote  his  prescrip- 
tion on  the  door  of  the  house  with  a  bit  of  char- 
coal. The  family,  after  vainly  endeavoring  to 
make  something  like  a  copy  of  the  doctor's  hiero- 
glyphics, at  last  wisely  resolved  to  detach  the  door 
itself,  and  carry  it  to  the  pharmacien  in  order  to  get 
the  medicine  prepared. 


ANNUAL  REPORT  OF  THE  WOMAN'S 
HOSPITAL  OF  THE  CITY  OF  MONT- 
REAL FOR  THE  YEAR  18S0. 

The  Committee  of  Management  of  the  Woman's 
Hospital  of  this  city,  representing  the  Corporation 
beg  to  submit  the  following  report : — 

During  the  year  now  passed  the  Hospital  has 
undergone  considerable  change.  For  the  first  four 
months  it  occupied  a  building  on  St.  Antoine  street, 
which  was  ill-adapted  to  the  purposes  of  the  insti- 
tution, and  where  it  had  been  for  several  years. 
The  demands  made  upon  it  for  relief  became  so 
urgent  that  it  was  found  impossible  to  admit  over 
one-half  of  the  patients  who  applied.  It  was, 
therefore,  decided  to  obtain  some  larger  building 
in  a  better  locality.  Fortunately  the  building 
known  as  the  Western  Hospital,  which  the  insti- 
tution now  occupies,  was  vacant,  and  could  be 
obtained  for  a  rental  of  $700.00  a  year.  At  the 
same  time,  owing  to  the  perspective  increased 
outlay,  and  the  evident  benefit  that  such  an  insti- 
tution would  bestow,  a  number  of  friends  directly 
interested  themselves  in  its  welfare  by  becoming 
governors  and  members  of  the  Corporation,  under 


168 


THE  CANADA   MEDICAL   RECORD. 


the  provisions  of  the  charter.  The  Management, 
thus  increased,  then  leased  the  Western  Hospital 
building  at  the  above  rental  for  a  term  of  six  years, 
and  on  the  first  of  May  moved  into  possession. 

The  Committee  beg  to  draw  attention  to  the  fact 
that  this  Hospital  is  the  only  one  of  its  kind  in 
•Canada,  being  specially  devoted  to  the  treatment 
of  diseases  of  women,  and,  therefore,  filling  a  want 
hitherto  unsupplied  ;  in  proof  of  which  the  increas- 
ing number  of  patients  bears  testimony.  The  Com 
mittee,  for  this  reason,  would  state  that,  in  solicit- 
ing public  support,  they  do  so  without  infringing 
upon  the  claims  of  older  institutions,  Ihe  very 
unobtrusive  manner  in  which  the  Management  in 
former  years  had  worked  considerably  delayed 
the  full  recognition  of  its  merits  by  the  general 
public,  so  that  the  amount  of  subscriptions  was  not 
as  large  as  it  would  otherwise  have  been.  This 
the  Corporation  hope  in  future  to  remedy,  and  by 
soliciting  subscriptions,  and  more  publicly  claim- 
ing support,  trust  that  the  institution  will  soon 
tecome  known  by  all  as  a  great  public  charity. 

Since  the  Hospital  has  moved  into  its  present 
quarters  a  considerable  sum  has  been  expended  in 
placing  the  building  in  effective  working  order, 
obtaining  new  furniture  and  altering  the  arrange- 
ment of  some  of  the  rooms  so  as  to  make  them 
better  adapted  for  the  purposes  intended.  They 
are  thankful  to  announce  that  they  have  received 
many  donations  in  kind  of  articles  absolutely 
required  by  the  Hospital,  and  friends  have  come 
forward  with  subscriptions  in  aid  of  its  support. 
One  special  feature  deserving  of  notice  is  its  private 
department,  which  admits  patients  of  a  better  class 
who  are  able,  by  the  payment  of  a  special  rate,  to 
have  all  the  benefits  of  hospital  treatment  and 
nursing,  while,  by  a  wise  liberality,  such  patients  are 
permitted  to  have  the  attendance  of  the  physician 
of  their  choice,  irrespective  of  any  connection  with 
this  Hospital,  being  the  only  institution  in  this  city 
■which  permits  of  this  privilege.  The  Committee 
beg  to  state  there  are  four  large  public  wards,  con. 
taining  twenty  beds,  for  the  reception  of  patients, 
this  being  the  utmost  limit  which  they  feel  justified 
in  providing,  thereby  being  obliged  to  refuse  admis. 
sion  to  many  deserving  applicants.  This  the 
Committee  deeply  regret.  Should,  however,  the 
financial  condition  of  the  Hospital  afford  an  in. 
crease  in  the  number  of  beds  in  the  future,  there 
is  room  enough  for  an  additional  twenty  beds 
■which  would  be  obtained,  and  are  at  present 
required  to  meet  the  demands  made  by  applicants. 


Durng  the  past  summer,  a  few  members  of 
the  Ladies  Committee  held  a  bazaar  in  aid  of 
the  funds  of  the  Hospital ;  the  sale  of  articles 
was  chiefly  limited  to  the  circle  of  friends  and 
acquaintances  of  those  interested  in  the  welfare 
of  the  Institution.  The  sum  realized  by  this 
almost  private  effort  amounted  to  $80.14,  for 
which  the  thanks  of  the  Corporation  are  due. 
Thanks  are  also  due  to  the  Ladies  Committee  for 
their  valuable  co-operation  in  visiting  the  patients, 
and  assistance  in  the  management  by  suggesting 
and  surpervising  the  necessary  domestic  require- 
ments. 

The  Management  congratulate  themselves  on 
the  efficient  assistance  rendered  to  the  Hospital 
by  the  Matron  and  staff"  under  her,  and  also  to 
the  interest  manifested  by  the  members  of  the 
Medical  staff  in  the  care  and  treatment  which 
they  have  bestowed  on  the  inmates. 

Special  acknowledgment  is  also  due  to  the 
Provincial  Government  for  the  annual  grant  of 
$500.00,  which  sum  your  Committee  expect  to 
receive  during  the  present  month. 

In  addition  to  the  above  information  the  Com- 
mittee would  announce  that  the  Hospital  is  visited 
daily,  at  noon,  by  three  physicians,  at  which  time 
patients  presenting  themselves  at  the  out-door 
department  also  receive  attention. 

PATIENTS. 

In-door  Department. 

At  date  of  last  report,  remaining  in  Hospital..     1 1 

Admitted  during  the   year 107 

Remaining  in  at  present 13 

Total 131 

Protestants 85 

Roman  Catholics 46 

Deaths 5 

Protestants 3 

Roman  Catholics 2 

5 
Out-door  department 176 

Protestants 100 

Roman  Catholics 76 

176 

DIED. 

In  Montreal,  on  the  9th  March,  Elizabeth  Steel,  aged  77 
years,  widow  of  the  late  Rollo  Campbell,  and  mjther  of 
Dr.  Francis  W.  Campbell. 


THE  CANADA  MEDICAL  RECORD. 


Vol.    i!C. 


MOViPv-iAL,  APRIL,   i83i 


N 


J.  7. 


(OCDJ<i  TEnsTTS. 


ORICINlAl   COMMUNICATIONS. 

Valedictory  Address  to  the  Graduat- 
ing Class, Medical  Faculty  of  Bish- 
c>}.s  College,  169. — On  the  Treat- 
ment «f  Tape-Worm  (Taenia 
Solium),  172. — On  Some  Points  of 
Contemporary  Interest 173 

PROGRESS  OF  M EDICAL SCI ENCC 

Death  fi-om  Bromide  of  Ethyl,  174. 
— A  Lecture  on  Peritonitis,  175. — 
Lecture  on  Measles,  177  — The 
Opifm-Hdbit  —  a   Possih'e   Anti- 


dote, 180. — Chian  Turpentine  in  the 
Treatment  of  Cancer,  181. — How 
to  Use  Iodoform  in  Chancroid, 182. 
— Bromide  of  Ethyl  as  an  Anaes- 
thetic, 182. — The  Strongest  Man  in 
the  World,  183. — Ringworm  of  the 
Scalp,  183.  —  Prof.  Ball's  Pres- 
cription in  Epilepsy,  183. — Iodo- 
form and  Goitre,  183. — The  Treat- 
ment of  Summer  Diarrhoea,  184. 
— Double  Piicumonia  and  Abor- 
tion, 1S4 — Bismuth  Ointment,  185. 
— Ilie  Cool  Air  and  Water  Treat- 
ment of  Measles,    185. — P^emoval 


of  Strong  Odors  from  the  Hands. 185 
THE  CANADIAN  MEDICAL  RECORD 

Decision  respecting  the  Rights  of 
Qualified  Ontario  Druggists  Practi- 
sing in  the  Province  of  Quebec,  186. 
— Wyeth's  Peptonib  Pills,  187.— 
— Tenth  Convocation  of  the  Medi- 
cal Faculty  of  Bishop's  College,  1S7 
— McGill  University,  Meeting  of 
Convocation,  191. — Wood's  Li- 
brary of  Standard  Medical  Autliors 
for  1881 192 


Valedictory  Hddres^  to  th^  Graduating;  Class, 
delivered  at  the  Tenth  Com  vocation  of  the 
'Medical  Faculty  of  Bishops  College,  by  James 
C.  Cameron,  M.D.,  M.  K.  C.  P.  I.,  Professor  of 
Medical  Jurisprudence  and  Lecturer  upon 
Diseases  of  Children. 

Gentlemen  of  the  Graduating  Class, — It 
is  now  my  pleasing  duty,  on  behalf  of  the  Medical 
Faculty  of  this  University,  to  congratulate  you 
upon  the  successful  completion  of  your  collegiate 
course,  and  your  admission  into  the  ranks  of  the 
medical  profession.  The  daily  round  of  lectures, 
the  hard  and  weary  nightly  grinds,  the  feverish 
anxieties  aid  dreadful  uncertainties  of  Examination 
day,  are  at  last  all  safely  over,  and  to-day  you  hold 
in  ycur  iiands  the  just  and  substantial  reward  of 
four  years'  diligence  aiid  attention.  We  congra- 
tulate you  heartily  upon  the  creditable  examiiia- 
tior  you  have  passed,  and  we  welcome  you  cor- 
dially into  our  number  as  professional  brethren  aiid 
colleagues.  But,  thougii  your  College  duties  are 
now  at  an  end,  and  you  stand  here  graduates  in 
Medicine,  let  me  remiml  you  that  your  life-w^rk 
lias  cnly  just  begun  ;  hitherto  you  have  pursued 
your  studies  under  the  constant  guidance  and 
direction  of  your  teachers — now  you  must  pass 
rora  under  their  supervision  and  control  aiid  rely 


upon  you!  owr  resources.     You  I -ave  studied  hard 
heretofore,  you  must  study  hard  still     you  -viust 
press  on,  the  wurld  will  not  wait  for  you  j  science 
is  advancing  with   rapid  strides,  earnest   thou^ht■ 
ful  iiien  are  pushing  their  iijvestigations  in  every 
departnient ;   new  facts  are    accumulating,    new 
theories  springing  up,  tiew  mcdiods  of  treatment 
elaborated  ;  if  you  wouK'  keep  abreast  of  the  times, 
you  must  study  long  and  well,  and  familiarize  your- 
selves with  the  progressive  labors  and  discoveries 
of  others.     The   physician   who    is   content   with 
what  he  already  knows,  and  thereupon  ceases  to 
study;  voluntarily  drops  from  the  ranks,  and  is  soon 
left  far  behind ;   in    the   medical   profession  you 
cannot  stand  still,   you   must   either  advance  or 
retrograde.      But,  while  studying   with  diligence 
and  regularity,  do  not  over-estimate  its  importance, 
and  fall  into  the  error  of  supposing  that  book- 
learning  alone  can  ensure  success  in  yuur  profes- 
sion; reading  may  certainly  make  you  well-infonned 
men,  it  can  never  of  itself  niake  you  skillful  men. 
An  eminent  Professor  was  once  asked  by  a  young 
graduate  what  he  would  recommend  him  to  do,  in 
order  to  secure  success  in  the  profession.     "  Three 
things,"  replied  the  Professor,  "  ist,  observe  ;  a: id 
2nd,  observe  ;  and  3rd,  observe."     Careful  obser- 
vation is  the  only  road  to  success ;  it  is  the  magic 
key  which  unlocks  the  mysteries  of  Nature  and 
reveals  her  secrets  to  the  studious  inquirer.     Train 
the  eye,  the  ear,   the  touch  daily;   take  pains  to 
investigate   every   case    entrusted  to    your    care 


170 


TIIK    CANADA    MEDICAL    RECORD. 


thoroughly  and  systematically ;  observe  everything, 
consider  nothing  as  too  trivial  or  minute;  then, 
after  having  collected  all  your  data,  sift  the  evi- 
dence, and  bring  reason  and  common-sense  to  bear 
in  forming  your  conclusion  and  determining  a 
rational  line  of  treatment.  Endeavor  always  to 
treat  your  patient  rather  than  his  disease.  Do  not 
allow  yourselves  to  degenerate  into  the  mere  routine 
practitioner,  i.e.,  into  a  kind  of  peripatetic  pre- 
scribing machine;  but,  regarding  each  case  as  a  sort 
of  vital  problem,  strive  to  bring  to  its  solution  not 
only  competent  knowledge,  but  also  your  reason 
and  good  sound  common-sense  ;  and  then,  as  ripen- 
ing experience  comes  apace,  and  advancing  years 
add  dignity  and  authority  to  your  opinions,  your 
self-evident  knowledge  and  skill  will  e.xcite  the 
admiration,  and  win  the  respect  and  esteem,  of 
your  professional  brethren  and  the  community  at 
large. 

•  When  you  eater  upon  the  practice  of  your  profes- 
sion, you  will  at  once  be  thrown  into  contact  and 
competition  with  other  medical  men.  Remember 
that  you  are  fellow-workers ;  let  no  unseemly  rivalry 
or  jealousy  mar  your  friendly  relations — act  always 
with  courtesy  and  consideration,  strive  to  follow 
the  golden  rule  ;  never  slander,  depreciate  or  con- 
demn a  confrere  behind  his  back,  but  rather  defend 
him  ;  and  remember  that  there  is  such  a  thing  as 
damning  by  faint  praise,  and  that  a  curl  of  the  lip, 
a  contemptuous  smile,  a  shrug  of  the  shoulder, 
may  do  far  more  damage  to  a  confrere's  reputation 
than  an  open  charge ;  such  means,  I  need  hardly 
say,  are  far  more  despicable  because  more  treach- 
erous. When  called  to  a  case  in  consultation,  aid 
your  confrere  X.Q  the  best  of  your  ability,  and  loyally, 
cheerfully  and  honorably  accept  the  responsibili- 
ties which  ordinarily,  attach  to  the  consultant. 

In  the  practice  of  your  profession,  gentlemen, 
you  have  certain  well-defined  duties  to  your  patients 
— there  is,  in  fact,  an  implied  contract  existing 
between  you.  On  their  part,  trust  and  confidence 
are  placed  in  you,  all  that  they  hold  nearest  and 
dearest  are  entrusted  to  you,  health  and  happiness, 
sickness  and  suffering,  honor  and  r^eputation,  the 
issues  of  life  and  death,  are  placed  in  your  hands  ; 
while  on  your  part,  in  accepting  these  grave  respon- 
sibilities, you  are  bound  to  j)Ossess  a  competent 
knowledge  of  your  profession,  to  devote  due  care 
and  attention  to  your  patients,  and  to  exercise  in 
their  treatment  your  very  best  skill.  In  your  pro- 
fessional relations  you  enter  the  family  circle,  sick- 
ness often   rudely  tears  off  the  society-mask  and 


discloses  the  inner  life  of  your  patients.  You  know 
the  shadows  that  darken  many  a  home,  the  hidden 
sorrows  that  imbitter  many  a  life  ;  weighty  secrets, 
important  confidences  are  committed  to  your  care. 
And  thus  not  only  the  lives,  but  often  the  fortunes 
and  prospects  of  individuals,  the  peace,  honor 
and  happiness  of  families,  the  welfare  of  commu- 
nities, may  rest  in  your  hands.  Upon  your  pru- 
dence and  caution  great  interests  hang,  beware 
how  you  betray  them  ;  beware  lest  you  violate  the 
sacredness  of  professional  confidence.  As  the 
family  physician,  you  will  frequently  become  not 
only  the  medical  adviser,  but  also  the  trusted 
counsellor  and  friend — one  whose  advice  is  sought 
in  times  of  difficulty  or  distress — one  who  must  at 
times  cheer,  sympathize,  comfort  or  support. 
While,  then,  you  strive  to  be  skilful  and  accom- 
plished in  your  profession,  do  not  forget  that,  when 
human  skill  is  of  no  more  avail,  sympathy  and 
kindness  may  temper  a  blow  you  cannot  ward  off, 
or  lighten  a  sorrow  you  cannot  avert. 

Let  me  urge  upon  you  not  to  begin  practice  with 
too  great  mercenary  inclinations  ;  if  money-making 
is  your  aim  in  life,  I   fear  you  sadly  missed  your 
vocation ;    you   should  really,    gentlemen,    have 
chosen  some    other    calling.      Undoubtedly   the 
laborer  is  worthy  of  his  hire,  and  people  as  a  rule 
do  appreciate  kindness,    attention  and  skill,  and 
gratefully  remunerate  them  as  they  deserve ;  while 
you  need,  therefore,  feel  no  hesitation  in  expecting 
or  receiving  a  fair  equivalent  for  your  time  and 
labor,  be   not  discouraged  or  disheartened  if  you 
do  occasionally  meet  with  inconsiderateness   and 
ingratitude  ;  but  you  should  endeavor  to  sink  as 
far  as  possible  the   money  aspect  of  the  question, 
and  go  forth  into  practice  seeking  rather  how  you 
may  best  be  of  use  in  the  world,  how  you  may 
best    combat    disease    and    alleviate    pain    and 
suffering.     Do     not    become    so     strictly  profes- 
sional in  your  manner  and  habit   of  thought  as  to- 
look  upon   your  patients  as   merely  so  many   in- 
teresting specimens  or  examples  of  disease  that  are 
to  be  merely  examined,  diagnosed,  prognosed  and 
treated  secundum  artem  ;   but  in  your  professional 
dealings  with  them  remember  always  that  they  are 
frail  and  human,  with  feelings  and  sensibilities  like 
yourselves.     Make  allowance  for   fretfulness  and 
irritability,  be  gentle,  kind  and  patient  with  them; 
make  them  feel  that  you  are  sorry  for  their  suffer- 
ings while  you  are  doing  all  that  you  can  to  relieve 
them.     Kind  words  and  tender  sympathy  go  a  long 

way  in  the  sick  room.     Prejudiced  or  thoughtless 

i 

I 


THE    CANADA    MEDICAL    RECORD. 


171 


people  are  fond  of  characterising  doctors  as  hard- 
hearted pitiless  men,  generally  fond  of  hacking  and 
cutting  and  giving  pain.  Even  the  Poet-Laureate, 
in  a  recent  poem,  has  gone  rather  out  of  his  way 
to  describe  an  imaginary  medical  ghoul.  While 
this  is  undoubtedly  a  libel  on  the  great  majority  of 
the  profession,  there  is,  at  the  same  time,  a  color- 
ing of  truth  in  the  accusation.  Familiarity  with 
suffering  is  said  to  breed  contempt,  and  thus  blunt 
the  sensibilities,  and  eventually  harden  a  man.  It 
all  depends  upon  yourselves,  however.  If  you 
•enter  practice  thinking  always  of  the  loaves  and 
fishes,  if  you  treat  your  patients  in  a  strictly  pro- 
fessional manner,  if  you  repress  your  natural  sym- 
pathies and  hold  yourselves  aloof,  remaining  im- 
passive and  cold  as  marble,  then,  most  assuredly 
you  will  become  hardened  and  callous  ;  but  if  you 
always  aim  at  doing  good  for  the  love  of  it,  if, 
while  relieving  suffering  you  allow  sympathy  and 
kindliness  to  temper  every  word  and  act,  then,  day 
})y  day,  your  hearts  will  expand  with  benevolence 
and  love,  and  you  will  become  purer,  nobler,  bet- 
ter. Strive  to  be  as  a  ray  of  sunshine  in  every 
home  ;  let  the  sick  brighten  at  your  entrance  ;  let 
the  httle  ones  long  for  your  visits  ;  then,  when 
your  life  work  is  drawing  to  a  close,  when  you  are 
old  and  grey,  men  and  women  grown,  whom  you 
have  watched  and  tended  from  infancy,  will  love 
and  revere  you  with  the  tenderest  affection  and 
esteem. 

As  medical  men,  you  have  important  duties  to 
the  community  at  large.  Not  only  must  you  seek 
to  cure  disease  in  the  individual  when  it  exists, 
but  you  must  strive  to  forestall  its  onset  and  pre- 
vent its  spread.  No  branch  of  medical  science  is 
progressing  more  rapidly  than  Preventive  Medi- 
cine. Hosts  of  keen  observers  are  studying  epi- 
demics, investigating  their  origin  and  spread, 
seeking  to  discover  the  specific  causes  of  infectious 
diseases,  and  the  best  methods  of  destroying  or 
removing  them.  Vast  progress  has  been  made  of 
late  in  Sanitary  Science  ;  impure  air,  impure  water, 
impure  food,  impure  milk,  bad  ventilation,  bad 
drainage,  have  been  repeatedly,  in  fact  almost 
invariably,  recognised  as  playing  a  large  part  in  the 
origin  and  spread  of  disease  ;  sanitary  precautions 
have  been  devised,  and,  when  faithfully  carried 
out,  have  cut  short  epidemics  and  saved  thousands 
of  valuable  lives.  Those  fearful  scourges, 
typhus  and  small-pox,  are  now  practically  under 
control ;  and,  judging  from  the  recent  interesting 
and  important  experiments  of  Pasteur,   we  shall, 


some  day,  be  able  to  protect  our  patients  from 
the  ravages  of  scarlet  fever  as  successfully  as  we 
now  do  from  small-pox.  A  vast  field  for  original 
research  is  open  to  every  one  of  you,  gentlemen  ; 
those  of  you  who  settle  in  country  districts  will 
have  even  greater  opportunities  for  the  investiga- 
tion of  infectious  disease  than  your  city  brethren  ; 
for  you  can  there  investigate  the  circumstances 
attending  the  origin  and  spread  of  disease  far 
more  accurately  and  satisfactorily  than  you  could 
in  crowded  localities  where  so  many  fallacies 
must  be  guarded  against.  Let  me  urge  upon  you 
to  neglect  no  opportunity  of  contributing  your 
mite  to  the  rapidly  accumulating  stores  of  know- 
ledge in  this  most  important  subject. 

There  is  yet  another  important  matter  to  which 
I  would  like  very  briefly  to  direct  your  attention. 
As  medical  jurists  your  services  will  be  continually 
invoked  to  aid  the  law  in  furthering  the  ends  of 
justice  ;  let  your  influence  be  impartially  cast  on 
the  side  of  right  and  truth ;  never  allow  your 
judgment  to  be  warped  by  personal  or  mercenary 
considerations.  In  many  directions,  the  law  is 
slowly  but  surely  yielding  to  the  demands  of  ad- 
vancing scientific  knowledge,  and  is  being  amend- 
ed and  remodeled  in  conformity  with  more  correct 
ideas  of  true  justice  and  humanity.  In  no  case  is 
this  more  strikingly  manifested  than  in  the  treat- 
ment of  the  insane.  Thank  God,  the  day  has 
gone  by  when  unfortunate  sufferers  from  mental 
disease  were  indiscriminately  classed  as  dangerous 
lunatics  and  committed  to  gaols  and  asylums — 
why? — simply  to  get  rid  of  them.  As  the  result 
largely  of  the  constant  agitation  kept  up  by  the 
members  of  the  medical  profession,  it  is  at  last 
dawning  upon  the  public  mind  that  insanity  is  not 
a  special  dispensation  of  Pro\adence,  inscrutable 
and  irremediable,  but  is  in  reality  the  result  of 
morbid  processes  chiefly  affecting  the  brain,  just 
as  bronchitis  is  the  result  of  morbid  processes 
affecting  the  respiratory  tubes.  Insanity,  there- 
fore, is  a  disease,  and,  like  other  diseases,  is  amen- 
able to  suitable  treatment ;  moreover,  as  in  other 
diseases,  some  cases  can  be  cured,  some  can  be 
only  improved,  while  others  are  beyond  the  reach 
of  our  present  knowledge  and  skill.  Would  that 
the  name  "  Lunatic  Asylum,"  with  all  its  painful 
associations  of  ignorance,  incompetence,  cruelty 
and  neglect,  could  be  forever  swept  away  and  for- 
gotten !  I  sincerely  trust  that  the  day  may  not  be 
far  distant  when,  to  the  triumph  of  education, 
civilization  and   common  humanity,  special   hos- 


172 


THE    CANADA    MEDICAL   RECORD. 


pitals  will  be  established  for  the  treatment  of  men- 
tal ai.d  nervous  disease,  which  will  be  quite  as 
importani  and  ([uite  as  successful  as  those  similar 
institutions  for  the  treatment  of  eye,  ear,  chest 
and  other  form;:  of  special  disease.  The  medical 
profession  has  labored  hard  to  rescue  the  helpless 
ins.i'ie  from  the  degradation  and  misery  to  which 
they  had  been  consigned,  and  to  mark  out  the  true 
limits  andconditivjiis  of  civil  and  criminal  responsi- 
bility, .■'luch  has  been  accomplished  in  tlie  past, 
but  mi.c".  still  rcuiains  to  be  dju^  in  t'le  future; 
let  me  cnhst  ;'0'  sympathy  ah-l  ^...ippDrt  in  tiiis 
great  work. 

V'l'Ht  will  nof  pernii'.  iiie,  gentlemen,  to  enlarge 
further  upo  1  the  vast  fiel  li  of  nsefuhiess  w'lich 
are  now  open  to  thj  ih»  ightful,  stulious  and  coa- 
scientious  physicia  i.  Wherever  your  lot  may  be 
cast,  there  is  mac''  to  'lo,  your  opportunities  are 
great ;  remember  always  ch^  sacredncss  and  res- 
ponsibility of  vour  profession  ;  be  just  a;id  upright, 
patient  and  self-sacrifici'ig  ;  let  your  mission  be 
one  of  benc^cence  and  co'nfort;  strive  to  emulate 
the  sunbeam  brightei-ing  and  c'-ieering  the  cottage 
of  the  poo)  a'^d  Ic.vly,  as  readily  as  the  niansijn  of 
the  powerful  -i  id  rich. 

Gei'.tleiuei'j  yur  Alma  Mater  this  -.lay  enrolls 
you  among  lier  sons,  and  sends  you  forth  into  tlie 
w'orld  bcarirg  her  ^lamc  :  your  reputation  i^  her 
reputation,  your  success  is  her  success;  guard  well 
th*"  chargv"  we  this  day  entrust  to  your  care.  Go  forth 
iiitothe  battle  of  life,  beari-ig  aloft  the  motto  "  Ex- 
-^elsior,"  ever  onward  and  upward,  and  may  siccess 
attend  your  efforts.  In  th.^  nar.T^  of  your  Professors, 
in  the  iiame  jf  die  University,  God-speed  -md  fare 
yo-i  .veil. 


ON  THE  TFvEATMENT   01'  TAPE-WORM, 
(T^NIA  SOLIUM). 

By  Dr.  Cassi;ls,  Three  Rivers,  P.  Q. 

Persons  afflicted  with  tape-worm  are  compara- 
tively rare  in  Canada,  and  there  is  little  doubt  that 
the  great  majority  of  our  medical  practitioners 
pass  a  lifetime  at  busy  practice  without  meeting 
with  the  disease  perhaps  half  a  dozen  times  ;  con- 
sequently it  is  not  to  be  wondere  1  at  that,  when  a 
doctor  is  called  upon  to  treat  an  isolated  case  of 
the  kind,  even  the  most  able  n<an  may  find  it  difti- 
cult,  if  not  impossible,  to  effectually  expel  this 
parasite. 

I'he  standard  authorities  enumerate  a  vast  vari- 
ety of  remedies  supposed  to  be,  and  many  of  which 


actually  are,  efficacious  ;  but  it  is  one  thing  to  know 
the  names,  and  quite  another  to  understand  the 
best  way  of  applying  them. 

Having  several  times  been  consulted  by  Ijro- 
ther  practitioners,  who  found  themselves  troubled 
^y  cases  of  this  description,  I  venture  to  send  you 
this  short  article  on  the  subject,  hoping  that  it  -.lay 
prove  of  service  to  some  of  the  junior  members  d( 
our  j)rofession. 

I  have  been  fortunate  enough  to  have  had  a  bet. 
ter  opportunity  of  getting  experience  on  this  matter 
than  most  Cap.cdian  medical  men,  inasmuch  as 
sixteen  years  ago  •  was  for  two  years  and  a  half  in 
the  military  hospital  a*^^  Valetta,  Malta,  as  dispenser,- 
where  there  was  always,  at  z  low  estimate,  fro.n  3 
to  5  cases  of  the  disease  in  the  wards,  on  an  aver- 
age. Ti'ie  garrisoii  consisted  at  that  time  of  several 
thousand  me}i,  together  with  a  proportionate  num- 
ber of  women  and  children,  and  although,  during 
part  of  the  year,  the  troops  were  served  with,  if  I 
remember  rightly,  Ohe  salt  ration  (consisting  of 
equal  parts  of  beef  and  pork)  per  week,  the  mili- 
tary surgeons  were  generally  of  opinion  that  the 
prevalence  of  tape-w- ^nn  was  more  due  to  the  water 
(which  is  rain  water  preserved  in  tanks,  there  being 
very  few  natural  springs  on  the  Island;  than  to  the 
pork,  especially  as  there  was  no  difference  in  the 
number  of  cases  during  the  summer  months,  when 
th':;  salt  food  was  discontinued. 

I  may  mention  }iere  that  both  Wood  in  his 
"  Practice  of  Medicine  "  and  Vogel  in  his  "  Chil- 
dren's Diseases  "  assert  that  females  are  more  sub- 
ject to  tlic  complaint  tha*"  males  ;  this,  however,  is 
not  borne  out  by  my  experience,  for,  during  the 
time  I  speak  of,  maiiy  hundred  men  were 
treated,  and,  as  well  as  I  can  remember,  only  two 
or  three  cases  in  females. 

Another  point  was  that  the  long  train  of  symp- 
toms, as  laid  down  by  the  standard  authorities, 
were  never  present  at  the  most  there  was  an  uneasy 
feeling,  hardly  amounting  to  pain,  at  the  pit  of  the 
stomach,  more  marked  after  a  long  fast,  perhaps  a 
furred  tongue  a  id  bad  breath,  with  some  languor 
in  the  jnorninff,  and  a  capricious  appetite ;  but  in 
very  many  cases  the  only  symptom  was  the  in- 
fallible one  of  pieces  of  the  worm  continually  pass- 
ing per  anuni. 

Common  as  the  disease  was,  it  was  very  impor- 
tant that  the  treatment  should  be  prompt  and 
effective,  and  to  this  end  all  sorts  of  combinations 
were  tried.  Very  excellent  results  were  sometimes 
obtained  from  kusso,  and  from  bosk  of  thepjme- 


THE   CANADA    MEDICAL    RECORD. 


JL  to 


granate  root,  and  seeds  of  the  fruit,  but  their  action 
was  not  always  sure,  more  especially  kusso,  which, 
when  fresh  and  pure,  is  very  reliable,  but  deteri- 
orates rapidly  when  kept  any  time,  and,  frum  its 
expense,  is  apt  to  be  adulterated. 

After  many  trials,  the  following  was  found  to  be 
the  best  mode  of  procedure  : 

When  a  man  was  admitted  with  taenia,  he  was 
allowed  no  food  after  dinner  the  day  of  his  admis- 
sion ;  that  evening  he  was  giveii  a  full  dose  of 
■compound  infusion  of  senna  with  one  or  two 
drachms  of  rochelle  salts.  The  senna  was  found 
to  clear  the  mucus  from  the  intestines  and  expose 
the  worm  better  than  any  other  purge.  The  follow- 
ing morning,  after  the  bowels  were  well  cleared 
out,  and  the  man  had  fasted  i^  or  i8  hours,  he 
was  given  from  i}^  to  2  drachms  of  kamale  pow- 
der, together  with  the  same  quantity  of  ethereal  ex- 
tract of  male  fern.  This  was  given  in  the  follow- 
ing way  :  the  kamala  was  first  suspended  in  an 
aromatic  mucilage  and  the  male  fern  added.  Just 
before  giving  it  to  the  patient  this  mixture  was 
poured  into  half  a  teacupful  of  warm  milk  and 
taken  while  hot.  An  hour  or  so  afterwards,  half 
an  ounce  each  of  castor  oil  and  turpentine  w  e 
given. 

The  rationale  of  the  treatment  is  as  follows  : 
The  worm  is  made  hungr)',  and  exposed  by  clear- 
ing the  mucus  from  the  bowels,  then  the  remedy 
is  given  in  hot  niilk,  as  the  animal  is  particularly 
fond  of  that  article  of  diet  ;  the  turpentine  is  to 
give  the  coup  de  grace,  if  required,  and  the  oil  to 
remove  him  from  the  patient. 

It  is  necessary  to  carefully  examine  the  worm 
passed  to  make  sure  that  the  head  has  come  away  ; 
otherwise  all  the  trouble  is  for  nothing,  as,  uo  utat- 
ter  how  many  feet  are  removed,  the  wormre-gro  v.' 
very  rapidly,  and  in  a  short  time  will  be  as  trouble- 
some as  ever.  It  is  easy  to  distinguish  the  head 
after  having  seen  cue.  To  the  naked  eye  it  ap- 
pears as  a  white  pc'int  en  which,  with  a  small, 
pcvvcr  magnifying  glass  blackish  suckers  may  be 
detected.  Between  these  is  a  conical  proboscis 
surrounded  by  a  double  circle  of  hooks,  so  small 
that  they  are  invisible  unless  with  a  glass  of  con- 
siderable power.  The  neck  is  several  inches  in 
length,  not  jointed,  and  remains  attached  to  the 
head. 

If  the  directioi-.s  1  have  given  are  strictly  ob- 
served, in  the  great  majority  of  cases  the  patient 
will  be  cured,  although  occasionally  it  is  necessary 


to  repeat  the  operation  in  a  week  or  ten  days,  when 
the  head  has  been  left  behind. 

Very  often,  however,  I  have  found  that,  in  cases 
where  a  second  dcse  was  required^  some  irregu- 
larity or  deviation  from  the  prescribed  routine 
had  been  committed. 

Particular  care  must  be  taken  to  use  good  sam- 
ples of  kamala  and  male  fern  ;  the  kamala  espe- 
cially is  very  hard  to  get  pure. 


ON  SOxME  POINTS  OF  CONTEMPORARY 

INTEREST. 

By  C.  E.  Nelson,  M.P.,  New  York. 

Sc'ivers,  and  sewer-gases. — In  a  large  metropolis, 
these  cannot  be  dispensed  with  ;  if  they  are  well 
constructed  (as  in  London),  in  conjunction  with 
the  most  improved  "  stink-traps,"  charcoal  trays, 
&:c.,  sewers  may  be  very  beneficial ;  if  inefficiently 
built,  of  poor  materials,  with  useless  traps  (as  in 
New  York),  they  may  be  productive  of  a  certain 
amount  of  malaise,  but  hardly  of  severe  disease  : 
many  of  these  cases  of  so-called  town  malaria 
were  probably  contracted  in  country  watering 
places,  from  evening  exposure  ;  and  the  cases  of 
typhoid  fever,  from  drinking  foul  cistern  water  in 
country  hotels  ;  they  return  to  town  sick  and 
wearied ;  on  the  return  these  persons  probably 
rarely  take  the  accustom.ed  out-door  walk,  so, 
being  confined  in  rooms  which  often  are  super- 
heated, they  become  languid,  and  the  implanted 
seeds  (now  it  is  called  "  germs ")  of  malaria 
develop  into  lingering,  and  sometimes  fatal 
disease.  It  is  surely  improper  to  include  these 
cases  in  the  city's  sick  list  (considering  tliey  were 
contracted  in  the  country),  attributing  them  to 
our  sewer-system.  Our  watering-claos  population 
commit  many  imprudencies  in  the  country  that 
they  would  not  dream  of  doing  in  town.  sucl.>  as 
sitting  outside  the  house  during  the  evening, 
when  the  air  is  raw  and  damp  ;  they  do  not  take 
pattern  by  the  farming  class,  who  never  dream  of 
sitting  outside  their  houses  in  the  evening. 
Drinking  milk  in  large  quantities,  this  is  "  de 
rigueur"  with  town  people,  thinking  it  would 
not  be  "  the  country "  if  they  did  not  do  so  ; 
farmer  families  rarely  drink  milk,  knowing  how  it 
goes  through  the  dirty  fingers  of  cow-boys ;  it, 
however,  deranges  the  stomach  and  digestion. 
When  the  city  boarders  have  drunk  and  gorged 
themselves  sick,  then  a  doctor  is  called  in,  whose 
medical  education  may  be  none  of  the  highest. 


174 


THE    CANADA    MEDICAL    RECORD. 


Heater-closets  and  privies. — The  former  are  very 
convenient,  and  can  hardly  be  dispensed  with  in  a 
large  city  ;  but,  likely  the  privy  system,  at  a  little 
distance  from  the  house,  is  the  best. 

Stationary  wash  basins  in  the  rooms. — These 
often  are  the  means  of  diffusing  sewer-gases 
through  the  houses,  but  not  to  the  extent  that  is 
generally  imagined  ;  keeping  water  in  basins  and 
bath-tub  might  obviate  that,  the  water  absorbing 
the  gases. 

Dirty  cabins,  dung-heaps  at  the  door,  or  in  th<^ 
house,  may  not  be  prejudicial,  as  the  door  is  being 
continually  opened,  the  cabin  is  in  the  midst  of 
glorious  air  ;  then  again,  animal  manure  is  not 
unhealthy  as  to  odor,  it  containing  ammonia ; 
stable  helpers  (even  in  cities)  are  as  healthy  as 
any  other  class  of  men. 

Hygiene  and  Boards  of  Health,  Quarantine. — 
The  two  former  of  these  are  found  in  the  larger  cities 
of  the  more  advanced  nations,  especially  in  the 
''  temperate  zone  :  "  it  is  a  question  whether  they 
have  done  much  good ;  according  to  the  news- 
papers, which  usually  photograph  the  truth, — 
"  no."  As  to  quarantine,  that  is  especially  bene- 
ficial in  a  negative  way,  i.  e.,  keeping  out  disease, 
but  no  curing  it.  We,  of  New  York,  complain 
that  Southern  (and  foreign  cities  in  the  tropics,  as 
Havana)  cities  are  not  kept  clean,  thereby 
engendering  repulsive  diseases  ;  they  might  with 
reason  retort,  mentioning  our  "  high  rate  of 
mortality  ; "  because  after  all  what  does  it  matter 
what  name  is  given  to  the  disease  (yellow  fever,  or 
diphtheria),  as  long  as  it  is  fatal  ;  su.imer  diarrhoea 
and  teething  kill  as  well  as  chole:.'. 

Diphtheria  caused  by  bad  odours  and  defective 
drainage. — I  cannot  exactly  subscribe  to  this 
theory  ;  I  rather  think  that  our  ward-school  system 
(crowding  dirty  children  of  all  classes  and  con- 
stitutions together)  is  at  the  bottom  of  this.  A 
healthy  child  goes  to  school,  gets  in  contact  or 
catching  distance  of  an  infected  child,  comes  home, 
takes  sick,  communicates  disease  to  other  younger 
children  in  the  family,  several  of  which  may  die  ; 
then  people  go  smelling  around  the  house,  and  if 
there  is  a  dead  rat  or  so  behind  the  wainscotting, 
they  forthwith  blame  our  Cexceedingly  laborious  and 
painstaking)  BoardofHealih  about  '•  sewer  gases  !  " 
Perhaps  also  an  inefficient  doctor  has  been  called 
in. 

Typhoid  fever  may  possibly  be  caused  by  sewer 
gases,  but  it  is  not  perfectly  certain. 

Typhoid  types  of  acute  disease  may  originate 


from  sewer-gases,  but  these  two  last  conditions 
(fevers,  and  typhoid  types  supervening  on  other 
complaints)  are  more  likely  partially  caused  by 
close  ill-ventilated  apartments,  and  also  by  inferior 
kinds  of  food.  Malaria  may  possibly  be  induced 
by  sewer-gases ;  it  is  likely  intensified  by  that 
agency. 

Increased  rate  of  mortality  in  tenement  house 
districts. — I  think  this  is  due  to  the  fact  princi- 
pally, that  there  are  more  poor  people  than  rich  ; 
also,  that  there  are  more  people  occupying  a  room 
(merely  as  regards  simple  numbers)  in  tenements 
than  in  rich  houses.  Send  away  the  bulk  of  the 
tenement  house  population,  .  leaving  merely  as 
many  people  in  a  tenement  house  as  there  would 
be,  on  an  average,  in  a  rich  house,  it  is  a  question 
whether  any  more  would  die  in  the  former  than  in 
the  latter  :  of  course,  there  is  a  little  difference  as 
regards  buying  delicacies,  getting  good  food,  wines, 
&c.  The  laboring  men,  who  live  in  tenements^ 
go  to  their  work  every  morning,  perfectly  healthy, 
although  of  course  they  are  in  the  fresh  air  most 
of  the  day  ;  the  mothers  pass  through  their  confine- 
ments about  as  well  as  rich  ladies  do. 

Are  vile  odours  unhealthy  ? — Doctors  are 
divided  on  this  question  ;  bad  odours  are  very  un- 
pleasant, but  I  do  not  think  they  are  fatal — witness 
the  men  who  work  in  rendering,  and  other  such 
establishments  ;  also  those  who  work  in  gas-housest 
sewers,  the  former  "  night-men,"  who  used  to 
clean  out  privies  (now  called  soil-vaults). 

A  country  village  with  no  sewer,  or  water-pipe 
system,  no  house  water-closets,  is  more  likely 
healthier  (apart  from  the  country  air)  than  a  town 
which  contains  those  conveniences  of  civilization 
the  dirty  water  and  manure  thrown  out  over  the 
fields  hurt  no  one. 


j^y.QrjiteSi  ofJiiedkal  Science, 


DEATH  FROM  BROMIDE  OF  ETHYL. 

Dr.  R.  J.  Levis,  of  Philadelphia,  the  distinguish- 
ed advocate  of  Bromide  of  Ethyl,  recently  lost  a 
patient  under  this  anaesthetic  at  the  Jefferson  Med- 
ical College  Hospital,  Philadelphia.  The  patient 
was  about  to  be  operated  upon  for  stone  in  the 
bladder,  but  died  as  the  first  incision  was  being 
made.  Dr.  Levis  was  present  during  the  adminis- 
tration of  the  anaesthetic,  and  no  doubt  exercised 
every  known  precaution. 


THE   CANADA    MEDICAL   RECORD. 


175 


A  LECTURE  ON  PERITONITIS. 

Delivered  at  the  College  of  Physicians  and  Surgeons,  N.  Y. 

By  Alonzo  Clark,  M.D.,  LL.D., 

Professor  of  the  Principles  and  Practice  of  Medicine. 

{Reported for  the  Hospital  Gazette!) 

This  disease  is  important  from  the  great  extent 
-of  the  membrane,  which  is  arranged  in  the  form 
of  an  irregular  sac,  with  no  openings  of  any  great 
importance.  It  is  important  in  its  connections  with 
liver,  intestines  and  stomach,  for  when  a  viscus  is 
inflamed  and  the  inflammatory  action  reaches  the 
surface  it  will  involve  the  serous  membrane  of  that 
viscus,  and  consequently  when  a  membrane  is  in- 
flamed the  action  will  proceed  to  a  hmited  extent  to 
the  viscus.  As  regards  degree,  this  serous  inflamma- 
tion stands  next  to  arachnitis.  This  is  not  very  com- 
mon inflammation,  much  less  frequent  than  the  in- 
flammation of  pleura  and  pericardium.  Pleurisy 
is  most  common  of  all.  To  me  it  seems  that  per- 
itonitis is  most  common  in  mountainous  districts. 
I  think  I  have  seen  more  of  this  disease  in  Ver- 
mont than  in  all  other  places  together,  including 
hospital  practice.  I  shall  consider  peritonitis  under 
four  heads,  ist.  Sporadic  peritonitis.  2nd.  Per- 
itonitis from  perforation.  3rd.  Puerperal  periton- 
itis. 4th.  Chronic  peritonitis,  which  is  almost 
always  associated  with  tubercles.  We  may  have 
any  of  the  three  products  of  serous  effusions,  but 
there  will  always  be  plastic  exudation  which  will  be 
found  more  posteriorly  on  account  of  the  supine 
position  which  these  patients  assume.  In  the  or- 
dinary forms  there  will  be  serum  and  fibrin.  Pus 
is  very  rarely  found  alone.  In  the  chronic  form 
the  plastic  effusion  will  be  organized  in  layers, 
the  greatest  quantity  on  the  surface  of  intestines. 
Tubercles  will  be  usually  found  in  connection 
with  the  organized  matter.  Purulent  eft'usion  is 
frequent  in  the  2nd  form  of  the  disease. 

SPORADIC  PERITONITIS. 

The  rule  is  that  this  is  a  very  painful  disease, 
and  that  the  pain  begins  at  one  point  and  spreads 
rapidly.  This  symptom  is  observed  early  in  the 
dit-ease.  A  chill  .does  not  commonly  occur.  The 
pulse  does  not  feel  the  influence  of  the  disease 
until  a  later  period,  as  a  rule.  I  believe  that  we 
have  no  acute  inflammation  where  the  pulse  runs 
up  as  high  as  it  does  in  peritonitis.  Constipation 
of  an  unyielding  character  exists  in  the  height  of 
the  disease.  This  is  as  complete  as  if  produced  by 
some  obstacle  in  the  intestinal  canal.  The  inflamma- 
tory condition  extends  just  through  the  muscular 
•coat  of  the  intestinal  canal  (the  same  plexus  of  ves- 
sels supplying  both  the  muscular  and  peritoneal 
coats).  When  a  muscle  is  inflamed  it  cannot  act, 
and  to  this  paralysis  is  to  be  attributed  the  consti- 
pation ;  as  long  as  the  intestines  are  in  this  condi- 
tion cathartics  can  only  do  harm  by  exciting  inflam- 
matory action  in  the  mucous  coat.  This  constipa- 
tion lasts  the  whole  time  tliat  the  inflammation  is 
severe. 


Vomiting  frequently  begins  in  the  early  stages  of 
this  disease,  and  is  due  to  reflex  action  of  par 
vagum.  The  contents  of  stomach  are  first  thrown 
up,  then  the  greenish  '*  spinach-like  ?natier" 
whose  color  and  ap[)earance  is  due  to  biliverdine. 
The  explanation  of  this  fact  is  not  known,  but  it 
occurs  in  other  diseases.  Gaseous  extension  or 
tumefaction  of  abdomen  called  tympanites  or 
meteorism  is  present  in  first  twelve  hours.  This 
gas  which  is  chiefly  C  O2.,  is  contained  in  the  in- 
testinal cavity  and  not  in  the  peritoneal  cavity.  It 
does  not  readily  escape,  and  this  forms  one  of  the 
differences  between  this  and  other  diseases.  The 
tympanites  is  one  of  the  most  common  and  marked 
symptoms  of  the  disease.  The  countenance 
becomes  pale,  with  the  expression  of  calmness  ; 
features  are  somewhat  pinched.  This  condition  is 
known  as  the  "  Hippocraiic  countenance."  The 
mind  is  generally  clear.  The  urinary  secretion  is 
not  generally  affected,  but  there  may  be  inability 
to  pass  urine  from  adhesions  of  the  bladder.  There 
is  no  special  condition  of  tongue,  sometimes 
slightly  furred. 

The  causes  are  :   ist. 
produce  inflammation. 

2nd.  Perforation  of  stomach,  colon  or  vermi- 
form appendix.  Perforations  of  stomach  are  from 
two  causes. 

ist.  Perforating  ulcer,  which  occurs  near  the 
pylorus  and  sometimes  partly  in  the  stomach  and 
partly  in  the  duodenum.  This  ulcer  appears  like 
a  little  "well,"  and  causes  thickening  of  tissues  to 
the  extent  of  ^  in.  "W" hen  perforation  takes  place 
the  contents  of  stomach  pass  into  the  peritoneal 
cavity  and  persons  die  in  12  or  16  hours,  though 
they  often  live  to  the  second  or  third  day.  There 
may  be  ulceration  of  stomach  without  endanger- 
ing life,  as  in  spinal  or  apthous  sore  mouth  of 
children.  They  are  not  of  common  occurrence 
because  ordinary  inflammation  does  not  produce 
them.  This,  however,  must  not  be  taken  for  the 
erosion  caused  by  the  solvent  action  of  the  gastric 
juice  after  death.  In  protracted  diseases  this  ero- 
sion does  not  take  place  because  it  is  not  apt  to  be 
taken  to  any  extent  previous  to  death.  Some  years 
ago  an  ulcer  was  found  in  a  Bellevue  patient  3  in.  by 
extending  to  pancreas  and  liver  and  pro- 


The  obscure  causes  which 


2  I. 


in. 


ducing  erosion,  and  opening  two  large  vessels  of 
the  liver,  which  gave  rise  to  fatal  hemorrhage. 

2nd.  Stomach  may  be  perforated  by  cancerous  dis- 
ease, and  then  it  is  rapidly  fatal.  These  are  the  only 
causes  of  perforation  of  stomach.  Perforation  of 
intestine  at  duodenum  may  result  from  an  ulcer, 
and  is  much  the  same  as  perforation  of  the 
stomach  ;  this  form  is  less  rapid.  I  have  never  seen 
an  instance  of  perforation  of  jejunum.  Perforation 
of  ileum  may  happen  in  typhoid  fever  near  the 
ileo-caecal  valve  ;  pain  will  first  be  felt  on  the  right 
side  low  down.  The  whole  colon  is  susceptible  to 
perforation  during  acute  dysentery,  or  from  ulcers 
or  cancerous  disease.  The  ulcer  is  very  much  like 
that  in  stomach.  They  are  circular,  and  have  been 
known  to  surround  the  intestine.     Ulceration  may 


176 


THE    CANADA    MEDICAL   RECORD. 


be  produced  by  a  calculus  in  the  gall  bladder,  but 
these  generally  pass  into  iniesli'ial  lube.  The 
mont  cotntnori  seal  of  perforation  is  at  the  venni- 
forra  appei.dix.  In  this  sac  a  great  quantity  of 
substances  takcuwith  the  food  have  been  fou.id  at 
the  i>ost-niortc'ni  cxaniinatio.i.  The  most  cumniou 
cause  is  fa;cal  aecumulalio.is,  which  fill  the  sac 
aii'l.  cause  ulceration,  though  I  cann'^t  recall  a  case 
of  peritonitis  in  childreu  under  14  years  which  did 
not  occur  from  ])erforation  at  vermiform  a;'i^e.idix. 

The  i^ain  begins  at  R.  I.  fossa  and  exteiids  along 
the  transverse  colon  ;  this  disease  always  yields  to 
treatuient  and  seems  subdued,  but  soon  breaks  out 
again  with  greater  severity.  In  healthy  persons 
there  is  a  tendency  to  adhesion  and  to  form  a  sac 
to  contain  the  effusion  for  a  day  or  two,  but  as  it 
accumulates  the  sac  breaks  and  so  produces  the 
symptoms  over  again.  This  feature  seems  to  be 
distinctive  of  ])erforation  at  vermiform  appendix. 
The  elfusion  which  is  purulent  gives  rise  to  dull- 
ness. In  a  few  instances  the  disease  is  not  fatal, 
the  pus  being  dischar^'ed  by  some  opening. 

Peritonitis  is  apt  to  be  confounded  with  bilious 
colic ;  this  is  not  an  inflaniniation,  and  is  not  at- 
tended with  any  paralysis  of  muscles  of  intestines, 
but  depends  upon  an  unusual  contraction  of  the 
muscular  fibres.  There  is  no  increase  in  the  fre- 
quency of  the  pulse  for  some  hours,  while  in  periton- 
itis this  happens  early.  Colic  is  relieved  by  pres- 
sure in  begim.ing,  but  there  is  some  tenderness  after 
a  wliile.  No  tympanites  a.s  in  peritonitis.  Obstruc- 
tioj  of  intestines  is  taken  for  peritonitis,  but  here 
there  is  no  increased  pulse. 

Under  proper  treatment  a  considerable  number 
will  recover,  but  whatever  is  done  must  be  done 
with  energy,  as  the  natural  duration  of  the  disease 
is  ""/our  days."  Bloodletting  both  general  and 
local  has  been  practised  to  a  considerable  extent 
in  the  treatment  of  this  disease.  Dr.  Armstrong 
proposed  biood-letting.  followed  by  a  full  dose  of 
opium,  as  the  latter  pe-petuated  the  effect  of  the 
bleeding  ;  but,  while  he  looked  upon  both  as  neces- 
sary, if  he  could  have  but  one  he  preferred  the 
opium.  Drs.  Palmer  and  Child  of  Vermont  treated 
their  patients  by  the  Armstrong  method  in  1844 
with  success.  When  I  first  adopted  this  mode  of 
treatment  eight  recovered,  the  nmth  died.  The  rule 
is  to  give  as  much  opium  os  the  patient  can  take 
without  being  narcotized.  Begin  with  grsij.  to  iv. 
every  two  hours  until  the  symptoms  of  narcosis 
begin  to  show.  In  the  case  of  a  hospital  patient 
grs.  iv.  were  given  and  the  dose  increased  gr.  j. 
every  hour  until  a  gr.  xii  dose  was  taken.  One 
objection  to  this  plan  of  treatment  is  that  it  re- 
quires the  attention  of  the  physician,  who  should 
always  administer  the  opium  himself.  It  is  not 
important  which  preparation  of  o])iuni  you  use,  but 
use  the  same  from  begiiniing  to  end.  If  jjills  are  used 
they  should  be  freshly  made  up  every  twelve  hours. 
You  are  to  give  the  opium  by  its  effects  and  not 
by  quantity  ;  these  effects  are  sensible  contraction 
of  the  pupils,  marked  reduction  in  the  frequency 
of  respiration,    diminished    frequency   of    pulse, 


gentle  perspiration  of  skin,  itching  oi  the  mucous 
membrane  of  the  nose,  and  easy  but  very  much 
protrac  led  sleep,  from  which  patient  may  be  easily 
aroused.  The  pain  first  disappears.  Tympanites 
continues  until  inflammation  is  subdued.  Ix-t  the 
bowels  alone  for  one  week  longer,  as  they  will 
move  when  inflammation  subsides.  The  influence 
of  opium  is  to  be  kept  up  until  peristaltic  action  is 
re  established.  The  dose  may  then  be  diminished 
and  when  a  spontaneous  movement  occurs  it  may 
be  suspended  altogether.  A  full  dose  may  be  re- 
quired at  night  to  produce  sleep.  I  believe  I  have 
seen  peritonitis  from  perforation  cured  by  opium. 
In  this  form  there  seems  to  be  a  tendency  for  .seal- 
ing up,  and  the  ojjening  gives  time  for  this  healing 
process  to  be  more  complete.  No  other  mode  of 
treatment  has  been  successful.  Strong  coffee  and 
the  cold  effusions  are  to  be  used  as  antidotes  in 
poisoning  from  opium.  With  a  fair  amount  of  cau- 
tion and  these  two  antidotes  yon  will  not  likely  be 
to  lose  a  patient.  I  do  not  know  of  a  single  death 
produced  by  opium  in  this  disease. 

PUERPER.\L  PERITONITLS. 

This  form  of  the  disease,  called  also  puerperal 
fever  and  metro-peritonitis,  occurs  in  lying-in 
women,  although  it  may  occur  independent  of 
parturition.  It  is  liable  to  happen  within  thirty 
days  of  the  occurrence  of  parturition,  but  generally 
within  the  first  week,  and  greatest  liability  on  the 
second  or  third  day.  This  disease  and  its  asso- 
ciate metritis  are  believed  to  be  contagious  for 
those  in  the  same  condition.  There  is  no  doubt  but 
that  it  may  be  conveyed  by  the  physician,  although 
this  is  denied  by  Dr.  Meigs,  of  Philadelphia.  This 
disease  has  some  connection  with  the  cause  which 
produces  erysipelas.  We  rarely  hear  of  one  case 
alone,  it  is  much  more  apt  to  be  epidemic,  and  the 
elfusion  is  purulent.  The  fatality  of  the  disease, 
until  lately,  was  enormous.  In  Bellevue  Hospital 
not  more  than  one  in  twenty-eight  recovered. 
Now  we  have  much  better  results,  and  the  disease 
is  much  more  manageable  in  private  practice. 
Metro-peritonitis  is  much  more  commonly  attended 
by  a  chill.  It  is  far  less  often  attended  by  pain, 
and  this  leads  to  mistakes  in  the  diagnosis.  The 
I^aralysis  of  muscular  coat  of  intestines  is  not  so 
great,  and  hence  constipation  is  not  so  obstinate, 
and  cathartics  are  not  forbidden.  The  other  symp- 
toms are  quite  regular.  The  inner  sui  fa  :e  of  uterus 
is  always  inflamed  in  puerperal  perils  nitis,  so  that 
I  have  given  the  name  of  endometritis  to  this  con- 
dition. On  examination  there  is  found  a  pasty 
secretion  on  the  walls  of  the  uterus,  which  resem- 
bles thick  glue  and  of  the  color  of  beef  brine. 
Sometimes  the  whole  interior  of  the  organ  is  lined 
with  this  adventitious  material,  made  up  of  blood, 
pus,  and  fibrin,  formed  into  fibers,  not  unfrequently 
with  cells.  This  indicates  a  most  intense  form  of 
inflammation.  The  uterine  sinuses  may  be  inflamed 
and  jiurulent  matter  deposited  in  their  cavities.  Pus 
is  then  mingled  with  the  blood,  and  all  the  symp- 
toms of  pyemia  are  present.  From  this  symptom  it 


THE    CANADA   MEDICAL    RECORD. 


177 


has  been  called />uru/ef/f  uterine  phlebitis.  These 
uterine  sinuses  open  on  the  inner  surface  of  uterus 
by  valvular  mouths,  situated  where  the  placenta  was 
attached.  The  inflammation  passes  over  these 
mouths  very  readily  into  the  veins  and  it  is  this  which 
makes  the  disease  so  dangerous.  Tht  lymphatics  of 
the  uterus  take  on  the  same  kind  of  action  and  those 
in  the  neighborhood  of  the  round  ligament  are  sub- 
ject to  purulent  inflammation.  The  ovaries  are  en- 
larged and  covered  with  lymph.  There  are  evidences 
of  inflammation  in  Fallopian  tubes  ;  purulent  matter 
exudes  by  pressure.  The  librinated  extremities  are 
deeply  congested  and  covered  with  lymph.  In  some 
instances  the  Graaflian  vesicles  are  destroyed  by  this 
process.  Puerperal  fever,  in  which  peritonitis  is  the 
leading  feature,  is  much  more  easily  cured  than 
puerperal  fever  with  metritis,  the  difference  being 
in  the  purulent  effusion.  The  symptoms  of  this 
are  suppression  of  the  lochia  for  twelve  or  twenty- 
four  hours,  pulse  frequent  and  very  small,  extretne 
prostration  like  that  in  pyemia,  impaired  digestion. 
"Wxe  perspirations  constitute  the  chief  features  of 
the  disease.  These  take  place  after  six  to  ten  days, 
or  in  the  second  week.  The  first  is  usually  pre- 
ceded by  a  chill,  but  after  this  they  come  on  with- 
out any  reference  to  the  chill.  They  seem  to  be 
conservative  in  their  action,  for  without  these  the 
elimination  of  pus  cannot  take  place.  Abscess  of 
the  breast,  or  broken  breast,  may  result  from  the 
sympathy  of  the  breast  with  the  uterus.  Again  an 
abscess  may  occur  in  the  illiac  fossa,  and  obtain  a 
great  size,  so  as  to  open  spontaneously,  or  require 
opening.  The  woman  dies  in  a  few  days  from  the 
depressing  influence  of  the  pus  upon  the  nervous 
system.  The  opium  treatment  is  used  in  cases 
where  peritonitis  is  a  most  prominent  element.  In 
Bellevue  Hospital  five  out  of  six  were  cured 
by  this  treatment.  Besides  the  opium,  these 
women  took  a  few  doses  of  ver  veride  to  diminish 
frequency  of  pulse.  Norwood's  mixture  of  vera- 
trum  may  be  given,  dose  gtt.  v,  when  the  opium 
has  reduced  respiration  but  not  the  pulse.  It  pro. 
duces  great  nausea,  attended  by  prostration  and 
a  tendency  to  syncope.  Alcoholics  are  to  be  used 
when  such  effects  are  produced.  It  is  a  very  good 
treatment  to  give  opium  and  ver  viride  in  alternate 
doses,  and  this  is  all  that  is  necessary.  In  metro- 
peritonitis opium  does  not  serve  any  important 
purpose,  and  it  is  useless  to  give  it,  except  to  soothe 
the  patient.  Leeches  to  the  vulva  or  perinjeum 
and  bleeding  promoted  to  a  great  extent.  Opium 
grs.  j  oriij  every  two  or  three  hours.  Injections  of 
warm  and  tepid  water  into  vagina  and  uterus.  The 
veratrum  viride  treatment  has  been  introduced  and 
is  successful.  During  the  period  of  purulent  in- 
fection quinia  sulph.  grs.  (xv  per  day)  combined 
with  morph,  sulph.,  to  reduce  irritability.  If  there 
is  a  tendency  to  the  formation  of  abscesses  food 
and  stimulants  will  be  necessary. 

CHRONIC    (or   tubercular)    PERITONITIS. 

A   somewhat  rare   disease,  usually  dependent 
upon  tubercles,  but  sometimes  upon  cancer.  Occurs 


mostly  in  young  persons,  say  from  ten  to  twenty- 
Jive  years  of  age.  Is  very  insidious  in  its  approach, 
and  not  usually  made  out  until  far  advanced.  I'he 
symptoms  constitutional  are  those  of  pulmonary 
tuberculosis,  viz :  paleness,  emaciation,  loss  of 
strength,  and  frequency  of  pulse.  Constipation 
of  Boioels  alternates  with  Diarrhoea,  which  is  easily 
explained  by  the  lesions  existing.  The  peristaltic 
action  being  hindered  by  the  glueing  of  the  intes- 
tines together,  faeces  accumulate.  These  in  short 
time  inundate  mucous  membrane,  and  produce  a 
free  watery  secretion,  which  constitutes  the  diar- 
rhoea. The  cause  of  irritation  being  removed  by 
this  discharge,  the  bowels  become  quiescent,  and 
constipation  again  ensues,  and  soon.  The  bowels 
are  persistently  tumefied  and  tympanitic.  Tuber- 
cles (miliary)  are  on  or  under  the  pleura,  and  a 
low  grade  of  inflammation  is  set  up.  A  thin  layer 
of  fibrinous  exudation  is  poured  out  on  surface  of 
pleura.  This  speedily  becomes  organized.  Upon 
this  new  tissue  another  exudation  takes  place  and 
this  in  turn  receives  another,  and  so  layer  after 
layer  is  fonned  until  the  contents  of  the  abdomen 
become  so  welded  and  hidden  in  the  exudation 
that  it  is  impossible  to  distinguish  anything  with, 
certainty.  Although  tubercles  almost  invariably 
exist  in  the  lungs  at  the  same  time  it  sometimes 
happens  that  their  symptoms  are  not  well  devel- 
oped, and  the  phthisis  may  be  far  advanced  with- 
out cough  or  other  rational  signs  of  its  existence. 
As  a  rule  the  treatment  can  only  be  palliative. 
(Yet  Dr.  C.  has  seen  two  cases  recovered.)  We 
know  tubercles  can  be  softened  and  absorbed. 
There  is  no  theoretical  reason  why  recovery  should 
not  occasionally  take  place.  Fresh  air,  nutritious 
diet,  cod  liver  oil,  tonics,  stimulants  (in  modera- 
tion), with  counter  irritation  (iodine  being  prefer- 
able), are  the  chief  remedial  agents.  The  after- 
noon fever  may  be  controlled  by  quinine  and  acidi 
sulph.  arom. — N.  V.  Hospital  Gazette. 


LECTURE  ON  MEASLES. 
By  Alonzo  Clark,  M.D.,  LL.D., 

Professor  of  Principles  and  Practice  of  Medicine,  College  of 
Physicians  and  Surgeons,  Nr.v  York. 

I  call  your  attention  now  to  another  of  the  erup- 
tive diseases — measles.  A  disease  so  mild  m 
many  cases  that  the  family  do  not  call  a  physician ; 
and  yet  so  severe  in  many  as  to  make  a  pretty 
large  mortality  in  a  city  like  New  York.  You  will 
be  surprised,  perhaps,  to  hear,  if  you  know  any- 
thing about  the  course  of  measles  as  it  most  coni- 
monly  presents  itself,  that  the  mortality  here  is 
two,  three,  or  four  hundred  a  year,  vaiying  very 
much ;  down  below  a  hundred  many  yeare,  and 
up  to  two  or  three  hundred,  or  more,  some  years. 
The  explanation  of  this  lies  pardy  in  the  fact  tliat 
measles  is  a  more  prevalent  disease  than  scarlet 
fever.  If  you  look  into  the  medical  register,  or 
any  medical   jounial  that  reports  the  number  of 


17S 


TH3   CANADA    MEDICAL    RECORD. 


contagious  cases  that  occur  in  the  city  week  after 
week,  you  will  see  almost  invariably  that  measles 
is  two  or  three  times  ahead  of  scarlet  fever  in  the 
number  of  cxses. 

It  is,  then,  sometimes  a  very  grave  disease  ;  at 
other  times  a  very  mild  disease.  I  will  describe  it  to 
you  in  the  same  manner  that  I  did  scarlet  fever, 
by  marking  the  several  stages. 

It  is  only  to  be  had  by  contagion.  It  dons  not 
arise  de  novo,  even  from  decomposing  oat-straw  ! 
A  western  physician  made  this  a  source  of  measles 
for  the  young  members  of  the  army  in  the  late 
war;  but  tiiere  is  no  good  ground  for  the  opinion 
that  I  can  see.  Measles  is  obtained  from  measles, 
and  from  nothing  else. 

The  peiiod  of  incubation  is  not  definitely  fixed. 
Indeed,  it  is  fixed,  and  we  have  ascertained  that  it 
is  irregular ;  that  it  is  uncertain.  As  for  example, 
Dr.  Buell,  who  lived  in  New  York  a  good  many 
years  ago  and  moved  to  San  Francisco,  recited  to 
a  medical  society  his  experience  with  reference  to 
a  house  down  town,  in  College  Place.  College 
Place  was  then  a  place  of  residence  ;  it  is  now  a 
place  of  stores.  At  a  boarding-house  there  a  lady 
with  t^vo  or  three  children  was  so  unfortunate  as 
to  have  measles  break  out  among  them.  As  soon 
as  it  made  its  appearance,  the  boarding-house 
mistress,  conscious  that  it  would  injure  her  busi- 
ness by  causing  other  boarders  to  leave,  required 
this  one  to  go  out  of  the  house.  The  room  was 
left  unoccupied  for  a  week,  when  another  fixmily 
came  in  to  occupy  it  with  children  also.  In  seven 
days  from  the  time  they  entered  that  room  measles 
broke  out  in  the  family.  The  landlady  drove 
this  family  away  and  another  took  its  place,  and  in 
seven  days  after  the  third  family  came  in  measles 
broke  out  among  their  children,  so  that  for  two 
particular  instances  seven  days  was  the  period  of 
incubation.  But  there  are  other  instances  that  can 
be  quite  as  well  marked  in  which  it  goes  on  to 
eight,  nine,  ten,  or  even  to  fourteen  days.  The 
period  is  given  very  variously  by  the  different  per- 
sons who  have  written  about  the  disease.  As  for 
example,  Holme  makes  it  from  seven  to  fourteen 
days  ;  Williams,  from  six  to  sixteen  days  ;  Rilliet 
and  Barthez,  five  to  thirty,  and  even  fifty  days; 
and  they  are  very  good  authority.  Their  statements 
are  received  as  statements  made  on  careful  obser- 
vation. 

I  should  doubt  very  much  whether  it  has  an 
incubation  of  fifty  days  ;  at  the  same  time  I  cannot 
limit  possibilities  in  the  matter. 

When,  then,  it  makes  its  appearance  in  different 
persons,  at  a  variable  period  after  exposure  it  has 
its  stage  of  invasion,  and  this  is  pretty  long  for  an 
eruptive  disease  ;  the  longest  of  them  all,  three  to 
four  days.  It  is  rarely  ushered  in  with  a  chill, 
though  cases  are  recorded  in  which  a  chill  did 
occur  as  the  first  symptom.  There  is  commonly, 
before  anything  very  marked  is  observed,  an 
indefinite  feeling  of  not  being  well ;  malaise^  as  the 
French  call  it.  And  then  comes  a  little  febrile 
action,  which  increases  day  by  day,  and  with  that 


febrile  action  a  redness  of  the  eyes,  and  a  little 
watery  condition  of  them.  The  tears  are  secreted, 
and  then  there  is  the  extension  of  the  inflamma- 
tion that  was  at  first  confined  to  the  numbrane  of 
the  eyes.  On  the  outer  membrane  of  the  eyes  it 
extends  into  the  nose  and  into  the  fauces,  and  so 
down  gradually  into  the  breathing-tubes.  You 
have,  in  a  word,  a  catarrh,  and  the  catarrh,  when 
it  is  fairly  formed,  is  attended  by  a  peculiar  cough 
in  most  of  these  children,  'i'he  French  have  called 
it  the  '•  iron  "  cough  ;^a  harsh,  coarse  cough.  The 
eyes  run  a  good  deal ;  the  nose  is  a  little  busy  in 
that  same  business.  There  is  some  headache  ; 
the  temperature  is  elevated  moderately,  and  this 
condition  continues  for  a  period  of  from  three  to 
four  days.  The  invasion  of  small-jjox  is  two 
days  ;  the  invasion  of  scarlet  fever  from  six  or 
seven  hours  to  twenty-four  ;  the  invasion  of  measles 
three  to  four  days.  The  child  is  not  very  sick 
during  this  period  of  invasion,  as  a  rule  ;  though, 
as  I  told  you,  there  is  considerable  fever,  the  tem- 
perature rising  to  102°,  or  it  may  be  to  103°. 

Then  comes  the  eruption.  The  eruption  appears 
upon  the  upper  part  of  the  body  first,  and  gradu- 
ally descends  to  the  lower  part,  just  as  scarlet 
fever  does  in  the  majority  of  cases,  and  yet  there 
are  exceptions.  Measles  may  break  out  all  over 
the  body,  or  it  may  break  out  upon  the  back  first, 
but  the  general  rule  is  that  it  appears  u])on  the 
neck  and  face  first,  and  gradually  descends.  It 
takes  it  about  two  days  to  reach  the  feet  in  the 
greater  number  of  instances. 

I'he  character  of  the  eruption  you  may  get  an 
idea  of  from  this  fiortrait,  and  notice  particularly 
the  condition  of  the  eyes.  They  arc  red,  and  so 
are  the  fauces  and  the  bronchial  tubes  and  the 
nasal  passages — all  reddened  by  this  catarrhal 
inflammation.  This  eruption  is  sometimes  called 
crescentic.  I  believe  this  is  a  fair  representation 
of  it,  and  you  will  hardly  find  a  crescent  in  any 
of  these  spots  of  eruption.  It  is  better  described 
as  being  irregular  in  shape,  varying  somewhat  in 
size,  but  rarely  larger  than  a  bean — sometimes  in 
some  degree  linear  and  curved,  but  always  var\'- 
ing.  f^very  particular  case  of  measles  will  give 
you  a  multiple  form  of  eruption ;  it  does  not 
occupy,  as  the  scarlet  fever  eruption  does,  all  the 
skin.  There  will  be  healthy  skin  along  between 
the  several  spots  ;  red  eyes,  and  a  peculiar  eru])- 
tion  of  a  dingy  color,  not  bright  red.  The  erup- 
tion lasts  in  any  one  spot  about  four  days,  and  the 
whole  eruption  about  six  or  seven  days,  it  dis- 
appearing on  the  feet  after  four  or  five  days  of  con- 
tinuance, as  it  does  upon  the  upper  part  of  the 
body  in  the  same  period.  You  observe  there  is  no 
difficulty  in  distinguishing  the  eruption  of  scarlet 
fever  from  the  eruption  of  measles.  They  are 
both  produced  by  numerous  slightly  elevated  little 
points,  the  loops  of  the  capillaries  of  the  skin,  but 
the  irregular  patches  of  measles  and  the  darker 
hue  of  the  eruption  are  sufficient  to  distinguish  it 
from  the  continuous  eruption  of  scarlet  fever. 

In  a  mild  case,  as  in  scarlet  fever,  the   fever 


THE    CANADA    MEDICAL    RECORD. 


179 


gradually  diminishes  after  the  eruption  appears, 
but  iu  a  bad  case  the  fever  continues  and  the  tem- 
perature rises.  The  bad  cases  are  made  by  certan 
complications.  As,  for  example,  there  is  the 
hemorrhagic  form  of  measles, in  the  old  time  called 
black  measles.  The  patches  take  on  a  dark, 
ecchymotic  color — not  so  marked  as  ecchymosis, 
but  still  approaching  it.  In  this  case,  as  in  the 
hemorrhagic  cases  of  scarlet  fever,  the  danger  be- 
comes very  great,  and  the  chances  of  recovery  of 
course  are  diminished.  In  certain  other  instances 
there  is  a  tendency  to  gangrene,  particularly  about 
the  mouth  ;  and  in  the  female,  the  vagina,  and 
sometimes  about  the  anus.  And  this  gangrene 
comes  to  be  a  very  grave  matter.  It  is  excep- 
tional, fortunately. 

Then,  again,  you  have  a  form  of  measles  that 
resembles,  in  its  general  symptoms,  that  form  of 
scarlet  fever  I  described  to  you  under  the  name  of 
scarlatina  maligna.  The  child  appears  to  be  over- 
Avhelmed  by  the  poison  that  produces  the  disease. 
The  nervous  system  seems  to  give  way.  He  be- 
comes delirious  and  comatose,  perhaps  awakening 
occasionally  from  his  coma,  making  a  shriek,  a 
hydrocephalic  cry,  though  there  is  no  hydro- 
cephalus. 

You  observe,  then,  that  measles,  though  in  a 
greater  number  of  cases  a  very  mild  disease,  can 
take  on  very  grave  symptoms. 

When  the  period  of  desquamation  occurs,  there 
is  a  noticeable  difference  between  the  desquama- 
tive scales  of  scarlet  fever  and  measles.  They  are 
branny  in  measles,  and  branny  for  the  most  part  in 
scarlet  fever,  but  the  scales  are  larger  in  scarlet 
fever  than  in  measles,  as  a  rule.  Sometimes  in 
measles  you  have  it  in  great  quantities.  I  have 
scooped  it  up  in  teaspoonfuls  from  the  sheet  on 
which  the  patient  lay.  There  is  nothing  of  the 
glove-form  of  exfoliation  in  measles. 

There  is,  as  a  sequela  of  measles,  a  very  con- 
siderable amount  of  ozaena,  as  it  is  sometimes 
called — a  bad  catarrh  ;  running  at  the  nose ;  the 
eyes  retain  their  redness  frequently  for  a  consider- 
able time  ;  the  cough  holds  over,  and  may  con- 
tinue for  some  months.  And  persons  have  been 
known  to  pass  into  phthisis,  tuberculous  disease  of 
the  lungs,  out  of  measles. 

As  to  the  treatment  of  measles,  the  mild  cases 
hardly  require  any.  The  catnip-tea  that  the 
mother  gives  is  as  about  as  good  as  anything.  And 
when  you  come  to  the  severe  complications  you 
are  baffled  very  much,  because  you  can  hardly  find 
anything  that  will  have  much  influence  over  it. 
If  it  is  the  hemorrhagic  form,  why,  then,  iron  and 
the  vegetable  acids,  together  with  the  supporting 
effects  of  quinine  and  food,  will  probably  do  more 
for  you  than  anything  else,  if  you  can  save  the  case 
at  all.  If  it  is  attended  by  gangrene,  there  is 
nothing  that  has  as  good  a  reputation  as  quinine, 
and  you  of  course  support  the  power  of  the  patient 
by  alcoholics  as  far  as  your  judgment  will  require. 
In  the  malignant  form  I  do  not  believe  you  will 
find  any  medicine  do  much  good.     If  ergot  has 


the  control  that  it  has  the  reputation  of  having  over 
the  capillary  circulation,  it  may  be  possible  that 
it  may  have  some  effect  upon  this  form  of  disease. 
It  has  not  been  tried,  so  far  as  I  know,  and  I  do 
not  know  that  it  would  be  useful.  Cold  to  the 
head,  cold  to  the  body  as  the  temperature  becomes 
more  and  more  elevated,  is  certainly  admissible 
and  desirable,  to  reduce  the  temperature  to  a  safe 
point  at  any  rate  ;  and  in  measles  the  temperature 
rises  in  the  bad  cases  sometimes  to  io6°  or  107''. 

There  are  a  few  things  more  to  be  said  regard 
ing  measles.  I  neglected  to  say  to  you  that 
another  name  for  it  is  morbilli.  Among  the  symp- 
toms is  rather  a  curious  one ;  an  odor  like  that 
which  comes  from  the  nest  of  mice — a  mouse-odor. 
In  any  case  of  pretty  full  eruption  you  will  be 
hkely  to  find  it. 

Among  the  sequelae  will  be  found,  not  unfre- 
quently,  indeed  pretty  commonly,  a  certain  amount 
of  nasal  catarrh,  and  this  may  continue  for  some 
weeks  after,  and  associated  with  that,  very  com- 
monly, is  a  pulmonary  catarrh.  One  of  the  fea- 
tures of  the  disease,  and  with  its  early  development, 
is  this  catarrhal  affection  of  the  mucous  membrane 
of  the  eyes,  nose,  and  breathing-tubes,  and  this 
holds  over  in  a  considerable  number  of  cases,  and 
not  unfrequently  gives  some  anxiety,  and  the 
anxiety  is  in  a  few  cases  well  founded,  for  this 
disease  and  typhoid  fever  are  followed  more 
frequently  by  phthisis  than  any  of  the  other  acute 
affections  that  I  know — by  a  tubercular  phthisis. 
Still  the  vast  majority  of  persons  v/ho  have  measles 
recover  from  it  wholly. 

This  ophthalmia  is  sometimes  the  occasion  of 
some  trickery.     I  was,  a  great  many  years  ago,  in 
company  with  a  gentleman  from  the  south.     His 
eyes  were  red  and  inflamed  to  a  certain  extent,  and 
I  saw  at  once  that  it  was  a  peculiar  relic  of  the 
measles.     After  dinner  the  entertainer's  son  asked 
me  what  that  young  gentleman  had  better  do  for  his 
eyes.     He   had  been   to  an   advertiser,  and  the 
advertiser  had  informed  him  that  it  would  cost  him 
$500  to  be  cured,  and  the  friend  asked  me  whether 
it  was  worth  while  to  pay  it.     When  I  learned  who 
it  was  that  he  had  applied  to,  I  told  him  certainly 
not,  but  to  go  to  Dr.  Delafield,  the  father  of  my 
colleague  (who  was  then  giving  considerable  atten- 
tion to  the  eyes),  and  let  him  put  him  under  the 
regular  treatment.      He    had   sent   word   to    his 
father  to  forward  to  him  the  $500  as  a  fee  that  he 
had  to  pay  to  cure  his  eyes.     Instead  of  it,   how- 
ever, at  my  advice,  he  went  to  Dr.  Delafield.     Dr. 
Delafield  applied  around  the  eyes  some  veratrum 
ointment,  and  in  five,  six,  or  ten  da>s,  he  was  all 
right,  and  the  fee  was  $19.     This  advertiser  had 
tricked  him  in  this  way.     When  he  urged  that  $500 
was  a  large  sum  to  pay,  the  advertiser  replied  : 
''The   medicine  is   so   expensive.     You  get   the 
medicine  and  I  will  treat  you  for  very  much  less." 
He   gave   him,  therefore,   a  prescription   for  an 
ounce  of  veratrum,  which  at  that  time  cost  about 
$500.     He  called  on  one  druggist  with  the  pre- 
scription.    The  druggist  said :  "  I  have  not  that 


180 


THE   CANADA   MEDICAL   RECORD. 


amount,  but  I  can  procure  it  for  you."  Well, 
what  will  it  cost  ? "  '•  Four  hundred  and  seventy- 
five  dollars." 

He  went  to  another,  and  what  would  it  cost? 
He  had  not  that  quantity,  but  he  could  get  it  for 
him.  What  would  it  cost?  Four  hundred  and 
eighty  dollars.  And,  after  trying  three  or  four 
times,  he  went  back  to  the  advertiser  and  said  he 
could  not  do  any  better,  and  the  advertiser  was 
getting  ready  to  use  a  few  grains  of  this  ounce  that 
he  had  prescribed. 

Occasionally  wry-neck  follows  measles.  The 
muscles  of  the  neck  get  stiff  and  contracted,  and 
turn  the  head.  That  is  rather  a  wearisome  thing 
when  it  occurs.  It  occurs  exceptionally,  and  fre- 
quently requires  a  good  deal  of  patience  on  the 
l)art  of  the  physician,  and  1  cannot  tell  you  of  any 
j)articular  prescription,  or  any  method  of  treatment 
that  is  of  s])ccial  aid. 

Anasarca  not  unfrequently  follows  scarlet  fever. 
It  is  a  very  much  less  frequent  sequela  of  measles, 
and  yet  it  does  from  time  to  time  occur,  and  acts 
in  the  same  way,  with  the  same  symptoms,  the 
same  developments  with  reference  to  the  tendency 
to  convulsions,  the  tendency  to  the  production  of 
inflammatory  action,  particularly  about  the  heart 
and  pericardium,  and  will  require  the  same  treat- 
ment. But  its  unfrequent  occurrence  will  give  you 
a  little  satisfaction.  That  is,  as  you  are  coming 
to  the  end  of  a  case  you  will  not  consider  that,  as 
a  matter  of  course,  this  oedema  or  anasarca  is  to 
occur. — iVew  York  Medical  Record. 


THE  OPIUM-HABIT— A   POSSIBLE  ANTI- 
DOTE. 

By   E.  R.  Palmer,    M.D., 
Professor  of  Physiology,  University  of  Louisville. 

It  is  not  my  purpose  to  enter  into  a  lengthy 
dissertation  upon  this  "  social  evil ; "  yet  such  a  dis- 
sertation would  be  by  no  means  inappropriate, 
seeing  how  great  is  the  evil  of  the  opium-habit, 
and  how  poor  and  insufficient  the  literature  bear- 
ins;  on  its  treatment  and  cure.  No  people  so  well 
know  the  uniform  evil  effects  of  opium-eating  as 
the  medical  fraternity.  De  Quincy  and  others  have 
founded  the  pernicious  notion  among  the  laity 
that  there  is  a  something  far  more  exhilarating,  far 
more  divine  in  the  into.xication  produced  by  opiimi 
than  in  the  commoner  intoxication  of  alcohol. 

Few  people,  comparatively  speaking,  need  look 
beyond  personal  experience  to  know  that  the  poet 
has  not  been  niggard  of  his  coloring  when  singing 
the  praises  of  the  rosy  juice.  Tiie  majority  of 
mankind  has  too  vividly  imprinted  in  memory  the 
clouded  intellect,  headache,  and  nausea  following 
bibulation  to  bow  unqualified  assent  to  the  poet's 
ecstatic  verses  recounting  the  virtues  of"  the  gene- 
rous wine."  On  the  contrary,  hapj)ily,  so  far  as 
we  Americans  are  concerned,  what  the  vast  major- 
ity of  us  know  of  the  opium-habit  is  gained  from 


hearsay,  and  is,  as  is  well  known  to  the  doctor, 
unreal  in  the  extreme.  It  has  been  my  lot,  like 
that  of  most  practitioners,  to  come  in  contact  with 
o|)ium-eaters,  and  I  will  j^ositively  affirm  that  I 
have  yet  to  see  one  who  even  approximated  in  his 
nature  the  "  happy-go-lucky  "  character  of  the 
drunkard.  Opium  eating  is  a  curse  without  any 
qualifying  dispensation — a  black  cloud  in  a  sun- 
less life.  Unlike  alcohol,  it  cannot  be  said  of 
opium  that  its  constant  use  improves  the  vital  pow- 
ers of  the  enfeebled.  No  debates  as  to  its  food 
properties  ever  have  or  ever  can  be  held.  It  is 
simply  a  powerful  drug,  useful  in  time  of  great 
jjhysical  distress,  and  pernicious  beyond  the  pow- 
er of  pen  to  portray  when  once  it  fastens  itsel- 
upon  the  mortal  frame  as  a  daily  necessity. 

To  be  able  to  cure  the  opium-habit  has  been 
the  laudable  ambition  of  many  a  worthy  doctor  and 
the  vaunted  claim  of  many  a  blatant  quack.  I 
believe  that  so  far  as  the  literature  of  medicine 
goes  to-day  we  have  no  remedy  with  any  claims 
whatsoever  as  a  curative  of  this  habit.  Those 
doctors  who  have  succeeded  in  reforming  any  of 
its  victims  have,  I  believe  I  am  safe  in  saying,  done 
so  by  aiding  the  weak  resolves  of  their  patients 
with  their  own  strong  will  and  influence.  If  any 
medical  man  has  yet  discovered  a  cure  for  opium - 
eating,  I  am  sure  the  medical  world  is  not  aware 
of  it. 

Recent  experience  has  led  me,  in  view  of  the 
facts  just  stated,  to  hope  that  I  have  discovered  a 
cure.  What  it  is  and  how  I  came  to  use  it  may 
be  briefly  told  as  follows  :  In  looking  over  the 
different  remedies  which  various  drug-houses  have 
kindly  donated  to  the  University  Dispensary,  I 
read  upon  the  back  of  a  bottle  of  fluid  ext.  of  coca, 
made  by  Parke,  Davis  &  Co.,  that  this  drug  "  pro- 
duces a  gently  excitant  effect ;  is  asserted  to  support 
the  strength  for  a  considerable  time  without  food  ; 
in  large  doses  produces  a  general  excitation  of  the 
circulatory  and  nervous  system,  imparting  increas- 
ed vigor  to  the  muscles  as  well  as  to  the  intellect, 
with  an  indescribable  feeling  of  satisfaction 
amounting  altogether  sometimes  to  a  species  of  de- 
lirium, not  followed  by  feelings  of  languor  or 
depression,"  etc.,  etc.  At  this  time  I  was  treating 
in  private  practice  an  obstinate  case  of  cardiac 
irregularity  due  to  a  somewhat  dissolute  life,  and 
not  amenable  to  either  belladonna,  digitalis,  or 
tonics.  I  started  the  patient  on  coca.  From 
dropping  one  beat  in  every  four,  his  heart  went, 
with  increasing  doses  of  the  drug,  to  one  in  seven, 
one  in  twenty-one,  one  in  thirty-eight,  and  finally 
a  cure.  The  absolute  relief  and  cheer  that  a  good, 
big  dose  of  coca  imparted  to  this  patient  were 
wonderful  to  observe.  I  had  hardly  begun  with 
this  case  before  a  similar  but  even  worse  case  of 
cardiac  exhaustion,  with  irregular  action,  offered 
at  the  University  Chest  Clinic  for  treatment.  To 
be  brief,  he  got  coca  and  got  well.  In  both  cases 
hypochondriasis  was  a  marked  symptom,  and  was 
speedily  cured. 

In  March  last  I  was  sent  for  in  great  haste  by 


TIIK    CANADA    MEDICAL    RECORD. 


181 


the  proprietor  of  a  neighboring  saloon,  and  on  my 
arrival  was  told  that  "  a  chap  "  had  just  gone  to 
his  room  from  the  saloon  in  a  fearfiU  fix.  "  He 
looks,"  said  the  publican,  "  as  if  he  had  been  on  a 
terrible  sp^ee,  and  needs  a  doctor  mighty  bad." 
1  was  shown  to  the  gentleman's  room,  and  was 
struck  at  once  by  his  peculiar  appearance.  He 
told  me  frankly  that  he  was  an  opium  eater ;  that 
he  liad  not  taken  a  drink  for  months  ;  but  that 
this  morning,  feeling  so  badly  from  morphine,  he 
had  gone  to  the  saloon  a  id  taken  a  brandy  cock- 
tail, whichj  however,  did  not  stick.  He  protested 
that  he  was  dying,  and  altogether  was  in  a  sorry 
plight.  I  subsequently  learned  his  dose  was  three 
grains  of  morphine  several  times  a  day.  I  tried 
•various  remedies  for  a  day  or  two,  and  by  moral 
:3uasion  got  him  to  reduce  the  dose  very  materially, 
ibut  much  to  his  discomfort.  About  the  third  day 
of  my  attention  I  bethought  myself  of  the  coca  and 
ordered  it  for  him.  Imagine  my  surprise  upon 
meeting  him  the  next  day  with  fine  spirits  and  a 
record  of  only  one  fourth  of  a  grain  of  morphine 
iaken  since  my  last  call.  This  was  the  end  of  the 
case.  He  took  the  coca  for  some  days,  and  entire- 
ly broke  off  from  opium.  His  statement  was  that 
whenever  he  felt  depressed  or  bad  he  took  a  good, 
big  dose  of  the  medicine,  and  in  a  few  moments 
was  all  right. 

My  second  cise  was  so  striking  in  its  results  and 
is  so  recent  that  I  hardly  feel  justified  in  reporting 
it.  It  is  as  follows  :  Upon  the  i8th  of  the  present 
month  a  gentleman  sent  for  me.  I  found  him  in 
bed,  lookmg  like  a  consumptive.  He  at  once  told 
me  that  he  was  an  opium-eater,  and  tliat  he  had 
reached  a  point  where  thirty  grains  of  morphine 
daily  were  necessary  to  supply  the  cravings  of  his 
perverted  nature.  He  said  that  he  was  now  trying 
to  break  off,  and  wanted  me  to  help  him.  I  told  him 
of  what  the  coca  had  done,  and  with  a  few  cheerful 
words  prescribed  it  for  him.  The  next  day  I  found 
him  still  taking  morphine,  although  in  small  doses, 
as  he  had  not  been  able  to  find  the  coca.  Upon  the 
following  day  he  had  had  but  one  dose  of  morphine 
in  eighteen  hours  (one  fourth  grain  i  and  plenty 
of  coca.  He  was  hopeful  and  cheerful.  The  next 
day  I  failed  to  see  him.  and  on  calling  the  day  fol- 
lowing the  servant  met  me  at  the  door  with  the 
statement  that  he  was  well,  and  had  gone  down 
street.  This  much  I  can  say  for  the  last  case,  that 
when  I  last  saw  him  he  looked  like  another  man, 
so  light  and  cheerful  was  his  face,  and  so  free  from 
the  evidences  of  opium. 

These  are  very  brief  and  slender  claims  upon 
■which  to  base  a  claim  of  discovery :  and  while  I 
might  supplement  them  by  several  cases  of  ordin- 
ary hypochondriasis  relieved  by  the  agent  in  ques- 
tion, I  do  not  deem  it  v/orth  while,  as  my  only 
desire  is  to  direct  professional  attention  to  the  ad- 
ministration of  coca  in  the  treatment  of  the  opium- 
habit. 

Erythroxylon  coca  is  a  native  of  the  eastern 
slope  of  the  Andes.  It  is  cultivated  in  the  tropical 
valleys  of  Bolivia  and  Peru.  The  greatest  of  care 


is  given  to  its  culture  by  the  natives.  An  idea  of 
its  importance  as  an  agricultural  product  may  be 
gained  from  the  fact  that  the  duties  upon  coca  in 
Peru  amount  yearly  to  four  hundred  thousand  dol- 
lars. The  Peruvians  are  pre-eminently  a  despon- 
dent, an  unhappy  race,  and  coca  is  their  balm.  To 
them  it  is  a  relic  of  departed  days  of  glory,  and 
under  its  benign  influence  they  enjoy  in  dream 
and  delirium  the  halcyon  days  of  Monco  Capac. 

Professor  Steele,  of  the  American  Pharmaceuti- 
cal Association,  from  whose  article  upon  Coca  I 
glean  these  facts,  says  :  "  Coca  is  both  salutary 
and  nutritious  ;  in  fact,  the  best  gift  the  Creator 
could  have  bestowed  upon  the  unfortunate  Indians. 
They  always  carry  a  bag  of  leaves  suspended  from 
their  necks,  upon  which  they  draw  three  tim^s  a 
day  with  as  much  pleasure  and  deHght  as  a  con- 
noisseur in  tobacco  smokes  a  fragrant  Havana. 
It  imparts  briUiancy  to  the  eye  and  a  more  ani- 
mated expression  to  the  features,  agility  to  the  step, 
and  a  general  appearance  of  animation  and  con- 
tent." Indeed,  one  can  scarcely  read  Prof. 
Steele's  article  *  without  wishing  to  test  the  virtues 
of  this  great  antidote  for  the  blues.  The  ordinary 
dose  for  adults  of  the  fluid  extract  is  a  tablespoon- 
ful. 


CHIAN  TURPENTINE    IN    THE   TREAT- 
MENT OF  CANCER. 

The  Lancet,  for  March  27th,  1880,  contains  a 
paper  by  Professor  John  Clay,  of  Birmingham,  on 
"  The  Treatment  of  Cancer  of  the  Female  Genera- 
tive Organs  by  a  new  method."  The  remedy  he 
uses  is  Chian  Turpentine,  and,  although  his  ex- 
perience extends  over  a  period  of  only  twelve 
months,  yet,  from  the  results  which  have  been  ob- 
tained from  its  use  during  that  time,  the  author 
asserts  that  an  amount  of  relief  has  been  secured 
to  the  patients  put  under  its  influence  which  has 
not  been  afforded  by  any  other  mode  of  treatment 
hitherto  employed.  In  the  first  case  in  which  it 
was  tried  it  was  given  in  doses  of  six  grains,  with 
four  grains  of  flowers  of  sulphur,  every  four  hours. 
The  patient  was  52  years  of  age,  and  suffered  from 
scirrhus  cancer  of  the  body  and  fundus  of  the 
uterus.  Hemmorrhage  was  excessive,  and  pain  in 
the  back  and  abdomen  agonizing,  and  the  cancer- 
ous cachexia  was  well  marked.  The  patient  ap- 
parently had  not  long  to  live.  The  uterus  was 
extensively  destroyed  by  the  cancer,  and  its  cavity 
admitted  three  fingers.  On  the  fourth  day  of  treat- 
ment by  the  Chian  turpentine  the  patient  reported 
herself  greatly  relieved  of  the  pain.  The  os  was 
found  quite  contracted,  hardly  admitting  the  index 
fino-er,  and  the  surrounding  cancerous  infiltration 
was  much  diminished.  At  the  twelfth  week  ex- 
amination was  made,  and  the  parts  felt  ragged  and 


*  Proceedings  of  the  American  Pharmaceutical  Associa- 
tion, 1S78,  pp. 774-778- 


1S2 


THE    CANADA    MEDICAL    RECORD. 


uneven,  and  did  not  bleed  on  roughly  touching 
them.  Several  cicalririaIsj)ots  were  seen  persj)ecu- 
lum.  There  was  no  pain  or  liemorrhage,  and  the  gen- 
eral health  was  improved.  Other  three  cases  are 
recorded  in  the  I'apcr,  showing  similar  results  from 
continued  use  of  the  drug,  tiie  os  uteri  speedily 
becoming  contracted,  and  its  tissues  assuming  a 
more  natural  and  healthy  condition.  The  author 
concludes  that  the  best  method  of  administration 
of  the  Chian  turpentine  is  to  give  it  uncomhined ; 
that  its  effects  are  more  rapid  and  more  marked 
when  given  alone.  Whatever  be  the  ultimate  re- 
sults of  further  experience  of  this  drug,  he  believes 
there  can  be  no  doubt  that  in  these  diseases  of  the 
uterus  it  is  a  most  valuable  remedy.  In  the  early 
stages  of  cancer,  it  may  be  affirmed  that  a  speedy 
cure  may  undoubtedly  be  expected,  while  in  ad- 
vanced cases  of  the  disease,  if  the  surrounding 
structures  are  not  too  much  involved  in  the 
destructive  process,  an  ultimate  cure  may  reason- 
ably be  hoped  for. 


HOW    TO     USE     IODOFORM     IN   CHAN- 
CROID. 

From  Keyes's  Venereal  Diseases  : 

Unquestionably  the  most  efficient  local  applica- 
tion for  these  chancroids  is  iodoform,  and  its  appli- 
cation pure,  in  powder  or  mixed  into  a  paste  with 
glycerin  and  scented  with  essential  oils,  is  rarely 
painful.  But  respectable  people  will  not  use  iodo- 
form. Its  peculiarly  penetrating  and  tenacious 
odor  is  unmistakable.  Those  who  have  once 
snielled  it  upon  any  one  else  fear  disclosure  from 
the  very  fact  of  using  it,  and  most  of  those  who  are 
unfamiliar  with  it  at  first  soon  get  to  abhor  it.  In 
spite  of  all  this  it  remains  the  most  efficient  local 
application  for  chancroids  too  old  to  burn,  and  by 
a  careful  person  can  be  often  so  used  as  to  escape 
all  the  disadvantage  attaching  to  it. 

Nothing  will  disguise  the  odor  of  iodoform.  Oil 
of  perpi)ermint  is  perhaps  the  best  of  the  aromatic 
oils  for  the  purpose.  Many  other  sweet-smelling 
oils  have  been  used.  These  are  combined  with 
powdered  iodoform  in  ointment  with  various  greasy 
excipients,  or  the  powder  is  rubbed  into  a  paste  with 
glycerin  and  then  scented.  The  misfortune  is  that 
the  odoriferous  principle  is  more  volatile  than  the 
iodoform,  and,  aided  by  the  heat  of  the  body,  soon 
leaves  the  odor  of  the  iodoform  supreme.  Applica- 
tions of  iodoform  dissolved  in  ether  or  chloroform 
have  been  recommended.  Their  ajjplication  is 
painful,  the  solvent  evaporates,  and  the  odor  ex- 
hales as  strongly  from  the  fine  dust  left  precii)itat- 
ed  over  the  surface  of  the  ulcer  as  if  it  had  been  at 
first  dcjjosited  there  in  its  natural  state. 

Still  iodoform  is  too  good  a  substance  to  be  given 
up.  Those  who  do  not  object  to  the  odor  can  use 
it  freely  as  a  powder,  or  rubbed  into  a  paste  with 
glycerin.  Others  may  use  it  undetected  if  their 
chancroids  are  sub-preputial  and  the  prepuce 
reasonably  long.     The  sores  must  be  washed  and 


dried.  A  little  fine  iodoform  dust  is  then  taken 
upon  a  narrow  piece  of  card  and  scattered  over  the 
ulcerated  surfaces.  The  prepuce  must  now  be  care- 
fully pulled  forward  and  a  piece  of  absorbent  cot- 
ton placed  in  its  orifice.  No  portion  of  the  iodo- 
form must  be  allowed  contact  with  the  clothes  or 
the  fingers  of  the  patient.  He  must  be  careful, 
upon  urinating,  to  pull  out  the  cotton  gently,  retract 
the  prepuce  only  enough  to  disclose  the  meatus, 
and  put  in  a  fresh  piece  of  cotton  immediately.  He 
must  change  his  dre.ssing  frequendy  at  home,  and 
use  great  care  in  his  washings,  not  to  let  the  water 
which  has  run  over  the  .sores  touch  any  part  of  his 
person  or  of  his  clothing.  By  using  such  precau- 
tions the  most  fastidious  i)atient  may  employ  this- 
valuable  remedy  without  betraying  himself. 


BROMIDE    OF    ETHYL   AS  AN    ANAES- 
THETIC. 

A  discussion  on  this  subject  took  place  at  the 
last  meeting  of  the  Societe  de  C/iirurgie  of  Pa.ns. 
Considerable  interest  attaches  to  the  debate,  from 
the  eminent  position  on  the  Continent  of  several 
who  took  part  in  it.  M.  Terrillon  opened  the 
subject  with  his  experience.  He  said  he  had  used 
bromide  of  ethyl  as  a  general  anaesthetic  in  fourteen 
cases.  The  anaesthesia  lasted  from  eight  minutes 
to  an  hour.  The  results  obtained  were  :  i.  At  the 
commencement,  when  he  used  a  large  dose  of  five 
or  six  grammes,  there  was  little  irritation  and  less 
suffocation  than  in  administering  chloroform,  anaes- 
thesia supervening  in  about  a  minute  without  con- 
vulsion. Muscular  relaxation  takes  place  in  from 
two  to  four  minutes.  In  most  patients  the  excite- 
ment was  less  than  with  chloroform,  and  instead 
of  clonic  there  were  only  tonic  convulsions.  The 
face,  conjunctiva,  and  neck,  were  congested,  and  a 
sweat  sometimes  supervened;  the  pupils  were 
moderately  dilated,  the  pulse  always  quickened, 
and  each  time  the  bromide  was  added  the  accele- 
ration increased.  2.  During  the  anaesthetic  stage 
the  intermittances  must  be  very  short,  and  the 
napkin  not  entirely  removed.  1  he  pulse  becomes 
very  rapid  and  small,  125  per  minute.  The  face  is 
congested  and  covered  with  sweat.  The  respiration, 
which  is  quickened  by  the  bromide,  is  sometimes 
obstructed  by  mucus  collecting  in  the  pharynx,  and 
breathing  is  stertorous  and  roaring.  The  patients 
attempt  to  swallow,  and  the  mucus  must  be  re- 
moved by  a  sponge  on  a  whalebone  stem,  intro- 
duced to  the  back  of  the  mouth.  Thus,  instead 
of  chlorofonnic  ancemia,  we  have  congestive  pheno- 
mena. 3.  The  waking  is  very  rapid.  Patients 
can  answer  questions  in  less  than  a  minute,  and 
have  no  desire  to  vomit.  \'omiting  sometimes 
occurs  during  the  sleep ;  most  of  the  patients 
vomit  after  administration  of  the  bromide  as  after 
chloroform.  From  these  facts,  M.  Terrillon 
thinks  bromide  of  ethyl  is  preferable  to  chloro- 
form for  simple  anaesthesia,  if  it  is  desired  to  be 


THE   CANADA   MEDICAL    RECORD. 


183 


rapid,  and  to  last  only  a  short  time.  If,  on  the 
•contrary,  we  require  to  push  it  to  tlie  point  of 
muscular  relaxation,  it  cannot  be  so  considered. 
If  accidents  occur  they  will  probably  be  in  connec- 
tion with  the  respiration,  and  will  be  such  as  we 
may  ward  off,  and  which  do  not  take  us  by  surprise, 
like  those  due  to  chloroform.  M.  Berger  thought 
that  some  caution  was  required  when  the  anaes- 
thesia had  to  be  long  continued.  He  had  been 
struck  with  the  ease  by  which  death  occurred  in 
animals,  which  was  more  rapid  in  rabbits  than 
•with  any  other  anaesthetic.  In  one  case  of  anges- 
thesia  in  man,  under  M.  Gosselin,  the  bromide  of 
ethyl  did  not  give  good  results  on  account  of  the 
agita'ion  during  the  anaesthesia  and  the  subse- 
quent vomiting.  M.  Verneuil  had  seen  a  case 
where  general  an.'esthesia  was  produced,  even 
before  it  was  wanted.  He  was  about  to  remove  a 
small  tumour  from  the  vicinity  of  the  nose  in  a 
woman  fifty  years  of  age,  and  recourse  was  had  to 
3.  spray  of  bromide  of  ethyl  as  a  local  ancesthetic, 
but  he  had  scarcely  commenced  before  the  inha- 
lation of  the  vapour  caused  general  anaesthesia. 
As  a  local  anaesthetic  he  considered  the  bromide  of 
ethyl  valuable,  and  had  obtained  good  results 
from  its  use.  M.  Lucas-Champonniere  had  given 
the  bromide  in  small  doses  to  lying-in  women  :  the 
results  resembled  those  of  chloroform,  but  were 
more  disagreeable  both  to  the  patient  and  the 
attendants.  M.  Nicaise  had  seen  very  good  effects 
from  local  anaesthesia  by  bromide  of  ethyl,  when 
it  was  desired  to  use  the  thermo-cautery  or  red-hot 
iron. 

It  is  evident  from  this  debate  that  the  use  of 
this  substance  as  an  aniesthetic  requires  further 
•experimental  observations.  Sufficient  has  been 
adduced  to  show  that  it  has  a  certain  value,  but 
we  are  not,  at  present,  disposed  to  accept  it  as 
superior  to  those  tried  agents,  chloroform,  ether, 
bichloride  of  methylene,  or  nitrous  oxide.  A 
m  ire  thorough  investigation  than  appears  yet  to 
have  been  accorded,  will  place  bromide  of  ethyl  in 
its  proper  position. — Dublin  Med.  Press,  June  9, 
1880. 


THE  STRONGEST  MAN  IN  THE  WORLD. 

At  Reno,  in  Nevada,  according  to  one  of  Mr. 
R.  A.  Proctor's  letters  to  an  English  journal, 
there  now  lives  a  man  who  is  probably  the  strong- 
est in  the  world.  His  name  is  Angelo  Cardela. 
He  is  an  Italian,  age  38  years,  5  feet  10  inches 
in  height,  and  weighing  190  lbs.  He  is  a  laborer, 
of  temperate  habits,  but  not  objecting  to  the  mod- 
erate use  of  malt  Hquors  and  light  wines.  In  per- 
sonal appearance  he  is  not  remarkable,  but 
"merely  a  good-natured-looking  son  of  Italy,  with 
a  broad,  heavy  face,  a  noble  development  of  chest 
and  shoulders,  and  large  fleshy  hands."  His 
strength  was  born  with  him,  for  he  has  had  no 
athletic  training.  This  strength  does  not  reside  in 
his  hair  by  any  means,  but  apparently  as  much  in 


his  bones  as  in  his  muscles.  At  any  rate,  he  differs 
from  other  men  chiefly  in  his  osseous  structure. 
Though  he  is  not  of  unusual  size,  his  spinal 
column  is  double  the  ordinary  width,  and  his 
other  bones  and  joints  are  made  on  a  similarly  large 
and  generous  scale.  He  has  been  known  to  lift  a 
man  of  two  hundred  pounds'  weight  with  the  mid- 
dle finger  of  his  right  hand.  The  thing  was  done 
as  follows  :  The  man  to  be  lifted  stood  with  one 
foot  on  the  floor  and  arms  outstretched,  his  hands 
being  lightly  grasped  by  two  friends,  one  on  each 
side,  to  preserve  the  balance  of  the  body.  "This 
slight  assistance,"  we  are  assured,  "  had  no  ten- 
dency to  raise  the  body  being  merely  to  keep  him 
from  toppling  over."  Cardela  then  stooped 
down  and  placed  the  third  finger  of  his  right 
hand  under  the  hollow  of  the  man's  foot,  on  which 
he  was  balancing,  and  with  scarcely  any  percepti- 
ble effort  raised  him  to  the  height  of  four  feet,  and 
deposited  him  standing  on  a  table  near  at  hand. 
It  is  said  that  two  powerful  Irishmen,  living  near 
Verdi,  in  Washoe  County,  Nevada,  waylaid 
Cardela  with  intent  to  thrash  him ;  but  he  seized 
one  in  each  hand,  and  beat  them  together  till  life 
was  nearly  hammered  out  of  them.  He  is,  how- 
ever, of  a  quiet  and  peaceable  disposition.  His 
strength  seems  to  have  been  inherited,  for  he 
states  that  his  father  was  even  more  powerful  than 
he  is  himself. 


RINGWORM  OF  THE  SCALP. 

Dr.  MacLeod  (Dundee),  after  failing  to  cure 
an  obstinate  case  of  ringworm  by  various  remedies 
— as  ascetic  acid,  carbolic  acid,  oil  of  cade,  oil  of 
stavesacre,  etc. — found  it  yield  readily  to  a  mixture 
of  iodine  and  oil  of  tar  in  the  proportion  of  two 
drams  to  one  ounce  painted  over  the  patches  three 
or  four  times.  This  plan  has  been  recommended 
bv  Professor  McCall  Anderson. — Lancet. 


PROF.    BALL'S    PRESCRIPTION    IN    EPI- 
LEPSY. 

Ammon.  bromid.,  sod.  bromid.,  aa  equal  parts ; 
take  two  to  five  grams  twice  daily  (with  food). 
Ext.  bellad.,  tinct.  oxid.,  aa  .02  gram  ;  make  a 
pill ;  two  pills  to  be  taken  morning  and  evening. 
—Ibid. 


IODOFORM  AND  GOITRE. 

In  1843  Bouchardat  recommended  iodoform  as 
a  substitute  for  tincture  of  iodine  and  iodides,  and 
gave  it  in  pastilles  and  pills.  In  1848  Glover 
followed  his  example,  curing  two  women  who  had 
goitre  by  internal  and  external  treatment  com- 
bined. He  gave  it  internally  in  the  dose  of  thirty 
to  forty-five  centigrams  (4.6  to  7  grains)  a  day  in 
three  or  four  pills,  making  inunction  upon  the 
tumor  at  the  same  time  with  a  pomade  containing 
iodoform. —  Trousscait  s  Therapeutics. 


184 


THE    CANADA    MKDICAL    KECORD. 


THE   TREATMENT   OE  SUMMER    DIAR- 
RIKKA. 

An  interesting  lecture  on  the  summer  diarrha-a 
of  adults,  by  Dr.  Horatio  R.  liigelow,  of  Wash- 
ington, D.C,  is  rei)orted  in  full  in  the  Phila- 
delphia Afcilical  and  Surgical  Reporter.  \\'e 
rejjrint  the  portion  of  it  relating  to  the  treatment 
of  the  disorder,  as  likely  to  be  of  practical  service 
to  many  of  our  readers  at  this  time  of  year  : 

In  all  cases  where  we  have   reason   to  suppose 
that  there  is  undigested  food  in  the  alimentary  tract 
it  is  good  practice  to  exhibit  at  the  very  commence- 
ment a  dose  of  castor-oil  and  opium.      This  some- 
what nauseous  admixture  may  be  rendered  ]jalat- 
able  by  combining  with  it  conii)ound  tincture  of 
cardamoms,  oil  of  gaultheria,   pulverized  acacia, 
white  sugar,  and  cinnamon  water.  Should  there  be 
extreme  i)ain  or  cramp,  a  spiced  hop  poultice  (hops, 
cinnamon,  cloves,  linseed,  and  brandy)  over  the 
abdomen  gives  much  relief,  while  the  subcutaneous 
injection  of  vi.-x.  minims  of  Magendie's  solution 
will  quiet  pain  and  nausea.     If  the  stomach  is  inca- 
pable of  retaining  the  oil  it  should  be  administered 
as  an  enema.     A  persistent  diarrhoea  should  be 
treated  with  powders  of  oxide  of  zinc   with  bi- 
carbonate of  potash,  or  with  gallic  acid  and  opium. 
Where  the  anaemia  is  marked,  the  debility  extreme: 
and  the  diarrhoea  malignant,  in  the  sense  that  some 
anaemias  are  said  to  be  malignant,  there  is  no  more 
desirable  mixture  than  the  elixir  of  calisaya  bark 
and  aromatic  sulphuric  acid.     If  the  tendency  be 
to  cholera,  quinine  and   ergot,  or   carbolic   acid, 
should  be  given  with  hot  brandy  punches,  w'ith  lau- 
danum, or  the  subcutaneous  injection  of  the  hydrate 
of  chloral.  The  simple  uncomplicated  diarrhoea  that 
one    meets    so  often  in  the   summer  will  usually 
yield  to  a   litde   chalk   mixture,  with  tincture   of 
krameria  ;  when  more   severe  we  may  use  a  mix- 
ture of  tincture   of  opium,  spirits  of  chloroform, 
alcohol,  and  spirits  of  camphor.     An  enema  of  the 
sulphate  of  copper  before   breakfast  is  useful  in 
many  cases  of  great  tenesmus.     As  a  general  rule, 
when  sent  for  to  attend  a  case  of  cramps  resulting 
from  unripe  fruit,  or  anything  of  that  nature,  I  order 
a  castor-oil   enema  at  once,  with  the  immediate 
aj^plicadon  of  a  hot  spiced  hop  poultice  over  the 
abdomen.  If  necessary  I  add  a  subcutaneous  injec- 
tion of  morjjhine,  and  leave  the  patient  with   the 
assurance  thit  he  will  be  well  in  a  few  hours,  and 
that  nothing  more  will  be  necessary.     If  an  adult 
patient  comes  to  my  office  complaining  of  an  active 
diarrhcea  attributable  to  no  other  cause  than  that  of 
heat  and  over-exertion,  I  order  him  a  few  powders 
of  the  oxide  of  zinc  and  bicarbonate  of  potash,  to 
be  followed  by  a  mixture  of  the  elixir  of  calisaya  and 
sulphuric  acid. 

If  the  diarrhoea  be  due  to  constipation,  we  have 
nothing  better  than  a  pill  of  extract  of  nux  vomica, 
extract  of  belladonna,  with  extract  of  jjhysostigma. 
These  should  be  taken  regularly  to  overcome  the 
habit,  which  is  due  probably  to  a  relaxed  condition 
Of  he  muscular  coat  of  the  bowel.     The  antemia  of 


malaria  attended  with  diarrhoea  is  admirably  treated 
with  a  pill  containing  chinoidine,  sulphate  of  iron, 
and  the  resin  of  podophyllum.  Astringents,  as  we 
usually  understand  the  term,  are  of  no  jjossible 
avail.  They  do  not  reach  the  seal  of  the  disease. 
An  ordinary  bilious  diarrhcea,  not  due  to  catarrhal 
or  obstructive  jaundice,  will  generally  yield  to  a  pill 
containing  I'urkey  rhubarb,  resin  of  podophyllum, 
and  blue  pill,  with  a  little  hyoscyamus.to  prevent 
grijiing.  After  decided  action  has  resulted  we  may 
jjut  our  patient  upon  a  mixture  containing  dilute 
nitro-muriatic  acid.  The  diarrhoeas  preceding 
attacks  of  icterus  are  treated  with  a  pill  of  purified 
ox  bile,  suljjhate  manganese,  and  ])odophyllum,  or 
with  thehydrated  succinate  of  the  peroxide  of  iron. 
In  the  reflex  diarrhoea  due  to  intense  heat,  \vith 
excessive  mental  excitement,  we  have  a  remedy 
above  all  others, — finely  powdered  ice  applied  to 
the  whole  length  of  the  si)ine,  in  one  of  Dr.  Chap- 
man's ice  bags,  for  one  or  two  hours  at  a  time,  has  a 
wonderful  and  immediate  effect.  It  relieves  the  hy- 
pera;mia  of  the  nerve  centres,  tranquillizes  nervous 
irritability,  overcomes  insomnia,  and  checks  the 
diarrhoea.  In  diarrhoeas  generally,  attended  with 
great  nervous  prostration  we  have  nothing  in  medi- 
cine of  half  the  value.  In  these  cases  the  great 
object  to  be  attained  is  to  subdue  as  rapidly  and 
completely  as  possible  the  hypera^mia  of  the  spinal 
cord  and  sympathetic  ganglia,  and  re-establish  the 
healthy  equilibrium  of  the  circulation  ;  and,  while 
the  future  may  demonstrate  the  way  in  which  this 
may  be  accomplished  by  galvanism,  we  have  net 
now  any  means  of  reaching  the  automatic  nervous 
centres  comparable  to  that  of  ice  applied  along  the 
spine,  together  with  heat  to  the  genehil  surfice. 
\\'ith  this  we  may  give  bromide  of  lithium  and 
calisaya.  or  the  elixir  of  calisaya,  quinine,  and 
strychnia. 


DOUBLE  PNEUMONIA  AND  ABORTION. 

Dr.  L.  A.  Rutherford  reports  the  following  in- 
teresting case  to  the  Medical  and  Surgical  Re- 
porter. The  case  is  of  so  great  interest  that  we 
])ublish  it  in  full  : 

On  the  14th  of  March  I  was  called  to  see,  with 
another  physician,  a  white  woman,  aged  thirty-three; 
skin  very  hot ;  both  cheeks  flushed  ;  eyes  suffused  ; 
respiration  about  twenty-three;  pulse  120.  Com- 
l>lained  of  severe  pain  in  both  sides  of  the  chest, 
Cough  constantly.  Both  sides  dull  on  percussion 
right  side  more  involved.  Respiratory  n>urmur  at 
upper  part  of  both  lungs  very  loud,  a(Compar.iedb/ 
some  fine  crepitation.  Tongue  very  broad  and 
flat,  decjjly  furrowed  in  centre,  base  covered  with 
a  dense  dirty,  brownish  fur  ;  lijjs  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  drachni  c  oses,  to  be 
given  every  three  hours.  Five  grains  o'"  i  e  ctro- 
(juinine  every  six  hours.  Eleven  a.  m.  nc>  t  day  \  ulse 


THE    CANADA   MEDICAL    RECORD. 


185 


was  1 20.  Right  lung  more  involved,  pain  more 
acute,  respiration  more  rapid,  mouth  dry,  tongue 
more  brown,  fissure  deeper,  heat  of  skin  103 '4. 
Ordered  poultice  to  be  continued,  and  increased 
my  dose  of  dextro-quinine  to  twelve  grains,  to  be 
given  at  once,  and  repeated  in  four  hours.  At 
9  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  Monsell's  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 
twelfth  symptoms  much  improved,  though  the  dull- 
ness was  as  great,  but  heat  and  restlessness  abated 
somewhat ;  diarrhoea  under  control.  During  the 
next  two  days  the  acetate  of  ammonia  was  con- 
tinued in  one  drachm  dose,  every  four  hours,  five 
grains  of  dextro-quinine  to  be  given  three  times  a 
day. 

On  the  fifteenth  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  hemor- 
rhage, and  before  I  left  the  house  the  foetus  was 
expelled,  minus  the  placenta.  The  shock  this  abor- 
tion inflicted  on  the  system  was  fearful ;  she  became 
semi- comatose,  pulse  went  up  to  150,  small  and 
thready,  breathing  diaphragmatic.  Several  convul- 
sions 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  forthwith,  and  as  I  put 
about  as  much  faith  in  dextro-quinine  as  most  men 
do  in  a  good  brake  on  an  express  train,  I  poured  out 
what  I  thought  to  be  a  good  twenty-grain  dose  of 
that  drug,  which  was  dissolved  in  a  solution  of  tar- 
taric 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  to  forty  beats,  and  the  skin  much 
cooler.  Though  the  convulsions  did  not  entirely 
subside  in  that  time,  they  were  very  much  lessened. 
In  three  hours  niore  I  gave  her  ten  grains  again  ;  by 
night  she  recovered  her  senses.  Next  day  L  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 
comments  on  this  case,  but  would  ask  the  attention 
of  the  profession  to  the  line  of  treatment  followed, 
which  I  behve  will  be  found  a  successful  one  in 
cases,  both  of  double  pneumonia,  pleuro- 
pneumonia; intermittent  fever,  and  allied  diseases. 


BISMUTH  OINTMENT. 

Dr.  Sweet  writes  to  the  Medical  Summary  .-  1 
wish  briefly  to  call  the  attention  of  my  medical  breth- 
ren to  the  value  of  the  sub-nitrate  of  bismuth  as  an 
external  application.     Whenever  Erasmus  Wilson 
recommends   the  oxide  of  zinc  ointment,  I  use  the 
bismuth,    and    with  much  more  satisfactory   re- 
sults. I  do  not  know  what  has  been  the  experience 
of  others,  but  I  have  found  the  zinc  ungt.  too  stimu- 
lating for   any  acute  eruptions.     But  the  bismuth 
fulfills  the  indications  perfectly.     Mixed  with  cos- 
naoline  or  fresh  lard,  in  almost  any  proportion,  it 
is  a  sovereign  remedy  for  eczema,  herpes,  intertri- 
go of  infants,  and  anything  where  there  is  an  abra- 
ded  or   irritated    surface.     A   short  time   since  I 
succeeded  in  healing  an  extensive  ulcer  of  the  leg 
which  had  resisted  other  treatment.     It  is  also  an 
excellent  application  for  piles,  applied  as  an  ungt. 
externally,  or  injected  in  the  form  of  a  solution — 
a  teaspoonful  to  "a  it\N  ounces  of  water  or  other 
fluid. 


THl-  COOL  AIR  AND  WATER  TREAT- 
MENT OF  MEASLES. 

The   AUgemeine    Med.   and    Central  Zeitun^y. 
No.  29,  1879,  contains  an  abstract  of  a  long  arti- 
cle by  Dr.  Kaczorowski,  of  Posen,  on  the  discov- 
ery (!)  made  by  him  that  cool  air  and  sponging 
with  cool  water  have   no  such  disastrous  effect  in 
measles  as  old  writers  taught,  but,  on   the  con- 
trary, relieve  the  distress  of  the  disease  and  hasten 
recovery.     This  may     be    news    in   Poland,  but 
we  hope  it  is  not  in  this  country.     Various  able 
writers,  among,  whom  we  signalize,  for  his  earnest 
statements,    Dr.    Hiram  Corson,  have  for  years- 
advocated  it  in  this  journal  and  in  the    Transac- 
tions of  the  Medical  Society  of  this  State.     The 
old  treatment  of  close  rooms    and   warm  drinks 
ought    forever   to   be   banished.     They   cause  a 
more  intractible  form   of  disease,  retard  convales- 
cence, and   render  the  sequelae  more   serious. — 
Med.  and  Surg.  Reporter. 


REMOVAL    OF    STRONG    ODORS    FROM 
THE  HANDS. 

Ground  mustard  mixed  with  a  little  water  is  an 
excellent  agent  for  cleansing  the  hands  after  hand- 
ling odorous  substances,  such  as  cod-liver  oil,, 
musk,  valerianic  acid  and  its  salts.  A.  Huber 
states  that  all  oily  seeds  when  powdered  will 
answer  this  purpose.  In  the  case  of  almonds  and 
mustard,  the  development  of  ethereal  oil  under 
the  influence  of  water  may  perhaps  be  an  addi- 
tional help  to  destroy  foreign  odors.  The  author 
mentions  that  the  smell  of  carbolic  acid  may  be 
removed  by  rubbing  the  hands  with  damp  flaxseed 
meal,  and  that  cod-liver  oil  bottles  may  be  cleansed 
with  a  little  of  the  same  or  olive  oil. — Druggists' 
Circular. 


186 


THE    CANADA    MEDICAL    RECORD. 


The  Canada  Medical  Record, 

£li«onil)li,>  .Jounial  o(  Xttrbiriiic  nnli  ^fjarmntM 

KJDITOR  : 
fa&NCIS  W.  CAMPBELL, MA.. M. D.,L.K.C. p. .LOND 

ASSISTANT  EHrious: 

R.  A.  KENNEDY,  M.A.,  M.D. 

JAMES  PEilRIUO,  M.D.,  M.R.C.S.  Eng. 

KDITOK  OK   PHARMACKmCAL   DEPAIITMENT: 

ALEX.  H.  KOLLMYER,  M.A.,  M.D- 

9CBSCUIPTI0N  TWO  DOI.LAHS  PKK  ANM  M  . 

AH  rommniiic<i1ions  and  Eitclnnujesf  rnust  ie  addressed  to 
ike  Editor,  O rawer 'SoG,  PostOJice,  Montreal. 

MONTREAL.  APRIL,  1881. 

DECISION  RESPECTING  THE  RIGHTS 
OF  QUALIFIED  ONTARIO  DRUGGISTS 
PRACTISING  IN  THE  PROVINCE  OF 
QUEBEC. 

A  case  which  has  created  considerable  interest 
for  some  time  among  our  Pharmaceutical  friends 
in  this  Province'  is  that  of  the  Pharmaceutical 
Society  of  Quebec  (Province)  vs.  John  C.  Bennett, 
in  which  a  final  decision  has  at  last  been  reached- 
The  circumstances  are  briefly  stated  by  the  Cana- 
dian Pharmaceutical  Journal  as  follows  : 

Mr.  John  C  Bennett,  of  Brantford,  was  regis- 
tered a  member  of  the  Ontario  College,  on  June 
14th,  1879,  ^^y  virtue  of  his  having  served  as 
apprentice  and  assistant  prior  to  the  passing  of  the 
Pharmacy  Act.  Shortly  after  the  above  date  he 
commenced  business  in  Montreal,  but  was  quickly 
summoned  by  the  Quebec  Society,  and  on  trial 
was  fined  five  dollars  and  costs  for  unlawfully  using 
the  title  of  "  Chemist  and  Druggist."  He  still 
continued  business,  and  was  again  subjected  to  a 
legal  ordeal  with  a  like  result.  He  then  signified 
his  intention  of  carrying  the  matter  to  a  higher 
tribunal,  and  the  case  was  brought  up  before  the 
Superior  Court;  but  the  decision  of  the  Police 
Magistrate  was  sustained.  Mr.  Bennett,  who 
throughout  has  endeavored  to  maintain  his  posi- 
tion with  a  pertinacity  more  creditable  to  his  pluck 
than  profitable  to  his  purse,  next  applied  for  an 
injunction  to  restrain  the  Pharmaceutical  Society 
from  further  prosecution,  and  asking  that  the 
Quebec  Act  be  declared  unconstitutional  and  ultra 
vires,  as  being  an  interference  with  trade  and  com- 
merce. Judge  Rainville,  before  whom  the  case 
was  argued,  dismissed  the  petition,  holding  that 
pharmacy  is  only  a  branch  of  medicine,  and  comes 
under  the  jurisdiction  of  the  Provincial  Legislature. 

The  petitioner  was  by  no  means  satisfied  wiih 


this  judgment,  and  consequently  exercised  his 
right  to  aj)pcal.  The  case  came  up  on  March 
22nd,  before  Chief  Justice  Dorion  and  Justices 
Monk,  Cross  and  Baby.  It  was  merely  another 
edition  of  the  suit  entered  by  the  College  here 
against  certain  general  traders  in  the  vicinity  of 
Hamilton.  The  attempt  to  upset  the  Pharmacy  Act 
of  Quebec,  was  however,  equally  unsuccessful  with 
the  effort  to  prove  the  Ontario  Act  unconstitutional. 
Chief  Justice  Dorion  remarked  that  the  ques- 
tions arising  upon  the  division  of  powers  between 
the  Dominion  and  the  Local  Legislatures  were 
surrounded  with  very  great  difficulty.  The  appel- 
lant here  urged  that  the  Quebec  Pharmacy  Act  of 
1875  was  unconstitutional,  on  the  ground  that  the 
Act  was  an  infringement  u[)on  trade  and  commerce, 
a  subject  which  falls  exclusively  within  the  juris- 
diction of  the  Parliament  of  Canada.  The  Court 
was  against  the  appellant  on  this  point.  In  many 
instances  the  exercise  of  the  powers  confided  to 
the  Local  Legislatures  must  trench  in  some  degree 
upon  the  powers  entrusted  to  the  Dominion 
Legislature,  just  as  the  exercise  of  the  powers 
given  to  the  Federal  Legislature  must  trench  to 
some  extent  upon  the  powers  assigned  to  the  Local 
Legislature.  There  was  an  example  of  this  in  the 
recent  case  of  Gushing  &  Dupuy,  where  the  bank- 
rupt laws  passed  by  the  Dominion  interfered  in 
some  degree  with  provincial  procedure.  The 
Privy  Council  treated  the  question  in  a  comprehen- 
sive manner,  and  held  that  the  Confederation  Act> 
in  assigning  to  the  Dominion  Parliament  the  sub- 
jects of  bankruptcy  and  insolvency,  intended  to 
confer  also  the  power  to  interfere  with  civil  rights 
and  procedure  so  far  as  a  general  law  on  the  sub- 
ject of  insolvency  might  affect  them.  A  great 
many  of  the  powers  given  to  one  Legislature  must 
incidentally  conflict  with  the  ])0wers  given  to  the 
other.  Thus,  the  police  regulations  requiring  the 
doors  of  saloons  to  be  closed  at  a  certain  hour  had 
been  hold  not  an  infringement  upon  the  powers  of 
the  Federal  Legislature  to  regulate  trade  and  com- 
merce. The  proper  rule  was  this,  that  wherever 
power  was  given  to  one  Legislature  for  a  certain 
object,  and  the  exercise  of  that  power  incidentally 
trenched  upon  the  powers  assigned  to  the  other 
Legislature,  the  incidental  power  was  included  in 
the  power  for  the  main  object.  Here  pharmacy 
was  a  local  subject,  and  the  Act,  in  so  far  as  it 
touched  the  subject  of  commerce,  was  merely 
incidental  to  the  larger  power,  and  was  not  uncon- 
stitutional. The  judgment  would  therefore  be 
confirmed. 


THE    CANADA    MEDICAL    RECORD. 


18T 


Dr.  J.  A.  Grant  of  Ottawa  writes  us  with  refer- 
ance  to  Dr.  Bessey's  paper  on  the  treatment  of 
Psoriasis  by  Vaccination,  published  in  our  Febru- 
ary number.  He  directs  our  attention  to  an 
article  published  by  him  eighteen  years  ago  in  the 
London  Medical  Titnes  and  Gazette,  in  which  he 
reported  several  cases  treated  for  the  first  time  in 
the  same  manner  as  that  followed  in  Dr.  Bessey's 
case. 


WYETH'S  PEPTONIC  PILLS. 

This  pill  will  give  immediate  relief  in  many 
forms  of  Dyspepsia  and  Indigestion,  and  will  prove 
of  permanent  benefit  in  all  cases  of  enfeebled 
digestion  produced  from  want  of  proper  secretion 
of  the  Gastric  Juice.  By  supplementing  the  action 
of  the  stomach,  and  rendering  the  food  capable  of 
assimilation,  they  enable  the  organ  to  recover  its 
healthy  tone,  and  thus  permanent  relief  is  afforded. 
One  great  advantage  of  the  mode  of  preparation 
of  these  pills  is  the  absence  of  sugar,  which  is  pre- 
sent in  all  the  ordinary  Pepsin  and  Pancreatin 
compounds — in  this  form  the  dose  is  much  smaller* 
more  pleasant  to  take,  and  is  less  apt  to  offend  the 
already  weak  and  irritable  stomach  — The  results 
of  their  use  have  been  so  abundantly  satisfactory, 
that  we  are  confident  that  further  trial  will  secure 
for  them  the  cordial  approval  of  the  Medical  Pro- 
fession. 


Pepsin,  pancreatin,  vegetable  ptyalin,  or  diastase, 
lactic  acid,  and  hydrochloric  acid  with  milk  sugar 
— such  are  the  component  parts  of  lactopeptine. 
Surely  the  physiologist  must  contemplate  a  formula 
like  this  with  satisfaction ;  for  it  embraces  the 
most  important  of  his  discoveries  relative  to  diges- 
tion, and  shows  how  the  fruits  of  his  researches 
may  be  made  to  do  good  service  in  the  department 
of  practical  therapeutics. 

This  is  the  age  of  physiological  medicine,  and 
the  New  York  Pharmacal  Association  has  certainly 
proved  its  ability  to  meet  the  requirements  of  the 
time  by  bringing  lactopeptine  before  the  profession. 
The  name  of  its  manufacturers  is  sufficient  warrant 
for  the  purity  of  this  preparation,  while  its  worth 
as  a  medicine  in  the  treatment  of  dyspepsia  is 
attested  by  practitioners  of  well-known  ability. 


TENTH    CONVOCATION  OF    THE  MEDL 

CAL  FACULTY  OF  BISHOP'S 

COLLEGE. 

The  Tenth  Annual  Convocation  of  Bishop'* 
College  Faculty  of  Medicine  was  held  in  the 
Synod  Hall,  Montreal,  on  the  12th  of  April.  The 
attendance  was  very  large,  the  spacious  hall  being 
crowded,  the  ladies  being  present  in  large  num- 
bers. The  presence  of  His  Honor  Dr.  Robitaille 
the  Lieut.-Governor  of  the  Province  of  Quebec,  for 
the  purpose  of  having  the  ad  eundem  degree  of 
CM.,  M.D.,  conferred  upon  him,  gave  additional 
interest  to  the  proceedings.  About  three  o'clock 
the  Chancellor,  Mr.  R.  W.  Henneker,  entered  the 
Hall,  accompanied  by  the  Lord  Bishop  of  Quebec,. 
His  Honor  the  Lieut.-Governor,  Dr.  Robitaille, 
and  took  seats  upon  the  dais.  On  the  platform 
also  were  the  following  members  of  the  Faculty  : — 
Canon  Norman,  Vice-Chancellor  ;  Rev.  Principal 
Lobley,  D.C.L. ;  Dr.  A.  H.  David,  Dean  of  the 
Faculty ;  Dr.  F.  W.  Campbell,  Registrar ;  Drs. 
Kennedy,  Wilkins,  KoUmyer,  Cameron,  Simpson^ 
Armstrong,  Proudfoot,  Wood,  Drs.  Kerry  and 
Kannon,  graduates,  were  also  present. 

The  proceedings  were  opened  by  the  Chancel- 
lor delivering  the  following  address  : — 

On  this  the  completion  of  the  first  decade  of  this- 
Medical   School,    I    feel   particular    pleasure    in 
occupying  this  chair.     Ten  years  of  faithful  wo.k 
is  a  suh'.cient  guarantee  that  our  Medical  School  is- 
well  founded.     The  report  of  the  Faculty  will  give 
the  record  of  the  work  done  during  the  past  year. 
I  can  only  express  my  deep  regret  that  our  friend 
Dr.   David   should   have   felt  himself  obliged  to 
retire  from  the  active  duties  he  has  so  well  fulfilled 
in  the  past,  and,  at  the  same  time,  to  congratulate 
him  on  the  fact  that  he  has  earned  the  good  opinion 
of  his  confreres,  so  that  they  have  thus  determined 
to  associate  his  name  permanently  with  the. work 
he  and  they  have  taken  in  hand.     I  wish  now  to- 
add  a  few  words  as  to  University  work  in  general, 
and  that  of  our  own  University  in  particular.  That 
the  work  of  superior  education  is  gaining  in  the 
estimation  of  the  public  of  all   nations  must  be 
evident  to  the  looker-on,  and  that  University  work 
is  more  widespread  in  its  action  and  influence  is 
equally  apparent.     The  older  Universities  of  the 
Mother  country  have  enlarged  their  field  of  study 
by  the  introduction  of  subjects  but  little  thoughtof 
or  known  in  former  times.     Physical  Science,  and 
other   cognate    subjects,    are   now   accessible   to 
students,  and  the  throwing  open  of  College  fellow- 
ships to  competitors  in  the  great  EngUsh  Univer- 
sities  has    given   a    stimulus    to   University   life 
scarcely  dreamed  of  a  few  years  ago.     In  fact,  the 
Universities  of  England  are  gradually  becoming 
what   the  term  itself  implies  :  seats  of  learnings 


188 


THE    CANADA    MEDICAL    RECORD. 


concentrating  a  turning  into  one  whole  the  entire 
mental  rcsuurtcs  of  num.  In  these  great  centres 
each  man  may  now  follow  the  special  course  of 
study  for  which  he  has  a  call  or  deems  himself 
fitted.  Jiut  to  bring  about  this  large  result  an 
almost  unlimited  supply  of  money  has  been 
required.  In  some  countries  the  State  has  con- 
trolled the  L'niversities  on  the  ground  that,  as  every 
man  is  a  member  of  the  State,  so  his  education  is 
more  or  less  a  matter  of  State  interest,  and  this,  of 
course,  reminds  us  of  the  position  of  the  citizen  in 
ancient  times.  Our  condition  in  Canada  is  very 
different  from  this.  What  the  State  does  for  us  is 
simply  to  aid  voluntuary  effort.  It  does  not  even  in- 
quire as  to  whether  the  result  corresponds  with  the 
outlay.  It  would,  indeed,  be  almost  impo.ssible,  until 
we  become  a  more  concrete  people,  to  have  one 
uniform  system.  Our  three  different  Universities 
of  the  Province  of  Quebec  prove  at  a  glance  our 
diversities  of  language,  creed  and  origin.  Laval  is 
French  in  character,  McGill  mostly  Scotch  and  non- 
denominational,  Bishop's  College  denominational, 
and;  to  the  extent  of  its  means,  a  copy  in  its  Arts 
course  of  Oxford  and  Cambridge.  The  great  want 
in  Canada  is  money — the  means  to  establish  more 
than  a  very  few  chairs.  In  Bishop's  College  we 
have  at  the  present  time  represented  the  so-called 
"  Learned  Professions,"  with  an  Arts  course  in 
addition.  It  is  clear,  therefore,  that,  if  viewed  from 
the  standard  of  what  a  University  should  be,  it  is 
but  a  nucleus.  We  do  aim,  however,  though  our 
Avork  is  not  broad  nor  varied  in  extent,  to  do  that 
work  well  and  thoroughly,  so  that  those  who  have 
passed  through  our  hands  may  prove  themselves 
to  be  men  of  thought  and  action,  fitted  to  cope 
with  the  peculiar  difficulties  which  surround  life  in 
this  new  and  ever-growing  country.  Beyond  the 
special  technical  pursuits  of  Divinity,  Law  and 
Medicine,  our  means  are  applied  to  the  study  of 
language,  and  as  language  lies  at  the  base  of  all 
knowledge — without  which  knowledge  itself  is 
inconceivable — we  think  it  better  to  apply  our- 
selves to  language  for  the  present  rather  than  to 
attemjit  too  much.  And  if  the  study  of  the  Earth, 
of  the  Heavens,  of  Chemistry,  and  of  matter 
generally  is  important — which  we  readily  admit — 
yet  language  must  be  held  to  be  of  even  greater 
importance,  as  containing  within  itself  not  only 
the  means  of  interchanging  thought  between  man 
and  man,  but  of  recording  for  all  future  ages  the 
thoughts,  discoveries,  arts  and  sciences  of  each  age, 
and  everything  relating  to  nature  itself.  Again, 
without  language  we  could  have  no  revelation  of 
God's  will,  and  we  are  brought  back  to  first 
principles  when  we  say  that  language  is  the  main 
distinction  between  man  and  the  brute  creation. 
Kecent  discoveries,  through  the  reading  of  the 
tablets  found  in  the  Assyrian  monuments,  have 
brought  to  light  the  fact  that  i,ooo  years  before 
the  call  of  Abraham,  there  were  enlightened  people 
with  a  knowledge  of  astronomy  and  mathematics, 
keeping  records  of  the  events  of  their  period,  of 
the  traditions  of  their  origin,  of  the  Creation  itself. 
the   Deluge,  and  the  other  incidents  of  the  early 


history  of  the  world  which  we  find  recorded  in  the 
book  of  Genesis.  With  these  peoj;le  of  a  far 
distant  age  government  was  reduced  to  a  system  ; 
the  relations  between  rulers  and  ]jeople  were 
defined  ;  education  was  fostered  ;  libraries  were 
collected,  and  the  tablets  themselves  (the  books  of 
the  period)  were  studied  with  marginal  references. 
Surely  this  study  can  yield  to  none  in  interest, 
and  yet  it  is  the  language  study  of  which  1  speak 
which  has  brought  about  these  discoveries.  I  do 
not  pretend  to  say  that  Bishop's  College  as  yet  has 
its  chair  of  philology,  or  that  it  can  boast  a  Max 
Muller  amongst  its  profes.sors,  but  I  do  say  that 
we  are  endeavoring  to  walk  in  one  branch  of  the 
great  University  .system,  and  that,  not  the  least 
important  branch,  when  we  make  a  special  eiTort, 
to  teach  soundly  and  well  the  often-abused  but 
most  important  ancient  classics.  But  I  must  bring 
these  remarks  to  a  close,  commending  the  great 
cause  of  superior  education  to  your  hearty  sym- 
pathy and  sujjport.  One  or  two  words  iu  conclu- 
sion before  the  real  work  of  this  Convocation 
begins.  The  College  and  School  at  Lcnnoxville 
have  been  sadly  aftlicted  during  the  past  year  by 
an  access  of  typhoid  fever,  which  has  been  unfor- 
tunately fatal  in  a  few,  hapi-ily  a  very  few  cases. 
As  may  well  be  supposed,  none,  not  even  the 
immediate  relatives  and  friends  of  the  sufferers, 
have  been  more  grieved  and  pained  than  the 
authorities  of  the  College.  Immunity  fr(>m  sickness, 
except  that  which  is  at  times  epidemic,  has  been 
one  of  the  boasts  of  Bisho})'s  College  awd  Bishop's 
College  School,  but  the  blow  has  come  at  last 
when  least  expected,  for  at  the  time  of  the  annual 
Convocation  in  June  last,  for  granting  degrees  in 
Arts,  nothing  could  exceed  the  apparent  healthi- 
ness of  the  students  and  scholars.  Oa  the  emer- 
gency arising  it  was  thought  expedient  to  call  in  a 
commission  of  medical  men  to  examine  and  report 
on  the  probable  cause  of  the  outbreak,  and  the 
report  of  this  commission  has  been  ]jublished. 
The  authorities  of  the  College  feel  deeply  grateful 
to  these  gentlemen  for  so  readily  coming  to  their 
aid  under  the  circumstances,  and  it  is  a  matter 
worthy  of  remark,  that  this  conunission  was  formed 
from  what  may  be  termed  rival  medical  schools, 
both  McGill  and  Bishop's  College  being  re;)re- 
sented.  These  gentlemen  worked  together  in 
perfect  harmony,  and  used  every  effort  to  ascertain 
the  cause  of  the  outbreak  and  to  suggest  remedies. 
They  have  been  more  successful  in  the  latter  than 
in  the  former  part  of  their  work,  for  the  true  origin 
of  the  outbreak  is  still  a  mystery.  At  the  same 
time,  the  remedies  applied  to  the  drainage  a'ld 
ventilatiim  of  the  College  and  School  IniilUings 
and  premises  will,  I  I'eel  confident,  render  a 
naturally  most  healthy  site  proof  against  any 
recurrence  of  the  disaster.  I  can  scarcely  explain 
how  fully  I  feel  the  kind  sympathetic  aid  of  these 
gentlemen,  and  I  believe  I  exjjress  the  sentiments 
of  our  whole  budy. 

Dr.  F.  W.  C.\MPBELL,  the  Registrar,  then  read 
the  following  : 


THE    CANADA    MEDICAL    RECORD. 


180 


REPORT  OF  SESSION  1880-81. 

The  number  of  matriculated  students  for  the 
session  1 880-81  was  32,  being  five  in  excess  of 
last  year.  Of  this  number  four  were  from  the 
Province  of  Ontario,  one  from  the  United  States. 
orie  from  Porta  Rica,  and  26  from  the  Province 
of  Quebec.  Ten  of  this  number  were  from  the 
City  of  Montreal,  where,  it  is  but  reasonable  to 
suppose,  the  School  and  the  facilities  which  it 
offers  for  learning  are  best  know.i. 

The  Faculty  deeply  regret  that,  early  last 
summer,  ])r.  David,  owing  to  failing  health, 
tendered  the  resignation  of  his  chair  of  Practice 
of  Medicine  and  his  ofnce  of  Dean.  Tlie  former 
was  accepted  with  regret,  bu;  the  Faculty  declined 
to  accede  to  the  latter  request,  and  they  are 
pleased  to  be  able  tu  state  that  he  still  continues 
to  occu})y  the  position  he  has  so  ably  filled  for  the 
past  ten  years. 

Tlie  fact  that  this  is  the  tenth  annual  Convoca- 
tion iiaturally  suggests  a  review  of  the  past 
decade,  and  witliout  entering  fully  into  the  history 
of  the  School  during  that  period,  it  uiay  be  said, 
in  spite  of  many  obstacles,  we  have  made  a  solid 
foundation.  The  lab'>r  involved  has  been  great^ 
pecuniary  reward  there  has  been  ^ionc,  but  ro 
those  who  have  been  with  the  Faculty  since  its 
organization,  the  outlook  to-day  is  brighter  than  ii 
ever  was  before.  The  superstructure  is  about  to 
be  raised,  and  that  it  will  assume  fair  proportions 
before  the  next  decade  ends  is  assured,  we  feel 
satisfied,  from  the  enthusiasm  which  per\aded  the 
class  of  1880-81. 

The  Faculty  have  for  several  years  had  the 
pleasure  of  presenting  at  the  anr«u.al  Medical 
Convocation  "  The  Wood  Gold  Medal "  to  the 
student  who  lias  attained  the  highest  number  of 
marks  in  both  the  primary  and  final  exannnatiors. 
This  year  they  are  proud  to  be  able  to  announce 
the  founding  of  another  Gold  Medal,  to  b-:;  knov/n 
as  "  The  Robert  Nelson  Medal."  The  name  of 
"  Nelson  "  is  one  that  has  been  well  kn^wn  in 
medical  circles  in  Montreal  during  the  last  50 
years,  and  this  medal  is  founded  1  ly  Dr.  C.  Eugene 
Nelson,  of  New  York,  a  descendant  of  the  family, 
in  memory  of  his  late  father,  Dr.  Robert  Nelson, 
who  died  at  Staten  Island,  New  York,  in  March, 
1873.  A  word  or  two  may  not  be  out  of  place 
concerning  the  man  in  whose  memory  this  oiedal 
has  been  founded.  Dr.  Robert  Nelson  was  born 
near  Sorel,  iii  this  Proviiice.  Commencing  the 
study  of  medicine  in  Montreal,  he  was,  as  was 
the  custom  in  those  days,  apprenticed  to  Dr. 
Ryan,  and  afterwards  to  Dr.  Arnoldi,  with  whom 
he  subsequently  acted  as  assistant.  After  some 
time  he  commenced  practice  on  his  own  acc-unt, 
residing  in  St.  Gabriel  street.  He  represented  the 
Eastern  District  of  Montreal  in  Parliament  for 
several  years  ;  was  Health  Commissioner  during 
the  terrible  outbreak  of  cholera  in  this  city  in 
1832  and  1834;  was  President  of  the  Medical 
Board,  and  Physician  to  the  Hotel  Dieu  Hospital. 


In  the  year  1837,  ^.I'ing  with  his  brother,  the  late 
Dr.  \Volfred  Nelson,  he  became  implicated  in  the 
Rebellion,  and  was  obliged  to  take  refuge  in  the 
United  States.  In  1S38  he  headed  an  incursion 
into  Canada,  which  met  with  disastrous  fixilure. 
For  some  years  he  remained  in  Vermont,  following 
his  profession,  but  subsequently  removed  to  New 
York  City,  where  his  reputation  as  a  surgeon,  first- 
made  in  this  city,  brought  him  fame  and  fortune. 
It  seems  peculiarly  fitting,  therefore,  that  his  son 
should  establish,  in  couiiection  with  a  Canadian 
College,  a  medal  in  memoriam  of  his  late  father, 
and  that  he  should  select  J3ishop's  College  as  the 
favored  one,  inasmuch  as  the  first  name  which 
was  enrolled  as  a  student  of  medicine  on  the 
Registration  Books  of  this  faculty  on  its  establish- 
ment, in  1 87 1,  was  "  Wolfred  Nelson,"  a  grand- 
nephev/  of  the  deceased. 

The  Faculty  also  have  pleasure  in  making  the 
announcement  that  they  have  established  a. 
scholarship,  which  they  have,  in  honor  of  their 
venerable  Dean,  named  "The  David  Scholarship." 
This  scholarship  will  consist  of  one  full  set  of  the 
Final  Classes,  delivered  at  the  College,  and  will 
become  the  perquisite  of  the  student  who  each 
year  attains  the  higliest  number  of  marks  in  the 
Primary  Examinations. 

Ever  solicitous  of  the  welfare  of  its  graduates,, 
and  proud  to  chronicle  their  success,  the  Faculty 
is  pleased  and  proud  to  be  able  to  state  that  Dr. 
Chandler,  who  this  tims  last  year  in  this  hall 
graduated,  taking  '•  The  "\7ood  Gold  Medal,"  has 
recently  received  the  appointment  as  House 
Surgeon  to  the  Brooklyn  Hospital,  containing 
150  be<ls,  after  a  competitive  examination  with  21 
candidates.  Dr.  Foley,  the  Final  Prizeman  of  laSt 
year,  has  been,  since  September  last,  following  the 
practice  if  the  London  Hospital,  London,  Eng. 

The  following  is  the  result  of  the  examina- 
uons : — 

Passed  in  i^otany — Jabez  B.  Saunders,  Mon- 
treal, prize ;  Edgar  O'B.  Freleigh,  LMJrignal. 

Passed  in  Practical  Chemistry — Wm.  Albert 
Mackay,  St.  Eustache,  Q.,  honorable  mention. 

Passed  in  Practical  Anatomy — Frank  M.  R. 
Spendlove,  Ayer's  Flats,  Q. ;  honorable  mention  ; 
William  Caldwell  McGilliS;  Montreal ;  Charles  S. 
Fenwick,  Montreal. 

Passed  in  Materia  Medica — Charles  De.xter 
Ball,  Stanstead,  Q.  ;  Edgar  O'B.  Freleigh,  L'Ori- 
gnal,  Q. ;  William  A.  Mackay,  St.  Eustache,  Q. ; 
James  A.  Shepstone,  Brantford,  Q. 

Passed  in  Physiology — William  Patterson,  Mon- 
treal ;  William  A.  .Mackay,  St.  Eustache,  Q. 

Passed  in  Chemistry — Charles  Dexter  Ball, 
Stanstead,  Q. ;  William  Patterson,  IMontreal ; 
William  A.  Mackay,  St.  Eustache,  Q. 

Passed  in  Anatomy — William  Caldwell  McGil- 
lis,  IMontreal;  Charles  S.  Fenwick,  Montreal. 

Passed  in  Hygiene — Heber  Bishop,  B.  A., 
i>Iarbleton,  Q. ;  Frank  M.  R.  Spendlove,  Ayer's 
Flats,  Q.  ;  Niniau  C.  Smillie,  Montreal ;  Robert 
H.    Wilson,    Montreal ;    Walter    de   Mouilpied, 


190 


TUE   CANADA   MEDICAL    RECORD. 


Montreal ;  Eleuterio  Quinones,  Porta  Rica  ;  Wil- 
liam Patterson,  Montreal ;  Wm.  A.  Mackay,  St. 
tustache  ;  Wm.  C.  McGillis,  Montreal. 

Passed  in  Medical  Jurisprudence — Ninian  C. 
Smillie,  Montreal ;  Heber  Bishop,  B.A.,  Marble- 
ton,  Q. ;  Charles  S.  Fenwick,  Montreal. 

'JTie  following  gentlemen  i)assed  their  primary 
examination,  which  consists  of  Chemistry,  Practical 
Chemistry.  Materia  Medica,  Physiology,  Anatomy, 
J'ractical  Anatomy  and  Hygiene,  arranged  in  order 
of  merit: — Frank  M.  R.  Spendlove,  Ayer's  Flats, 
().,  I  St  class  honors  and  primary  prize  ;  Eleuterio 
(Quinones,  Porta  Rica;  Joseph  Arthur  Rochette, 
(Quebec ;  Wm.  C.  McGillis,  Montreal ;  Chs.  S. 
Fenwick,  Montreal. 

The  following  gentlemen  passed  their  final 
examination  for  the  Degree  of  CM.,  M.D.,  con- 
sisting of  the  Practice  of  Medicine,  Surgery,  Ob- 
stetrics, Pathology  and  Medical  Jurisprudence  : — 
Frank  M.  R.  Spendlove,  Ayer's  Flats,  Q.,  Wood 
"Cold  Medal.  (This  medal  is  awarded  to  the 
jjraduate  who  has  attended  at  least  two  full  sessions 
in  the  Faculty,  and  has  obtained  the  highest  num- 
ber of  marks  in  both  the  primary  and  final  examin- 
ations.) Robert  H.  Wilson,  Montreal,  final  prize; 
Walter  de  Mouilpied,  Montreal,  and  Eleuterio 
■Quinones,  Porta  Rica,  ist  class  honors,  75  per 
<;ent ;  Joseph  Arthur  Rochette,  Quebec,  and  Wm. 
•C.  McGillis,  Montreal,  2nd  class  honors,  60  per 
<ent. 

PRIZES. 

Frank  M.  R.  Spendlove,  Ayer's  Flats,  Q.,  takes 
"  The  Wood  Gold  Medal ;  "  Robert  Henry  Wilson, 
Montreal,  takes  the  final  prize  ;  Walter  de  Mouil- 
])ied,  Montreal,  takes  "  The  Robert  Nelson  Gold 
Medal.  "  This  medal  is  awarded  for  the  best  special 
•examination  upon  surgery  (and  for  which  only 
those  who  obtain  first-class  honors  can  compete), 
-and  the  examination  extended  over  three  days, 
one  day  written,  one  day  oral  and  one  day  practical. 
The  competition  for  this  prize  was  very  keen. 
P'rank  M.  R.  Spendlove,  Ayer's  Flats,  Q.,  gets  the 
primary  prize ;  Frank  M.  R.  Spendlove,  Ayer's 
P'lats,  Q.,gets  the  senior  dissector's  prize  ;  E.  O'B. 
Freleigh,  L'Orignai,  Q.,  junior  dissector's  prize  ;  J. 
B.  Saunders,  Montreal,  botany  prize. 

Certificates  of  honorable  mention  will  be 
.•granted  to  the  following  gentlemen  : 

Practical  Chemistry — Wm.  A.  Mackay. 

Chemistry — Chs.  Dexter  Ball. 

Materia  Medica — Chs.  Dexter  Ball,  Eleuterio 
Quinones,  E.  O'B.  Freleigh,  Wm.  A.  Mackay,  Jos. 
A.  Rochette. 

Physiology — F.  M.  R.  Spendlove. 

Hygiene — Heber  Bishop,  B.A.,  F.  M.  R. 
Spendlove,  N.  C.  Smillie,  R.  H.  Wilson,  Walter 
<le  Mouilpied. 

Medical  Jurisprudence — N.  C.  Smillie,  Heber 
Bishop,  B.A. 

The  oath  of  allegiance  was  next  administered  to 
the  candidates  for  degrees  by  the  Chancellor,  after 
which  the  whole  assembly  sang  the  National 
Anthem. 


Dr.  Campbell  next  administered  the  medical 
oath. 

CONFERRING  OT    DEGREES. 

His  Honor  Dr.  Robitaille,  and  Professors 
Simpson  and  Cameron,  immediately  afterwards 
received  their  ad  eundem  degrees  of  CM.,  M.D., 
amidst  much  applause.  The  graduating  class  were 
next  presented,  and  received  their  degrees  and 
diplomas,  after  which  the  gold-medal  men  and 
honor  men  were  called  up  and  received  their  well- 
earned  prizes  at  the  hands  of  His  Lordship  the 
Bishop  of  Quebec,  who  made  a  few  pleasant  and 
encouraging  remarks  to  each  of  the  fortunate 
winners. 

The  Valedictory  was  delivered  by  Dr.  Walter 
DeMouilpied.  He  referred  to  the  feelings  of  the 
student  when  he  has  reached  that  most  important 
stage  of  his  life,  the  receiving  of  his  degree,  when 
ceasing  to  be  a  student,  he  assumes  the  responsi- 
bility of  his  profession,  and  said  that  another  work 
now  lay  before  him  and  his  fellow-graduates. 
Heretofore  they  have  been  under  the  guidance  of 
Professors  who  directed  them  through  the  regular 
course  of  study  ;  but  now  they  were  about  to  go 
forth  amidst  the  cares  and  struggles  of  a  world 
where  they  will  have  to  forage,  cull  and  elaborate 
for  themselves.  He  then  referred  to  the  great 
amount  of  work  there  was  cut  out  for  men  of 
the  medical  profession.  He  spoke  of  the  drud- 
gery there  was  in  store  for  all  young  doctors, 
but  they  were  amply  repaid  by  the  feelings  they 
should  entertain  ni  spending  their  lives  in  the  alle- 
viation of  pain  and  suffering.  He  advised  the 
under-graduates  to  avoid  in  future  what  they  had 
seen  wrong  in  himself  and  brother-graduates,  and 
to  persevere  with  the  same  perseverance  they  had 
shown  this  session,  remembering  always  that  for- 
tune favors  the  brave.  He  closed  with  an  expres- 
sion of  thanks  to  the  Professors  for  the  benefits 
they  had  conferred  upon  them,  and  an  appeal  to 
his  brother-graduates  to  work  hard  in  their  profes- 
sion, remembering  that  they  have  the  example  of 
the  great  Physician  to  whom  they  all  have  at  last 
to  answer  for  their  talents  given  and  spent. 

Professor  Cameron  then  delivered  the  address 
to  the  Graduates  on  behalf  of  the  Faculty.  This 
will  be  found  among  the  original  communications. 

The  Chancellor  then  called  upon  His  Honor 
the  Lieut. -Governor. 

His  Honor  on  rising  was  received  with  much 
applause.  He  thanked  the  University  for  the 
honor  just  conferred  on  him,  which  he  was  as 
proud  of  as  that  which  he  received  from  his  own 
Alma  Mater,  McGill.  He  pointed  out  the  good 
work  which  the  four  Universities  in  the  Province 
were  doing,  and  wished  them  all  possible  success. 

His  Lordship  the  Bishop  of  Quebec,  who  is 
President  of  the  College,  also  addressed  some 
kindly  words  of  encouragement  to  the  students, 
and  graduates  now  going  forth  to  fight  the  battle 
of  life.  He  impressed  upon  them  the  necessity  of 
keeping    up  their  studies  so  that  they  would  do 


TDE   CANADA   MEDICAL   RECORD. 


191 


honor  and  credit  to  themselves  and  their  Alma 
Mater. 

Rev.  Canon  Norman  and  Principal  Lobley  also 
made  brief  and  practical  addresses.  The  latter 
touching  upon  the  recent  outbreak  of  fever  at  the 
College,  and  the  means  which  had  been  taken  to 
prevent  a  recurrence  of  it.  He  said  the  College 
authorities  were  indebted  in  a  great  measure  to  the 
medical  men  of  Montreal  for  the  assistance  ren- 
dered the  College  in  a  sanitary  way. 

This  closed  the  proceedings,  and  the  Convoca- 
tion of  1880-S1  came  to  an  end. 

DINNER. 

In  the  evening  Dr.  Francis  W.  Campbell  enter- 
tained at  the  "  Metropolitan  Club  "  the  following 
gentlemen,  to  celebrate  the  tenth  anniversary  of 
the  founding  of  the  Medical  Faculty  of  Bishop's 
College  : — His  Honor  the  Lt.-Governor  of  Quebec, 
Dr.  Robitaille  ;  Mr.  Henniker,  Chancellor  of  the 
University ;  Rev.  Canon  Norman,  Vice-Cancellor 
of  the  University  ;  Rev.  Dr.  Lobley,  Principal  of 
the  University ;  Hon.  Mr.  Chapleau,  Premier  of 
the  Province  ;  Hon.  Mr.  Robertson,  Provincial 
Treasurer ;  Hon.  Mr.  L\-nch,  Solicitor-General ; 
Dr.  R.  P.  Howard,  of  Medical  Faculty  of  McGill 
College  ;  Dr.  Hingston,  School  of  Medicine  and 
Surgery  \  Dr.  E.  Lachapelle,  Medical  Faculty  Laval 
University,  Montreal ;  Dr.  Gibson,  of  Cowansville, 
Dr.  Robillard,  of  Montreal,  the  "Assessors"  of 
the  Faculty  ;  Capt.  Harry  Shepherd,  A.D.C  to  His 
Honor  the  Lieut. -Governor  ;  Dr.  Robt.  Craik,  Drs. 
David  (Dean),  Kennedy,  Wilkins,  Perrigo,  KoU- 
myer,  Armstrong,  Wood,  McConnell,  Cameron^ 
Simpson,  Proudfoot,  and  A.  Lapthorn  Smith, 


McGILL  UNIVERSITY— MEETING  OF 
CONVOCATION. 

The  annual  meeting  for  conferring  of  degrees 
in  the  Faculty  of  Medicine  was  held  in  the  William 
Molson  Hall  on  Thursday  afternoon,  31st  ult.,  the 
room  being  crowded. 

Dr.  Osier  read  the  following  list  of  honors  in 
the  Faculty  of  Medicine  : — 

The  total  number  of  students  enregistered  in 
this  Faculty  during  the  past  year  was  168,  of 
whom  there  were  from  Ontario,  79  ;  Quebec,  48  ; 
Nova  Scotia,  5  ;  Manitoba,  i  ;  New  Brunswick,  9  ; 
P.  E.  Island,  5 ;  Newfoundland,  i ;  West  Indies 
I ;  United  States,  19. 

The  following  gentlemen,  36  in  number,  passed 
their  primary  examination  on  the  following  sub- 
jects :  Anatomy,  Practical  Anatomy,  Chemistry, 
Practical  Chemistry,  Materia  Medica  and  Phar- 
macy, Institutes  of  Medicine  and  Botany  or 
Zoology.  Their  names  and  residences  are  as 
follows  : 


Clarence  E.  Allan,  East  Farnham,  Q.  ;  Edson 
C.    Bangs,    Faribault,    Minn.  ;   S.    A.    Bonesteel, 
Columbus,  Neb.  ;   James    C.   Bowser,   Kingston,. 
N.B.  ;    C.  O.  Brown,  Lawrenceville,  Q.  ;   C.   E. 
Cameron,  Montreal,  Q. ;  J.  W.  Cameron,  Montreal,. 
Q. ;  A.  M.  Cattenach,  Dalhousie  Mills,  O. ;  H.  J. 
Clarke,  Pembina,  Dakota  ;  W.  C.  Cousins,  Ottawa, 
O.  ;  W.  J.  Derby,  North  Plantagenet,  O.  ;  George 
A.  Dearden,  Richmond,  Q. ;  J.  J.  Gardner,  Beau- 
harnois,  Q. ;  James  A.  Grant,  B.A.,  Ottawa,  O.  ; 
James  Gray,  Brucefield,  O. ;  Chas.  B.  H.  Hanvey, 
Cleveland,  O.  ;  Joseph  A.  Hopkins,  Cookshire,  Q.  ; 
J.  H.  Harrison,  Moulinette,  Q. ;  R.  J.  B.  Howard^ 
B.A.,  Montreal,  Q. ;  W.  D.  B.  Jack,  B.A.,  Frederic- 
ton,  N.B. ;  P.  N.  Kelly,  Rochester,  Minn. ;  John  S. 
Lathern,   Yannouth,    N.S.  ;   J.    B.  Loring,   Sher- 
brooke,  Q.  ;  Robert  K.  McCorkill,  Montreal,  Q.  ; 
W.  J.  Musgrove,  West  Winchester,  O. ;  Floyd  S. 
Muckey,    Medford,    Minn. ;    T,    Pierce   O'Brien,. 
Worcester,   Mass. ;  T.   A.  Page,  Brockville,   O.  ; 
Allen  P.  Poaps,  Osnabruck  Centre,  O. ;  And.  J. 
Rutledge,    Bayfield,    O. ;    C.    Rutherford,    M.A.,. 
Waddington,   N.Y.  ;  W.  McE.  Scott,  Winnipeg^ 
Man. ;  George  A.  Sihler,  Simcoe,  O.  ;  E.  W.  Smithy, 
B.A.,    New    Haven,    Conn. ;    Andrew    Stewart,. 
Howick,  Q. ;    W.  E.  Thompson,  Harbor  Grace, 
Nfld. 

The  following  gentlemen,  38  in  number,  have 
fulfilled  all  the  requirements  to  entitle  them  to  the 
degree  of  M.D.,  CM.,  from  the  University.  These 
exercises  consist  in  examinations,  both  written  and 
oral,  on  the  following  subjects  :  Principles  and 
Practice  of  Surgery,  Theory  and  Practice  of 
Medicine,  Obstetrics  and  Diseases  of  Women  and 
Children,  Medical  Jurisprudence  and  Hygiene  ;. 
and  also  Clinical  Examinations  in  Medicine  and 
Surgery  conducted  at  the  bedside  in  the  Hospital : 

S.  A.  Bonesteel,  Columbus,  Neb. ;  T.  L.  Bro\\Ti, 
Ottawa,  O. ;  Paul  Cameron,  Lancaster,  O. ;  J.  H. 
Carson,  Port  Hope,  O. ;  W.  Comiack,  Guelph,  O. ; 
H.  C.  Feader,  Iroquois,  O. ;  H.  D.  Eraser,  Pem- 
broke, O. ;  E.  C.  Fielde,  Prescott,  O. ;  W.  L.  Grey, 
Pembroke,  O. ;  C.  M.  Gordon,  Ottawa,  O. ;  J.  B. 
Harvie,  Ottawa,  O.  ;  H.  E.  Heyd,  Brantford,  O.  ; 
H.  A.  Higginson,  L'Orignal,  O.  ;  D.  W.  Houston,. 
Belleville,  O. ;  J.  J.  Hunt,  London,  O. ;  G.  E. 
Josephs,  Pembroke,  O. ;  W.  A.  Lang,  St.  Mary's, 
O.  ;  E.  J.  Laurin,  Montreal,  Q. ;  Henry  Lunam, 
B.A.,  Wakefield,  Q.  ;  R.  T.  Macdonald,  Montreal^ 
Q. ;  E.  A.  McGannon,  Prescott,  O. ;  Kenneth 
McKenzie,  Richmond,  Q. ;  F.  H.  Mewburn^ 
Drummondville,  O. ;  W.  Moore,  Owen  Sound,  O.; 


192 


THE   CANADA    MEDICAL    RECORD. 


W.  C.  Perks,  Port  Hope,  O. ;  T.  ^V.  Reynolds, 
Brockville.  O.  ;  E.  J.  Rogers,  Peterboro',  O. , 
James  Ross,  B.A.,  Dewittville,  Q. ;  J.  W.  Ross, 
Winthrop,  O.  ;  T.  W.  Serviss,  Iroquois,  O. ;  J.  C. 
Shanks,  Huntingdon,  Q. ;  W.  A.  Shufelt,  Brome, 
Q. ;  E.  H.  Smith,  Montreal,  Q.  ;  W.  Stephen, 
Montreal,  Q. ;  A.  D.  Struthers,  Philipsburg,  Q. ; 
J.  E.  Trueman,  B.A.,  ^\'oodstock,  N.B. ;  G.  C 
Wagner,  Dickinson's  Landing,  O. ;  J.  Williams, 
London,  C). 

Of  the  above-named  gentlemen,  W.  Cormack  is 
under  age.  He  has,  however,  passed  all  the 
examinations,  and  fulfilled  all  the  requirements 
■necessary  for  graduation,  and  only  awaits  his 
majority  to  receive  his  degree. 

Mr.  H.  A.  iiiggmson,  of  L'Orignal,  has  been 
taken  ill  since  the  examination,  and  is  conse- 
quently unable  to  present  himself. 

Messrs.  James  Ross,  E.  J.  Laurin,  K.  McKenzie, 
-and  A.  D.  Struthers,  natives  of  the  Province  of 
Quebec,  have  fulfilled  all  the  requirements  for 
graduation,  but  await  the  completion  of  four  years 
from  the  date  of  passing  the  matriculation  before 
receiving  the  degree.  ' 

MEDALS,  PRIZES  AND  HONOURS. 

The  Holmes  Gold  Medal  for  the  best  examina- 
tion in  the  primary  and  final  branches  was  awarded 
to  James  Ross,  B.A.,  Dewittville,  Q. 

The  prize  for  the  best  final  examination  was 
awarded  to  John  W.  Ross,  of  Winthrop,  Ont. 
The  gold  medallist  is  not  permitted  to  compete 
for  this  prize. 

The  prize  for  the  best  primary  examination  was 
awarded  to  R.  J.  B.  Howard,  B.A.,  of  Montreal. 

The  Sutherland  Gold  Medal  was  awarded  to 
C  E.  Cameron,  of  Montreal. 

The  following  gentlemen,  arranged  in  the  order 
of  merit,  deserve  honourable  mention :  In  the 
final  examination,  Messrs.  Perks,  Heyd,  Laurin, 
Josephs,  Grey,  Shufelt  and  Rogers  ;  in  the  primary 
examination,  C.  E.  Cameron,  W.  L.  Lathern,  W 
McE.  Scott,  and  J.  Gardner. 

professors'  prizes. 

Botany. — First  prize,  G.  A.  Graham,  of  Hamil. 
ton,  Ont.,  and  E.  Gooding,  of  Barbadoes,  W.  I., 
equal.  For  the  best  collection  of  plants,  J.  ^'• 
McKee,  of  Port  Colborne,  Ont. 

Practical  Anatomy. — Demonstrator's  prize, 
awarded  to  C.  E.  Cameron,  of  Montreal. 

Dr.   K.  Mv"Kenzie    then  read   the   valedictory 


address,  and  Prof.  R.  P.  Howard  delivered  the 
address  to  the  graduating  class  on  the  part  of  the 
Faculty. 


WOOD'S  LIBRARY  OF  STANDARD  MEDI- 
CAL AUTHORS  FOR  1881. 

We  are  a  little  late  in  calling  attention  to  the 
excellent  enterprise  of  Messrs.  Wm.  Wood  &  Co., 
of  New  York,  in  their  Standard  Library  for  this 
year.  Their  list  for  1881  comprises  the  following 
valuable  works : 

I.  On  Albuminuria.  By  W.  H.  Dickinson, 
M.D. 

II.  Materia  Aledica  and  Therapeutics  of  the 
Skin.     By  Henry  G.  Piffard,  A.M.,  M.D. 

III.  i  Treatise  on  Disease  of  the  Joints.  By 
Richard  Barwell,  F.R.C.S. 

IV.  A  Treatise  on  the  Continueu  Fevers.  By 
James  C.  Wilson,  M.D.  With  an  introduction  by 
].  N.  DaCosta,  M.D. 

V.  Rheumatism,  Gcut ,  and  some  of  the  lllied 
Diseases.     By  A' orris  Longstreth,  M.D. 

VI.  A  Medical  Formulary.  By  Laurence  John- 
son, A.M.,  M.D. 

VII.  Disease  jf  the  Esophagus,  A''asal  Cavities, 
and  Neck.     By  Morrell  McKenzie,  M.D.,  London. 

VIII.  Artificial  Anesthesia  and  Anesthetics. 
By  Henry  M.  Lyman,  A.M.,  M.D. 

IX.  General  Medical  Chemistry.  A  Practical 
Manual  for  the  use  of  Physicians.  By  R.  A.  Witt- 
haus,  A.M.,  M.D. 

X.  The  Diseases  of  Old  Age.  By  J.  M.  Charcot, 
M.D.  Translated  by  L.  Harrison  Hunt,  M.D. 
With  numerous  additions  by  A.  L.  Loomis,  M.D., 
etc. 

XL  Diseases  of  the  Eye.  By  Henry  D.  Noyes, 
M.D. 

XII.  Oti  Diseases  of  the  Reproductive  and  Uri- 
nary Organs.     By  Robert  F.  Weir,  M.D. 

The  first  year  of  Wood's  Library  {^ave  excellent 
works,  and  well  published.  Those  issued  for  1880 
far  excelled  the  previous  year,  especially  in  the 
style  of  the  binding  and  the  character  of  the  press 
work.  This  year  we  are  promised  a  still  further 
improvement,  and,  judging  from  the  jtast,  the  pro- 
mise is  soon  to  be  fulfilled.  We  are  glad  to 
know  that  our  Canadian  Medical  men  have  very 
largely  purchased  this  Library  from  its  outset. 


THE  CANADA  MEDICAL  RECORD. 


Vol.  IX. 


MONTREAL,  MAY,  i88i. 


No.  8. 


ORIGINAL  COMMUNICATIONS. 

Dangerous  Inhalation  of  Nitrous 
Oxide  Gap 193 

PROGRESS  OF  MEDICAL  SCIENCE 

The  Treatment  of  Epilepsy,  194. 
— Acute  Rheumatism,  197. — 
Nervous  Dy.'^pep«ia,  201. — The 
Pulse,  201. — Summer  Diarrhoea 
of  Children,  204.  —  Nana's 
Daughter, 208.— For  Treatment 


of  Diseases  of  the  Throat  and 
Lungs,  208.— Chilblain?,  20^*.— 
Cystitis,  208.  —  Treatment  of 
Cough  in  Bronchitis  and  Phthi- 
sis, 208.  —  Cod-Liver  Oil  in 
Phthisis  and  Bronchitis,  209. — 

THE  CANADA  MEDICAL  RECORD 

The  Montreal  General  Hospital, 
209.— The  Bogus-Diploma  Bu- 
siness in  Philadelpliia,  210. — 
Another  Dodge,  210. — How  to 
Restore  tiie  Scale  of  Thermo- 


meters, 211.— Canada  Medical 
Association,  211. — A  propo.^ed 
New  Plan  to  Disinfect  Sewers, 
211.^ — Correction,  211.  —  Ergo- 
tine  :  Its  Inconveniences  and 
Dangers,  211. — Wyeth's  Elixir 
of  Phosphorus,  212.— The  Po- 
pular Science  Monthly,  212. — 
Elixir  Ferri  et  Calcis  Pho.-;ph, 
Co.,  218.  —  Gymnastics  as  & 
Cure  of  Disease,  213.— To  Pre- 
serve the  Brain,  213. — Review, 
214.— Pergonal 218 


0m6inai  BammunimUoni , 


DANGEROUS  INHALATION  OF  NITROUS 
OXIDE  GAS. 

By  Dr.  C.  E.  Nelson,  New  York. 

As  chloroform  accidents  are  reported,  I  can  see 
no  valid  reason  for  not  reporting  a  similar  event, 
in  the  case  of  inhalation  of  nitrous  oxide  gas. 
As  far  as  I  am  aware,  no  accident  in  the  case  of 
inhalation  of  nitrous  oxide  has  as  yet  been 
reported,  Dr.  Colton  alone  having  caused  it  to  be 
administered  to  more  than  122.000  without 
accident. 

The  facts  of  the  case,  in  this  paper,  are  as 
follows:  On  April  21,  my  six-year  old  boy  required 
the  extraction  of  two  carious  molars  in  the  lower 
jaw ;  he  was  accompanied  to  the  dentist's  (not  Dr. 
Colton's)  by  myself,  wife  and  a  female  domestic  ; 
not  wishing  to  see  anything  done,  in  the  case  of 
my  own  child,  I  left  the  child  in  the  dental  apart- 
ment in  charge  of  the  servant,  letting  the  child 
suppose  I  was  right  behind  him,  and  joined  my 
wife  in  the  waiting  room  ;  the  child  is  courageous, 
and  was  not  in  the  least  flurried  in  the  presence 
of  the  dentist ;  on  the  contrary,  he  obeyed  all  the 
instructions  with  alacrity  ;  I  mention  these  points 
to  show  he  was  not  frightened  in  any  way.  The 
following  account  was  afterwards  told  me  by  the 


servant ;  the  readers  of  this  journal  may  say  I 
did  not  see  the  symptoms  myself,  but  I  have  every 
reason  to  believe  the  girl's  statements  at  all  times, 
which  were  as  follows  : — The  child  took  a  few  deep 
inhalations,  when  the  face  turned  pale,  the  child 
then  cried  out,  and  all  of  a  sudden  the  face,  neck 
(back  and  front),  arms  and  hands  became  covered 
with  purple  blotches,  lips  very  dark,  face  swollen, 
eyes  protruding,  and  the  physiognomy  of  the  child 
perfectly  unrecognizable ;  arms  and  legs  moving 
rapidly  ;  the  teeth  were  extracted  with  marvellous 
rapidity ;  the  dentist  then  rubbed  the  ecchymosed 
patches,  with  the  effect  of  almost  instantaneously 
restoring  the  skin  to  its  normal  colour ;  all  this 
happened  perhaps  within  the  space  of  three 
quarters  of  a  minute.  I  then  returned  to  the 
dental  apartment,  and  saw  nothing  wrong  with 
the  child,  although  my  wife,  on  entering  before  me, 
noticed  the  dark  blue  marks  on  the  back  of  the 
neck,  leading  her  to  suppose  he  had  been  forcibly 
held,  which  was  not  the  case.  As  Shakspeare 
says,  "  all's  well  that  ends  well,"  but  the  child  was 
certainly  as  near  death  as  could  possibly  be. 

Thinking  that  this  was  an  unusual  condition  of 
persons  during  the  inhalation  of  nitrous  oxide,  I 
to-day  (April  22)  visited  Dr.  Colton,  who  very 
politely  told  me  that  in  his  large  experience  he 
had  never  noticed  it ;  that  when  a  couple  of  teeth 
are  extracted,  person  becomes  slightly  pale  ;  that 
when  up  to  fifteen  teeth  are  extracted,  some  people 
may  have  their  ears  a  little  bluish,  and  the  face  a. 


104 


TUE    CANADA    MEDICAL    RECORD. 


deep  red  with  a  slight  purplish  tinge,  such  as  you 
may  see  in  persons  who  are  out  in  the  street  on  a 
sharp,  cold  day ;  he  informed  me  also  that  no 
sense  of  suffocation  is  experienced. 

Some  years  ago,  Dr.  Carnochan  performed  an 
operation,  prior  and  during  which,  anaesthesia 
was  produced  by  the  nitrous  oxide,  administered 
by  Dr.  Collon,  but  I  suppose  not  pushed  to  the 
full  extent,  as  in  extraction  of  teeth  ;  the  patient, 
a  lady,  was  under  the  influence  during  some  little 
time,  perhaps  a  quarter  of  an  hour  ;  my  father,  the 
late  Dr.  Robert  Nelson,  was  present ;  said  nothing 
about  the  skin  being  blue,  but  remarked  that  the 
finger-nails  were  bluish,  which  he  regarded  as  a 
very  dangerous  sign  ;  this  was  observed  in  a 
marked  degree  yesterday  in  the  case  of  my  child. 


^m^ftvAiof  JtUdkui  iSmme. 


THE  TREATMENT  OF  EPILEPSY. 

Dr.  W.  R.  Gowers  concluded  his  recent  course 
ofGulstonian  Lectures  before  the  Royal  College  of 
Physicians  with  the  following  interesting  remarks 
on  the  treatment  of  epilepsy  : 

The  treatment  of  epilepsy  is  a  subject  on  which 
numerical  analysis  gives  little  help.  A  large  num- 
ber of  cases  are  under  observation  too  short  a 
time  to  enable  the  effect  of  remedies  to  be  fairly 
estimated ;  and  of  the  cases  in  which  benefit  is  de- 
rived, we  have  no  means  of  ascertaining  how  many 
relapse  when  treatment  is  discontinued.  My 
notes  of  the  result  of  treatment  in  this  series  of 
cases  extend  to  562  cases  only.  In  the  re- 
mainder, either  the  period  of  observation  was  too 
.short  for  just  conclusions  to  be  drawn,  or,  in  the 
press  of  out-patient  work,  the  influence  of  reme- 
dies was  not  noted  with  sufficient  precision.  The 
effect  of  treatment  is  more  likely  to  be  recorded 
when  it  is  distinct  and  considerable  than  when  it 
is  slight.  Hence  the  following  figures  have  no  re- 
lative value.  Of  the  562  cases,  the  attacks  ceased 
while  the  treatment  was  maintained  in  241  ; 
doubtless  many  of  these  relasped  when  treatment 
was  discontinued,  but  in  a  few  I  have  been  able 
to  ascertain  that  the  patients  remained  free  from 
fits  even  for  years  after  they  ceased  to  take  medi- 
cine. In  266  cases  improvement  short  of  arrest 
was  obtained  ;  the  fits  being  reduced  in  many  to 
i,  30^  ?o ,  and  even  jo',,  of  their  former  frequency. 
In  55  cases  little  imjirovement  was  obtained  by  any 
method  of  t.e  t  nent. 

Time   forbids  me  to  enter  at  any  length  on  the 

details  of  treatment,  and  I  can  do  little  more  than 

mention  the  remedies  which  in  this  series  of  cases 

were  of  most  distinct  service.  The  subject  of  pos- 

ible  modes  of  action  it  is  better  to  leave   almost 


untouched.  It  may  be  doubted  whether  a  rationa? 
therapeutics  of  epilepsy  is  yet  possible.  At  any 
rate,  up  to  the  present  time,  remedies  used  empiri- 
cally have  been  of  most  service. 

Although  the  results  shown  that  we  must  not 
only  rely  exclusively  upon  bromides  in  our  treat- 
ment of  epilepsy,  they  show  also,  as  might  be  ex- 
pected, that  on  these  our  chief  trust  must  still  be 
placed.  Of  the  arrests  of  fits,  66  per  cent.,  and 
of  the  improvements  short  of  arrest,  62  per  cent., 
were  due  to  bromides,  given  alone.  Of  the  three 
alkaline  salts  of  bromine,  that  of  potassium  de- 
serves, I  think,  as  it  has  popularly  received,  the 
first  place.  I  have  made  a  careful  comparison 
between  the  salt  of  sodium  and  potassium  in  a 
series  of  about  fifty  cases,  substituting  the  one  for 
the  other.  In  a  few  cases  the  sodic  salt  appeared 'i' 
to  do  better  ;  in  the  great  majority  it  was  distinct- 
ly less  useful.  Bromide  of  ammonium  possesses 
slightly  more  power  than  bromide  of  potassium, 
but  this  is  not  greater  than  the  larger  quantity  of 
bromine  which  it  contains  will  account  for. 

The  period  after  its  administration  at  which  the 
maximum  effect  of  a  dose  of  bromide  is  obtained 
varies,  I  believe,  with  the  dose.  The  larger  the 
dose  the  longer  is  the  maximum  effect  deferred  ; 
the  smaller  the  dose  the  sooaer  does  it  occur,  and 
the  sooner  is  its  action  over.  When  small  doses 
are  employed  in  cases  in  which  attacks  occur  at 
regular  times,  they  should  not  therefore  be  given, 
more  than  two  or  three  hours  before  the  attack 
is  expected.  This  is  contrary  to  some  opinions 
which  have  been  expressed,  but  I  have  several 
times  known  attacks  arrested  when  a  dose  was  given 
some  two  or  three  hours  before  the  fit  was  expected, 
which  were  not  arrested  when  the  same  dose  was 
given  twelve  hours  earlier. 

The  effect  of  bromide  upon  fits  appears  to  be 
for  a  time  cumulative,  just  as  is,  indeed,  its  action 
in  causing  bromism.  Attacks  may  continue 
under  its  administration  for  a  time,  and  yet  ulti- 
mately cease  without  any  increase  in  the  dose. 
On  the  other  hand,  still  later,  tolerance,  or  rather 
indifference,  maybe  established,  and  attacks  which 
have  been  for  a  time  arrested  may  ultimately 
recur. 

Drugs  which  increase  reflex  action,  such  as^ 
strcyhnia,  are  now  believed  to  do  so  by  lessening 
the  resistance  in  the  nerve-centres  involved.  Bro- 
mide diminishes  reflex  action,  antagonizes  strychnia, 
and  it  is  probable  that  it  does  so  by  increasing 
the  resistance  in  the  centres.  If  the  view  above 
expressed  be  correct,  that  the  morbid  state  in  epi- 
lepsy is  essentially  an  instability  of  the  resistance  in 
the  cells,  it  is  also  probable  that  bromide  acts  by 
increasing  the  stability  of  this  resistance. 

Bromide  is  commonly  administered  in  a  contin- 
uous course,  in  such  moderate  doses  as  will  just 
suffice  to  keep  the  fits  in  check.  Given  thus  it 
needs  to  be  given  frequently.  I  have  more  than 
once  observed  that  a  daily  quantity  which  given 
in  two  doses  did  not  quite  arrest  the  fits,  arrested 
them  completely  when   given  in  three  doses,     li. 


TUE    CANADA   MEDICAL    RECORD. 


196 


therefore,  the  greater  convenience  of  infrequent 
doses,  one  or  two  daily,  is  preferred,  a  somewhat 
larger  quantity  needs  to  be  given. 

When  bromide  is  thus  given  continuously,  it 
has  not  seemed  to  me  desirable  to  increase  the 
daily  dose  beyond  a  drachm  or  a  drachm  and  a 
half.  If  this  does  not  arrest  the  fits,  I  have 
very  rarely  found  that  larger  doses  succeed  so 
well  as  the  combination  of  bromide  with  other 
drugs.  But  it  is  I  think  open  to  question  whether 
this  method  of  administration,  using  doses  only 
just  sufficient  to  arrest  the  fits,  is  the  wisest  in  all 
■cases.  If  bromide  cures  epilepsy,  as  without 
doubt  it  does  sometimes,  it  must  be  by  effecting  a 
nutritive  change  in  the  nerve-cells  corresponding  to 
its  action,  whereby  they  are  rendered  permanently 
more  stable.  That  it,  or  any  other  drug,  does 
good  in  epilepsy  by  influencing  the  vascular  state 
of  the  brain,  appears  to  me  without  even  probable 
proof.  Even  if  such  were  its  action,  we  are  only 
driven  back  to  similar  influence  in  increasing  the 
stability  of  the  cells  of  the  vaso-motor  centre. 
There  are,  I  think,  many  grounds  for  the  belief 
that  the  change  in  the  nutrition  of  the  cells  may 
be  produced  more  effectually  by  subjecting  the 
})atienty"^r  a  time  to  the  full  influence  of  bromide, 
giving  doses  much  larger  than  are  needed  to  ar- 
rest the  fits,  in  the  hope  of  producing  more  read- 
ily a  permanent  nutritive  change.  In  giving  bro- 
mide thus  I  have  preferred  large  doses  at  inter- 
vals of  two  or  three  days,  gradually  increasing 
the  dose  until  it  is  as  large  as  can  be  well  borne, 
and  then  diminishing  it.  The  largest  single  doses 
which  I  have  given  in  this  way  have  been  doses 
of  one  ounce.  This  in  some  patients  produces 
•slight  stupor,  sometimes  reaching  its  maximum 
on  the  second  day  after  the  dose.  In  other  cases  it 
produces  very  little  disturbance  beyond  headache. 
From  the  marked  differences  which  patients  pre- 
sent in  their  tolerance,  it  is  not  well  to  begin  this 
method  of  treatment  with  a  larger  dose  than  four 
drachms. 

The  value  of  the  various  combinations  of  bro- 
mide with  other  drugs  was  tested,  as  far  as  possi- 
ble, on  a  uniform  plan.  First,  bromide  was 
^iven  alone  for  several  months,  and  then  an  addi- 
tional drug  was  added  to  the  same  dose  of  bro- 
mide, and  the  result  watched  for  several  months 
longer.  Of  the  various  combinations  which  are 
in  common  use,  those  with  digitalis  and  bella- 
donna unquestionably  deserve,  as  they  have  com- 
monly received,  the  first  place.  Digitalis  is  one 
of  the  oldest  remedies  for  epilepsy.  It  was  re- 
commended by  Parkinson  two  hundred  years  ago, 
and  has  been  perhaps  for  a  still  longer  time  a  popu- 
lar remedy  for  this  disease  in  certain  rural  districts 
in  the  west  of  England.  I  have  met  with  no  case 
in  which,  given  alone,  digitalis  arrested  the  fits  for 
more  than  a  few  months,  in  several  cases  it  effected 
very  distinct  improvement.  The  combination  of  digi- 
talis and  bromide,  however,  was  distinctly  more 
useful  than  bromide  only,  in  no  less  than  sixty-three 
cases.  In  more  than  half  of  these  thirty-seven  cases, 


the  attacks  ceased  under  its  use,  although  they  had 
continued  under  bromide  alone.  In  the  cases  in 
which  cardiac  disturbance  was  associated,  the 
combination  was  almost  always  superior  to  bro- 
mide alone ;  but  its  use  is  not  confined  to  these 
cases.  Many  cases  of  nocturnal  and  other  forms 
of  epilepsy  yielded  to  the  combination,  although  the 
attacks  had  continued  under  bromide,  and  this 
when  there  was  no  evidence  of  cardiac  disease. 
I  know  of  one  patient  with  nocturnal  epilepsy  who, 
for  two  years  under  this  combination,  has  not  had 
a  single  fit,  although  the  attacks  occurred  every 
{t\s  weeks  on  bromide  only. 

In  rare  cases  belladonna  alone  will  arrest  attacks. 
I  have  met  with  only  one  case  in  which  attacks, 
which  continued  on  bromide,  ceased  entirely  when 
belladonna  was  substituted,  and  this  was  a  case 
with  hystero-epileptic  symptoms.  The  combina- 
tion of  bromide  and  belladonna,  however,  was  dis- 
tinctly better  than  bromide  alone  in  35  cases,  and 
in  15  of  these  arrest  of  the  fits  was  thus  obtained. 

Indian  hemp  was  first  employed  in  epilepsy  by 
Dr.  Reynolds,  and  is  sometimes  of  clear  value. 
In  one  case  the  attacks  were  invariably  arrested 
for  many  months  by  its  use,  recurring  only  when 
the  patient  ceased  attendance,  but  twice  on 
his  resuming  attendance  the  drug  instantly  arrest- 
ed the  attacks.  When  bromide  was  substituted 
for  the  Indian  hemp,  the  attacks  at  once  recurred. 
Combined  with  bromide  it  is  also  sometimes  useful, 
and  seems  to  exercise  most  influence  over  attacks 
in  cases  in  which  thefe  is  persistent  headache.  The 
same  fact  has  seemed  true  of  the  combination  with 
gelseminum,  which  is  occasionally  of  marked  ser- 
vice. 

The  use  of  opium  in  epilepsy  has  long  been 
advocated  by  Dr.  Radcliffe,  and  in  some  cases  it  is 
certainly  effective.  The  combination  of  bromide 
and  morphia  I  have  rarely  found  to  present  spe- 
cial advantages.  In  the  status  epilepticus  in 
which  attacks  occur  with  great  frequency  and 
severity,  and  where  bromide,  even  in  large  doses, 
was  useless,  I  have  found  small  hypodermic 
injections  of  morphia  of  great  service. 

The  combination  of  bromide  with  aconite  and 
hydrocyanic  acid  I  have  also  tried,  and  found  it  in 
some  cases  slighdy  better  than  bromide  only. 
The  addition  of  iodide  to  bromide  has  been  lately 
said  to  increase  its  effect.  Occasionally  this  is 
true,  and  in  four  cases  of  the  series  the  combination 
was  distinctly  better  than  bromide  only,  but  in 
manyother  cases  it  was  in  effective.  Even  in  the 
cases  the  subjects  of  inherited  syphilis  it  has  not 
appeared  of  special  value. 

Zinc  unquestionably  deserves  some  of  the  repute 
it  has  enjoyed  for  more  than  a  hundred  years  as  an 
anti-epileptic.  Of  the  cases  of  this  series  in 
which  it  was  employed  it  was  distinctly  useful  in 
ten,  but  in  only  three  did  the  attacks  cease.  In 
three  other  cases  attacks  which  continued  under 
bromide  ceased  under  bromide  and  zinc,  and  in  a 
fourth  they  ceased  under  zinc,  digitalis,  and  bro- 
mide. The  oxide  of  zinc  was  the  form  commonly 


1Q6 


THE    CANADA    MEDICAL   RECORD. 


employed.  Its  nauseating  influence  constitutes  a 
serious  drawback  to  its  use,  as  toleration  is  diffi- 
cult to  establish,  and  I  have  rarely  succeeded  in 
giving  more  than  twenty  grains  a  day.  Bromide 
of  zinc  has  seemed  of  small  value,  and  is  borne 
badly.  The  addition  of  arsenic  to  bromide  in  no 
case  produced  any  marked  effect  on  the  attacks. 
It  was  used  in  a  large  number  of  cases  on  ac- 
count of  the  readiness  with  which,  it  was  found, 
the  bromide  rash  could  be  prevented  by  its  use. 

Bromide  of  camphor,  highly  praised  by  Bourne- 
viile,  was  tried  in  a  considerable  number  of  cases, 
but  without  any  good  results.  Turpentine  has 
been  recommended  by  Dr.  Radcliffe,  and  I  have 
seen  it  produce  very  striking  benefit,  but  only  in 
cases  of  hystero-epilepsy. 

The  use  of  iron  in  epilepsy  has  been  discoun- 
tenanced by  high  authorities,  on  grounds  which 
are  not  altogether  beyond  question.  In  rare  cases 
it  increased  the  frequency  of  attacks ;  in  the 
majority  of  cases  in  which  it  was  used  it  was  borne 
without  any  ill  result ;  in  many  the  addition  of  iron 
to  bromide  was  attended  with  a  marked  and  per- 
manent improvement,  and  in  some  cases  iron  alone 
arrested  the  fits.  The  series  includes  4  cases 
which  ceased  under  iron  only,  and  8  others  in 
which  iron  alone  was  distinctly  better  than  bro- 
mide, and  19  cases  in  which  the  addition  of  iron 
to  bromide  exercised  a  marked  influence.  In  no 
less  than  1 1  cases  attacks  which  persisted  on  bro- 
mide, ceased  on  the  addition  of  iron, and  remained 
absent  as  long   as   the  treatment  was  continued. 

In  several  inveterate  cases  of  epilepsy  in  which 
bromide  had  no  effect,  I  have  tried  borax.  In 
some  cases  it  did  no  good,  but  in  1 2  its  value  was 
most  distinct.  I  may  mention  one  or  two.  In 
one,  fits  which  had  continued  on  bromide  and  on 
zinc  ceased  entirely  on  borax  for  three  months, 
and  then  only  recurred  when  the  medicine  was 
discontinued.  In  another  case  the  fits  continued, 
about  one  weekly,  during  three  months'  treatment 
on  bromide  and  on  belladonna.  Borax  was  then 
substituted,  the  fits  at  once  ceased,  and  for  five 
months  the  patient  had  not  a  single  fit  ;  then  he 
had  one  in  each  of  the  two  following  months  ; 
the  dose  of  borax  was  increased,  and  up  to  the 
present  time,  eight  months  later,  no  other  attack 
has  occurred.  In  a  third  case,  one  or  two  attacks 
occurred  once  a  fortnight  on  bromide.  Borax 
was  substituted,  and  for  five  months  the  patient 
had  not  a  single  fit.  The  doses  given  have  been 
ten  or  fifteen  grains  twice  or  three  times  a  day. 
It  produces  in  some  patients  gastro-intestinal  dis- 
turbance, and,  rarely,  a  form  of  dysenteric  diarrhcca. 
By  others  it  is  well  borne,  and  one  of  my  patients 
has  taken  forty- five  grains  a  day  for  twelve  months 
without  the  slightest  inconvenience,  and  says  that 
no  medicine  has  ever  done  him  so  much  good.  In 
cases  in  which  bromide  fails,  borax  certainly  de- 
serves a  trial. 

The  use  of  cocculus  indicus  in  epilepsy,  recom- 
mended by  Uujardin-Beaumetz,  has  lately  attracted 
attention,  in   consequence    of  the    recommenda- 


tion of  Planat.  I  have  tried  the  alkaloid  picrotox- 
xine  in  a  few  instances,  but  only  in  one  case  has  it 
appeared  to  do  good.  My  own  experience  of  its  use 
has,  however,  been  small,  and  I  am  very  much 
indebted  to  my  colleague.  Dr.  Ramskill,  for  per- 
mitting me  to  mention  some  interesting  results 
which  he  has  obtained  by  the  hypodermic  injection 
of  picrotoxine.  His  experience  of  its  effect  on 
the  fits  when  given  through  the  skin  is  nearly  the 
same  as  my  own  of  its  employment  by  the  mouth. 
In  seven  cases  in  which  it  was  injected,  in  daily 
doses  of  from  one  to  four  milligrammes,  no  benefi- 
cial result  was  obtained ;  in  most  cases,  indeed,, 
the  attacks  were  rather  more  frequent  and  severe 
Of  course,  we  are  not  justified  in  assuming  that  the 
effects  of  picrotoxine  and  of  the  cocculus  indicus- 
itself  are  identical.  A  very  interesting  fact  has, 
however,  been  ascertained  by  Dr.  Ramskill — viz., 
that  picrotoxine  in  larger  doses  of  from  fifteen  to 
eighteen  milligrames  will  almost  invariably  produce 
a  fit  in  twenty  or  thirty  minutes.  In  one  patient,, 
for  instance  (according  to  the  notes  of  Mr. 
Broster,  who  carried  out  the  experiments),  the 
dose  was  daily  increased,  and  when  more  than  five 
milligrammes  were  injected,  a  sensation  of  giddi- 
ness followed,  similar  to  that  with  which  the 
attacks  commenced.  The  same  effect  followed 
larger  injection8,and  when  the  dose  reached  eighteen 
milligrammes  a  severe  attack  occurred  thirty  min- 
utes later,  and  an  attack  always  followed  the  injec- 
tion of  this  dose.  In  another  patient  a  similar  pro- 
gressive increase  of  the  dose  was  followed  by  giddi- 
ness and  headache,  when  eight  milligrammes  were 
injected.  When  the  dose  of  fifteen  milligrammes 
was  reached,  a  severe  epileptic  fit  followed.  Next 
day  a  second  dose  of  fifteen  milligrammes  did  not 
cause  a  fit,  but  eighteen  milligrammes,  two  days 
later,  caused  a  fit  in  half  an  hour.  After  a  week's  in- 
termission twenty-four  milligrammes  were  injected, 
and  a  severe  fit  occurred  in  twenty-five  minutes.  In 
a  third  patient  a  fit  occurred  after  one  injection  of 
eight  milligrames,  but  ten  milligrammes  next  day 
caused  no  fit.  Fifteen  milligrammes,  however,  were 
followed  by  a  fit  in  thirty  minutes,  and  a  second 
injection  of  the  same  dose  the  following  day  caused  a 
fit  in  fifteen  minutes.  Seventeen  milligrammes  next 
day  caused  a  fit  in  thirty  minutes.  In  a  fourth 
patient  a  single  dose  of  eighteen  milligrammes 
caused,  in  ten  minutes,  giddiness  and  slight  dazzling 
before  the  eyes,  and  in  thirty  minutes  there  occurred 
the  usual  aura  of  an  attack — a  sensation  of  something 
creepmg  up  the  right  arm  to  the  top  of  the  head,  and 
numbness  and  twitching  in  the  right  thigh,  but  no 
fit  followed,  although  the  patient  was  stupid  and 
dull  for  a  time  just  as  alter  a  fit. 

Among  other  drugs  which  I  have  tried  and 
found  useless  I  may  mention  benzoate  of  soda  and 
nitro-glycerine. 

In  hystero-epilepsy  bromides,  sometimes  useful, 

fail  entirely  much  more  frequently  than  in  simple 

epilepsy,  and  the  combinations  with  digitalis  and 

belladonna  are  also  less  frequently  useful.     Iron, 

i  especially  guarded  by  aloes,  is  often  of  the  highest 


THE   CANADA    MEDICAL    RECORD. 


197 


^alue,  quite  apart  from  the  existence  of  anaemia, 
and.  next  to  it,  valerianate  of  zinc,  morphia,  and 
turpentine. 

High  authorities  have  urged  on  different  grounds 
that  the  diet  of  epileptics  should  contain  little  orno 
animal  food.  In  a  few  observations  which  I  have 
made  by  keeping  a  patient  under  unaltered  medi- 
cinal treatment  for  alternate  periods  on  a  diet 
with  and  without  animal  food,  I  could  observe  no 
difference  in  the  attacks,  except  that  in  one  patient 
they  were  slightly  more  frequent  in  the  periods 
when  animal  food  was  excluded,  and  in  one  patient 
hystero-epileptic  attacks  on  ordinary  diet  became, 
when  meat  was  excluded,  severe  epileptic  fits, 
and  again  became  hystero-epileptic  when  ani- 
mal food  was  restored. 

In  pure  epilepsy  the  only  treatment  needed 
■during  the  attacks  is  such  care  as  shall  secure  the 
patient  as  far  as  possible,  from  injury.  It  is  very 
different  with  the  attacks  of  hystero-epilepsy,  which, 
from  their  character,  severity,  and  long  duration, 
often  furnish  the  attendants  with  a  task  of  no 
small  difficulty,  and  which  can  almost  always  be 
cut  short  by  appropriate  treatment.  The  patients 
often  hurt  themselves  during  the  attacks,  and  some 
control  is  absolutely  necessary.  But,  as  already 
stated,  restraint  tends  to  increase  the  violence  and 
makes  the  paroxysm  last  longer.  Hence  consider- 
able judgment  is  often  required,  so  to  adjust  con- 
trol as  to  be  efficient,  and  not  too  much.  I  have 
seen  these  patients  put  within  padded  partitions 
and  left  alone,  but  I  have  never  myself  found  this 
necessary. 

The  slighter  attacks  can  be  arrested  by  closing 
the  mouth  and  nose  with  a  towel  for  some  thirty 
seconds,  after  Dr.  Hare's  method.  The  profound 
effect  on  the  respiratory  centre,  and  the  related 
higher  centres,  caused,  by  the  anoxaemia,  seems 
to  arrest  the  convulsive  action.  Cold  water  over 
the  head  is  often  successful,  if  applied  freely ;  in 
severe  attacks  a  moderate  quantity  only  excites 
redoubled  violence,  while  a  second  gallon  is  often 
more  effectual  than  the  first.  This  has  the  disad- 
vantage of  drenching  the  patient's  head  and  often 
giving  cold.  When  the  mouth  is  open  during  the 
attacks  a  small  quantity  of  water  poured  into  it  is 
often  effectual.  A  much  more  convenient  and  more 
effectual  remedy  than  water,  however,  is  strong  fara- 
dization to  the  skin  ;  applied  almost  anywhere  it 
will  commonly  quickly  stop  the  attack.  It  is  rare 
that  ovarian  pressure  will  arrest  an  attack.  In 
some  cases  all  these  means  fail,  even  when 
thoroughly  used,  and  I  have  known  such  attacks  go 
on,  in  spite  of  skilled  treatment,  for  several  hours. 
Chloroform  is  of  little  use  ;  its  administration  is  a 
matter  of  extreme  difficulty,  often  impossibility, 
and  the  attack  is  commonly  renewed,  when  the  in- 
fluence of  the  anaesthetic  passes  off.  The  remark- 
able effect  of  nausea  in  relaxing  spasm,  led  me 
some  years  ago  to  try  the  effect  of  injections  of 
apomorphia,  and  I  have  found  in  it  an  unfailing 
means  of  arresting  the  attacks.  After  the  injec- 
tion of  a  twelfth  of  a  grain  in  four  minutes  with  cer- 


tainty all  spasm  ceases,  and  normal  consciousness 
is  restored  ;  in  six  minutesthe  patient  will  get  up 
and  go  to  the  sink  ;  in  eight  minutes  will  vomit,  and 
afterwards,  except  for  slight  nausea,  is  well.  A 
twentieth  of  a  grain  has  the  same  action,  but  is 
rather  longer  in  its  operation.  Moreover,  I  have 
found  that  the  treatment  is,  so  far  as  the  hysteroid 
symptoms  are  concerned,  curative  as  well  as  pal- 
liative, for  the  attacks  in  many  cases  ceased  after  a 
few  paroxysms  had  been  thus  cut  short. — Lancet, 


ACUTE  RHEUMATISM. 

[A  Clinical  Lecture  at  the  Louisville  City  Hospital.] 

By  John  A.  Octerlony,  A.M.,  M.D., 

Professor  of  Theory  and  Practice  of  Medicine  in  the  Kentucky 

School  of  Medicine. 

[Reported  by  A.  H.  Kelch,  Stenographer.] 

Gentlemen  : — I  wish  to  speak  to  you  this  after- 
noon about  acute  rheumatism  as  illustrated  in  the 
patient  we  have  before  us.  This  young  man  has 
had  one  attack  after  another  of  acute  rheumatic 
fever.  "  Inflammatory  rlieumatism  is  a  term  that 
has  been  given  to  a  number  of  affections  that  are 
characterized  by  fever,  an  affection  of  the  joints 
and  fibrous  tissues,  and  which  are  not  produced  by 
injury,  nor  due  to  gout,  nor  to  pyemia,"  and  this 
is  perhaps  as  good  a  definition  as  we  could  give. 
We  may  add  that  acute  rheumatism  depends  upon 
a  peculiar  condition  of  the  blood,  and  is  often  ex- 
cited by  some  cause  that  for  the  time  being  lowers 
the  vitality  of  the  system.  There  is  no  doubt  that 
rheumatism  of  the  variety  I  now  allude  to  is  a 
blood  disease  ;  that  it  affects  especially  the  larger 
articulations ;  that  it  attacks  the  fibrous  and  the 
fibro-serous  tissues ;  that  it  is  attended  by  fever  ; 
and  that  when  left  to  itself  it  runs  a  rather  uncer- 
tain course.  A  tendency  to  recovery  is  certainly 
observed,  for  persons  get  well  when  nothing  is 
done  for  them,  and  they  get  well  sometimes  quick- 
ly enough  when  they  are  honestly  treated  with  ho- 
moeopathic medicine,  and  of  course  the  nominal 
medication  receives  the  credit.  Shrewd  and  un- 
scrupulous homoeopathists  give  rational  medicine, 
and  homceopathy  gets  the  credit,  as  well  as  the 
homoeopathist,  which  is  due  to  rational  medicine. 

The  tendency  to  run  a  certain  course  is  so  well 
known  that  long  ago,  before  the  treatment  for  rheu- 
matism was  as  successful  as  it  now  is,  it  used  to 
be  said  that  the  best  remedy  for  rheumatism  was 
"  six  weeks,"  for  experience  had  shown  that  it  took 
about  that  length  of  time  to  run  its  course. 

I  believe  when  the  patient  is  left  to  nature, 
given  the  simple  conditions  of  good  hygienic  sur- 
roundings, that  the  disease  will  often  be  fovmd  to 
nui  a  much  shorter  course  than  six  weeks.  It  is 
very  certain  that  the  average  duration  of  the  disease 
at  the  present  time  will  be  found  to  be  very  much 
less. 

It  is  very  frequently  developed  after  exposure  t 


198 


THE    CANADA    MEDICAL    RECORD. 


cold  ;  or  when  the  individual  is  debilitated  by  some 
disease,  such  as  scarlet  fever  or  some  other  trouble  ; 
when  owing  to  bad  food  or  depressing  influences 
wrich  reduce  the  system  below  par.  ]}ut  not  all 
persons  exposed  to  these  influences  will  fall  victims 
to  acute  rheumatism.  So  we  are  forced  to  admit 
that  the  system  must  be  in  a  peculiar  condition ; 
these  must  be  something  beyond  the  mere  exciting 
caure,  and  that  has   been   called   the  rheumatic 

ahesis,  which  makes  a  person  liable  to  attacks 
of  theumatism  on  exposure  to  any  of  these  causes. 

Among  predisposing  causes,  heredity  plays  a 
very  important  part.  Persons  of  rheumatic  stock 
are  more  liable  to  this  disease  than  those  who  come 
of  parentage  free  from  it.  Persons  who  have  had 
one  attack  are  very  liable  to  have  another.  I  do 
not  believe  exactly  that  one  attack  of  rheumatism 
predisposes  to  another,  for  that  peculiar  condition 
of  the  system  which  led  to  the  first  attack  will  also 
make  the  patient  liable  to  a  second  or  a  third, 
'ihere  is  really  nothing  in  the  attack  of  rheuma- 
tism itself,  except  that  it  lowers  the  vitality  of  the 
system,  that  can  be  looked  upon  as  predisposing 
to  another  attack. 

The  disease  began  as  follows  :  This  man  tells 
us  he  felt  cold  ;  then  he  had  fever.  Sometimes  a 
distinct  chill  is  first  experienced.  In  this  first 
attack  the  disease  was  confined  to  the  knee-joints. 
It  is  a  notable  fact  the  rheumatism  affects  by  pre- 
ference the  larger  joints.  Another  peculiarity  of 
the  affection  is  that  it  flits  about.  I  know  of  no 
disease  that  furnishes  a  better  illustration  of  what 
has  Deen  called  metastosis.  It  affects  one  joint, 
which  swells  up  and  becomes  tender  and  painful — 
becomes  the  seat  of  excruciating  suffering  and  of 
a  really  violent  inflammation,  and  as  if  by  magic  it 
disappears  in  a  few  hours  or  in  a  night,  simply  to 
transfer  itself  to  another  joint,  frequently  the  cor- 
responding joint  upon  the  opposite  side,  or  from 
the  knee  to  the  shoulder,  and  so  on.  These  joints 
then  in  their  turn  become  swollen,  red,  and  tender. 
'J'he  pain  is  often  greatly  aggravated  by  the  slight- 
est provocation,  even  by  some  one  walking  across 
tlie  floor. 

You  must  not  always  expect  that  because  the 
disease  attacks  a  new  joint  there  will  be  a  speedy 
subsidence  in  the  joint  first  affected.  The  disease 
may  affect  all  the  joints  at  the  same  time  so  as  to 
render  the  individual  helpless. 

Along  with  this  affection  of  the  joints  there  is 
high  fever,  as  there  was  in  this  case.  This  some- 
times runs  as  high  as  105°  ;  sometimes  indeed  we 
have  hyperpyrexia,  as  it  is  called,  in  which  the 
temjierature  has  been  known  to  run  as  high  as 
1 1 2^,  but  these  are  rare  exceptions  which  you  may 
never  witness  although  you  pass  a  long  life  in 
active  practice.  'I'he  fever  is  usually  remittent. 
There  is  an  exacerbation  in  the  evenin<^  and  to- 
ward morning  a  remission,  but  it  does  not  run  as 
regular  a  course  as  we  observe  in  typhoid  fever. 
It  is  not  characterized  by  regular  excursions,  as  in 
acute  pneumonia,  but  it  varies  very  much  for 
several  reasons.      First  of  all,  each   invasion  of  a 


new  joint  will  be  characterized  by  a  rise  of  tem- 
perature. Any  complication  will  be  accompanied 
by  it.  Sometimes  you  will  find  that  the  first  evid- 
ence of  the  disease  is  not  an  affection  of  this  or 
that  joint,  but  a  rheumatic  inflammation  of  the 
heart.  I  do  not  remember  having  witnessed  such 
a  case,  but  it  is  well  known  that  the  cardiac  in- 
flammation may  be  the  only  evidence  of  the  rheu- 
matic diathesis  at  the  time.  For  instance,  a  man 
has  had  an  attack  of  inflammatory  rheumatism  and 
passed  through  it  without  any  cardiac  complication. 
A  few  months  after  that  he  is  attacked  again,  and 
this  time  it  is  not  the  joints  but  simply  the  peri- 
cardium or  endocardium  that  is  the  seat  of  the 
inflammation  ;  and  after  this  has  existed  for  a  few- 
days,  then  lo,  and  behold,  a  joint  affection  sets  in. 
This  or  that  joint  becomes  tender,  swollen,  red, 
and  painful,  and  we  have  now  a  typical  case  of 
acute  articular  rheumatism.  The  tongue  is  usually 
coated,  the  appetite  wanting,  the  bowels  constipat- 
ed, and  the  urine  scanty  and  loaded  with  urates. 
You  must  make  the  distinction  between  these  and 
uric  acid.  Even  so  far  as  gross  appearances  are 
concerned  this  is  easily  done.  Uric  acid  lies  at  the 
bottom  of  the  vessel  like  fine,  glistening  sand.  It 
does  not  stain  the  bottom,  and  when  you  tip  it  up 
you  see  the  uric  acid  roll  over.  When  you  have  a 
deposit  of  lithates  the  vessel  is  stained  by  it  of  a 
brick-dust  or  pinkish  color,  and  while  we  find  the 
uric  acid  as  soon  as  it  has  had  time  to  settle,  the 
lithates  do  not  appear  until  the  urine  cools.  Some- 
times the  urine  is  muddy  when  it  is  first  passed. 
This  is  not  infrequently  the  case  when  the  patient 
drinks  but  little,  when  the  skin  is  over-active,  and 
when  there  is  high  fever  ;  but  even  then  we  do  not 
notice  the  staining  of  the  vessel  until  after  the  urine 
has  stood  for  some  time. 

The  skin  as  a  general  thing  is  bathed  in  sour- 
smelling  perspiration.  I  do  not  believe  that  the 
perspiration  really  is  more  acid  in  reaction  than  in 
health,  but  the  acid  is  peculiar.  It  gives  a  very 
sour  and  unpleasant  odor,  and  is  in  greater  abun- 
dance, simply  because  of  the  increased  perspiration, 
and  we  are  likely  to  presume  that  the  latter  is  more 
intensely  acid.  Another  thing  to  be  noticed  is  that 
the  sweating  gives  no  relief  to  the  fever.  In  acute 
rheumatism  the  symptoms  are  in  no  way  alleviated 
by  the  free  perspiration,  but,  on  the  contrary,  the 
more  severe  the  rheumatic  fever  the  more  perspir- 
ation there  is  apt  to  be.  The  popular  opinion  is 
that  when  a  patient  sweats  freely  he  can  have  no 
fever  ;  that  free  perspiration  indicates  a  condition 
of  the  system  the  very  opposite  to  that  of  fever. 
This  is  a  great  mistake.  For  instance,  in  some 
forms  of  i)uerperal  fever,  where  the  temperature 
runs  very  high  indeed,  the  surface  is  bathed  in 
coi'ious  sweats.  In  that  condition  of  far-advanced 
phthisis  when  we  have  constant  hectic  fever  the 
surface  is  bathed  in  drenching  sweats — the  thermo- 
meter in  the  axilla  showing  a  high  temperature  in- 
deed. So  we  find  in  rheumatism,  also,  that,  though 
there  is  copious  persjMralion,  this  in  no  way  abates 
the  affection  nor  in  any  way  lessens  the  intensity 
of  the  fever. 


THE   CANADA   MEDICAL    RECORD. 


199 


The  pain  is  often  terrible.  The  patient  can  not 
sleep ;  he  is  tormented  by  pains  both  day  and 
night.  In  consequence  of  the  high  fever,  the  loss 
of  sleep  and  appetite,  and  impaired  digestion,  and 
constant  suffering,  there  is  rapid  loss  of  flesh. 

The  remedies  for  rheumatism  are  as  numerous 
as  those  employed  for  hooping-cough. 

First  of  all,  you  want  to  relieve  pain  ;  secondly, 
you  want  to  shorten  the  disease ;  and,  tliird,  to  pre- 
vent complications. 

How  shall  you  relieve  pain  ?  There  are  two  ways 
of  doing  it ;  one  is  by  internal  remedies,  the  other 
by  external  applications.  For  the  relief  of  pain  the 
internal  use  of  opium  in  some  form  is  necessary, 
and  the  proper  thing  to  do  is  to  administer  an 
opiate  without  delay  if  the  pain  is  at  all  severe  ; 
■certainly  you  ought  to  give  it  at  bedtime  so  as  to 
secure  rest  and  sleep.  A  hypodermic  injection  is 
perhaps  the  speediest  and  surest  way  to  accomplish 
that  result.  A  quarter  of  a  grain  of  morphine  at 
bedtime  will  often  give  the  patient  a  comfortable 
night's  sleep  and  will  allay  the  pain.  I  think  it 
■decidedly  preferable  to  the  administration  of  opium 
by  mouth.  Secondly,  combine  with  the  morphine, 
atropia.  By  so  doing  you  prevent  some  of  the  un- 
pleasant effects  of  the  morphine,  and  obtain  all  its 
good  effects.  If  the  perspirations  are  very  co- 
pious and  debilitating,  I  am  sure  it  is  an  object  to 
relieve  them.  That  can  be  done  by  atropia,  which 
has  a  powerful  influence  in  diminishing  and  con- 
trolling the  action  of  the  skin. 

I  am  in  the  habit  of  treating  the  local  trouble. 
It  may  be  done  in  several  ways. 

First,  if  there  is  not  very  severe  pain,  or  if  i  > 
flammation  is  not  very  violent,  I  simply  wrap  t";e 
joint  in  cotton  batting.  If  the  pain  is  very  severe 
and  the  distention  of  the  joint  very  distressing,  I 
use  alkaline  fermentations.  sTake  a  sufficient  num- 
ber of  short  and  broad  bandages,  also. a  quarter  of 
a  yard  of  quite  soft  rubber  cloth  or  oiled  silk.  Then 
make  a  solution  of  carbonate  of  potash  in  hot 
water,  one  dram  to  the  pint,  and  after  dipping  the 
flannel  cloths  in  it  wring  them  out  and  apply  them 
around  the  joint,  last  of  all  putting  on  the  oiled 
silk.  You  will  find  that  this  dressing  affords  rapid 
^nd  marked  relief.  Sometimes  I  add  laudanum, 
^bout  two  ounces  to  the  pint  of  the  alkaline  solu- 
tion. Sometimes  relief  is  obtained  by  applying  to 
the  joint  an  ointment  of  extract  belladonna,  one 
dram  to  one  ounce ;  or  the  affected  joint  may  be 
surrounded  with  a  succession  of  small  blisters.  This 
■will  sometimes  greatly  mitigate  the  pain  and  reduce 
the  local  inflammation. 

What  ought  to  be  the  treatment  directed  against 
the  disease  itself?  How  shall  we  shorten  the 
•disease  ?  Can  it  be  done  ?  I  think  it  can  be  very 
materially  shortened.  I  believe  the  average  dura- 
tion of  acute  rheumatism  at  the  present  time  is 
about  nine  days — a  good  deal  better  than  six 
"weeks.  While  a  good  many  cases  must  have  lasted 
longer  than  that,  it  is  evident  that  a  good  many 
must  have  run  a  much  shorter  course. 

At  the  present  day  the  fashion  is  to  give  salicylic 


acid,  and  it  is  given  not  only  in  acute  rheumatism 
but  also  in  the  chronic  form  indiscriminately.  It 
is  doubtless  true  that  a  great  many  cases  of  acute 
rheumatism  are  benefited  by  it ;  that  the  duration 
is  shortened,  and  the  intensity  lessened  by  the  ad- 
ministration of  this  remedy  ;  yet  I  am  .satisfied 
that  in  many  other  cases  little  good  is  done  by  it. 
What  cases  are  to  be  treated  by  it  and  what  cases 
are  not,  and  how  are  those  not  amenable  to  salicy- 
lic acid  to  be  treated  ?  The  more  violent  the  case 
the  higher  the  fever,  and  the  earlier  in  the  case  you 
begin  its  administration  the  greater  the  likelihood 
that  you  will  do  good  with  salicylic  acid.  This  is 
a  good  practical  rule.  When  you  meet  with  a  case 
that  has  lasted  for  several  weeks,  I  don't  think  sa- 
licylic acid  the  best  remedy.  When  you  find  a 
patient  that  is  very  anemic,  one  in  whom  the  fever 
does  not  run  high,  where  the  disease  tends  to  as- 
sume a  subacute  form,  salicylic  acid  is  not  so  likely 
to  do  good.  In  a  case  like  the  one  before  us  I 
would  not  use  salicylic  acid. 

If  you  have,  then,  a  moderately  well-nourished 
patient  with  violent  symptoms  give  salicylic  acid, 
and  give  it  in  full  doses.     How  shall  you  give  it  ? 
Salicylic  acid  is  not  only  a  powerful  antipyretic  but 
it  is  also  powerful  antiseptic.      When  it  is  given 
pure,  uucombined,  it  is  perhaps  as  powerful  an  an- 
tiseptic as  we  have.     It  deserves  to  stand  side  by 
side  with  quinine.     But  when  we  give  it  in  combi- 
nation, as  the  salicylate  of  soda,  it  no  longer  acts 
as  an   antiseptic,  but   merely  as  an   antipyretic. 
Then,  so  far  as  rheumatism  is  concerned,  it  is  as 
well  to  give  the  salicylate  of  soda,  because  only  the 
antipyretic  effect  is  wanted.     As  a  rule  the  salicy- 
late of  soda  is  better,  because  not   so   irritating. 
About  twenty  grains  in  some  syrup,  and  repeated 
every  two  hours  until  the  fever  falls,  and  with  the 
fall  of  the  fever  there  is  usually  a  subsidence  of  the 
articular  symptoms.    If  the  fever  rises  again  begin 
with  the  acid  again.     There  is  no  doubt  that  this 
remedy   is   absolutely   curative  in  a  considerable 
proportion  of  cases.    If  you  were  to  ask  me  with 
what  remedy  my  best  results  have  been  obtained 
I  would  answer,  "  veratrum  viride."     If  you  have 
a  patient  in  the  early  stage  of  the  disease,  the  fever 
running  high,  the  pulse  bounding  and  full,  in  whom 
there  is  no  evidence  of  anemia  nor  cardiac  asthe- 
nia, I  would  put  him  upon  veratrum  viride,'  and  I 
would  expect  to  do  a  great  deal  of  good  with  it. 
I  would  give  immediately  three  or  four  drops,  re- 
peated every  two  hours,  and  increasing  the  dose 
each  time  by  one  dro])  till  a  decided  impression 
is  produced,  until  the  fever  had  fallen,  the  pulse 
becomes  slower,  and  the  respirations  less  hurried, 
and  the  skin,  from  being  hot  and  dry,  had  become 
cool  and   moist.     When  these  violent  symptoms 
pass  away  the  joint  symptoms  abate,  the  tender- 
ness and  swelling  subside.  While  it  rapidly  removes 
the  most  important  symptoms,  it  tends  to  shorten 
the  disease. 

Some  friends  of  mine  are  partial  to  the  use  of 
aconite ;  but  while  I  admit  I  have  seen  it  do  good 
in  their  hands,  it  is  a  remedy  I  have  not  desired  to 


200 


THE   CANADA    MEDICAL   RECORD. 


use  so  long  as  I  can  produce  good  results  with  the 
veratrum  viridc.  While  this  remedy  has  been  used 
on  an  enormous  scale  in  many  acute  diseases 
throughout  the  southern  parts  of  our  country,  the 
number  of  cases  of  poisoning  by  it  have  been  ex- 
ceedingly rare.  It  is,  then,  a  remedy  that  can  be 
used  with  safety.  It  may  produce  unpleasant 
effects,  such  as  prostration  and  diarrhea,  but  when 
it  does  these  symptoms  are  easily  controlled  by  the 
administration  of  alcohol  and  opium.  Indeed  some 
physicians  are  in  the  habit  of  prescribing  opium 
and  alcohol  in  combination  with  the  drug. 

I^rge  doses  of  quinine  have  been  used  and 
with  signal  success  in  some  cases.  I  would  class 
quinine  with  salicylic  acid.  They  act  very  much 
alike  and  the  only  thing  that  can  be  said  in  favor  of 
salicylic  acid  is  that  it  does  not  cause  as  unpleasant 
effects,  though  it  does  produce  head  symptoms, 
fullness,  and  even  delirium,  but  not  to  the  same 
degree  as  the  alkaloids  of  bark,  especially  qumine. 
Quinine  ought  to  be  used,  then,  in  the  same  class 
of  cases  in  which  salicylic  acid  is  indicated. 

We  have  another  class  of  cases  in  badly-nourish- 
ed, weak,  anremic  persons.  In  these  you  will  find 
the  best  treatment  will  be,  not  by  those  remedies 
I  have  mentioned,  but  by  large,  what  is  called  satu- 
rating, doses  of  the  tinct.  ferri  chloridi.  Thirty  drops 
given  every  three  or  four  hours  will  sometimes  be 
found  in  the  course  of  three  or  four  days  to  cut  the 
disease  short.  How  it  does  it  I  can  not  tell  you. 
We  must  be  content  with  the  fact  itself  when  our 
knowledge  extends  no  further.  We  must  not  say, 
'•  I  will  not  cure  the  patient  with  this  medicine, 
simply  because  I  do  not  know  how  it  accomplished 
the  cure."  That  would  be  unreasonable.  While 
we  strain  every  faculty  to  solve  the  mysteries  of 
therapeutics,  while  we  study  with  the  utmost  care 
the  physiological  action  of  remedies,  the  crucial 
test  of  their  value  is  clinical  experience,  and  it  is 
that  which  will  finally  decide  what  will  be  the  rank 
of  a  drug.  Some  years  ago  alkalies  were  very  ex- 
tensively employed.  The  carbonate  or  bicarbonate 
of  potash  or  soda  in  doses  of  twenty  or  thirty 
grains  was  administered  every  two  or  three  hours. 
The  nitrate  of  potash  was  also  used.  But  this  was 
very  soon  found  to  be  decidedly  debilitating  to  the 
heart,  and  it  was  so  nauseating  that  the  patient 
objected  to  taking  it,  and  it  also  caused  irritation  of 
the  stomach.  I  have  employed  the  bicarbonate  of 
soda  and  potash  very  largely  in  connection  with 
the  veratrum  viride  in  sthenic  cases  of  acute  rheu- 
matism. 

1  would  mention  in  connection  with  this  the  treat- 
ment of  acute  rheumatism  by  lemon-juice.  That 
amounts  to  the  same  as  the  administration  of  alka- 
lies. The  acid  is  the  citric,  and  does  not  exist  in  a 
free  state,  but  as  a  citrate  of  soda  or  potash.  So 
when  this  acid  is  taken  in  large  quantities  it  makes 
the  urine  alkaline.  The  citric  acid,  during  its  tran- 
sit through  the  circulation,  is  replaced  by  carbonic 
acid  ;  so  we  find  citrates,  tartrates,  and  malates  of 
soda  and  potash  are  excreted  from  the  system 
under  the  form  of  bicarbonates.  Now  these  reme- 


dies were  given  on  the  principle  that  the  poispn 
that  causes  acute  rheumatism  is  an  acid.  For  a 
long  time  it  was  supposed  to  be  lactic  acid,  but  now 
we  know  this  is  not  the  materics  morbi,  and  we 
know  that  the  alkalies  are  not  a  remedium  univer- 
sale of  acute  rheumatism,  though  we  find  they  are 
well  adapted  to  certain  cases.  It  was  supposed  at 
one  time  that  the  administration  of  alkalies  pre- 
vented cardiac  complications.  I  have  met  with  a 
considerable  number  of  cases  that  have  been  con- 
scientiously treated  by  alkaline  measures  from  the 
beginning  of  the  disease,  and  yet  cardiac  complica- 
tions arose. 

With  this  brief  survey  of  the  remedies  used  in 
combating  this  disease  I  will  close  my  remarks  so 
far  as  the  treatment  directed  to  cutting  short  the 
disease  is  concerned. 

I  must  now  say  a  {g.\s  words  about  the  pre- 
vention of  complications.  Can  we  do  it  ?  I  think 
we  can  to  a  certain  extent.  I  will  put  it  this  way  : 
A  certain  proportion  of  cases  will  have  cardiac 
complications,  no  matter  what  we  do.  In  a  certain 
proportion  of  cases,  I  have  already  said,  the  heart 
is  the  organ  first  affected.  In  a  certain  proportion 
of  cases  you  will  find  that  the  cardiac  complications 
arise  from  the  want  of  attention  to  proper  and 
necessary  precautions.  What  are  they  ?  A  person 
suffering  from  acute  rheumatism,  in  the  first  place, 
ought  to  have  no  linen  next  to  his  body.  He 
ought  to  be  swathed  in  flannel.  Chambers  gives 
some  excellently-reported  cases  of  acute  articular 
rheumatism.  He  shews  how,  after  patient  had  been 
carefully  swathed  in  flannel  for  a  number  of  days, 
he  allowed  his  vanity  to  get  the  better  of  him,  and 
put  on  a  shirt  with  a  linen  bosom,  and  in  twenty- 
four  hours  afterward  he  had  pericarditis.  Such 
events  have  occurred  sufficiently  often  to  make  it 
probable  that  it  is  something  more  than  a  mere 
coincidence.  If  I  were  attacked  myself  I  would 
immediately  be  dressed  in  flannel  from  neck  to 
foot.  I  would  sleep  between  blankets,  and  when 
the  daily  examination  of  the  heart  was  made  the 
stethoscope  should  be  insinuated  between  the  folds 
of  the  blanket.  When  the  daily  evacuations  of 
the  patient  are  made  he  should  not  be  allowed  to 
get  out  of  bed  ;  he  ought  to  use  an  urinal  or  bed- 
pan. Then  the  air  of  the  room  ought  to  be  uni- 
formly warm.  It  is  one  of  the  defects  in  our  methods 
of  heating  our  apartments  at  the  present  time.  We 
make  a  big  fire  during  the  day  and  evening,  and 
during  the  night  it  is  allowed  to  die  out ;  and  toward 
morning,  when  we  know  the  vitality  of  the  system 
is  at  its  minimum,  the  air  of  the  sick-room  is  ac- 
tually chilly.  I  am  satisfied  that  in  a  certain  pro- 
j)ortion  of  cases  comj)Iications  are  caused  by  want 
of  attention  to  these  imi)ortant  details.  The  nurse 
ought  to  see  that  the  fire  is  kept  up,  night  and  day, 
and  there  ought  to  be  a  thermometer  in  the  room 
by  which  to  regulate  the  temperature. 

The  patient's  general  strength  should  be  kept 
up.  There  is  no  doubt  that  complications  are 
favored  by  a  much  lower  vitality  of  the  system. 
The  tendency  is    to  a  very  considerable   reduction 


THE   CANADA   MEDICAL   RECORD. 


201 


of  strength,  and  the  more  feeble  the  system  is  as  a 
a  whole  the  more  feeble  will  be  every  part. 

High  fever  and  rapid  action  of  the  heart  tend  to 
weaken  this  organ,  and  I  have  no  doubt  that  this  is 
the  reason  why  cardiac  complications  arise  as  a  rule 
vhen  rheumatism  has  been  going  on  for  a  number 
of  days.  I  don't  think  such  complications  are  prone 
to  arise  much  before  the  second  week,  and  that 
indicates  that  the  tendency  to  rheumatic  inflamma- 
tion of  the  heart  becomes  strongest  after  the  sys- 
tem has  been  weakened.  The  heart  is  so  enfeebled 
as  to  rapidly  take  on  diseased  action ;  and  if  you 
can  cure  the  patient  before  that  time  comes,  and 
keep  his  strength  up  to  a  certain  point,  you  will 
diminish  very  greatly  the  tendency  to  cardiac  com- 
plications. Look  at  this  poor  fellow  now.  He  is 
twenty-three  years  old.  Suppose  he  were  entirely 
cured  of  his  rheumatism;  suppose  we  had  the 
power,  by  some  magic  art,  of  freeing  him  in  a 
moment  of  all  rheumatic  taint ;  what  would  be  his 
future?  He  has  a  crippled  heart,  and  its  tendency 
is  to  grow  worse  and  worse.  His  circumstances  in 
life  are  such  as  to  preclude  the  possibility  of  his 
taking  good  care  of  himself  The  best  thing  that 
could  be  done  for  him  would  be  to  keep  him  in 
the  hospital  all  his  life.  But  the  hospital  is  not 
intended  for  the  care  of  incurables,  and  in  a  short 
time,  when  suflSciently  improved,  he  must  go  out. 
You  know  what,  after  a  while,  will  be  the  end. 

Are  there  no  other  complications  that  may  arise  ? 
There  are.  The  first  is  suppurative  inflammation  of 
the  joint ;  secondly,  we  may  have  rheumatic  perito- 
nitis— both  exceedingly  rare.  Then,  we  may  have 
rheumatic  meningitis,  also  very  rare.  Then,  again, 
when  there  is  acute  rheumatism,  and  when  there  is 
endocarditis,  we  may  have  embolism  ;  hence  we 
ought  to  endeavor,  by  every  possible  means  in  our 
power,  to  prevent  the  cardiac  complication  which  is 
the  most  fruitful  cause  of  embolism. 

In  this  disease  there  is  hyperinosis — a  very 
serious  thing  under  certain  circumstances.  Embo- 
lism may  occur  in  connection  with  rheumatism 
from  this  cause,  independent  of  any  heart  trouble. 

Finally,  chorea  may  be  a  complication  of  a 
sequel,  and  a  large  proportion  of  cases  of  chorea 
arise  in  connection  with  rheumatism,  and  especially 
in  the  young,  when  the  original  disease  has  been 
protracted  and  severe  and  the  patient  is  enfeebled 
and  anemic- — Medical  Herald,  Louisville,  Ky. 


NERVOUS  DYSPEPSIA. 

Dr.  Myers  writes  to  the  Virginia  Medical 
Monthly  :  I  can  not  speak  too  highly  of  the  follow- 
ing preparation  which  I  have  employed,  with  the 
happiest  results,  in  those  cases  of  nervous  dyspep- 
sia the  result  of  cerebral  hyperemia  : 

9     Bromid.  sodium         ....      ^  j 

Ext.  ergot,  fluid         ....      3  ij 

Pepsin  (saccharated) 

Pulv.  carbo-lignis     ....  aa.  3  iij 

Aqua 5  ij 


M.  fiat  mistura.  S  :  A  teaspoonful  every  three 
or  four  hours. 

It  contracts  their  cerebral  vessels  in  their  ordi- 
nary size,  thereby  relieving  gastric  derangement, 
etc.  If  constipation  exists,  I  employ,  as  a  purga- 
tive, the  combination  of  ox  gall  and  ext.  aloes  aa 
grs.  XV ;  podophyllin,  grs.  iii,  made  into  five  pils, 
of  which  one  is  given  every  night,  or  every  other 
night,  as  the  case  may  require. 


THE  PULSE. 

By  T.  A.  McBride,  M.D., 

Lecturer  on   Symptomatology,  Spring  Course,  College  of 
Physicians  and  Surgeons,  New  York. 

Gentlemen, — We  begin  to-day  with  the  study 
of  the  pulse.  The  word  pulse  is  derived  from  the 
Latin /?//ytf,  I  strike,  and  expresses  the  striking  or 
lifting  of  the  finger  by  the  distending  vessel,  as, 
with  each  contraction  of  the  heart,  blood  is  forced 
into  the  vessels.  The  significance  of  the  word  has 
also  been  extended,  so  as  to  be  applied  to  the 
appearance  of  a  lifting  up  of  the  coverings  over  a 
distending  vessel,  so  that  the  word  pulse  is  applied 
not  only  to  that  which  is  felt,  but  to  that  which  is 
seen. 

There  are  two  kinds  of  pulse — the  arterial  and 
the  venous.  The  arterial  is  appreciated  mainly  by 
palpation,  the  venous  by  inspection.  We  have  to 
study  especially  the  arterial  pulse. 

In  the  writings  of  the  old  school  of  physicians, 
even  to  the  days  of  Hippocrates,  the  pulse  was 
regarded  as  one  of  the  most  important  symptoms, 
and  although  some  of  the  distinctions  that  these 
observers  made  were  too  fine  and  subtle  to  be 
really  appreciated  at  the  bedside,  there  can  be  no 
doubt  that  their  observations  of  the  changes  in  the 
pulse  were  often  extremely  acute  and  accurate. 
So  accurate,  indeed,  that  Dr.  Broadbent,  refer- 
ring to  these  observations,  says :  *  "  It  was  with 
astonishment  that  I  learnt  when  I  first  took  up  the 
study,  that  every  single  element  of  the  pulse  re- 
vealed to  us  by  the  sphygmograph  had  been  pre- 
viously recognized  by  the  old  school  of  physicians, 
and  that  a  nomenclature  existed  ready  made  for  all 
of  its  teachings. 

The  radial  pulse  is  the  one  usually  selected, 
since  it  answers  all  of  the  requirements.  It  is  of 
moderate  size,  is  superficial,  and  can  be  readily 
compressed  against  the  radius.  The  pulse  in  vessels 
elsewhere  must  sometimes  of  necessity  be  ob- 
served, as  in  the  brachial,  the  facial  in  front  of  the 
masseter  muscle,  the  temporal,  posterior  tibial, 
dorsalis  pedis,  the  carotid  and  femoral  arteries. 

When  the  pulse  is  to  be  taken,  the  patient 
should  be  either  sitting  or  lying  down.  The  ob- 
server should  place  his  index,  middle,  and  ring 
fingers  lightly  upon  the  pulse,  and  should  then 
appreciate  the  state  of  the  coats  of  the  artery,  and 

•  Lancet,  vol.  ii.,  1875,  p.  441. 


202 


TIIK    CANADA    MEDICAL    KFXORD. 


should  next  note  the  frei]uenry,  the  rhythm,  the 
tension,  volume  and  force  of  the  j)ulse.  and  lastly, 
any  peculiarities,  if  j)resent.  Moreover,  the  pulse 
of  one  side  of  ihe  body  should  always  be  compared 
with  the  other.  It  should  also  be  remembered 
that  forcible  extension  or  tlexion  of  the  forearm 
will  sometimes  arrest  the  radial  pulse.  In  taking 
the  pulse  in  children  and  infants,  it  is  well  to  count 
the  pulse,  if  possible,  while  they  are  asleep.  This 
can  often  be  done  nicely  in  the  temporal  artery. 
In  taking  the  pulse  at  the  wrist,  asleep  or  awake, 
there  are  often  involuntary  movements  of  the  arm 
and  twitchings  of  the  muscles,  which  render  it 
difficult  to  keep  the  finger  of  the  observer  on  the 
pulse.  The  difficulty  may  be  overcome  in  a  great 
degree  by  grasi)ing  the  entire  hand  of  the  child, 
and  then  extending  the  index  finger  upon  the 
pulse. 

It  is  also  advisable  not  to  take  the  pulse  of  the 
patient  until  some  little  time  has  elapsed  after  the 
appearance  of  the  physician. 

The  factors  of  the  pulse,  and  the  several  pheno- 
mena dependent  upon  them,  are  shown  in  the  fol- 
lowing table : 


1.  Heart. 


(a.   Rate  or  frequency. 

J  i>.   Rhythm — intermittency  and  irregularity. 

J  c.   Force  or  streneth. 


■  Degree  of  resist- 
ance t«  the  passage 
of  blood  through  ■ 
small  arteries  and  | 
capillaries.  J 


trength. 
[d.  Quantity  of  the  blood. 

a.  Degree  of  tension. 


B.  Size  of  vessels. 


J  Hard  or  long. 
I  Soft  or  short. 
<,  Large. 
I  Small. 


3.   Elasticity    of 
sets. 


Sa.   Dicrotism,  hyperdicrotism . 
f'.   Non-dicrotism  (senile  pulse). 


In  health,  changes  in  the  frequency  and  rhythm 
of  the  pulse  are  often  met  with. 

I  subjoin  a  table  of  the  variations  in  the  fre- 
quency of  the  pulse  in  health  which  is  taken  from 
Hooper's  "Physician's  Vade-mecum,"  edited  by 
Drs.  Guy  and  Harley,  and  from  this  work  is  also 
taken  most  of  what  follows  on  the  changes  of  the 
frequency  of  the  pulse  in  health. 

Infant  asleep  at  birth 140 

Infancy 120 

Child  five  years  of  age 100 

Youth  90 

Male  adults  72-80 

Female  adults 80-85 

Old  age 70 

Heberden  records  42,  30,  and  26  beats  to  the 
minute,  in  an  old  man  of  eighty,  apparently  in 
perfect  health  ;  Fordyce,  another  of  26  ^Hooper's 
"Vade-mecum,"  p.  179,  London,  1869).  Great 
frequency  in  health  is  not  often  met  with,  but  I 
have  under  observation  a  case  where  the  pulse 
ranges  from  100  to  120,  and  the  individual  states 
that  this  frequency  has  existed  all  his  life. 

Sex  has  some  influence.  Up  to  seven  years  of 
age  the  freciuency  is  about  the  same  in  both  sexes, 
but  later  the  female  pulse  is  from  6  to  14  beats — 
average  9,  greater  than  in  the  male. 

Posture  also  affects  the  pulse.  It  is  most  fre- 
quent in  the  standing,  and  least  in  the  recumbent 
position.     The  pulse  of  a  man  is  twice  as  much 


affected  by  change  in  position  as  that  of  a  woman. 
When  the  {)u!se  is  much  increased  in  frequency, 
change  in  position  has  but  little  effect,  and  for  the 
higher  numbers  entirely  disappears.  When  the 
head  is  lower  than  the  body  the  pulse  falls  (a  hint 
for  the  treatment  of  some  forms  of  palpation), 
The  general  law  as  to  the  degree  of  freriuency  of 
the  i)ulse  as  affected  by  position  is  as  follows — th« 
fre(]uency  is  directly  proportioned  to  the  amount 
of  muscular  effort  required  to  support  the  body  in 
different  positions. 

The  pulse  falls  in  sleep  as  much  as  ten  beats 
Sleeplessness  increases  its  frequency.    On  awaken- 
ing from  sleep  there  is  usually  a  decided  increase 
in  frequency. 

Food  increases  the  rate.  Mental  excitement 
and  activity  of  the  emotions  increase  the  frequency  ; 
mental  depression  is  often  accompanied  by  a  de- 
crease. Cold  lowers  and  heat  raises  the  rate. 
Among  other  causes  producing  an  increase  in  the 
frequency  of  the  pulse  in  health  may  be  mentioned 
spirituous  and  warm  drinks,  tobacco,  diminished 
atmospheric  pressure.  Among  the  remaining 
causes  producing  diminished  frequency  there  are 
fatigue,  long-continued  rest,  debility  without 
disease,  and  increased  atmospheric  pressure.  Oc- 
casionally the  pulse  is  irregular  in  health,  but 
when  that  is  so  it  is  usually  congenital. 

Intermittency  is  not  infrequent  in  health,  and  it 
is  then  either  congenital,  or,  as  Dr.  B.  W.  Richard- 
son* has  shown,  may  be  due  to  terror,  anxiety, 
grief,  passion,  mental  or  physical  fatigue,  adverse 
fortune,  and  old  age.  The  intermittency  may  be 
only  temporary,  or  it  may  become  permanent ;  and 
if  it  becomes  very  frequent,  may  be  pathological. 

I  now  ask  your  attention  to  the  pulse  in  disease, 
and  I  shall  consider  the  subject  under  the  follow- 
ing heads : 

I  St. — The  condition  of  the  walls  of  the  vessel 
the  seat  of  pulsation. 

2d. — Changes  referable  to  the  several  factors  of 
the  pulse. 

3d. — Names  and  significance  of  certain  pulses. 

I  St. — The  condition  of  the  walls  of  the  vessel 
the  seat  of  the  pulsation.  In  health,  an  artery  of 
the  size  of  the  radial  should  not  be  felt  in  the 
interval  of  pulsation.  When  the  artery  can  be 
easily  appreciated  in  this  interval,  the  coats  of  the 
vessel  have  undergone  some  pathological  change, 
or  else  the  vessel  is  over-distended  with  blood  ;  the 
blood  pressure  is  greatly  increased.  The  artery 
sometimes  feels  like  a  rubber  tube  with  thick  walls, 
or  a  pipe  with  rigid  walls,  or,  again,  resembles  a 
string  of  beads.  It  is  often  tortuous  or  serpentine, 
and  may  be  traced  up  almost  the  entire  forearm. 
These  changes  in  the  walls  of  the  artery  are  the 
result  of  chronic  inflammation  with  subsequent 
degeneration — deposition  of  calcareous  matter. 
Usually  these  changes  are  widely  distributed  in 
the  arteries  throughout  the  body.     The  temporal 


»  Discourses  on    Practical  Medicine  :    On    Intermittent    Pulse   aad 
Palpitation.     London,  1871. 


THE   CANADA    MEDICAL   RECORD. 


203 


arteries  especially  are  tortuous  and  serpentine,  and 
sometimes  the  ophthalmoscope  reveals  thickening 
of  the  arteries  at  the  fundus  oculi.  Changes  in  the 
coats  of  the  arteries  are  observed  in  cases  of 
Bright's  disease,  in  the  rheumatic  and  gouty,  in  the 
syphilitic,  and  sometimes  in  athletes  as  the  result 
cf  overstrain,  and  in  lead-poisoning  and  scurvy. 
Excessive  use  of  tobacco  and  alcohol  occasion  these 
changes.  Certain  infectious  diseases  besides 
syphilis  seem  also  to  excite  pathological  altera- 
tions in  the  walls  of  the  vessels,  as,  for  example, 
diphtheria  and  typhus  fever.  Exposure  to  cold  and 
neat,  want  of  food,  or  good  air,  also,  may  produce 
these  changes  ;  and,  lastly,  they  may  appear  as 
among  the  earliest  of  the  degenerations  incident  to 
senility. 

It  is  important  to  appreciate  the  abnormal  con- 
ditions of  the  walls  of  the  artery  in  the  following : 
in  the  diagnosis  and  prognosis  of  cerebral  hemorr- 
hage and  thrombosis;  in  the  prognosis,  diagnosis, 
and  treatment  of  changes  in  the  aortic  valves  of 
the  heart ;  and  in  the  prognosis  and  just  estima- 
tion of  many  diseases  when  found  associated  with 
this  sign  of  beginning  degeneration,  and  which  may 
be  the  only  positive  sign  of  beginning  decay. 

I  have  already  alluded  to  the  fact  that  in  pulse 
of  high  tension  the  vessel  may  be  felt  in  the  interval 
of  pulsation,  and  one  may  be  so  deceived  as  to 
mistake  such  a  condition  of  things  for  a  vessel  with 
diseased  walls,  whereas  the  artery  is  over-dis- 
tended with  blood  and  the  walls  may  be  normal. 
This  is  not  so  infrequently  met  with,  and  very 
often  we  tind  that  disease  of  the  walls  eventually 
does  supervene,  apparently  by  reason  of  this  con- 
dition of  high  tension.  It  may  be  necessary  some- 
times to  differentiate  these  conditions,  and  Dr. 
Broadbent,  in  his  interesting  and  valuable  lectures 
on  the  pulse  in  the  Lancet,  1875,  to  which  I  shall 
often  refer,  has  demonstrated  how  perfectly  this 
can  be  done  by  having  the  patient  inhale  some 
nitrite  of  amyl.  If  the  pulse  be  one  of  high  ten- 
sion only,  the  thick,  cord-like  vessel  disappears  in 
the  interval  of  pulsation,  and  is  only  felt  during 
pulsation,  and  is  then  very  soft.  If  the  walls  of  the 
artery  are  actually  thickened  or  diseased,  very 
httle  change  takes  place.  But,  as  I  have  said,  you 
may  find  both  combined,  and  the  difference  is  in 
the  change  in  the  compressibility  of  the  pulse. 

2d. — Phenomena  referable  to  various  factors  of 
the  pulse. 

The  Heart: — Increased  and  diminished  fre- 
quency of  the  pulse. 

a.  Increased  frequency. 

I  ask  your  attention  to  the  following  schemes  of 
the  causes  of  increased  frequency  of  the  heart  as 
determined  by  experiment  on  animals.  It  is  taken 
from  Lauder  Brunton's  book  on  the  "  Experi- 
mental Investigation  of  the  Action  of  Medicines," 
Part  I.,  Circulation,  London,  1875.  I  do  this  so 
that  you  may,  if  possible,  explain  to  yourselves 
the  probable  cause  of  a  frequent  pulse  in  many 
conditions.  I  should  be  overstepping  my  limits 
of  time  were  I  to  attempt  it. 


paralysis  of  vagus  roots  or  vagus  fibres. 

"         "       "      ends  in  the  heart. 
Stimulation   of   the  I    Directly. 

sympathetic  roots  (    Indirectly  by  lowered  blood-pressure. 
Stimulation  of    the  I    Directly. 

cardiac  ganglia.    )    Indirectly  by  increased  temperature  of  the  body. 

A  pulse  of  90  or  more  may  be  regarded  as  a 
pulse  of  abnormal  frequency  in  an  adult.  There 
are  exceptions  to  this,  but  they  are  rare. 

In  the  following  pathological  conditions  a  fre- 
quent pulse  is  of  importance  in  diagnosis  or  prog- 
nosis. 

1.  Fevers. — "In  fevers  the  pulse  is  generally 
quickened  in  proportion  to  the  elevation  of  tempe- 
rature, though  the  proportion  between  the  pulse 
and  the  temperature  varies  in  different  fevers.  In 
scarlet  fever  the  pulse  is  quicker  than  in  typhoid 
fever  with  the  same  temperature,  hence  a  quick 
pulse  is  of  less  serious  import  in  scarlet  than  in 
typhoid  fever.  The  same  elevation  of  temperature 
quickens  the  pulse  relatively  much  more  in  children 
than  in  adults." 

"  If  a  pulse  is  quicker  than  the  temperature  will 
explain,  it  indicates  cardiac  weakness — the  weak- 
ness being  proportionate  to  the  want  of  ratio  be- 
tween the  temperature  and  the  pulse .  In  this  way 
the  pulse  affords  important  information  in  prognosis 
and  treatment." 

"A  pulse  that  day  by  day  progressively  in- 
creases in  frequency,  the  temperature  remaining 
the  same,  shows  increasing  cardiac  weakness." 

"  In  all  febrile  diseases  a  pulse  in  adults  over 
120  is  serious  and  indicates  cardiac  weakness.  A 
pulse  of  130  or  140  indicates  great  danger,  and 
with  a  pulse  at  160  the  patient  almost  always 
dies."  • 

a.  In  eruptive  fevers,  just  before  the  appearance 
of  the  eruption,  the  pulse  becomes  sometimes  very 
frequent. 

b.  In  relapsing  fever,  during  the  febrile  periods, 
the  pulse  is  of  very  great  frequency,  and  is  often 
130  to  140.  It  attains  a  greater  degree  of  frequency 
than  in  any  other  fever,  without  being  of  grave 
significance  (Murchison).  f 

c.  In  typhoid  fever  the  prognosis  is  usually  bad 
when  pulse  persistently  exceeds  120  (Murchison).  f 

d.  In  the  convalescence  from  all  fevers  the 
range  of  increase  in  the  frequency  of  the  pulse  in 
changing  from  a  recumbent  to  a  sitting  or  stand- 
ing position,  or  the  range  of  decrease  in  its  rate  in 
changing  from  a  standing  or  sitting  to  a  recum- 
bent position,  is  a  measure  of  the  debility  of  the 
patient.  During  the  pyretic  period  such  changes 
in  position  have  little  or  no  effect.  The  rate  of 
the  pulse  may  therefore  be  of  importance  in 
gauging  the  strength  of  the  patient. 

2.  Inflammations : 

a.  The  occurrence  of  a  sustained  frequency  of 
the  pulse  after  confinement  is  a  very  suspicious 
symptom,  and  may  betoken  advent  of  puerperal 
peritonitis.* 

•  A  Hand-book  of  Therapeutics,  by  Sidney  Ringer,  M.D.  William 
Wood  &.  Co.,  Ne.v  York,  1S79,  pp.  7  and  8. 

t  A  Treatise  on  Continued  Fevers,  by  Charles  Murchison,  M.D; 
London,  1873. 

*  Pulse  in  Forming  Stage  of  Puerperal  Peritonitis.  Archives  of 
Practical  M«dicine,  No.  3,  Mary  Putnam- Jacobi,  M.D.  New  York, 
1873. 


201 


THE    CANADA    MFDICAL    RF.CORD. 


b.  Diseases  of  the  lungs  and  pleura. 

1.  Under  the  age  of  fifteen  any  disease  of  the 
lungs  is  almost  invariably  accompanied  by  great 
frequency  of  the  pulse,  so  that  a  pulse  of  1 20  to 
140  would  not  be  considered  as  so  serious  in 
significance  as  if  it  occurred  in  an  older  person. 

2.  When  a  frequent  pulse  is  present  in  pneu- 
monia it  is  always  of  bad  significance,  even  if  only 
a  small  portion  of  the  lung  is  involved.  Moreover, 
when  a  pneumonia  occurs  in  the  cachectic  or  debi- 
litated, the  pulse  is  especially  apt  to  be  frequent, 
often  120  to  160,  and  such  cases  usually  die. 

3.  When  complicated  with  heart  disease,  the 
frequency  of  the  pulse  is  significant.  Traube 
asserts,  when  in  a  strong  robust  person  you  find  a 
pneumonia  with  a  pulse  of  120,  you  may  be  sure 
that  there  is  present  some  form  of  heart  disease.f 

L.  In  the  diagnosis  of  incipient  phthisis  a  sus- 
tained frequency  of  pulse  is  thought  to  be  of  im- 
portance by  Sir  Thomas  Watson,  and  others. 

d.  In  pleuritic  effusions  the  pulse  may  be  very 
frequent,  especially  when  there  is  displacement  of 
the  heart. 

e.  In  pericarditis  and  myocarditis  very  great  fre- 
quency of  the  pulse  is  observed  at  times — especially 
on  any  movement  by  the  patient — 130  to  1 60.  The 
change  in  rate  may  be  very  sudden,  and  is  of  some 
importance  in  diagnosis  and  prognosis, 

/.  In  acute  articular  rheumatism  unaccompanied 
by  peri-,  endo-  or  myocarditis,  a  pulse  of  120  or 
more  indicates  great  danger  (Ringer). 

g.  In  the  last  stages  of  meningitis  of  the  con- 
vexity, and  particularly  in  tubercular  meningitis,  a 
very  frequent  pulse  is  often  observed. 

3.  Diseases  of  the  nervous  system  : 

a.  In  diseases  affecting  the  medulla  oblongata — 
in  glosso-labio-laryngeal  paralysis  the  pulse  is  quite 
frequent. 

b.  In  the  early  state  of  locomotor  ataxia  a  fre- 
quent pulse  is  a  quite  constant  symptom. 

c.  In  Basedow's  disease  a  pulse  of  120  to  140, 
and  even  of  200,  is  often  observed  at  times. 

d.  In  hysteria  an  exceedingly  frequent  pulse  is 
not  uncommon,  130  to  160  and  more. 

e.  In  puerperal  mania.  Sir  James  Y.  Simpson 
insists  upon  the  very  great  importance  of  the  fre- 
quency of  the  pulse  in  prognosis,  and  he  states 
that  where  the  pulse  is  no  or  over,  the  outlook  is 
very  bad,  and  that  in  his  experience  no  case  had 
ever  recovered. 

/.  In  certain  cases  of  peripheral  irritation  a  very 
great  increase  in  the  rate  of  the  pulse  has  been 
otiserved  : 

1.  Where  tumors  in  the  neck  have  pressed  upon 
the  pneumogastric  or  sympathetic  nerves. 

2.  In  cases  with  intra-thoracic  tumors. 

3.  Where  there  has  been  some  inflammatory 
process  in  the  sheaths  of  the  pneumogastric  or 
sympathetic  nerves. 

4.  In  cases  of  irritation  of  nerves  in  the  abdo- 
minal cavity  as  by  over-distention  of  the  intestines 

t  Die  Symptome  dcr  krankheitcn  tics  Respiratioas,  und  Circulation* 
Apparat^.     Traube.     Berlin,  1867,  p.  31. 


by  gas  ;  in  the  passage  of  hepatic  and  rena?  calculi 
worms  in  the  intestines,  etc.  As  showing  the  very 
great  disturbance  of  the  pulse,  which  may  be  oc- 
casioned by  the  presence  of  entozoa  in  the  intes- 
tines, a  case  was  reported  in  the  British  Medical 
JoiirnaL  June,  1867,  in  which  attacks  of  palpiti- 
tion  of  the  heart  with  a  pulse  of  240  were  observec, 
and  after  the  expulsion  of  a  taenia  from  the  intes- 
tines the  attacks  entirely  disappeared. 

^^  In  nervous  exhaustion  the  result  of  venereal 
excesses,  of  over-indulgence  in  alcohol,  coffee,  o: 
tobacco,  or  from  excessive  mental  or  physica 
labor,  or  as  the  result  of  previous  disease,  a  very 
frequent  pulse  is  often  observed,  and  this  may, 
when  very  frequent,  have  an  alarming  significance. 
Dr.  Latham,  in  the  new  Sydenham  edition  of  his 
works,  vol.  ii.,  p.  538,  describes  most  eloquently 
the  significance  of  the  very  frequent  pulse.  Liken- 
ing the  heart  to  the  finger  of  the  clock,  he  says  : 
"  We  have  already  seen  in  these  two  cases  the 
index  hurrying  rapidly  round  the  dial-plate,  and 
telling  that,  from  some  cause  or  other,  the  mechan- 
ism within  was  running  down,  and  if  it  were  not 
arrested  that  it  would  quickly  stop.  Even  prior  to 
any  outward  presentments  to  give  assurance  of 
disease,  even  earlier  than  its  known  beginning,  we 
have  seen  countless  fluttering  of  the  heart  and 
arteries  give  token  of  the  nervous  system  already 
under  trial  of  mortal  suffering,  and  ready  to  let 
life  go  for  ever." — N.  V.  Medical  Record. 


SUMMER  DIARRHCEA  OF  CHILDREN. 
By  James   I.  Tucker,  A.M.,  M.D  .Chicago. 

In  the  broader  sense  of  the  term  the  summer 
diarrhoea  of  children  is  a  neurosis.  As  medical 
science  advances  this  doctrine  will  throw  ofl  the 
disguise  of  the  transcendental,  and  its  true  signi- 
ficance becoming  more  and  more  practically  recog- 
nized, will  finally  be  accepted  by  every  practitioner 
from  the  centre  to  the  periphery  of  the  profession. 
There  is  no  other  rational  explanation  of  the  phen- 
omena with  which  we  meet  in  the  complex  of 
symptoms  which  constitute  the  disorder  in  ques- 
tion. The  disharmony  of  function  amounts  to  a 
pathological  entity.  To  restore  harmony  is  the 
sole  duty  of  medicine.  Medicine  thus  becomes 
not  only  a  fine  art,  but  the  finest  of  the  fine  arts, 
because  it  deals  with  human  life.  Unless  we  are 
guided  by  this  principle  we  will  oscillate  between 
the  i:;loria  in  inferno  of  allotherapy  and  the  gloria 
in  excclsis  of  homceotherapy,  and  have  no  resource 
except  in  the  pitiless  and  pointless  paedriatics  of 
a  pathy.  Let  the  etiology  be  what  it  may,  cer- 
tainly heat  is  a  prime  factor,  but  be  it  what  it  may 
a  specific  disharmony  of  bodily  function  exists  be- 
longing to  the  first  and  second  periods  of  anthro- 
pological evolution.  The  first  period  is  brief, 
extending  not  beyond  the  seventh  month,  when 
the  first  teeth  generally  appear.  But  some  time 
before  the  appearance  of  the  teeth  there  are  many 


THE    CANADA    MEDICAL    RECORD. 


205 


disturbances  liable  to  occur  which  are  due,  not  to 
the  pricking  through  of  the  teeth  as  is  popularly 
supposed,  and  this  idea  is  not  entirely  foreign  to 
the  profession,  but  the  appearance  of  the  teeth  is 
but  an  index  of  the  general  evolution  of  the  ali- 
mentary canal.  Bear  this  in  mind,  and  consider 
the  necessary  alterations  which  take  place  in  the 
digestive  function  as  a  consequence,  and  we  have 
an  important  guide  to  therapeutics.  The  thera- 
peutics of  early  infancy  is  mainly  alimentary. 
The  mother's  milk  is  the  normal  food  for  her  in- 
fant. I  need  not  say  that  she  should  be  free  from 
emotional  disturbances  which  are  so  common  to 
American  life.  Doubtless  the  prominent  cause  of 
those  changes  which  render  the  human  milk  innu- 
tritions is  psychic  and  emotional,  and  is  often  re- 
moved by  whatBulwer  Lytton  calls  the  "  calm  in- 
telligence "  of  the  medical  adviser.  But  artificial 
feeding  must  often  be  resorted  to,  for  the  mam- 
mary secretion  is  often  deficient.  Now  we  have 
to  avoid  both  the  Scylla  and  the  Charybdis  ofme- 
dical  extremes.  A  wet  nurse  may  be  the  poorest 
substitute  for  the  mother.  On  the  other  hand  the 
market  is  flooded  with  foods  which  have  become 
an  abomination,  and  the  commercial  aim  back  of 
them  is  so  far  from  being  humane  that  it  has  for 
its  object  only  the  transmutation  of  nostrums  into 
nuggets.  In  my  experience,  and  it  has  not  been 
too  limited  to  justify  me  in  expressing  an  opinion, 
the  best  artificial  food  is  made  of  rice  flour 
with  water  or  with  pure  cow's  milk.  Cheap, 
wholesome,  pure,  highly  nutritious,  and  easily 
digestible,  there  is  no  one  article  which  commends 
itself  more  strongly  to  the  judgment  of  the  physi- 
cian. When  I  use  cow's  milk  alone,  I  generally 
follow  Vogel  and  deprive  the  milk  of  its  property 
of  coagulating  into  large,  compact  lumps  by  adding 
at  every  meal  a  teaspoonful  of  a  solution  of  car- 
bonate of  soda  (  3  j-  to  water  3VJ.).  In  hot 
weather  he  also  renders  the  milk  alkaline  by  adding 
a  tablespoonful  of  the  solution  to  five  ounces  of 
milk.*  The  following  is  a  very  useful  formula 
which  was  given  me  years  ago  by  Dr.  B.  E.  Cotting, 
of  Boston  Highlands,  and  has  now  and  then  served 
me  well.  Take  of  gelatine,  5  grains  ;  arrowroot, 
25  grains;  water,  i^A  pints;  milk,  i  pint  and 
4  ounces  ;  cream,  ^  pint.  Dissolve  the  gelatine 
in  half  the  quantity  of  water  cold.  Dissolve  the 
arrowroot  in  the  other  half,  hot.  Mix.  Boil,  add- 
ing the  milk.  In  cooling  add  the  cream. 
Sweeten  a  little.  A  very  exact  dietary,  prescribing 
he  food  for  different  ages,  in  sickness  and  in 
health,  would  be  desirable,  because  babies,  like 
nations,  cannot  subsist  on  "  glittering  generali- 
ties." The  nearest  approach  to  a  reliable  dietary 
is  to  be  found  in  Eustace  Smith's  work.f 

With  variations  in  quantities  and  with  regard  to 
the    difference   between   our  climate  and  that  of 


•Alfred  Vogel,  M.D.,  "Diseases  of  Children,"  p.  43. 
Raphael's  trans.  N.  Y.,  1873, 

tEustace  Smith,  M  D..  "The  Wasting  Diseases  of 
Infants  and  Children."     Phil.,  1871. 


London,  and  with  due  consideration  of  the  pecu- 
liarities and  idiosyncrasies  of  American  children, 
I  have  found  this  dietary  a  very  useful  guide.  So 
useful  in  fact  that  I  transcribe  it  for  the  benefit  of 
the  readers  of  the  Review. 

DIET  IN  HE.\LTH. 

I.  FROM  BIRTH  TO  SIX  MONTHS  OLD. 
DIET  I. 

If  the  child  be  suckled,  and  the  breast-milk  be 
found  in  all  respects  suitable  : 

No  other  food. 

The  child  should  take  the  breast  alternately 
every  two  hours  for  the  first  six  weeks  ;  afterwards, 
every  three  hours,  except  between  11  p.m.  and  5 
or  6  A.M. 

In  cases  where  the  secretion  of  milk  is  slow  to 
be  established,  and  the  quantity  drawn  is  insuffi- 
cient to  supply  the  wants  of  the  infant,  the  follow- 
ing food  may  be  given  as  an  addition  to  the 
breast- milk,  until  the  secretion  becomes  sufficient- 
ly abundant : 

One  tablespoonful  of  fresh  cream. 

Two  tablespoonfuls  of  whey. 

Two  tablespoonfuls  of  hot  water. 

This  mixture  must  be  taken  from  a  feeding  bot- 
tle. The  whey  is  made  fresh  in  the  house  by  add- 
ing one  teaspoonful  of  prepared  rennet  to  a  pint 
of  new  milk.  The  coagulated  casein  is  removed 
by  straining  through  muslin. 

DIET  2. 

If  the  infant  be  brought  up  by  hand  : 

New  milk  and  lime  water  in  equal  propor- 
tions. 

Three  to  four  ounces,  sweetened  with  a  tea 
spoonful  of  sugar  and  milk,  are  to  be  given  at  firss 
every  two  hours  from  a  feeding-bottle. 

The  proportions  of  milk  and  lime  water  may  be 
varied  according  to  the  age  of  the  infant. 

From  six  weeks  to  three  months,  one-third  of 
lime-water  may  be  used  ;  and  from  three  montht 
to  five  months  this  quantity  should  be  reduced  to 
one-fourth. 

DIET  3. 

If  the  infant  be  partially  suckled,  the  breast 
milk  being  poor  and  scanty  : 

The  breast  must  be  given  only  twice  a  day. 

For  the  other  meals  the  child  must  be  fed  upon 
milk  and  lime  water  as  directed  in  diet  2. 

Up  to  the  age  of  six  months  the  milk  should  be 
warmed  by  dipping  the  bottle  containing  it  into 
hot  water.  After  the  age  of  six  months  it  may  be 
boiled  if  convenient.  New  unskimmed  milk 
should  always  be  used.  If  the  milk  has  been 
previously  skimmed  a  teaspoonful  of  cream  must 
be  added  to  each  meal. 

In  all  cases  where  the  child  is  artificially  fed, 
the  utmost  attention  should  be  paid  to  the  cleanli- 
ness of  the  feeding  bottle. 

2.     FROM    SIX  TO  TWELVE  MONTHS  OLD. 


206 


THE    CANADA    MEDICAL    RECORD. 


KIVE  MEALS  IN  THE  DAY. 
DIET  4. 

First  meal,  7  a.  m. 

One  teaspoonful  of  baked  or  boiled  flour  care- 
fully prepared  with  a  teacupful  of  milk. 

Second  meal y  10.30  a.m. 

I'hirJ  meal,   2  P.M. 

A  breakfast-cupful  of  milk  alkalinized,  if  neces- 
.sary,  by  fifteen  drops  of  the  saccharated  solution 
of  lime. 

Fourth  meal,  5.30  P.M. 

Same  as  the  first. 

Fifth  meal,  11   p.m. 

Alkalinized  milk,  as  before. 

For  the  second  meal,  twice  a  week,  may  be 
given  the  yolk  of  one  egg,  beaten  up  with  a  tea- 
cupful  of  milk.     *     *     * 

DIET  5. 
FOR  A  CHILD  ABOUT  TEN   MONTHS  OLD. 

First  meal,  7  a.m. 

Dessert-spoonful  of  pearl  barley  jelly,  dissolved 
in  a  breakfast-cupful  of  milk,  and  sweetened  with 
loaf  sugar. 

Second  jneal,  10.30  a.m. 

A  breakfast-cupful  of  milk  alkalinized,  if  neces- 
sary, by  fifteen  drops  of  the  saccharated  solution 
of  lime. 

Third  meal,  2  p.m. 

The  yolk  of  one  egg  beaten  up  in  a  teacupful  of 
milk. 

Fourth  meal,  5.30  p.m. 

Same  as  the  first. 

Fifth  meal,  11   p.m. 

Same  as  the  second. 

Pearl  barley  boiled  for  six  hours  forms  on 
cooling,  after  the  water  has  been  strained  off,  a 
jelly  which  dissolves  readily  in  warm  water. 

DIET  6. 

To  alternate  with  the  preceding. 

First  meal,  7  a.m. 

Half  a  teaspoonful  of  cocoa  essence  boiled  for 
one  minute  in  a  breakfast-cupful  of  milk. 

Second  meal,   10.30  a.m. 

A  breakfast-cupful  of  milk  alkalinized  if  neces- 
sary by  fifteen  drops  of  the  saccharated  solution  of 
lime. 

Third  meal,  2   p.m. 

A  teacupful  of  beef  tea,  half  a  poimd  of  meat  to 
the  pint. 

A  rusk. 

Fourth  meal,  5.30  p.m. 

A  dessert-spoonful  of  pearl  barley  jelly,  dis- 
solved in  a  breakfast  cupful  of  milk  and  sweeten- 
ed. 

Fifth  meal,  11  P.M. 

Same  as  the  second. 

It  is  advisable,  as  a  rule,  to  avoid  giving  inter- 
mediate meals,  and  therefore  the  meals  should  be 
sufficiently  large  to  satisfy  all  reasonable  de- 
mands. 


If  the  child  requires  food  before  7  a.m.,  oa 
waking  from  sleep,  a  little  milk  may  be  given. 

A  healthy  child,  between  ten  and  twelve  months 
old,  will  require  from  a  pint  and  a  half  to  a  quart 
of  milk  in  the  twenty-four  hours. 

3.    KRO.M   TWELVE   TO    EIGHTEEN  MONTHS  OLD. 
DIET  7. 

First  meal,  7.30  a.m. 

A  rusk  or  a  slice  of  stale  bread,  well  soaked  in  a 
breakfast-cupful  of  new  rnilk. 

Second  meal,  1 1  a.m. 

A  drink  of  milk,  a  plain  biscuit  or  slice  of  thin 
bread  and  butter. 

Third  meal,  1.30  p.m. 

A  teacupful  of  good  beef  tea,  a  pound  of  meat 
to  the  pint,  or  of  beef  gravy  with  rusk. 

A  good  tablespoonful  of  light  farinaceous  pud- 
ding. 

Fourth  meal,  6  p.m. 

Same  as  the  first. 

Fifth  meal,  11  p.m.,  if  required. 

A  drink  of  milk. 

DIETS. 

To  alternate  with  the  preceding. 

First  meal,  7.30  a.m. 

The  yolk  of  a  slightly  boiled  egg. 

A  slice  of  thin  bread  and  butter. 

A  cupful  of  milk. 

Second  7neal,  11   a.m. 

A  drink  of  milk. 

A  slice  of  thin  bread  and  butter. 

Third  meal,   1.30  p  M. 

A  mealy  potato,  well  mashed  with  a  spoon,  mois- 
tened with  two  tablespoonfuls  of  good  beef  gravy. 

A  cupful  of  new  milk. 

Fourth  meal,  6  P.  M. 

A  rusk  or  slice  of  stale  bread,  well  soaked  in  a 
breakfast-cupful  of  milk. 

Fifth  meal,  if  required. 

A  drink  of  milk. 

The  fifth  meal,  at  11  p.m.,  should  never  be  given 
unnecessarily.  The  sooner  a  child  becomes  accus- 
tomed to  sleep  all  night  without  food,  the  better. 
When,  however,  it  wakes  in  the  morning,  refreshed 
by  its  night's  rest,  it  should  never  be  allowed  to 
remain  fasting  for  an  hour  or  more  until  its 
breakfast  is  ])repared.  A  drink  of  milk,  or  a  thin 
slice  of  bread  and  butter  should  be  given  at  once. 

Some  children  will  take  larger  quantities  than 
others  at  one  meal  ;  but,  if  the  meals  are  made 
very  large,  their  number  must  be  reduced  in  pro- 
portion. Many  children  between  twelve  and 
eighteen  months  old  will  be  found  to  do  well  upon 
only  three  meals  a  day,  as  in  the  following : 

DIET  9. 
First  meal,  8  a.m. 
One  teaspoonful  of  baked  flour. 
One  teaspoonful  of  fine  oatmeal. 
Three  quarters  of  a  pint  to  a  pint  of  fresh  milk. 
A  little  white  sugar. 
Second  meal,  i  P.M. 


TOE   CANADA    MEDICAL    RECORD. 


207 


The  same  with  the  addition  of  the  yolk  of  one 

egg- 

Third  meal,  5  p.m. 

Same  as  the  first. 

In  this  diet  the  baked  flour  and  the  oatmeal  are 
first  beaten  up  till  smooth,  with  four  table-spoon- 
fuls of  cold  water,  and  then  boiled.  The  milk  and 
sugar  is  then  added,  and  the  mixture  is  boiled 
till  it  thickens. 

For  the  second  meal,  the  yolk  of  egg  is  stirred 
up  in  the  sauce-pan  and  boiled  with  the  rest. 

If  the  child  requires  anything  early  in  the  morn- 
ing or  at  II  P.M.,  he  may  take  a  drink  of  milk,  or 
a  thin  slice  of  bread  and  butter. 

A  healthy  child  of  a  year  to  eighteen  months  old 
will  usually  take  between  two  or  three  pints  of 
milk  in  the  four  and  twenty  hours. 

4.       FROM  EIGHTEEN    MONTHS    TO  TWO    YEARS  OLD- 
DIET   ID. 

First  meal,  7.30  a.m. 

A  breakfast-cupful  of  new  milk. 

A  rusk  or  a  good  slice  of  stale  bread. 

Second  meal.  11  a.m. 

A  cup  of  milk. 

Thh'd  meal,  1.30  p.m. 

Under-done  roast  mutton,  pounded  in  a  warm 
mortar,  a  good  tablespoonful. 

One  well  mashed  potato  moistened  with  two  or 
three  tablespoonfuls  of  gravy. 

For  drink,  milk  and  water  or  toast-water. 

Fourth  meal,  6  p.m. 

A  breakfast-cupful  of  milk. 

Bread  and  butter. 

After  the  age  of  eighteen  months  it  is  well  to 
omit  the  meal  at  1 1  p.m.  A  healthy  child  of  eigh- 
teen months  old  should  sleep  from  6  p.m.  to  6  a.m. 
without  waking. 

DIET  II. 

For  a  child  of  the  same  age. 

First  meal,  7.30  a.m. 

A  breakfast-cupful  of  new  milk. 

The  lightly  boiled  yolk  of  one  egg. 

A  thin  slice  of  bread  and  butter. 

Second  tneal,  1 1  a.m. 

A  cup  of  milk. 

Third  jneal,    1.30  p.  M. 

A  breakfast-cupful  of  beef  tea,  a  pound  of  meat 
to  the  pint,  containing  a  few  well  boiled  asparagus 
heads,  when  in  season,  or  a  little  thoroughly  stewed 
flower  of  broccoli. 

A  good  tablespoonful  of  custard  pudding. 

Fourth  tneal,  6  p.m. 

A  breakfast-cupful  of  milk. 

Bread  and  butter. 

These  diets  can  be  given  on  alternate  days. 

Between  the  ages  of  two  and  three  years  the 
same  diets  may  be  continued.  Meat  can,  how- 
ever^  be  given  every  day,  and  a  little  well-stewed 
fruit  may  be  occasionally  added. 


The  morning  and  evening  meals  should  always 
consist  principally  of  milk.         *         *         *        * 

I  have  transcribed  these  several  diets  because 
they  are  the  most  complete  and  specific  of  any  I 
am  acquainted  with.  Variations  will  suggest  thern- 
selves  to  the  individual  practitioner  according  to  his 
peculiar  circumstances.  A  rigid  and  intelligent 
regimen  is  the  best  prophylactic  against  the  summer 
diarrhoea  of  children. 

I  will  close  with  a  brief  mention  of  some  of  the 
medicinal  agents  that  have  served  me  well.     First 
I  will  say  that  it  is  a  bad  practice  to  resort  at  once 
to  mercury.     If  Dr.  Clevenger's  theory  be  true,  it 
is  preposterous  to   do  so.     When  the   stools  are 
green,   many  colored   and  slimy,  which  is  a  very 
early  symptom  of  coming  trouble,  I  use,  especially 
in  very  young  children,  cajtiomile.     It  not  only  al- 
ters the  cliaracter  of  the  passages,  but  allays  rest- 
lessness and  peevishness.     It  may  be  given  in  in- 
fusion in  doses  of  half  a  drachm  or  drachm,*  or  in 
tincture  in  water  in  an  equivalent   dose.     When 
the  character  of  the  stools  are  not  readily  changed 
by  this  means,  I  sometimes  resort  to  mercury  in 
the  fonn  of  a  trituration  of  the  mild  chloride  with 
sugar  of  milk  in  doses  of  one-tenth  of  a  grain  or  less 
two  or  three  times  a  day,  or  a  trituration  of  the 
metal  hydrargyrum  with  sugar  in  doses  equivalent 
to  those  of  gray  powder,  upon  which  it  is  a  decid- 
ed improvement.     On  this  point  Dr.  H.  G.  Piffard, 
of  New  York  City,  has  given  important  testimony. 
When  there  is  vomiting,  in  addition  to  a  food  con- 
sisting of  diluted  whey  with  cream,  milk  and  hme 
water,   with  cinnamon  water  and  equal  parts  of 
veal  broth  and  barley-water,  given  cold  or  hot,  not 
tepid,  I  use  wine  of  ipecac  in  hourly  drop  doses, 
and   when  vomiting   and  purging  are  conjoined, 
small  doses  of  the  tincture  of  veratrum  album,  f 
This  is  a  valuable  remedy.     Opium  may  be  used 
when  the  diarrhoea  is  due  to  simple  irritation,  but 
it  is,  strictly  speaking,  not  a  remedy  for  infants, 
and  if  the  exigencies  of  a  case  seem  to  demand  it, 

it  should  be  used  with  great  caution,  and  in  doses 
that  are  stimulating,  not  narcotic.f  Among  the 
astringents  I  have  used  geraniutn*  in  infusion, 
and  sometimes  increase  the  astringency  by  catechu 
or  kino  or  red  wine,  and  in  older  children  continue 
to  use  the  mistura  creta  of  the  pharmacopoeia. 

One  observation  I  would  like  to  add.  that  poly- 
pharmacy in  infantile  therapeutics  should  be  studi- 
ously avoided.  Avoid  the  shot-gun  practice  and 
use  only  the  true  rifle,  which,  under  a  steady  eye 
and  hand,  is  most  sure  to  hit  the  mark.  Therefore  I 
would  seldom  combine,  but  use  my  remedies  singly 
wherever  practicable. — Chicago  Med.  Review. 

*Ringer.    Handbook  of  Therapeutics. 
jRinger's  Handbook  of  Therapeutics,  p.  413. 
+See  Austic's  work?. 

*IJ   Infusio.  geranii  mac,  one  and  one-half  ounces. 
Infusio.  authemidis  flor.  (vel  matricariac),  one  and  one 

half  ounces. 
Vini.  rubr.  optim.,  once  ounce. 
M.  Sig  :  Dose,  one-half  to  two  teaspoonfuls  p.  r.  n. 


208 


THE   CANADA    MEDICAL   RECORD. 


NANA'S  DAUGHTER. 

T.  B  Peterson  &  Brothers  have  just  published 
a  remarkable  book  which  will  create  a  great  sensa- 
tion, being  no  less  than  a  continuation  of,  and 
sequel  to,  Kmiie  Zola's  great  Paris  realistic  novel 
of  Nana,  being  a  far  superior  book,  which  can  be 
appreciated  by  all.  It  is  entitled  "  Nana's  Daugh- 
ter," and  is  one  of  the  most  exciting  and  absorb- 
ing stories  ever  given  to  the  public.  'I'he  heroine 
is  elevated  upon  the  stage  of  Parisian  fashion,  and 
is  more  natural  than  realistic.  Look  out  for  an- 
other eruj)tion. 


FOR  TREATMENT  OF  DISEASES  OF  THE 

THROAT  AND  LUNGS. 

Vapor  Cajuputi  : 

Oil  of  Cajuput 4  parts  ; 

Light  carbonate  of  magnesia i     " 

Water,  to 180     " 

Vapor  Calmi  Aromatical  : 

Oil  of  calamus  aromaticus 2  parts; 

Light  carbonate  of  magnesia  ....     i     " 
Water,  to  180     " 

Vapor  Camphorcs : 

Spirit  of  camphor 6  parts  ; 

Rectified  spirits  of  wine 9     " 

Water,  to 24     " 

Vapor  Carui : 

Oil  of  caraway 2  parts; 

Light  carbonate  of  magnesia i     " 

Water,  to 144     •< 

Vapor  Juniperi  Anglici : 

Oil  of  juniper 2  parts; 

Light  carbonate  of  magnesia i     " 

Water,  to  48     " 

One  teaspoonful  of  any  of  these  mixtures  in  the 
inhaler  is  a  suitable  quantity  for  one  inhalation.— 
The  Druggist. 


CHILBLAINS. 

In  response  to  an  inquiry  in  the  British  Medical 
Journal,  the  following  suggestions  for  the  treat- 
ment of  chilblains  are  given  : 

Have  the  patient  wear  large  shoes  which  do  not 
compress  the  feet.  Touch  the  toes  with  nitrate  of 
silver.  Galvanism  has  always  proved  successful  with 
one  writer.  Liniment  of  aconite  is  recommended. 

An  ointment  of  lard  and  dry  mustard  rubbed  in 
before  the  fire  for  twenty  minutes  will  cure  the 
trouble  after  a  few  ajjplications. 

Paint  the  affected  parts  with  flexible  collodion  to 
protect  them  from  the  air.  Very  hot  water,  applied 
with  flannels  or  sponges,  is  efficacious.  A  strong 
solution  of  acetate  of  lead  was  highly  recommend- 
ed by  Sir  Astley  Cooper.  Sulphurous  acid  is  use- 
ful in  mild  cases. 


CYSTITIS. 

Dr.  A.  J.  C.  Skene,  of  Brooklyn,  gives  the  fol- 
lowing, which  he  regards  as  almost  specific  in  cys- 
titis, especially  in  the  earlier  stages,  affording  rapid 
and  lasting  relief: 

\),  Acidi  benzoici ] 

Sodii  biboralis j       8  •      j 

Inf.  buchu 1  ij. 

M.  Sig.  This  quantity  to  be  taken  three  or  four 
times  a  day.  Tho  diet  should  also  be  carefully  regu- 
lated, and  the  skin  and  bowels  kept  in  an  active 
condition. 


TREATMENT  OF  COUGH  IN    BRONCHI- 
TIS AND  PHTHISIS. 

T.  Lauder  Brunton  (Lond.  Lancet^  thus  ana- 
lyzes the  following  prescription  of  Dr.  Warburton 
Begbie  : 

5  Liq.  morphiae  hydrochlorat  "| 

Acidi  hydrocyanici,   dil....  [-aa  v\  xviij  ; 

Chloroformi j 

Spiritus  chloroformi )       a  f 

Acidi  nitrici  dil ^aan.^J  ; 

Glycerinje A- 3  ij ; 

Infus.    cascarillas   (seu    infus 
quassias) fi.  lij- 

M.  A  sixth  part  to  be  taken  three  or  four  times  a 

day. 

Here  the  sedatives — morphia,  hydrocyanic  acid, 
and  chloroform — tend  to  lessen  the  excitability  of 
the  respiratory  centre  ;  the  glycerin  tends  to  retain 
the  sedatives  in  longer  contact  with  the  throat,  and 
acts  also  to  some  extent  as  a  nutrient,  and  the  ni- 
tric acid  and  bitter  are  supposed  to  have  a  tonic 
effect  on  the  stomach.  In  what  way  this  tonic  ef- 
fect is  produced  we  can  not  at  present  say ;  but 
we  will  imagine  that  they  will  in  some  way  par- 
tially counteract  the  effect  of  the  congestion  which 
the  cough  produces,  and,  exciting  appetite,  will 
counteract  the  influence  of  the  morphia.  Nitric 
acid  had  also,  as  Dr.  Brunton  points  out,  a  defin- 
ite effect  upon  the  secretions  of  the  lungs  them- 
selves. Considering  those  drugs  which  tend  to 
lessen  congestion,  Dr.  Bruuton  mentions  digitalis, 
and  gives  the  following  prescription  from  Beasley, 
as  used  by  Sir  A.  Crichton  : 

U     Succi  limonis fl.  |ss; 

Potassi  carbonat.  ad  saturand... 

Decoct.  sarsa])arillai fl.  3  x  ; 

Tinct.  digitalis  tT.  x  ad  xxx  ; 

Mucilag.  acacire .  fl.  3  x. 

M.  To  be  taken  every  sixth  hour. 
The  tincture  of  digitalis  here  tends  to  contract 
the  vessels,  diminish  ])ulmonary  congestion,  and 
lessen  cough.  The  potash  renders  the  pulrrwnary 
secretion  more  fluid  and  al)undant.  Warm  food, 
as  beef  tea.  Dr.  Brunton  says  is  a  good  expector- 
ant, as  also  is  cod-liver  oil.  Ice,  hydrocyanic 
acid,  and  alum  are  recommended  in  the  vomiting 
of  phthisis. 


THE   CANADA   MEDICAL    RECORD. 


20^ 


COD-LIVER 


OIL      IN     PHTHISIS     AND 
BRONCHITIS. 


Dr.  T.  Lauder  Brunton,  writing  on  this  subject 
in  the  London  Lancet,  says  : — 

One  of  the  most  powerful  expectorants  is  simply 
a  little  warm  food  in  the  stomach,  and  in  cases  of 
chronic  bronchitis,  in  which  the  patients  complain 
of  violent  coughing  immediately  after  rising,  one  of 
the  best  expectorants  is  a  glass  of  warm  milk, 
either  with  or  without  a  little  rum,  and  a  biscuit  or  a 
piece  of  bread,  about  a  quarter  of  an  hour  before 
they  get  up.  A  little  warm  beef  tea  will  have  a 
simliar  effect.  After  taking  this  for  a  short  time 
they  generally  tell  you  that  the  sputum  comes  away 
much  more  easily  than  before,  and  they  are  not  so 
much  exhausted  by  it.  But  perhaps  the  remedy, 
j)ar  excellence,  not  only  in  cases  of  phthisis,  but  in 
chronic  bronchitis,  is  cod  liver  oil.  Persons  suf- 
fering from  long-standing  chronic  bronchitis  will 
often  come  to  a  hospital  to  beg  for  cod-liver  oil, 
saying  that  it  eases  their  cough  far  more  than  any 
cough  mixture.  Other  oils  or  fats  have  not  this 
power  to  the  same  extent  as  cod-liver  oil.  We 
cannot  say  positively  what  the  reason  of  this  may 
be,  but  I  think  there  is  no  doubt  about  the  fact. 
My  own  belief  is  that  cod-liver  oil  is  more  easily 
assimilated  than  other  oils,  and  not  only  so,  but 
more  easily  transformed  into  tissues  themselves. 
Whether  it  owes  this  property  to  its  admixture 
with  biliary  substances  or  to  its  chemical  com- 
position, we  cannot  say.  Dr,  Weir  Mitchell 
quotes  a  remark  made  by  an  old  nurse,  that  "  some 
fats  are  fast,  and  some  fats  are  fleeting,  but  cod- 
hver  oil  fat  is  soon  wasted."  By  this  she  meant  that 
there  were  differences  in  the  kinds  of  fat  accumu- 
lated under  the  subcutaneous  tissues  of  men,  just 
as  there  are  differences  in  subcutaneous  fats  which 
accumulate  in  horses.  The  horse  fed  on  grass  soon 
gets  thin  by  hard  work,  while  the  fat  laid  on  when 
the  horse  is  feeding  on  hay  and  corn  is  much  more 
permanent.  Persons  fattened  on  cod-liver  oil  soon 
lose  the  fatness  again,  and  this,  I  think,  points  to 
the  power  of  ready  transformation  which  the  oil  pos- 
sesses. Supposing  that  it  does  possess  this  power, 
we  can  readily  see  how  very  advantageous  it  will 
be.  In  chronic  bronchitis,  and  in  catarrh  and 
pneumonia,  we  have  a  rapid  cell  growth,  but  want 
of  development.  The  cells  lining  the  respiratory 
cavities  are  produced  in  great  numbers,  but  they  do 
not  grow  as  they  ought  to  do.  They  remain,  more 
or  less,  lymphoid  cells,  instead  of  developing  into 
proper  epithelmm.  They  so  rapidly  form,  and 
are  thrown  off  so  quickly,  that  they  have  not 
time  to  get  proper  nutriment,  and  if  they  are  to 
grow  properly  we  must  supply  them,  not  with  an 
ordinary  kind  of  nutriment,  but  with  one  which  is 
much  more  rapidly  absorbed,  and  is  capable  of 
much  more  rapid  transformation  in  the  cell  itself 
than  the  usual  one.  This  power  is,  I  believe,  pos- 
sessed by  cod-hver  oil,  and  to  its  quality  of  nourish- 
ng  the  rapidly  formed  cells  in  the  lungs  in  cases  of 
ronchitis  and  catarrhal  pneumonia  I  believe  its 
reat  curative  power  is  owing. 


TEMPERATURE    OF   SLEEPING    ROOMS 

Dr.  Horace  Dobell,  of  London,  in  his  excellent 
work,  "  Winter  Cough,"  makes  remarks  on  the 
temperature  of  bed-rooms,  that  are  so  appropriate- 
that  I  will  quote  them.  He  says  :  "  But  before  leav- 
ing the  subject  of  sudden  changes  of  temperature, 
I  must  not  forget  to  speak  of  sleeping-rooms.  It  is 
quite  atonishing  what  follies  are  committed  with 
regard  to  the  temperature  of  sleeping-rooms.  On 
what  possible  ground  people  justify  the  sudden 
transition  frrom  the  hot  sitting-room  to  a  wretched 
cold  bed-room,  which  may  not  have  had  a  fire  irv 
it  for  weeks  or  months,  it  is  impossible  to  say ;  but 
it  is  quite  certain  that  the  absurd  neglect  of  pro- 
perly warming  bed-rooms  is  a  fruitful  source  of  all 
forms  of  catarrh.  We  cannot  too  much  impress 
this  upon  our  patients."  For  those  who  do  not 
become  warm  quickly  after  they  go  to  bed,  during 
cool  or  damp  weather,  the  bed-clothes  should  be 
warmed  by  a  hot  smoothing  iron,  or  a  warming  bed 
pan,  before  they  retired  for  the  night.  This  warm- 
ing operation  may  be  necessary,  even  if  there  has 
been  a  fire  in  the  sleeping-room  all  day.  If  a 
patient  is  subject  to  profuse  night  sweats  the  damp- 
ened bed-clothes  should  on  each  morning  be  re- 
moved from  the  bed,  and  fresh,  well-dried  coititi 
clothes  (linen  sheets  and  pillow  cases  should  be 
eschewed)  supplied  in  their  stead.  If  the  perspi- 
ration has  been  but  slight,  the  bed  sheets  alone 
may  be  all  that  requires  removal,  or  even  thcsi 
may  beso  slightly  dampened  that  their  being  placed 
before  a  grate  fire  will  be  sufficient  to  dry  them  for 
the  next  night's  use. — Dr.  Rumbold's  Hygiene  of 
Catarrh. 


The  Canada  Medical  Record, 

^  ittojit^li)  Sournal  of  ittcUCctne  an&  ^tJs^ntacB. 
FRANCIS  W.  CAMPBELL,  M. A.,  M.D.,L.K.C.P.,  LONE'. 

ASSISTANT  EDITORS  : 

R.  A.  KENNEDY,  M.A.,  M.D. 

JAMES  PERRIGO,  M.D.,  M.R.C.S.  Eng. 

BDITOR  OF   PHARMACEUTICAL   DEPARTMENT: 

ALEX.  H.  KOLLMYER,  M.A.,  M.D- 

SUBSCRIPTION  TWO  DOLLARS  PER  ANNUM  . 

All  communications  and  Exchanges  must  be  addressed  t<p 
the  Editor , Drawer 356, Post C^ce,  Montreal. 

MONTREAL.  MAY.  1881. 


THE  MONTREAL   GENERAL  HOSPITAL. 

Since  our  last  issue,  there  has  been  an  election 
for  an  indoor  and  an  outdoor  physician.  The 
indoor  vacancy  was  created  by  the  resignation  of 
Dr.  John  Reddy,  who,  after  twenty-five  years 
faithful  service,  retired  upon  the  consulting  staffs 
Dr.  Molson,  for  several  years  on  the  staff  of  assist- 
ant physicians,  was  elected  to  fill  Dr.  Reddy's  place. 
Dr.  Gardner  was  elected  to  the  vacancy  which  Dr. 


210 


THE   CANADA    MEDICAL    RECORD. 


Molson's  promotion  caused,     'i'hc  resignation  of 
Dr.  Reddy  took  ])lacc  on  the  17th,  the  election  was 
on  the  19th.     This  was  quite  in  accordance  with 
the  by-laws,  but  the  sooner  the  by-laws  arc  altered 
on  this  point  the  better.     The  contest,  if  such  it 
<an  be  called  (for  Dr.  Gardner's  friends  tried  to 
elect   him    to    Dr.  Reddy's   vacancy,    and    three 
•candidates  went  to  vote  with  Dr.  Gardner  on  the 
outdoor  stafQ,  has  apparently  resulted  in  promises 
of  some  amendment.     The  Governors,  badgered 
by  doctors,  relations  and  female   friends  in  these 
medical  elections,  are  now  loud  in  demanding  the 
ballot,  as  a  means  of  affording  them  relief  from 
persecution,  and  the  possibility  of  exercising  a  con- 
•scientious  vote.    Unfortunately  the  founders  of  the 
Hospital  did  not  apparently  believe  in  this  manner 
of  voting,  and  as  the  charter  names  how  it  shall  be 
conducted,  it  is  believed  the  Hospital  will  have  to 
^o   to    the  Legislature   for    an  amendment  to  it 
iye(oTe  this  desideratutn  can  be  obtained.  We  think 
the  movement  a  wise  one,  and  wonder  that  it  was 
not  long  since  adopted.    We  at  the  same  time  warn 
the   Governors   that  they   must  be   prepared  for 
opposition,   for  with  the  ballot  the  days   of  the 
Medical    Monopoly,  which   have  always    charac- 
terized that  institution,  will  we  believe   be  at   an 
end. 


THE      BOGUS-DIPLOMA     BUSINESS     IN 
PHILADELPHIA. 

The  confession  ofthe  now  notorious  Dr.  Buchan- 
an,  with  regard  to  the  infamous  traffic  in  bogus 
diplomas,  in    which   he  was  for  so  many   years 
engaged,  reveals  a  state  of  things  which  is  almost 
beyond  belief.     That  one  could  have  for  so  long 
a  period  carried  on  this  business  in  a  city  where 
medical  education  occupies  a  foremost  place,  and 
in  the  midst  of  men  jealous  of  professional  honor,  is 
difficult  of  comprehension,  in  spite  even  of  the 
explanation  given.     To   a  representative   of   the 
secular   press   the  credit    is    due    of    unearthing 
and  bringing  to  light  the  nefarious  traffic.     It  ap- 
pears from   the  statements   made   by    Buchanan 
that  the  bogus-diploma  business  was  not    only  a 
■distinct  branch  of  industry,  but  was  a  business  of 
immense  proportions,  having  its  recognized  agents, 
drummers,  go-betweens,  and   influential  advisers. 
Through  this  concern  alone  sixty   thousand  bogus 
diplomas  have   been   sold    within   the    last  forty 
years  j  of  these  forty  thousand  were  disposed  of  in 
Europe.     'Hie  price  for  each  of  these  pieces  of 
jjarchment  varied  from  ten  to  two  hundred  dollars, 


according  to  the  means  and  gullibility  of  the  ap- 
plicant.    Nothing  was  required  from  the  candi- 
date but   the  money.     The   representative  ofthe 
Philadelphia  Record  purchased  several  of   these 
diplomas  without  having  studied  medicine  a  single 
day,  and  without  making  the  slightest  pretension 
to   a  knowledge  of  the   science.     P'ac-similes    of 
these  documents  are  published  by  the  gentleman 
in  question,  and  help  to  make  up  an   interesting 
part  of  the  history  of  a  stupendous  and  barefaced 
fraud.     As  Buchanan  has  nothing  to  gain  one  way 
or   the  other  by  his  statements,  it  is  fair  to  pre- 
sume that  they  are  worthy  of  some  credence.     At 
all  events  they   are   corroborated  by   the   docu- 
ments which  he  has  surrendered  to  the  authorities. 
One  fact  of  special  interest  to  us  as  Canadians  is 
the  number  of  men  who  figure  in  the  published 
list  as  hailing  from  Canada.     So  far  as  we  are  able 
to  judge,  few  of  them  are  in  practice  in  the  Domi- 
nion to-day,  but,  at  the  same  time,  we  think  we 
have   not  got  rid  of  all   of  them.     In  the   Pro- 
vince of  Ontario  the  Registration  Act  cleared  out 
many  of  them.     If  any  are  in  our  own  Province, 
they  will  soon  be  heard  of,  for,  thanks  to  the  pre- 
sent Governing  Board  of  the  College  of  Physicians 
and  Surgeons,  the  present  Medical  Act  is  not  being 
left  a  dead  letter. 


ANOTHER  DODGE. 

Some  two  or  three  years  ago  the  Medical  Press 
of  the  United  States  and  Canada  suddenly  awoke 
to  the  fact  that  they  were  being  contemptibly 
swindled  by  those  men  who  from  one  end  of  the 
country  to  the  other  were  writing  for  "  a  specimen 
copy  of  your  Journal."  One  can  hardly  conceive 
that  there  exists,  in  the  form  of  humanity,  a  person 
so  mean  as  in  this  way  to  arrange  for  the  supply  of 
his  Medical  reading,  at  a  cost  calculated  simply  by 
the  number  of  post  cards  which  he  dispatches 
asking  for  "  a  specimen,"  yet  such  was  the  fact. 
For  a  time  after  the  expose,  these  little  missives, 
so  polite  in  expression,  ceased  to  come  to  us  ;  then 
they  began  to  reach  us  again,  but,  failing  to  elicit 
any  response,  they  once  more  ceased.  We  hoped 
the  "  swindle  "  had  collapsed,  but  if  we  are  not 
mistaken  it  has  once  more  come  to  life — in  a  form 
which  has,  we  confess,  deceived  us  for  the  last  six 
months.  During  that  time  we  have  received  from 
at  least  a  dozen  or  more  persons,  living  in  the 
United  States,  a  postal  card  asking  quotations  for 
a  small  advertisement,  "  and  the  favor  of  a  speci- 
men copy."     At  first  we  took  the  bait,  and  gave 


THE   CANADA   MEDICAL   RECORD. 


211 


ordinary  quotations,  but  never  getting  a  response, 
we  began  to  think  that  this  was  "  the  specimen 
copy  "  man  in  another  form.  We  then  gave  quota- 
tions ridiculously  low,  but  still  no  advertising  came, 
and  we  are  now  convinced  that  this  is  indeed  the 
old  swindle  in  a  new  form,  and  consign  all  such 
cards  to  our  waste  basket.  There  is,  however,  a 
very  singular  phase  to  both  these  swindles,  which 
is  difficult  to  understand.  The  cards,  asking  for 
specimen  copies,  came  in  floods  for  over  two  years, 
and  from  every  section  of  this  continent  from 
Nova  Scotia  to  Colorado,  and  yet  the  wording  was 
very  much  the  same  in  all.  In  the  new  departure 
the  same  thing  is  noticeable,  a  remarkable  simi- 
larity of  wording.  Does  there  exist  a  widespread 
organization  for  the  purpose  of  obtaining  medical 
and  general  literature  almost  without  cost  ?  We 
cannot  believe  it,  yet  facts  would  almost  seem  to 
point  that  way.  Do  they  believe  that  literature 
should  be  endowed  by  the  State,  and  disseminated 
for  the  general  good.-*  Till  that  time  arrives,  we 
must  decline  to  send  specimen  copies  free,  even 
though  it  be  to  one  "  who  desires  to  advertise" 


remove  the  coloring  matter,  which,  when  it  fades,, 
may  be  easily  renewed. 


Reader,  are  you  anxious  to  know  what  other 
practitioners  are  doing?  Are  you  anxious  to  ad- 
vance higher  day  by  day  in  the  practice  of  your 
profession  ?  Then  tell  others  what  you  have  learn- 
ed ;  what  strange  freaks  of  disease  you  have  en. 
countered;  what  remedies  have  yielded  good 
results,  and  what  have  failed.  Send  us  your  ex- 
perience and  your  subscription  money,  and  you 
shall  hear  from  the  rest.  Don't  hide  your  light 
under  a  bushel,  or  think  because  you  are  plodding 
away  among  the  hills  and  waysides  that  you  know 
nothing  of  interest — or,  worse  still,  think  you  know 
everything.  Keep  in  line,  or  the  world  will  wag 
along  and  keep  you  in  the  lurch. 


HOW  TO  RESTORE  THE  SCALE  OF 
THERMOMETERS. 

Physicians  are  frequently  troubled  by  the  scales 
of  their  thermometers  becoming  indistinct,  the 
pigment  in  the  marks  wearing  out.  The  scale  may 
be  made  distinct  again  by  painting  it  with  an 
alcoholic  solution  of  any  aniline  color.  Make  two 
or  three  applications,  let  the  color  dry,  and  then 
rub  off  with  a  dry  cloth.  The  aniline  will  fasten 
itself  on  the  roughened  glas8  of  the  scale  alone 
making  each  line  show  distinctly.     Water  will  not 


CANADA  MEDICAL  ASSOCIATION. 

The  next  meeting  of  this  Association  is  to  be- 
held in  Halifax,  Wednesday,  3rd  August.  Owing  to 
the  serious  illness  of  the  General  Secretary,  Dr.  A. 
H.  David,  all  communications  concerning  the 
meeting  should  be  addressed  to  the  Local  Secretary 
for  Ontario,  Dr.  Adam  Wright,  who  has  kindly 
undertaken  the  duties  of  the  General  Secretary. 


A  PROPOSED  NEW  PLAN  TO  DISINFECT 
SEWERS. 

Dr.  A.  J.  Holkett,  the  medical  examiner  for 
the  Germania  Life  Insurance  Company,  New  York, 
has  laid  a  new  plan  for  disinfecting  the  sewers  of 
that  city  before  the  Board  of  Health.  He  pro- 
poses by  the  use  of  electricity  to  neutralize  the 
gases  generated  in  the  sewers.  It  is  said  to  be 
probable  that  an  experiment  will  be  made, 
although  the  Commissioners  are  not  very  sanguine 
of  the  results. 


Correction. — In  the  February  number  of  the 
Record  we  published  a  paper  by  Dr.  F.  W.  Otiss 
of  New  York  "  On  the  Sulphide  of  Calcium  in  the 
Treatment  of  Suppurating  Buboes,"  and  credited  it 
to  the  N.  Y.  Medical  Record.  This  was  an 
error,  as  the  paper  first  appeared  in  the  New  York 
Medical  Journal. 


ERGOTINE  :  ITS  INCONVENIENCES  AND 
DANGERS. 

At  a  recent  meeting  of  the  Paris  Academy  of 
Medicine  (Zdt  France  Medicale)  Dr.  Boissarie  read 
a  memoir  on  the  above  subject.  His  conclusions 
are  that  ergotine,  which  is  of  important  service  in 
haemorrhage  when  we  require  immediate  energetic 
action,  cannot  be  used  with  impunity  in  affections 
of  long  continuance,  even  in  small  doses,  so  as  to 
saturate  the  system.  It  has  the  property  of  accu- 
mulating and  storing  itself  up  in  the  economy,  and 
of  manifesting  itself,  after  a  longer  or  shorter 
ime,  by  a  sudden  outburst  of  serious  consequences,. 
To  follow  the  precept  of  Trousseau  of  giving  the 
poison  for  a  long  time  in  small  doses  is  to  expose 
the  patient  to  gangrene. 


^12 


THE   CANADA    MEDICAL    RECORD. 


The  Medical  Press  gives  an  extract  from  the 
diary  of  the  late  Mr.  Mewbum  : — 

"  The  following  statement  from  the  fee-book  of 
Sir  Astlcy  Cooper  is  curious  : — 

••  My  receipt  for  the  first  year  was  5/.  5^.  ;  for 
the  second,  26/. ;  the  third,  64/.  ;  the  fourth,  96/.  ; 
"the  fifth,  100/. ;  the  sixth,  200/.  ;  the  seventh 
400/. ;  the  eighth,  610/. ;  the  ninth,  1,100/. 

"In  1815  Sir  Astley  made  21,000/.!  !  A  Mr. 
Hyatt,  an  ancient  merchant,  gave  him  1,000/.  on 
recovery  under  his  care ;  and  Mr.  Coles,  of 
Mincing  Lane,  for  a  long  course  of  time,  gave 
him  600/.  every  Christmas." 


The  invention  of  the  capsule  may  be  regarded 
as  one  of  the  triumphs  of  modern  pharmacy. 

The  old-fashioned  naked  pill,  with  its  irregular 
contour  and  its  nauseous  taste,  which  not  infre- 
quently excited  in  the  pharynx  an  inverted  deglu- 
tition, has  become  almost,  if  not  quite,  a  thing  of 
the  past. 

The  capsule  has  manifest  advantages  over  the 
pill,  such  as,  ease  in  swallowing,  readiness  of  solu- 
tion, together  with  the  protection  it  affords  the 
medicine  against  atmospheric  influences,  thus  in- 
suring that  it  shall  arrive  in  the  stomach  in  the 
best  condition  for  assimilation  ;  and  these  facts 
being  well  understood  by  the  physician,  the  term 
"  Ft.  pilulse  "  at  the  close  of  a  prescription  is  not 
now  very  often  seen. 

A  capsule  to  meet  the  above  requirements 
should  consist  almost  entirely,  if  not  wholly,  or 
pure  gelatin,  which,  on  entering  the  stomach,  ap- 
propriates water  of  composition,  and,  becoming  a 
jelly,  will  readily  dissolve  and  set  the  contained 
medicine  free. 

But  the  increased  demand  for  capsules,  together 
with  a  desire  to  furnish  them  at  a  low  price,  has 
tempted  some  manufacturers  to  use  glue  and 
various  other  cheap  and  impure  compounds  in 
their  manufacture. 

Capsules  made  of  these  substances  are  some- 
times so  slow  of  solution  as  to  seriously  delay  the 
action  of  the  medicine,  or,  worse  still,  resisting  the 
fluids  of  the  alimentary  tract  to  the  end,  pass  out 
like  bullets,  unchanged. 

Before  ordering  them  for  a  patient  the  physician 
should  test  a  given  specimen  of  capsules  by  hold- 
ing one  in  his  mouth  until  it  dissolves.  If  its 
solution  is  rapid,  and  no  unpleasant  flavor  is  per- 
ceived, it  may  be  safely  used  ;  but  if  it  tarries  long 


upon  the  tongue,  or  imparts  to  the  taste  a  savor  of 
the  hide-store  or  the  sour-paste  pot,  it  should  not, 
under  any  circumstances,  be  given  to  a  sick  person. 

The  old  and  highly  reputable  firm  of  H.  Plan- 
ten  &  Son,  224  William  Street,  New  York,  fur- 
nishes an  article  which  will  stand  any  test,  and  we 
can  conscientiously  recommend  their  capsules  to 
the  profession. 

They  are  made  of  seven  different  sizes  for  the 
mouth  and  of  three  for  the  rectum.  The  latter  are 
conical  at  one  end,  and  present  a  form  which 
may  be  easily  introduced  into  the  rectum,  and  re- 
tained by  this  organ  without  discomfort. 

WYETH'S  ELIXIR  OF  PHOSPHORUS. 

Although  Phosphorus  has  long  been  recognized 
as  of  great  therapeutical  value,  there  has  been  up 
to  the  present  time  a  drawback  to  its  extensive 
employment  in  the  difficulty  of  finding  a  safe, 
accurate,  and  agreeable  form  in  which  to  admin- 
ister it. 

Wyeth,  of  Philadelphia,  now  prepares  an  Elixir. 
OF  Phosphorus,  which  is  free  from  all  the  objec- 
tionable qualities  above  stated.  It  is  absolutely 
reliable,  non-irritating,  and  pleasant  to  the  taste. 
Each  teaspoonful  contains  grain  i-ioo  of  free  Phos- 
phorus, held  in  perfect  solution,  and  of  assured  sta- 
bility. This  article  has  been  tested  for  nearly  a  year 
by  leading  physicians,  and  their  satisfaction  with  it 
has  been  such  as  to  warrant  them  in  offering  it  to 
the  profession  at  large  as  worthy  of  their  favor.  It 
may  be  given  in  combination  with  other  prepara- 
tions, as  for  example  with  Elixir  of  Iron,  Quinine, 
and  Strychnia,  with  the  tincture  of  Nux  Vomica,  etc. 


THE  POPULAR  SCIENCE  MONTHLY. 

The  nineteenth  volume  of  The  Popular  Science 
Monthly  "  begins  with  the  May  number,  and  it  would 
be  difficult  to  find,  since  its  start,  an  issue  that  more 
fully  sustains  the  high  reputation  of  the  magazine 
as  an  exponent  of  modern  science  in  a  readable 
and  attractive  form.  The  first  article,  by  Professor 
David  S.  Jordan,  is  a  capital  example  of  the 
way  science  may  be  made  both  entertaining 
and  instructive  to  the  general  reader,  youth- 
ful or  adult,  without  any  sacrifice  in  accuracy  or 
dignity  of  statement.  It  is  entitled  the  "  Story  of 
a  Salmon,"  and  treats  of  the  life-history  of  that  in- 
teresting and  useful  fish  from  the  time  it  is  produced 
as  an  egg  until  it  becomes  itself  an  egg-producer. 


THE   CANADA   MEDICAL   RECORD. 


2ia 


Dr.Felix  L.  Oswald,  who,  as  readers  of  the  Monthly 
know,  has  always  something  interesting  and  usefu| 
to  say,  continues  his  articles  on  "  Physical  Educa- 
tion," treating  in  this  number  the  subject  of  "  Gym. 
nasties."  The  "  Mineral  Springs  of  Saratoga"  is 
an  illustrated  article  on  the  geology  of  the  springs 
with  a  brief  statement  of  the  two  rival  theories 
concerning  the  sources  of  their  mineral  constitu- 
ents, and  an  extended  table  giving  the  chemical 
compositions  of  the  various  waters. 

Professor  Tyndall  has  a  valuable  paper  entitled 
the  "Action  of  Radiant  Heat  on  Gaseous  Mat- 
ter," in  which  he  describes  some  wonderful 
experiments  with  the  photophone. 

Under  the  title  of  "  The  Eucalyptus  in  the 
Roman  Campagna,"  Mr.  H.  N.  Draper  gives  a 
history  of  the  introduction  and  cultivation  of  the 
eucalyptus  in  one  of  the  worst  parts  of  that  pesti- 
ferous plain,  and  the  remarkable  improvement  in  the 
healthfulness  of  the  locality  which  has  resulted, 
therefrom. 

New  York  :  D.  Appleton  &  Company.  Fifty 
cents  per  number,  $5  per  year. 


ELIXIR  FERRI  ET  CALCIS  PHOSPH,  CO. 

This  preparation,  made  by  Dr.  Wheeler  of  Mont- 
real, has  now  been  before  the  profession  for  a 
number  of  years,  and  the  fact  that  it  is  still  in 
large  demand  proves  most  conclusively  that  it  is 
a  medicine  of  very  great  value.  We  have  always 
held  it  in  high  esteem,  and  a  twelve  years'  experience 
of  it  has  only  confirmed  our  high  opinion  of  it.  It 
is  palatable,  and  does  not  leave  a  disagreeable 
after-taste.  Our  readers  who  have  not  done  so 
should  include  it  among  their  list  of  remedies,  and 
when  occasion  presents  where  it  should  be  useful, 
we  are  satisfied,  if  prescribed,  it  will  give  every 
satisfaction. 


GYMNASTICS  AS  A  CURE  OF  DISEASE. 

Physical  vigor  is  the  basis  of  all  moral  and 
bodily  welfare,  and  a  chief  condition  of  permanent 
health.  Like  manly  strength  and  female  purity, 
gymnastics  and  temperance  should  go  hand  in 
hand.  An  effeminate  man  is  half  sick ;  without 
the  stimulus  of  physical  exercise,  the  complex  or- 
ganism of  the  human  body  is  liable  to  disorders 
which  abstinence  and  chastity  can  only  partly 
counteract.  By  increasing  the  action  of  the  cir- 
c\ilatory  system,  athletic  sports  promote  the  elim 


ination  of  effete  matter  and  quicken  all  the  vital 
processes  till  langour  and  dyspepsia  disappear  like 
rust  from  a  busy  plowshare.  *■  When  I  reflect  on  the 
immunity  of  hard-working  people  from  the  effects 
of  wrong  and  overfeeding,"  says  Dr.  Boerhaave, 
"  I  cannot  help  thinking  that  most  of  our  fash- 
ionable diseases  might  be  cured  mechanically  in- 
stead of  chemically  ^  by  climbing  a  bitterwood-tree 
or  chopping  it  down,  if  you  like,  rather  than 
swallowing  a  decoction  of  its  disgusting  leaves." 
The  medical  philosopher,  Asclepiades,  Pliny  tells 
us,  had  found  that  health  could  be  preserved,  and 
if  lost,  restored,  by  physical  exercise  alone,  and 
not  only  discarded  the  use  of  internal  remedies,, 
but  made  a  public  declaration  that  he  would  for- 
feit all  claim  to  the  title  of  a  physician  if  he 
should  ever  fall  sick  or  die  but  by  violence  or 
extreme  old  age.  Asclepiades  kept  his  word, 
for  he  lived  upward  of  a  century,  and  died 
from  the  effects  of  an  accident.  He  used  to  pre- 
scribe a  course  of  gyTiinastics  for  every  form  of 
bodily  ailment,  and  the  same  physic  might  be  suc- 
cessfully applied  to  certain  moral  disorders,  incon- 
tinence, for  instance,  and  the  incipient  stages  of  the- 
alcohol-habit.  It  would  be  a  remedy  adprincipi 
urn,  curing  the  symptoms  by  removing  the  cause, 
for  some  of  the  besetting  vices  of  youth  can  with 
certainty  be  ascribed  to  an  excess  of  that  potential 
energy  which  finds  no  outlet  in  the  functions  of 
our  sedentary  mode  of  life.  In  large  cities  parents 
owe  their  children  a  provision  for  a  frequent  op- 
portunity of  active  exercise,  as  they  owe  them  an 
antiseptic  diet  in  malarious  climate. — By  Dr. 
Felix  L.  Oswald,  in  Popular  Science  Monthly 
for  May. 


TO  PRESERVE  THE  BRAIN. 

Extracted  from    fournal    of    Anatomy    and    Physiology^ 
January,  1 879.     (Giacomini  method.) 

The  organ  enveloped  in  its  membranes  is 
immersed  in  a  solution  of  zinc  chloride  sp.  gr. 
1.343.  Turn  two  or  three  times  a  day.  If  the 
subject  has  been  dead  for  some  time,  inject  600 
grammes  of  the  solution  through  the  carotids,  so  as 
to  give  firmness  to  the  somewhat  soft  brain  before 
its  removal.  After  forty-eight  hours  the  surface  is 
hard  enough  to  have  the  membranes  removed. 
Let  this  be  done  without  taking  the  organ  out  of  the 
solution.  After  having  been  cleaned  let  it  remain 
in  the  solution,  till,  as  the  hardening  proceeds,  it 
begins  to  sink  no  longer,  and  then  remove  it.     Now 


214 


TDE    CANADA    MEDICAL    RECORD. 


it  is  immersed  in  commercial  alcohol  for  not  less 
than  ten  or  twelve  days.  As  it  sinks  here  it  must 
be  turned  often  to  avoid  deformity  by  pressure  on 
•the  bottom  of  the  vessel,  and  it  is  well  to  renew 
the  spirit  two  or  three  times,  the  oftcncr  the 
sooner  the  process  is  required  to  be  fmishcd.  Let 
the  organ  now  be  immersed  in  commercial 
glycerine,  at  first  it  floats,  but  gradually  becomes 
heavier  as  the  alcohol  evaporates  ;  when  level  with 
the  fluid  it  is  to  be  taken  out.  Now  set  it  aside 
for  several  days  till  the  surface  is  dry,  then  cover 
with  gum  elastic  varnish. 

To  the  above  process  we  would  make  the  follow- 
Jng  suggestions  : 

(A  mixture  of  damar  and  copal  varnish  will  do 
better,  we  think.  A  brain  prepared  as  above  will 
make  a  beautiful  preparation  for  studying  the 
cortical  substance,  but  as  most  of  the  lesions  are 
in  the  anterior  ovule  it  is  advisable  to  make  sections 
as  advised  by  Pitres  in  his  '•  Lesions  du  Centre 
Ovule,"  and  referred  to  with  illustrations  in  Ferrier's 
^'  Localization  of  Cerebral  Disease."  The  sections 
-can  be  very  readily  made  after  the  brain  has  been 
-a  few  days  in  the  chloride  of  zinc  solution,  before 
transferring  it  to  the  alcohol.  After  the  sections 
are  made,  leave  them  in  the  chloride  of  zinc  for 
three  or  four  days, then  proceed  as  described  above.) 


REVIEW. 

lOn  the  Construction,  Organization  and  General 
Arrangements  of  Hospitals  for  the  Insane,  with 
some  Remarks  on  Insanity  and  its  Treatment. 
By  Thomas  S.  Kirkbride,  M.D.,  LL.D.,  &c. 
page  320.  J.  B.  Lipi'iNCOTT  &  Co.,  Phila- 
delphia and  16  Southaujpton  street,  Covent 
Garden,  London  ;  Montreal,  Dawson  Bros. 

This  book  is  nothing  more  nor  less  than  what  its 
title  implies,  and  our  author  has  given  us  a  most 
valuable  work,  one  no  doubt  which  will  prove  to 
be  of  the  greatest  possible  advantage  to  any  com- 
munity about  to  establish  an  insane  asylum. 
The  plan  of  choosing  a  proper  place  for  such  a 
building,  the  amount  of  land  that  should  surround 
the  building  or  buildings,  the  plan  of  the  build- 
ing or  buildings,  the  manner  of  choosing  a 
governing  board,  what  the  medical  superinten- 
dent, and  all  the  officers  and  employees  of  the 
establishment  should  be,  are  matters  all  gone  into 
with  the  most  minute  details,  and  although  these 
-are  subjects  that  have  been  written  upon  over 
■and  over  again,  yet  our  author  shows  himself  to 


be  no  apprentice  hand  at  the  work  he  has  under- 
taken, but  a  man  of  master  mind  ;  a  mind  well 
stored  with  knowledge  from  observation,  and 
wishes  to  impart  his  knowledge  to  others. 

We  said  the  book  would  be  found  useful  to 
those  about  to  establish  an  insane  asylum,  we  may 
add  that  it  will  be  found  useful,  even  to  those 
who  have  already  established  asylums,  for  it 
affords  many  practical  hints  that  can  be  taken 
advantage  of  by  medical  superintendents. 

Unfortunately,  from  the  peculiar  system  of 
farming  out  patients  to  contractors,  adopted  in 
the  Province  of  Quebec,  a  system  probably  our 
author  never  heard  of,  his  book  is  useless  in  this 
Province,  for  it  speaks  to  those  who  have  no 
existence  amongst  us,  a  medical  superintendent 
having  entire  power  and  control  of  the  whole 
establishment  and  all  that  is  therein,  he  being 
responsible  for  all  his  acts  to  the  executive,  either 
directly  or  indirectly.  We  doubt  if  our  author 
ever  heard  of  such  an  anomaly  as  of  a  religious 
community  of  ladies  being  contractors  with  a 
Government  for  the  insane  of  a  country  at  so 
much  per  capitum  for  pauper  patients,  said  ladies 
being  sole  proprietors  of  the  insane  asylum, 
appointing  one  of  themselves  as  Superior  and 
Superintendent  of  the  establishment,  who  in  turn 
appoints  her  own  attendant  physician,  that  is 
responsible  to  her  and  her  only  for  all  his  acts 
and  deeds,  and  so  does  she  appoint  all  keepers, 
and  discharge  them  at  her  pleasure.  That  these 
pauper  patients  are  treated  in  every  respect  as 
seems  best  to  this  Lady  Superior  and  her  own 
medical  attendant,  not  responsible  nor  letting  any 
one  know  what  the  treatment  consists  of.  Tme, 
that  the  Government  has  a  most  reliable,  capable 
and  experienced  alienist  as  Government  visiting 
physician  to  this  establisment,  who  performs  his 
duty  to  the  public  fearlessly  and  honestly,  guided 
in  all  his  acts  by  benevolence  and  justice.  But 
what  are  his  powers  ?  To  recommend  the  admis- 
sion of  those  whom  he  considers  suitable  persons 
for  admission  under  the  law,  to  recommend  to  the 
Government  the  discharge  of  those  patients  whom 
he,  in  his  judgment,  considers  should  be  dis- 
charged, to  report  from  time  to  time  the  mental 
and  physical  state  of  the  patients,  to  report  as  to 
their  comfort,  that  is  their  clothing,  bedding, 
lodging,  &c.,  and.  if  he  sees  anything  that  he 
disai)proves  of  in  a  sanitary  point  of  view,  such 
as  heating,  ventilation,  drainage,  &c.,  to  report 
the  same, — so  far  so  good,  but  he  controls  nothing. 


THE    CANADA   MEDICAL    RECORD. 


2V 


His  opinion  is  not  asked  nor  is  he  consulted  in 
anything ;  the  medical  attendent  never  consults 
him,  he  does  not  know  what  the  medical  treatment 
is.  He  cannot  control  the  classification  of  patients. 
He  may  see  cases  of  acute  mania  in  the  same 
apartment  with  dements  and  imbeciles,  and  he  is 
powerless  to  correct  it.  He  may  disapprove  of 
straps  and  straight  waistcoats,  but  he  can  do 
nothing  but  report.  The  Lady  Superior  controls 
all  these  things  herself.  From  the  foregoing  facts 
we  think  our  author  will  see  how  little  use  there 
is  for  his  book  in  the  Province  of  Quebec.  We, 
however,  take  this  opportunity  of  protesting 
against  our  unscientific  system.  It  is  different  in 
the  Province  of  Ontario — there  our  author's  book 
will  be  a  valuable  contribution  to  the  library  of 
medical  men. 

Dr.  Kirkbride  writes  from  the  standpoint  of  a 
medical  superintendent,  and,  like  all  others  who 
have  written  from  the  same  standpoint,  considers 
that,  for  the  majority  of  insane  persons,  the  best 
thing  to  be  done  with  them  is  to  have  them  treated 
in  an  insane  asylum,  but  here  we  will  let  him  speak 
for  himself:  "  As  the  insane  generally  cannot  be 
"  treated  successfully  nor  be  properly  cared  for  in 
"  private  houses,  very  clearly  they  cannot  be  in 
"  ordinary  hospitals,  almshouses,  nor  in  penal  in- 
"  stitutions.  The  only  mode,  then,  of  taking  proper 
"  care  of  this  class  in  a  community  it  is  obvious,  as 
"  all  enlightened  experience  shows,  is  to  provide  in 
"  every  State  just  as  many  special  Hospitals  as 
"  may  be  necessary  to  give  prompt  and  proper 
''  accommodations  for  a//  its  insane,  to  cure  those 
"  that  are  curable,  to  give  every  reasonable  com- 
"  fort  to  those  that  are  not  curable,  and  to  prevent 
"  their  becoming  worse."  We  entirely  agree  with 
our  author  in  all  the  foregoing,  but  we  maintain 
that,  amongst  the  affluent,  arrangements  can  be  so 
made  in  private  houses,  where  patients  can  be  as 
successfully  treated  at  home,  by  a  well  educated 
medical  man,  with  the  benefit  of  a  consultation 
with  a  mental  expert,  just  as  successfully,  if  not 
more  so,  as  in  an  insane  asylum.  We  have  had 
such  in  our  own  practice,  and  we  are  aware  that 
such  is  the  experience  of  many  of  our  confreres. 
We  confess,  however,  that  there  are  many  occasions 
where  we  would  avail  ourselves  of  a  public  institu- 
tion, if  there  was  one  in  our  province  that  we  had 
confidence  in  its  management. 

We  quote  one  passage  more,  as  bearing  upon  a 
rery  important  matter  in  very  many  respects  : 

"  There  is  no  power  to  insure  any  case,  or  to 


"  say  that  there  may  never  be  another  attack.  No' 
"  one  has  a  right  to  assert  that  a  combination  of 
"  circumstances,  like  that  which  produced  the 
"  first,  may  not  cause  another ;  that  ill-health,  and 
"  commercial  revulsions,  and  family  sorrows,  and 
"  the  many  other  causes  that  may  have  originally 
''  developed  the  disorder  may  not  again  bring  on 
"  the  return  of  the  same  symptoms,  just  as  they 
"  may  produce  them  in  one  who  has  never  before 
"  been  insane.  Out  of  seven  thousand  eight  hundred. 
"  and  sixty-seven  consecutive  cases  in  the  author's 
"  observation,  five  thousand  six  hundred  and 
"  ninety-five  had  never  had  an  attack  before. 
"  Whatever  induced  the  disease  in  them  certainly 
"  may  induce  it  in  those  who  have  already  suffered 
"  from  the  same  malady,  for  we  cannot  expect  one 
"  attack  of  insanity  to  act  as  a  prophylactic,  and, 
"  like  measles  or  small-pox,  to  give  immunity  for 
"  the  future.  But  this  new  attack  is  no  evidence 
"  that  the  patient  was  not  cured  of  the  previous 
"  one.  If  the  patient,  then,  is  well  in  the  sense  in 
"  which  he  is  considered  well  from  an  attack  of 
"  typhoid  fever,  or  dysentery,  or  rheumatism,  or  a 
"  score  of  other  maladies,  when  another  attack 
"  is  developed,  it  is  as  much  a  new  case  and  the 
"  recovery  is  a  cure  just  as  much  as  it  would  be  if 
''  he  suffered  from  any  other  form  of  illness,  and  it 
"  ought  to  be  so  recorded. 

"If  he  does  not  recover,  in  the  sense  in  which 
"  a  recovery  has  already  been  described,  he  should 
''  not  be  recorded  as  cured." 

Our  author's  experience,  from  length  of  years 
and  number  of  patients  treated  by  him,  gives  him 
the  right  to  speak  with  authority,  and  in  what  he 
has  said  in  the  foregoing,  we  agree  with  him  ia 
every  particular.  But  when  it  is  such  an  estab- 
lished fact  that  the  large  majority  of  persons  who 
have  been  once  insane  generally  become  insane 
again,  we  consider  the  term  recovery  is  preferable 
to  the  term  cure,  and  less  likely  to  lead  to  error  or 
misunderstanding.  A  man  loses  his  sanity  and 
recovers  it  again,  no  matter  from  what  cause  (and 
generally  it  is  very  difficult  to  pronounce  to  what 
cause  his  recovery  is  due)  is  a  term  quite  explicit 
enough  for  all  purposes.  But  when  the  term  cure 
is  made  use  of  persons  are  liable  to  imderstand  the 
term  as  meaning  that  the  remote  or  latent  cause 
of  insanity  has  been  removed  from  the  patient  by 
medical  treatment,  which  gives  him  immunity  for 
the  future. 


216 


THE   CANADA    MEDICAL    RECORD. 


Aphorisms  in  Fractures.  By  R.  O.  Cowling, 
A.M.,  M.D.  John  P.  Horton  &  Co.,  Lennox- 
ville,  Ky.,  U.  S. 

This  little  work  contains  some  good  practical 
information,  and,  although  we  may  not  agree  with 
all  it  states,  we  have  no  hesitation  in  recommend- 
ing it  to  the  busy  practitioner  and  the  student. 


We  are  in  receipt  of  a  little  brochure  from  the 
Trommer  Extract  of  Malt  Company,  the  object  of 
which  .seems  to  be  to  prove  that,  for  medicinal 
purposes,  the  extract  of  barley  malt  is  superior  to 
that  of  any  combination  of  cereals.  So  far  as  our 
opinion  is  concerned,  this  is  a  foregone  conclusion, 
as  all  investigation  goes  to  prove  that,  in  regard  to 
the  essential  (medicinal)  principle  of  malt  extract, 
Parley  is  richer  than  any  other  cereal.  The  facts 
in  regard  to  this  are  clearly  stated  in  the  pamphlet 
referred  to,  as  follow  : 

"  The  superiority  of  barley  for  malting  depends 
partly  upon  the  peculiar  structure  of  the  grain,  and 
partly  upon  the  greater  solubility  of  its  nitroge- 
nous principles.  The  protection  afforded  to  the 
radicle  (or  shoot)  by  the  husk  which  envelopes 
the  grain,  during  germination  or  malting,  is  of  the 
utmost  imi)ortance.  The  process  can  go  forward 
to  the  desired  extent  without  loss  by  imperfect  or 
incomplete  germination.  In  the  malting  of  wheat, 
maize,  and  even  oats,  a  considerable  portion  is  lost 
or  damaged  by  germinating  slightly  and  then 
perishing,  leaving  decayed  grains  in  such  abun- 
dance as  materially  to  lessen  the  value  of  the 
malt. 

"The  nitrogenous  matter  of  wheat  consists  mainly 
of  gluten,  albumin  and  vegetable  fibrin,  that  of  oats 
in  avenin,  substances  insoluble  in  water ^  and  which 
therefore  cannot  be  obtained  by  maceration  or  infu- 
sion in  a  watery  menstruum.  Wheat  and  oats 
are  poor  in  those  soluble  albuminoids  which 
abound  in  barley.  This  solubility  of  a  larger  pro- 
portion of  its  nitrogenous  matter,  in  water,  promi- 
nently characterizes  barley,  which  yields  its  con- 
stituents generously  to  this  convenient  menstruum. 
On  the  other  hand,  the  poverty  of  barley  in  coagu- 
lable,  glutcnous  and  albuminous  matter,  renders  it 
comparatively  unfit  for  bread-making.  Thus, 
while  barley  is  rich  in  all  the  principles  requisite 
for  the  nourishment  of  man,  these  exist  in  such 
form  that  malting  of  the  grain  is  alone  necessary 
to  make  them  soluble  in  water, 

"  But  a  remaining  fact  constitutes  a  most  impor- 


tant consideration.  Barley  is  best  adapted  for 
malting  because  it  yields  a  larger  quantity  of  dias- 
tase than  any  other  kind  of  grain.  Wheat,  oats, 
and  Indian  corn  furnish  by  malting  scarcely  suffi- 
cient diastase  to  convert  the  starch  they  contain 
into  maltose  and  dextrine  ;  whereas  barley  malt 
yields  so  large  an  amount  of  that  important  prin- 
ciple that  one  bushel  is  capable  of  converting  not 
only  all  its  own  starch  but  that  contained  in  from 
four  to  six  bushels  of  wheat,  oats,  Indian  corn  or 
rice,  into  maltose  and  dextrine.  Brewers  and  dis- 
tillers are  in  the  habit  of  availing  themselves  of  the 
diastatic  power  of  barley  malt,  thus  not  only  saving 
the  expense  of  malting,  but  enabling  them  also  to 
substitute  cheaper  unmalted  grain  in  the  manufac- 
ture of  ale,  beer,  &c." 

The  pamphlet  also  contains  interesting  reviews 
of"  the  Physiology  of  Starch  Digestion,"  and  the 
"  Value  of  Carbo- Hydrates  as  Food  "  (drawn  from 
most  recent  scientific  researches  on  these  subjects), 
which  make  it  very  interesting  to  medical  readers. 
Such  of  our  subscribers  as  have  not  received  a  copy 
of  the  pamphlet  can  do  so  free  upon  application 
to  Trommer  Extract  of  Malt  Co.,  Fremont,  Ohio. 


PERSONAL. 
Dr.   John  Reddy  has  resigned   his  position  of 
attending  Physician  to  the  Montreal  General  Hos- 
pital after  25  years'  service. 

Dr.  W.  A.  Molson  has  been  elected  to  the  In- 
door staff  of  the  General  Hospital,  in  place  of  Dr. 
Reddy  resigned. 

Dr.  Wm.  Gardner  has  been  elected  on  Out-door 
Staff  of  the  Montreal  General  Hospital,  in  place  of 
Dr.  Molson,  elected  on  the  In-door  Staff. 

Dr.  Henderson  has  been  appointed  House 
Surgeon  of  the  Montreal  General  Hospital. 

Dr.  J.  A.  Macdonald  and  Dr.  Mewburn  have 
been  appointed  resident  clinical  assistants  at  the 
Montreal  General  Hospital. 

Mr.  Ninian  C.  Smillie,  fourth  year  student  at 
Bishop's  College  Faculty  of  Medicine,  has  been 
appointed  resident  clinical  assistant  at  the 
Woman's  Hospital. 

Dr.  James  Bell,  of  Montreal,  who  retired  a 
year  ago  from  the  House  Surgeoncy  of  the  Mont- 
real General  Hospital,  was  on  the  19  inst.  appoint- 
ed, under  the  new  By-Laws  of  the  Instil ution,  its 
Medical  Superintendent  at  a  salary  of  $1500  the 
first  year,  and  increasing  till  $2000  is  reached. 


THE  CANADA  MEDICAL  RECORD. 


Vol.   IX. 


MONTREAL,  JUNE,  1881 


No.  9 


O  OIsTTEHSTTS. 


ORIGINAL  COMMUNICATIONS. 

Case  of  Perityphlitif',  217. — Noeg- 
gerath's  Operation 219 

73R0GRESS  OF  MEDICAL  SCIENCE 

The  Treatment  of  Eczema,  221.— 
The  Treatment  of  Dropsy  and 
Uraemic  Convulsions  during 
Pregnancy,  222. — Recent  Pro- 
gress in  the  Treatment  of  Dis- 
eases of  Children,  224. — Weak 
Spines  in  Young  Girls  and  llieir 
Treatment,  227. — Fissure  of  the 
Rectum  with  Constipation,  229. 


—The  Abortive  Treatment  of 
Erysipelas,  231. — Treatment  of 
Mammary  Abscess,  2.32.— He- 
moptvsi.-',  232.  —  Diagnosis  of 
Adherent  Placenta,  233.- Gly- 
cerine in  the  Treatment  ot  Fla- 
tulence, Acidity,  and  P}  rosi«, 
233.— Treatment  of  Menorrha- 
gia and  Metrorrhagia 234 

EDITORIAL. 

To  Our  Subscriber-s  234.—  Ca- 
nada Medical  Association,  234. 
— Electricity  in  the  Treatment 
of  Exophthalmic  Goitre,  234. — 


Bishop's  College  School,  Len- 
noxville,  236. — Iodide  of  Ethyl 
in  Asthma,  235.  —  To  Test 
House  Drains,  235. — Personal, 
236. — Collegeof  Physicians  and 
Surgeons,  236. — Tiie  New  York 
Sanitary  Engineer,  239. — Lac- 
topeptine,  239.  —  "  Nana's 
Daughter",  239.  —  Wveth's 
Vinum  Cibi,  2.39.— The  "Mac- 
Kinnon Pen  or  Fluid  Pencil, 
239.— Scribner  for  June,  240.— 
St.  Nicholas  for  June,  240. — 
The  Popular  Science  Monthly 
for  July,  1881,  240.— Cascara 
Sagrada 240 


0Fi0nal  ^ammunkoMon^. 


CASE   OF   PERITYPHLITIS. 

By  George  E.  Armstrong,    M.  D.,    CM., 

Professor  of  Anatomy,  Faculty  of  Medicine,  University  of 

Bishop's  College,  Montreal;    Attending^Physician 

Woman's  Hospital. 

On  the  1 6th  March  I  was  asked  to  see  Mr.  J. 
M.,  set.  38  years,  a  man  of  medium  height,  spare 
build,  dark  hair  and  complexion.  I  went  to*  his 
residence,  and  found  that  he  had  been  sick  for 
about  a  fortnight,  under  the  care  of  Dr.  Rodger, 
who,  being  exceedingly  busy,  had  requested  them 
to  get  some  one  else  to  attend. 

I  found  well-marked  symptoms  of  saturnism 
present — a  pale  anaemic  look,  together  with;  an 
icteroid  tinge  of  the  integument  and  conjunctiva, 
foetor  of  the  breath,  a  blue  line  along  the  margin 
of  the  gums,  furred  tongue,  anorexia,^  constipa- 
tion, muscular  weakness,  and  severe  paroxysmal 
pains  in  the  abdomen,  confined  to  the  umbilical 
region.  The  abdomen  was  slightly  tympanitic,  and 
pressure  and  percussion  over  the  abdomen  were 
moderately  well  borne.  His  temperature  was 
99.5  F.,  pulse  92.  The  integument  over  the  right 
tliac  region  was  cedematous,  and  presented  many 
bluish  spots,  giving  to  it  a  peculiar  mottled  appear- 
ance. On  pressure  being  made  in  this  region  there 
was  an  indistinct  feeling  of  localized  fullness,  and 


the  patient  complained  of  pain.  The  percussion  note 
over  this  circumscribed  fullness  was  dull,  but  quite 
clear  and  tympanitic  all  around.  The  tumor  was 
deep-seated  and  immovable.  No  fluctuation  could 
be  made  out.  Digital  examination  of  the  rectum 
discovered  nothing.  Liver  and  spleen  were  a  little 
enlarged,  heart  and  lungs  healthy.  The  only 
cause  he  could  assign  was  that  a  couple  of  weeks 
before  he  took  sick  he  had  strained  his  right  side 
in  lifting.  He  felt  it  sore  for  a  few  days  afterwards. 
Dr.  Rodger  told  me  that  the  patient  had  had  some 
local  peritonitis  in  the  right  iliac  fossa,  and  that  he 
had  had  mustard  and  turpentine  applied,  followed 
by  linseed-meal  poultices.  As  he  still  complained 
of  some  soreness  here,  I  had  the  poultices  con- 
tinued. On  the  1 8th  he  had  a  little  diarrhoea,  and  I 
ordered  Castor  Oil  3  ss.,  which  relieved  it. 

On  the  20th  he  had  a  rigor,  and  from  that  date 
until  the  5th  April,  a  period  of  15  days,  he  con- 
tinued to  have  rigors,  which  were  irregular  in  time 
of  occurrence,  and  varied  in  severity  and  duration, 
generally  having  2  or  3  in  24  hours.  Occasion- 
ally he  had  none  for  a  day  or  two.  They  were  all 
attended  by  a  high  fever,  the  temperature  running 
up  to  104''  or  105^  F.,  and  on  one  occasion,  imme- 
diately after  a  severe  rigor,  his  temperature  was 
106.  They  were  followed,  as  a  rule,  by  profuse 
exhausting  perspiration,  and  the  temperature  would 
fall  to  99  or  even  normal.  They  were  either  accom- 
panied  or   followed    by  retching  and  vomiting. 


2i8 


THE   CANADA    MEDICAJ.    RECORD. 


He  had  several  attacks  of  cpistaxis.  On  the  23rd 
I  asked  Dr.  Fenwick  to  see  him  with  me,  particu- 
larly as  to  the  advisability  of  making  an  explora- 
tory puncture  according  to  the  plan  recommended 
by  Dr.  VVilhrd  Parker  in  1867,  and  if  an  abscess 
was  found  to  empty  it,  but  he  did  not  think  the 
evidence  of  the  presence  of  an  abscess  sufficiently 
well  marked  to  do  so.  He  advised  the  adminis. 
tration  of  a  large  dose  of  ol.  olivae  to  make  sure 
that  the  ciecum  was  emptied.  This  was  done, 
but  it  did  not  throw  much  light  on  tiie  case.  On  the 
4th  April  Dr.  R.  P.  Howard  saw  him,  and  agreed 
with  me  that  the  symptoms  were  those  of  septi- 
caemia, and  suggested  the  possibility  of  hepatic 
suppuration. 

On  the  5th  April  a  smart  diarrhoea  set  in,  10  or 
12  stools  in  24  hours.  The  first  three  or  four 
stools  had  been  emptied  before  I  saw  them.  His 
wife  thought  she  had  seen  some  matter  in  the  first, 
but  was  not  very  sure.  Those  that  I  saw  were 
fluid  of  a  yellow  color,  and  horribly  foetid,  the 
smell  sometimes  causing  the  patient  to  vomit.  I 
had  all  the  stools  kept  until  I  saw  them,  for  a  day 
or  two,  but  never  found  any  trace  of  pus  in  them. 
The  diarrhoea  continued  for  ten  days. 

After  the  onset  of  the  diarrhoea  he  had  no  more 
rigors,  and  for  27  days  or  until  the  third  of  May 
his  condition  steadily  improved.  His  temperature 
ranged  from  99**  to  100°,  occasionally  rising  to 
100^.  His  pulse  fell  from  140  to  112,  and  one 
day  92.  The  vomiting  was  less,  though  it  never 
entirely  ceased.  Bowels  became  quite  natural,  one 
or  two  well-formed  stools  each  day,  the  abdominal 
pain  disappeared  entirely,  he  took  considerable 
nourishment,  and  was  looking  and  feeling  much 
better. 

On  the  3rd  May  when  I  saw  him  he  was  not  so 
well.  His  temperature  was  101.5°,  pulse  130,  and 
he  complained  of  severe  pain  in  his  stomach,  and 
the  nourishment  taken  that  morning  had  been  im- 
mediately returned.  From  the  3rd  until  the  15th 
May,  when  he  died,  he  was  unable  to  retain  any 
nourishment  of  any  kind,  and  became  rapidly 
emaciated.  His  bowels  remained  quite  regular  ; 
no  albumen  was  found  in  his  urine  at  any  time 
during  his  illness.  On  the  13th  May  I  noticed 
for  the  first  time  dullness  on  percussion  in  the  right 
loin,  which  extended  round  across  the  abdomen  to 
within  6  in.  of  the  linea  alba  ;  above,  it  was  con- 
tinuous with  liver  dullness,  and  below  with  the  dull- 
ness in  the  right  iliac  fossa.  There  was  no  bulging 
nor  any  sense  of    fluctuation.     Hepatic  dullness 


extended  from  the  lower  margin  of  the  7th  rib  to 
2  in.  below  the  margin  of  the  ribs  in  the  line  of  the 
right  nipple.  Percussion  showed  the  spleen  some- 
what enlarged,  though  I  could  not  feel  it  on  pal- 
pation. Heart  and  lungs  healthy.  Pulse  130, 
temperature  103.5''.  ^^e  next  day.  Dr.  Fenwick. 
being  present,  I  introduced  the  needle  of  a  hypo- 
dermic syringe  into  the  right  loin,  and  drew  off"clear 
serum.  I  then  introduced  an  aspirator  needle,  and 
drew  off  three  half-pints  of  the  same.  His  tem- 
perature was  then  104°,  pulse  144.  Immediately 
after  the  operation  for  the  severe  pain  in  the  epi- 
gastric region  I  gave  him  a  hypodermic  injection 
of  M  XXX.  of  Battley's  sedative  solution.  He  died 
the  following  morning,  seemingly  from  inanition- 
At  the  autopsy  performed  by  Dr.  Osier,  an  abscess 
was  found  behind  the  caecum  which  communicat- 
ed with  the  caecum  by  a  small  round  opening.  No 
concretions  were  found  in  the  abscess.  The  caecum: 
and  ascending  colon  were  healthy.  Considerable 
serum  was  found  in  the  cavity  of  the  peritoneum. 

Treatment. — For  the  lead  poisoning,  which 
seemed  to  be  the  principal  trouble  when  I  first  saw 
him,  I  ordered  potass,  iodid.,  grs  x.  four  times  daily^ 
and  morphia  to  relieve  the  colic.  Ten  days  after- 
wards the  symptoms  of  lead  poisoning  had  com- 
pletely disappeared.  When  the  symptoms  of 
septicaemia  came  on  I  placed  him  on  a  mixture 
containing  bark  and  ammonia,  to  which  was  after- 
wards added  at  Dr.  Fenwick's  suggestion  dilute 
nitro-muriatic  acid  ;  also  gave  him  each  day  in  a  sin- 
gle dose  quinia  bisulph.,  grs.  x.  to  grs.  xx.  in  pow- 
der, trying  to  give  it  a  couple  of  hours  before  a  chill, 
which,  however,  was  not  easy  to  do  on  account 
of  their  irregularity.  For  the  persistent  retching 
and  vomiting  he  had  bismuth  trisnit,  morphia, 
soda,  oxillate  of  cerium,  malto  pepsyn,  etc., 
and  mustard  applied  over  the  epigastrium,  but 
nothing  seemed  to  relieve  it.  At  Dr.  Howard's 
suggestion  he  took  dialysed  iron  for  some  time. 

Nourishment  was  given  in  varied  forms,  milk 
and  limewater,  beef  tea,  egg-nog,  raw  eggs  beat  up 
in  coffee,  raw  oysters,  raw  beef,  &c.  For  some 
time  I  gave  him  enemata  of  dessicated  bullock's 
blood  with  I  thought  some  benefit. 

I  believe  the  case  to  have  been  one  of  inflamma- 
tion of  the  cellular  tissue  behind  the  caecum  and 
of  that  part  of  the  peritoneum  immediately 
surrounding  it,  suppuration  and  the  formation 
of  an  abscess  taking  place  in  the  cellular  tissue 
which  ruptured  into  the  caecum ;  the  chills  to 
have  been   due    to    blood  poisoning.     It    seems 


THE    CANADA   MEDICAL    RECORD. 


219 


to  me  that  the  complete  cessation  of  the  chills  upon 
the  occurrence  of  the  diarrhoea,  which  probably  cor- 
responds to  the  rupture  of  the  abscess  into  the  cae- 
cum and  the  escape  of  the  pent-up  pus,  bears  out 
this  view.  I  cannot  understand  why  he  did  not 
continue  to  improve.  Why  did  he  begin  to  fail 
on  the  3rd  May?  I  would  like  the  opinion  of  some 
of  the  more  experienced  members  of  the  Society 
on  this  point.  Was  it  in  anyway  due  to  the  lead 
poisoning  ?  Could  he  again  suffer  from  lead  poison- 
ng  without  subsequent  exposure  to  lead  ? 

Dr.  Henry  B.  Sands,  of  Brooklyn,  reports  26 
cases  of  perityphlitis.  22  of  these  were  observed  in 
males  and  4  in  females,  thus  confirming  the  fact 
already  established  of  the  comparative  rarity  of 
this  disease  in  the  female  sex.  Ten  of  his  cases 
terminated  in  resolution  without  evidence  of  sup- 
puration. In  three  cases  there  was  conclusive 
proof  that  an  abscess  had  formed,  had  emptied  its 
contents  into  some  neighbonng  hollow  viscus, 
two  into  the  bowel  and  one  probably  junto  the 
bladder,  and  had  been  followed  by  rapid  recovery. 
Eleven  cases  were  treated  by  operation  ;  of  these 
•all  recovered  but  one,  in  which  the  patient  would 
not  consent  to  the  operation  until  the  9th  week, 
when  the  abscess  pointed  over  the  middle  of  the 
crest  of  the  ilium.  He  died  of  septicaemia.  Concre- 
tions were  found  in  four  of  the  eleven  cases  treated 
by  incision.  Two  cases  terminated  without  the 
abscess  discharging  its  contents  either  externally  or 
internally.  In  both  cases  a  large  abscess  was  found 
on  post-mortem  examination,  and  in  one  of  these 
there  was  also  discovered  in  the  brain  changes 
characteristic  of  purulent  meningitis. 

Dr.  Flint  advises  the  early  operation  for  the  relief 
of  a  perityphlitic  abscess  by  opening  it  as  soon  as 
the  nature  of  the  case  is  determined  without  even 
waiting  for  fluctuation.  He  refers  to  the  operation 
being  performed  by  Hancock  of  London  in  1848. 

Habershon  in  his  work  on  diseases  of  the  abdo- 
men reports  a  case  in  which  death  followed  from 
exhaustion,  after  large  abscess  behind  the  colon 
in  a  tubercular  patient  had  emptied  itself  into  the 
caecum. 

NCEGGERATH'S  OPERATION. 
By  Dr.  C.  E.  Nelson,  New  York. 
Complete  ablation  of  the  womb,  including  or 
not  the  ovaries,  was,  up  to  a  recent  period,  thought 
incompatible  with  the  life  of  the  patient ;  of  late, 
the  German  gynaecologists,  with  Freund  at  their 
head,  have  fearlessly  led  the  way,  achieving  an 
amount  of  success  sufficient  to  warrant  the  placing 


of  this  operation  almost  on  a  basis  similar  to  that 
now  held  by  ovariotomy,  which  latter  Velpeau  and 
other  Parisian  surgeons  said  "  should  never  be 
performed." 

FreuncTs  operation  has  been  the  operation  per- 
formed in  Germany  until  recently ;  also,  modifi- 
cations of  the  same.  This  method  consists  in 
making  a  median  abdominal  section,  through  which 
are  taken  out  womb,  with  or  without  ovaries,  after 
disengaging  these  organs  from  their  connections  • 
the  upper  end  of  the  vagina,  now  open  at  the  top,  is 
then  sewn  up,  the  suture  threads  hanging  out 
through  the  vulva.  The  other  German  gynaecologists 
since  modified  this  operation,  in  leaving  the  cut 
end  of  the  vagina  open,  it  healing  up  subsequently 
by  granulation;  in  the  meantime  a  Bardenhauer's 
rubber  drainage  tube  is  inserted  through  the 
cut  end  of  the  vagina  from  below,  the  upper  por- 
tion, "  abdominal "  (which  is  only  a  quarter  of  the 
diameter  of  the  "  v  aginal  "  portion),  passing  out 
upwards,  through  the  abdominal  incision ;  the 
upper  and  lower  wounds  heal  along  and  up  to  the 
tube.  To  prevent  hernia  of  the  intestines  through 
the  vaginal  wound,  a  flange  is  attached  to  the 
upper  end  of  the  "  vaginal  "  portion  of  the  tube ; 
this  flange  fits  closely  against  the  vaginal  wound  ; 
there  are  lateral  holes  in  the  tube,  to  permit  of 
sluicing  the  parts  with  detergent  injections,  and 
also  to  allow  of  the  natural  draining  of  fluids  ;  this 
tube  is  retained  till  cicatrization  is  complete. 
The  abdominal  incision  is  of  course  closed  with 
sutures. 

The  new  operation  which  Professor  Nceggerath, 
of  New  York,  has  inaugurated,  and  which  is  now 
being  the  more  generally  followed  in  Geraiany, 
consists  of  bringing  away  the  womb,  with  or  with- 
out the  ovaries,  after  extirpation,  through  the  va- 
gina, thus  doing  away  with  the  abdominal  section, 
thereby  simplifying  the  operation  materially  besides 
rendering  the  patient  less  liable  to  the  shock  in- 
separably connected  with  opening  the  abdomen. 
This  operation  is  now  a  recognized  surgical  pro- 
cedure, and  has  been  performed  with  varied  suc- 
cess in  Germany  and  the  United  States ;  Professor 
Noeggerath  being  the  chief,  and  perhaps  the  only 
exponent  of  it  in  America.  I  have  been  at  the 
pains  of  visiting  this  distinguished  gynaecologist^ 
and,  besides  being  present  at  two  of  his  operations, 
have  obtained  from  him  the  following  data  of  the 
various  steps  of  this  operation.  This  operation  is 
not  so  well  known  in  New  York  as  one  would  sup- 
pose, chiefly  from  its  being    so  very  difficult  in 


220 


THE    CANADA    MEDICAL    RECORD. 


performance, — it  requiring  the  hand  and  judgment 
of  an  able  and  daring  surgeon. 

Na-ggerat/i's  operation. — The  patient  being 
anKsihetized,  and  placed  in  the  position  for  litho- 
tomy, together  with  being  under  the  play  of  the 
carbolizcd  water  spray  apparatus,  to  lessen  the 
risk  of  sepsis,  the  operator,  with  or  without  using 
a  speculum,  as  the  case  may  be,  passes  either  a 
loop-shaped  galvano-cautery  knife,  heated  to  a 
white  heat,  or  a  very  long  handled  heated  knife, 
in  shape  not  unlike  a  very  long  quill  pen  (the 
cutting  portion  being  very  narrow  and  delicate), 
through  the  vaginal  attachment  of  the  cervix 
uteri ;  a  sufficient  incision  being  made,  a  two 
branched  steel  dilator  (made  on  the  same  principle 
as  a  glove-stretcher)  is  now  passed  through  this 
incision,  and  upwards  between  bladder  and  womb; 
the  blades  are  then  opened,  so  as  to  stretch  forcibly 
asunder  the  tissues  :  this  is  done  so  as  to  avoid  the 
hemorrhage  that  might  follow  the  remaining  step 
of  this  portion  of  the  operation  ;  the  knife  is  then 
re-introduced,  and  with  a  few  sweeps,  the  remain- 
ing anterior  attachments  of  the  womb  are  severed. 
A  like  proceeding  is  now  effected  posteriorly,  that 
is,  the  heated  knife  is  passed  along  Douglass'  cul- 
de-sac,  through  the  posterior  vaginal  attachment 
of  the  cervix,  dilator  introduced,  and  the  posterior 
attachments  of  the  womb  severed  ;  now  the  womb 
is  pulled  down  into  the  vagina  with  vulsellum 
forceps,  and  the  wire  rope  of  an  ecraseur  attached 
around  the  womb,  embracing  the  broad  ligaments ; 
the  wires  are  then  tightened  at  the  handle,  the 
rotatory  motion  being  kept  up  till  the  lateral  attach- 
ments of  the  womb  are  severed — that  is,  broad, 
round,  utero-ovarian  ligaments,  as  well  as  the 
Fallopian  tubes.  In  case  adhesions  have  formed 
connecting  the  womb  with  neighboring  viscera, 
Noeggerath's  operation  is  inadmissible,  as  the 
extraction  of  the  womb  per  vaginam  in  that  case 
would  be  impossible  ;  in  such  case,  we  have  to 
select  operation  by  abdominal  section.  Operating 
the  Ecraseur  always  occupies  a  considerable  time  ; 
when  the  womb  is  completely  disengaged  from  its 
connections,  it  is  withdrawn  per  vulvam  by  means 
of  a  vulsellum.  The  dilator  which  the  Professor 
uses  is  his  own  modification  of  Ellinger. 

Abdominal  section  is  effected  by  a  straight  nar- 
row-bladed  knife,  the  cut  being  merely  long  enough 
to  introduce  the  hand,  which  then  applies  the 
w.res  of  the  ecraseur  around  the  uterine  connec- 
tions, natural  and  morbid.     When  the  ovaries  (one 


or  botli)  are  removed,  the  operation  is  more  diffi- 
cult, and  very  much  prolonged. 

Dr.  Nfcggerath's  first  extirpation  uteri  per  vagi- 
nam was  performed  in  the  beginning  of  June,  1876, 
on  a  private  patient. 

T/ie  present  operation  in  Germany  is  a  some- 
what similar  proceeding  to  that  of  Dr.  Noeggerath's^ 
instead  of  using  a  heated  knife,  they  effect  his 
incisions  with  an  ordinary  cold  knife,  and  ligate 
the  vessels  as  they  proceed  ;  this  mode  renders- 
the  operation  much  more  difficult  and  tedious. 

A  more  especial  feature  of  this  modified  opera- 
tion is,  that  after  the  posterior  incision  is  made,  a 
sound  is  introduced  into  the.  uterus  which  is  then 
artificially  r^/r^^rrr/f^  through  the  posterior  inci 
sion  ;  the  womb  is  then  pulled  down  by  vulsellum,. 
broad  ligaments  cut  through,  and  arteries  of  liga- 
ments tied ;  this  is  a  reverse  proceeding  to  that 
employed  by  Dr.  R.  Nelson  in  ovariotomy,  where 
the  vessels  were  tied  first,  and  the  ligaments  cut 
through  afterwards. 

Adhesions.  It  might  be  supposed  by  some  that 
these  could  be  discovered  beforehand  by  the  opera- 
tor fas  they  render  Professor  Noeggarath's  operation 
inadmissable)  :  this  is  not  the  case,  as  the  adhes- 
ions are  often  (especially  in  the  prior  stages)  soft, 
exceedingly  pliable,  consequently  very  apt  "to  give.'f 

Size  of  tumor,  or  oi  uterus.  The  size  of  the  latter 
can  very  often  be  mapped  out,  by  previous  exami- 
nation, even  in  cases  of  fibrous  hypertrophy  of 
that  organ ;  but  in  cases  of  tumor  this  is 
different ;  as  it  would  be  almost  impossible  to  tell, 
in  cases  of  very  large  internal  tumors  of  uterus, 
or  tumors  growing  from  the  external  surface  ;  even 
in  those  cases,  where  small  polypi  stud  the  exter- 
nal surface,  this^would  cause  difficulty  of  traction 
per  vaginam.  I  have  a  specimen  in  my  house  of  an 
internal  polypus,  larger  than  a  child's  head ;  the 
woman  had  never  been  examined,  and  had  died 
of  something  else ;  the  tumor  had  never  given  any 
rational  symptoms,  and  it  was  only  at  the  autopsy 
made  by  the  coroner  that  it  was  discovered. 

Size  of  tiimor  rendering  extraction  per  vaginam 
impossible.  One  would  suppose  that  where  a 
child's  head  could  pass  (as  the  vagina  stretches  up 
to  the  boundary  of  the  bony  outlet)  a  tumor  of 
that  size,  or  under,  could  be  withdrawn  ;  but  such 
is  not  the  case ;  in  labor,  the  natural  process  o^ 
expulsion  consists  of  a  series  of  propulsions 
gradually  increasing  in  force  ;  besides  that^  the  bag 
of  waters  acts  a3  a  gradual  dilator  from  within 
pushing  with  a  beautifully  graduated  power  ;  these 


THE   CANADA    MEDICAL    RECORD. 


221 


forces  are  spread  out  from  a  few  hours  to  three  or 
four  days,  especially  in  primiparae ;  many  gynaeco- 
logical patients  operated  on  are  in  the  condition 
of  primipara;,  /'.  ^.,  they  have  never  been  stretched. 
\i force  were  employed  in  withdrawal  of  tumorsj 
we  would  have  to  encounter  laceration  of  arteries, 
causing  serious  haemorrhage,  destruction  of  tissue, 
and  severe  shock  to  the  patient.  Also  in  cases  of 
large  fibroids  there  is  often  uncontrollable  and 
dangerous  haemorrhage,  in  their  attempted  extrac- 
tion per  vaginam,  although  many  years  ago  I  was 
present  when  the  late  Dr.  R.  Nelson  extracted  with 
vulsellum  forceps  a  polypus  uteri  as  large  as  a 
child's  head,  at  one  sitting,  and  without  chloro- 
form ;  the  patient  belonged  to  another  doctor. 

Two  years  since  the  professor  did  not  remove 
the  ovaries,  not  thinking  it  necessary  ;  at  that  time 
I  objected  to  him  that  the  very  next  time  the 
patient  menstruated,  the  fluid  effused  in  the  abdo- 
men would  cause  death  ; — he  answered,  it  would 
only  be  a  few  drops  from  the  discharged  ovum  ; 
however,  a  few  days  after  our  conversation,  I  read 
of  a  case  having  been  operated  on  in  Germany, 
where,  the  ovaries  having  been  left,  the  menstrual 
flow  afterwards  came  on,  causing  the  patient's  death. 
At  present  the  doctor  has  modified  his  views  in 
this  respect,  and  ablates  ovaries  as  well.  His 
views  were  of  course  based  on  the  genera' ly 
received  notion  that  the  sanguineous  flow  proceeds 
from  the  internal  surface  of  the  uterus,  a  deciduous 
membrane  (exudation)  being  also  thrown  off,  of 
the  shape  of  the  womb  ;  this  has  been  proved  (by 
Mauriceau  among  others)  by  examining  women 
who  were  hanged  during  the  menstrual  nisus,  or 
who  were  overtaken  by  sudden  death,  by  accident 
or  sickness  :  in  these  cases,  a  bloody  fluid  was 
seen  exuding  from  uterine  surface  (lining).  When 
the  ovaries  are  taken  away,  e.  g.,  "  Battey's  opera- 
tions," there  is  no  menstruation,  showing  conclu- 
sively that  it  is  under  the  influence  of  ovarian  ex- 
citement that  the  excretive  action  takes  place  from 
the  uterine  cavity.  When  the  uterus  is  taken  away 
the  ovary  being  left  (because  I  presume  menstrua- 
tion would  take  place  if  only  one  ovary  was  present) 
menstruation  occurs  all  the  same.  A  fact  that  is 
probably  lost  sight  of  in  this  discussion  generally 
is  the  pathological  condition  present  in  fatal 
hemorrhagic  effusion  in  extra-uterine  pregnancy, 
where  the  aperture  in  the  ovarian  wall,  whence  the 
ovum  escaped,  is  no  larger  than  the  diameter  of  a 
pencil,  if  even  as  large  ;  in  these  cases  the  abdomen 
may  contain  a  pailfull  of  blood;    the  womb  is  rot 


concerned  in  this  latter  case.  I  was  present  at  a  post 
mortem  of  a  case  of  this  kind  many  years  ago  in 
New  York  :  one  of  our  most  distinguished  surgeons 
diagnosed  rupture  of  sac  of  abdominal  aortic  aneu- 
rism, even  after  the  abdomen  was  opened.  After 
I  had  ladled  out  a  large  quantity  of  sanguineous 
fluid,  the  ovary  was  carefully  examined,  and  the 
bloody  point  of  rupture  noticed  ;  my  father,  the 
late  Dr.  Robert  Nelson,  diae;nosed  ext.  uterine 
pregnancy,  causing  internal  hemorrhage,  two  days 
before  the  woman  died,  all  the  time  she  was  sick 
from  the  pain  and  sudden  collapse. 

Battefs  operation,  mentioned  above,  and  per- 
formed occasionally  by  Dr.  Battey  of  Rome, 
Georgia,  U.S.,  is  indicated,  as  Prof.  N.  informed 
me,  in  cases  of  ovarian  neuralgia,  diseases  of  ovary, 
painful  menstrual  nisus,  in  cases  of  malformation 
of  uterus,  in  cases  of  incurable  (per  se)  artesia  ; 
also  in  case  of  insanity  consequent  upon  ovarian 
diseases. 


J^PO^^r^dSofJiUdimi  Sueme. 


THE  TREATMENT  OF  ECZEMA. 

At  a  recent  meeting  of  the  Berhn  Medical  So- 
ciety, the  above  subject  came  under  discussion. 
Dr.  Lassar  is  in  favor  of  excluding  the  air  entirely 
from  the  inflamed  integument  and  treating  the 
affected  parts  with  disinfecting  remedies.  He 
commends  the  use  of  bandages  impregnated  with 
melted  ointments  and  applied  after  the  ointment 
has  cooled. 

The  nature  of  eczema  in  its  various  forms,  and 
wherever  seated  or  from  whatever  cause  it  may 
arise,  is  an  inflammation  of  the  superficial  layers 
of  the  integument,  with  a  tendency  to  exudation. 
It  must  at  once  appear  obvious  that  the  primary 
inflammation  will  the  more  rapidly  subside  if  not 
aggravated  by  the  decomposition  of  the  products 
of  the  morbid  process.  In  general,  it  may  be  stated 
that  an  inflammation  does  not  outlive  the  removal 
of  its  cause  ;  an  acute  irritation  is  followed  by  an 
acute  inflammation,  and  a  chronic  inflammation  is 
based  either  on  a  continued  irritation  or  a  repeti- 
tion of  the  first  cause.  If  the  offending  cause  has 
been  removed  and  the  inflammation  still  continues 
a  new  cause  must  be  sought  for.  An  illustration 
is  presented  in  that  form  of  eczema  which  results 
from  the  effects  of  turpentine  (varnishes,  etc.)  Long 
after  the  turpentine  has  ceased  to  exert  its  in- 
fluence upon  the  skin  the  cutaneous  affection  con- 
tinues to  exist;  as  soon,  however,  as  a  disinfecting 
occlusive  bandage  is  applied,  it  usually  disappears 
rapidly. 

Though    we  may  not   believe    in  the  parasitic 


222 


THE    CANADA    MEDICAL    RECORD. 


origin  of  eczema,  or  there  may  be  no  necessity  for 
such  a  belief,  we  shall  only  be  successful  in  our 
treatment  by  observing  absolute  cleanliness  in  our 
use  of  remedies.  This  is  especially  the  case  in  the 
so-called  acute  eczemas,  viz.  :  those  accompanied 
by  much  exudation,  swelling  and  moisture.  Hebra 
and  his  followers  advised  the  expectant  treatment 
during  this  acute  stage  :  to  cover  the  parts  with 
some  inert  powder,  or  at  the  most,  if  the  tension 
and  itchinj:  were  intolerable,  to  ai)ply  ice  or  water. 
It  is  a  fact,  however,  that  the  latter  are  not  well 
borne,  and  it  is  better  not  to  employ  aqueous  solu- 
tions in  acute  eczema  ;  but  the  patient  may  be 
rendered  very  comfortable  by  covering  the  inflamed 
parts  with  disinlecting  oils.  While  water  increases 
in  a  marked  deg  ree  the  tension  and  swelling  of  the 
integument,  oil  is  rapidly  absorbed,  and  thereby 
relaxes  it  and  loosens  adherent  crusts,  clots  and 
masses  of  epithelium  ;  one  to  two  per  cent,  of  car- 
bolic acid  added  to  the  oil  will  relieve  the  itch- 
ing. 

After  the  inflamed  parts  have  been  cleansed  and 
the  oil  thoroughly  applied,  bandages  saturated 
with  the  same  may  also  be  used.  The  carbolic 
acid,  which  may  itself  finally  produce  eczema,  is 
sometimes  tolerated  only  for  a  short  time,  and  must 
be  replaced  by  salicylic  acid  (t  to  2  per  cent.)  or 
thymol  (0.5  to  i  per  cent.)  :  the  latter  is  especially 
useful  in  all  bullous  and  pemphigoid  inflamma- 
tions. Linseed  oil  is  not  to  be  recommtended,  since 
it  undergoes  oxidation  in  contact  wih  the  atmos- 
phere, and  then  becomes  itself  an  irritant  to  the 
integument.  Dr.  L.  finally  mentioned  the  good 
results  from  the  use  of  salicyl-ointments  in  chronic 
eczema,  particularly  in  that  of  the  face  of  children, 
n  which  he  commends  the  following  paste  : — 

Acidi  Salicylici,     ....   2.0 

Zinci  Oxidi, 

Amyli,     aa.   25.0 

Vaselini,     50.0 

M  see  Fiat  pasta. 
This  adheres  firmly,  and    will  not   be  removed 
during  sleep. 

During  the  discussion  which  followed,  Dr.  Lewin 
testified  to  the  value  of  the  treatment  described  by 
Dr.  Lassar,  particularly  the  good  effects  of  the  oil 
in  relieving  the  tension,  excludmg  the  irritating 
influence  of  the  air  and  preventing  cutaneous 
evaporation;  he  also  adds  i  to  1.5  per  cent,  of 
carbolic  acid  to  the  oil. 

Based   on  an  experience  of  17  years  and  2,000 
cases  of  chronic  eczema  in  the  "  Charite  "  alone, 
besides    others  in  the   polyclinic   and   in  private 
practice.  Dr.  L.  recommends  as  a  remedy  Rrgotin, 
first  suggested  by  him  in  chronic  e<:zema,  and  with 
hich    he    has    obtained    excellent  results.     He 
bserved  that  the  assumption  of  the  chronic  char- 
cter  by  eczematous   affections  does  not  depend 
always  and  solely  upon  external  causes,  nor  the  in- 
fluences of  chemical,  thermal  or  mechanical  irrita- 
tions or  the  other  factors  mentioned  by  Dr.  Lassar  ; 
we  are  also  to  take  into  consideration  the    actual 


existence  of  a  constitutional  predisposition.  Per- 
sons suffering  from  eczema  are  mostly  feeble, 
anaemic  and  irritable.  The  disease  occurs  frequently 
during  infancy  because  the  infantile  organism 
ofiers  less  resistance  to  injurious  influences,  and  is 
more  susceptible  to  the  same.  Dr.  Lewin  found 
on  experimenting  with  patients  suffering  from 
eczema  that  there  exists  a  morbid  condition  of  the 
vaso-motor  nerves  ;  the  spasm  of  the  latter  being 
more  extensive  and  of  longer  duration  than  in  the 
normal  state.  L.  tried  ergotin  which  we  know  con- 
tracts the  vessels.  He  prescribed  it  successfully 
for  patients  who  had  suffered  from  eczema  for  10- 
15  years,  and  had  employed  all  possible  remedies 
without  avail ;  in  one  case,  a  physician  who  for 
20  years  had  suffered  from  the  disease  without 
being  able  to  secure  relief  was  treated  by  this 
remedy  with  complete  success.  He  gives  ordin- 
narily  1-3  to  i  grm.,  and  even  xuoxt  per  diem.  To 
children  he  prescribes  i  to  2  grm.  in  100  grm.  of 
water,  and  gives  of  this  a  desertspoonful  3  timcs^ 
daily.  As  to  the  external  treatment  of  chronic 
eczema,  he  had  never  found  cause  to  abandon  the 
use  of  oleum  cadini  (i.io).  The  average  length 
of  the  treatment  of  eczema  has  been  much  reduced 
since  the  internal  adm.inistration  of  ergotin  has 
been  added  to  external  medication. 

Dr.  Kobner,  who  took  part  in  the  discussion, 
had  not  met  with  such  success  in  the  use  of  ergotin, 
which  he  tried  in  3  cases,  but  Dr.  Lewin  observed 
that  the  value  of  the  remedy  could  not  be  decided 
upon  without  trial  in  a  large  number  of  cases. — 
International  Journal  of  Medicine  and  Surgery. 


THE  TREATMENT  OF  DROPSY  ANr> 
UREMIC  CONVULSIONS  DURING 
PREGNANCY. 

By  Prok.  Lehmann,  Amsterdam. 

K.  O.,  aet.  26,  was  admitted  to  the  hospital 
November  21st,  1879,  unconscious  and  in  convul- 
sions. Her  husband  states  that  she  has  been  ail- 
ing during  the  whole  time  of  her  second  pregnancy,, 
and  ocasionally  feverish  ;  her  feet  have  been 
cedematous  for  several  months ;  later,  general 
dropsy  and  diminished  excretion  of  urine.  At  5 
o'clock,  A.  M.,  she  had  a  convulsion  without  any 
prodroma  ;  again,  half  an  hour  later,  another  very 
severe  seizure.  At  the  time  of  admission  to  the 
hospital,  she  was,  as  ^>tated,  unconscious,  comatose, 
breathing  stertorous,  features  swollen  and 
cyanosed,  pupils  contracted,  and  a  bloody  froth 
around  her  mouth  ;  the  belly  very  large,  vulva  and 
limbs  swollen  ;  no  foetal  sound  could  be  detected  ; 
the  OS  dilated  to  the  size  of  a  silver  25  cent  piece, 
head  presenting,  Temj)erature  102.2°,  and  labor 
l)ains  were  insignificant.  Fifteen  minutes  after 
admission  she  had  a  third  severe  convulsion,  last- 
ing about  thirty  seconds,  followed,  by  many  more, 
occurring  with  but  short  intervals.  A  small  quantity 
of  urine  was  removed  by  the  catheter,  color   dark 


THE   CANADA    MEDICAL    RECORD. 


223 


brown,  reaction  acid,  sp.  g.  1.013  ;  it  contained  an 
unusual  quantity  of  albumen,  but  no  sugar. 

At  a  later  examination,  numerous  granular 
casts  and  fatty  epithelial  cells  were  found.  An 
enema  was  first  given  and  then  a  subcutaneous 
injection  of  a  two  per  cent,  solution  of  muriate  of 
pilocarpine.  This  last  injection  was  repeated  two 
hours  afterwards,  the  whole  quantity  used  amount- 
ing to  65  minims  (or  about  i^gr.  pilocarpine). 
Already  five  minutes  after  the  first  injection  the  pa- 
tient was  perspiring  freely,  with  abundant  secretion 
of  saliva,  but  the  convulsions  still  recurred  with 
unabated  violence  and  frequency.  At  half  past  7 
o'clock,  shortly  after  the  second  hypodermic  injec- 
tion, the  intermissions  seemed  to  become  somewhat 
longer.  The  os  was  yet  not  larger  than  a  silver  half- 
dollar,  the  general  condition  commenced  growing 
worse,  the  coma  continuing,  the  pulse  very  rapid  and 
barely  perceptible,  the  temperature  lowered  down 
to  100.4",  the  skin,  particularly  on  the  arms, 
•covered  with  a  profuse  perspiration,  a  quantity  of 
.sanguineous  slime  oozing  from  mouth  and  nostrils, 
labored  and  stertorous  breathing,  face  and  hands 
pale  and  clammy.  Considering  the  imminent 
danger,  and  fearing  she  might  die  undelivered,  as 
labor  pains  were  absent,  instrumental  delivery  was 
resorted  to  successfully,  the  child  was  easily 
delivered  in  a  few  minutes  but  dead,  and  another 
foetus  could  be  felt  in  the  womb.  About  ten 
minutes  after  this  delivery  she  had  another  severe 
convulsion  lasting  45  seconds,  and  the  second 
foetus  was  delivered,  also  dead.  The  placenta  was 
removed  about  ten  minutes  afterwards,  the  womb 
contracting  firmly.  The  patient  was  in  nearly  a 
collapsed  condition,  temperature  98.6".  Sulphuric 
ether  was  injected  into  the  arm,  and  this  injection 
repeated  two  hours  afterwards.  At  midnight  she 
still  remained  comatose,  with  stertorous  breathing. 
The  skin,  however,  was  everywhere  covered  with 
profuse  warm  perspiration,  pulse  stronger,  tempera- 
ture 99.5°,  no  convulsions  since  delivery.  The 
following  morning  found  the  patient  still  comatose, 
respirations  less  stertorous  ;  pulse  rapid  and  weak, 
-skin  warm  and  perspiring,  temperature  98.6*.  A 
large  quantity  of  urine  was  removed  with  the 
•catheter ;  no  change  in  its  composition  from  the 
preceding  day ;  uterus  well  contracted,  not  over 
sensitive  to  pressure,  lochia  normal.  Only  towards 
evening  did  she  commence  to  show  signs  of  return- 
ing consciousness.  She  drank  a  small  quantity  of  milk 
and  passed  the  night  quietly.  The  following  morn- 
ing she  was  in  the  full  enjoyment  of  her  mental 
faculties,  passed  a  large  quantity  of  light-colored 
urine  still  containing  an  abundance  of  albumen, 
and  the  odematous  swellings  had  decreased  con- 
siderably. Twelve  days  after  admittance  she  left 
her  bed — urine  non-albuminous. 

M.  S.,  aet.  27,  second  pregnancy,  was  admitted 
September  22nd,  1879,  ^^  7  P-ni.,  unconscious, 
after  repeated  severe  convulsions.  Her  first  preg- 
2iancy  ended  by  abortion  in  the  third  month  of 
gestation.  Three  months  ago,  while  apparently  in 
good  health,  dropsical  swellings  appeared,  first  in 


her  feet,  thence  spreading  up  her  limbs,  abdomen' 
face  and  arms.  Although  she  had,  up  to  the  pre 
sent  time,  violent  desire  to  void  her  urine,  it  had 
been  but  scantily  excreted  after  vomiting  several 
times.  She  was  first  seized  with  convulsions  at  6 
a.m  ;  they  recurred  with  but  short  intervals  and 
she  became  unconscious.  Her  whole  body  was 
oedematous,  particularly  her  face.  Coma,  breathing 
stertorous,  pulse  140;  temperature  105°;  pupils 
contracted ;  no  foetal  sound  could  be  heard.  The 
external  os  would  barely  admit  the  finger,  head 
presenting,  apparently  not  at  full  term,  foetus 
probably  dead,  no  labor  pains,  her  features 
cyanosed,  sanguineous  froth  around  her  mouth, 
convulsions  very  violent,  and  recurring  with  an 
interval  of  8  to  10  minutes.  From  7  to  8>^  p.m., 
she  had  nine  seizures  of  unusual  severity  and  dura- 
tion. Very  little  urine  could  be  obtained  by  the 
catheter ;  it  was  of  acid  reaction  and  loaded  with 
albumen  and  casts.  Prognosis  very  unfavorable. 
Death  before  deHvery  probable. 

This  case  was  treated  exclusively  with  pilocar- 
pine; no  other  remedy  was  used.  At  half-past  eight 
o'clock  an  injection  of  32  minims  of  a  2  per  cent, 
solution  of  pilocarpine  was  given  hypodermical- 
ly  on  the  anterior  surface  of  the  left  thigh.  Five 
minutes  afterwards  the  whole  surface  of  body  as  well 
as  of  limbs  was  covered  with  profuse  perspiration  ; 
saliva  and  slime  flowing  from  mouth  and  nostrils  ; 
pulse  156.  She  was  again  seized  with  another  con- 
vulsion, followed  with  but  short  intervals  by  many 
more.  Half-past  ten  o'clock  another  similar  injec- 
tion was  given,  causing  an  unusually  profuse  per- 
spiration of  her  whole  body,  so  abundant  that  it 
continually  ran  down  her  forehead  and  face  gut- 
tatim,  perfectly  bathing  her  arms  and  hmbs ;  never- 
theless the  seizures  would  recur,  but  not  as  severe 
as  before,  while  the  intervals  were  longer.  The  respira- 
tion, however,  became  more  oppressed.  At  half- 
past  eleven  o'clock,  she  was  lying  deeply  comatose, 
her  arms  bathed  in  cold,  clammy  perspiration,  fea- 
tures shrunken,  thready  and  very  rapid  pulse, 
temperature  in  vagina  105°.  She  appeared  to  be 
dying.  No  labor  pains.  At  half-past  one  o'clock  a 
third  hypodermic  injection  was  given,  and  15 
minutes  afterwards  the  perspiration  was  somewhat 
warmer  and  she  became  quieter,  so  that  only  light 
convulsions  of  her  arms  could  be  detected.  At 
half-past  seven  o'clock  on  the  following  morning 
she  was  found  in  labor  pains,  although  still  un- 
conscious. By  examination  it  was  seen  that  the 
head  was  born  and  the  body  came  shortly  after- 
wards. The  placenta  followed  immediately,  and 
the  womb  contracted  well.  The  foetus  was  still- 
born, the  skin  peeling  off  in  different  places.  It 
had  nearly  reached  full  term. 

Eleven  o'clock,  temperature  100.4°,  pulse  100 
and  stronger,  skin  covered  with  warm  perspiration, 
patient  still  comatose,  but  breathing  less 
stertorously,  no  convulsions.  At  8  o'clock  p.m., 
slight  signs  of  returning  consciousness,  copious 
excretion  of  urine,  temperature  101°.  After  passing 
the  night  quietly  she  woke  next  morning  perfectly 


224 


THE   CANADA    MEDICAL    RECORD. 


conscious,  temperature  99°.  The  swelling  was 
considerably  diminished,  and  had  com])lclcly  dis- 
appeared 5  days  afterwards,  although  the  urine  at 
that  time  still  contained  a  trace  of  albumen  but  no 
casts. 

The  author  considers  both  cases  as  results  of 
uraimic  poisoning,  contingent  upon  parenchymatous 
nephritis,  which  he  is  disposed  to  believe  had 
become  developed  during  pregnancy.  The  treat- 
ment wUh  pilocarpine  he  considers  to  have  been 
very  essential  as  a  diaphoretic  and  diuretic  agent, 
while  he  expresses  doubt  about  its  action  as  an 
oxytocic.  He  also  mentions  having  employed 
the  pilocarpin  in  six  primiparous  cases,  as  well  as 
in  two  multiparae  between  the  sixth  and  ninth 
month  of  gestation,  all  suffering  from  dropsical 
effusions  consequent  upon  chronic  parenchymatous 
nephritis  with  diminished  excretion  of  urine,  con- 
taining cylindrical  casts  and  a  very  large  quantity 
of  albumen.  He  used  two  injections  of  thirty-two 
minims  of  a  two  per  cent,  solution  twice  a  day,  and 
in  nearly  all  cases  did  he  succeed  in  completely 
curing  the  patient  after  using  five  injections  within 
from  8  to  14  days.  Three  women  gave  birth  to 
dead  fceti  of  6  to  7  months  gestation,  from  6  to  8 
days  after  the  last  injection.  One  was  admitted  to 
the  hospital  unconscious,  after  having  aborted  in 
the  seventh  month  of  her  pregnancy  during  violent 
convulsions.  The  remaining  four  cases  went  to  full 
term  and  bore  living  children. 

The  usual  effect  of  pilocarpine  is  first  to  cause 
a  general  warmth  of  the  whole  body,  followed  a 
few  minutes  afterwards  by  increased  secretion  of 
saliva  ;  then  the  perspiration  would  commence,  first 
on  the  forehead,  breast  and  limbs,  sometimes  very 
profuse,  so  that  it  would  flow  drop  after  drop, 
frequently  with  an  increase  of  the  secretion  of  tears. 
The  unpleasant  consequences  of  the  injections  con- 
sisted in  sickness  of  the  stomach,  vomiting,  rarely 
dizziness  and  headache,  and  only  once,  15  minutes 
after  the  injection,  irregular  action  of  the  heart.  It 
even  ceased  to  beat  for  a  moment,  the  features  be- 
came cyanosed,  and  the  pulse  slow  and  intermittent. 
These  symptoms  passed  away,  however,  as  sud- 
denly as  they  came.  This  patient  suffered  from 
mitral  insufficiency  with  hypertrophy  of  the  right 
ventricle.  After  the  lapse  of  six  to  eight  hours  all 
these  symptoms  would  usually  disappear.  Urine 
would  be  excreted  freely,  and  the  bowels  move 
repeatedly.  Occasionally  diarrhoea  would  super- 
vene. The  albumen  and  casts  would  frequently 
disappear  in  four  to  five  days. — Holland  Journal 
0/  Aledicine. — Noriv.  Med.  Jour. 


RECENT     PROGRESS    IN    THE     TREAT- 
MENT OF  DISEASES  OF  CHILDREN. 

BY  D.  H.  HAYDEN,   M.D. 
CONSTIPATION    IN    CHILDREN. 

Dr.  J.  I^wis  Smith  contributes  a  paper  on  this 
subject  in  the   January  number  of  the  American 


Journal  of  Obstetrics  and  Diseases  of  Women  and 
Children.  After  considering  the  various  kinds  of 
so-called  symptomatic  and  idiopathic  constipation 
and  their  causes,  the  author  refers  to  a  peculiar 
class  of  cases  where  there  seems  to  be  a  constitu- 
tional tendency  to  constipation, — a  tendency  quite 
independent  of  the  usual  conditions  (obstruction, 
disease,  sluggish  muscular  contractility,  improper 
diet),  atid  co  existing  with  perfect  health,  where 
defaication  takes  place  every  second,  third,  or  even 
fourth  day,  unless  produced  by  measures  employed. 

These  cases  are  the  exception,  however,  and  a 
largemajority  of  children  require  a  daily  evacuation 
of  the  bowels  to  do  well. 

In  the  treatment  of  this  complaint  the  author 
dwells  largely  on  the  idiopathic  form.  The  im- 
portance of  establishing  a  daily  habit  at  the  same 
hour  is  insisted  upon. 

Chicken  tea  and  to  a  certain  extent  beef  and  mut- 
ton tea  are  laxative,  and  when  made  plainly  are  use- 
ful in  connection  with  other  articles.  The  various 
kinds  of  berries  and  fruits  have  also  a  decidedly 
stimulating  effect  on  the  intestinal  surface,  and 
aid  in  removing  constipation.  The  apple  scraped 
or  baked,  or  apple  sauce,  may  be  given  to  quite 
young  children ;  and  for  those  that  are  older  cur- 
rants, cherries,  and,  among  dried  fruits,  prunes  and 
figs  are  laxative.  Unfermented  cider  in  its  season, 
which  has  been  found  so  useful  for  adults,  may 
also  be  given  to  children  in  moderate  quantity,  at 
least  to  those  who  have  reached  the  age  of  two  or 
three  years. 

It  is  generally  believed  that  the  small  size  of  the 
salivary  glands  in  the  first  months  of  infancy  pre- 
vents the  conversion  of  starch  into  glucose,  except 
in  very  inadequate  quantity.  It  appears,  however, 
highly  probable  that  there  is  an  epithelial  fennent 
which  converts  starch  into  sugar,  *  so  that  young 
infants  can  digest  starchy  food.  Nevertheless,  the 
theory  that  the  infantile  digestion  up  to  a  certain 
age  is  incompetent  to  effect  the  change  led  to  the 
preparation  of  food  for  infants  in  which  the  change 
of  starch  into  glucose  was  accomplished  by  a 
chemical  process.  Now  glucose,  administered  in 
considerable  quantity,  is  la.xative,  and  Dr.  Smith 
has  found  it  necessary  to  give  it  sparingly  or  not  at 
all  during  the  hot  months,  when  infants  are  so 
prone  to  diarrhcea.  This  laxative  .effect  renders 
the  glucose  preparations  of  the  shops  very  useful 
in  the  treatment  of  habitual  constipation  of  infants, 
whether  we  employ  the  "  maltose  "  or  •'  granulated 
sugar  of  malt,"  or  the  preparations  of  Liebig's 
food.  Of  four  constipated  infants  in  the  New  York 
Infant  Asylum  to  whom  Horlick's  ''  sugar  of  malt'' 
was  administered,  three  were  relieved.  Any  of  the 
glucose  preparations  can  be  given  quite  freely  to  a 
constipated  infant,  without  impairing  the  digestive 
function  or  producing  other  ill-effects,  so  long  as 
no  more  than  the  normal  evacuations  follow.  Dr. 
Smith  considers  them  among  the  best  and  safest  of 


*  See  Chemical    Phenomena  of  Digestion,    by  Charles. 
Richet.  Rrvue  des  Sciences  midicales,  October,  1878. 


THE   CANADA    MEDICAL    RECORD. 


225 


the  foods  for  the  reHef  of  constipation  in  infants  ; 
but  ghicose  or  grape  sugar  is  only  feebly  laxative, 
probably  not  more  than  cane  sugar.  The  laxative 
effect  of  oatmeal  gruel  for  nursing  infants  is  well 
known.  Bread  or  pudding  from  coarsely  ground 
or  unbolted  flouror  meal  and  vegetables  which  con- 
tain saline  and  fibrous  substances  have  a  stimulating 
and  laxative  effect  on  the  surface  of  the  intestines, 
and  therefore  are  useful  for  constipated  children  of 
the  age  of  two  or  three  years  and  upward.  There 
can  be  no  doubt  that  the  free  use  of  water  in  the 
ingesta  materially  aids  in  relieving  costiveness;  and 
it  i>  probable  that  the  laxative  effect  of  the  broths, 
gnels,  fruits,  and  mineral  water  are  partly  due  to 
the  amount  of  water  which  they  contain.  A  liberal 
quantity  of  water  has  doubtless  a  laxative  effect  in 
children,  and  its  judicious  use  is  proper  for  them. 

Frequent  kneading  of  the  abdomen  is  an  impor^ 
tant  aid  to  overcoming  constipation,  and  the  author 
rektes  a  case  in  which  obstinate  constipation  oc- 
curring in  a  child  of  three  years,  from  peritoneal 
bands  and  adhesion^,  w-as  to  a  great  extent  cor- 
recLed  by  friction  over  the  abdomen,  for  three  or 
four  minutes  at  a  time,  with  cod-liver  oil  three  or 
four  times  daily.  The  manipulation  probably  did 
the  good,  and  not  the  oil ;  but  the  use  of  one  of  the 
oils  for  inunction  renders  the  kneading  less  pain- 
ful, and  insures  its  more  thorough  performance  by 
the  nurse. 

Cold-water  bathing,  the  sudden  application  of  a 
cloth  wrung  out  of  cold  water  to  the  abdomen,  and 
in  certain  obstinate  cases  even  the  douche  maybe 
us^d  to  stimulate  the  muscular  coat  of  the  intestines 
and  the  abdominal  muscles  to  a  greater  activity. 

For  temporary  constipation  and  for  many  cases 
that  are  hiibitual,  enemata  should  be  employed. 

The  belief  that  the  frequent  use  of  warm  clysters 
produces  a  relaxing  effect  is  probably  correct,  so 
tliatif  it  is  necessary  to  employ  clysters  often  in 
consequence  of  the  torpid  state  of  the  intestines, 
cool  water  is  preferable.  For  infants  a  clyster  of 
one  or  two  ounces  generally  suffices.  In  certain 
Icng-continued  aggravated  cases  the  frequent  injec- 
tion of  a  large  quantity  of  tepid  water  is  indispens- 
able, and  perhaps  in  extreme  cases  the  dilatation  of 
the  sphincter  ani  and  the  introduction  of  the  spe- 
culum may  be  desirable.  Suppositories  may  be 
sometimes  usefully  employed  in  place  of  enemata. 
Cocoa-nut  butter,  molasses  candy,  or  soap  cut  in 
shape  of  a  pencil  may  be  used  for  this  purpose. 
Dr.  Nagel  speaks  highly  of  a  suppository  of 
brown  gelatine.  This  is  steeped  in  water  for  twelve 
hours,  and  having  been  thus  softened  is  introduced 
into  the  rectum,  and  an  evacuation  obtained.  The 
doctor  attributes  the  laxative  effect  to  the  hygro- 
metric  action  of  the  gelatine.  Those  who  have  em- 
ployed the  galvanic  current  to  relieve  constipation 
speak  favorably  of  its  use. 

The  ordinary  purgatives  should  not  be  given 
habitually  to  relieve  a  constipated  habit.  One  or 
two  doses  for  present  relief,  both  in  habitual  or 
temporary  constipation,  are  sometimes  required, 


provided  that  an  injection  is  for  any  reason  not  pre- 
ferred. For  this  pupose  castor-oil  or  a  few  grains 
of  calomel  mixed  with  syrup  of  rhubarb,  the  syrup 
of  senna,  or  the  compound  licorice  powder  of  the 
German  pharmacopoeia  may  be  administered  with 
advantage.  But  for  habitual  constipation  the  or- 
dinary purgative  medicines  should  be  discarded. 

Belladonna,  so  highly  recommended  by  Trous- 
seau, has  not  seemed  to  the  author  to  possess  any 
decided  purgative  effect ;  and  from  its  known 
physiological  properties  there  is  no  evidence  of  its 
increasing  the  intestinal  secretions  or  the  action  of 
muscular  fibres,  one  or  the  other  of  which  results 
we  expect  from  the  use  of  an  agent  which  is  really 
laxative.  Nux  vomica  and  strychnia,  its  active 
principle,  are.  on  the  other  hand,  valuable  adjuncts 
to  purgative  mixtures. 

Physicians  are  not  infrequently  at  a  loss  what  t© 
prescribe  for  the  habitual  constipation  of  nursing 
infants,  which  is  by  no  means  infrequent.  But  re- 
collecting that  the  colostrum  is  more  laxative  than 
ordinary  milk,  and  that  it  differs  from  it  in  con- 
taining more  sugar,  salts  (largely  phosphates),  and 
butter,  we  have  a  hint  as  to  what  is  probably  lacking 
in  milk,  and  what,  therefore,  should  be  supplied. 

Dr.  Smith  is  in  the  habit  of  giving  these  ingre- 
dients in  the  f  )llowing  formula,  and  usually  witk 
the  desired  laxative  effect: — 


R   01.  morrhuae  . 
Aq.  calcis, 
Syr.  calcis  lactophosphat. 


two  parts 
.  aa  one  part  M 


One-quarter,  one-third,  or  one- half  teaspoonful  may 
be  given  with  each  nursing,  or  a  larger  quantity,  as 
a  teaspoonful  or  more,  three  times  daily.  Breast 
milk  with  this  addition  becomes  more  nezxly  like 
colostrum  in  its  laxative  properties,  while  it  does 
not  possess  those  properties  of  colostrum  which 
disturb  the  digestive  process.  The  author  knows 
of  no  agent  of  a  medicinal  nature  which  meets  the 
indication  so  well  as  this  for  infantile  constipation. 

He  has  found  it  necessary,  however,  in  his 
practice  in  not  a  few  instances  to  rely  mainly  on 
simple  enemata  for  the  relief  of  the  constipated 
habit  till  the  infants  reached  the  age  where  a  mix&.d 
diet  was  proper. 

For  the  habitual  constipation  of  older  children, 
when  it  is  desirable  to  employ  active  purgatives  di 
the  pharmacopceia,  since  the  portion  of  intestii>ie 
which  is  chiefly  implicated  is  the  colon,  stich  shonJa 
be  selected  as  produce  little  or  no  irritation  of  the 
long  tract  of  the  small  intestines,  while  they  simu- 
late the  function  of  the  colon.  The  aloetic  pre- 
parations are  preferable  for  this  purpose,  as  the 
tincture  of  aloes  and  myrrh,  or  the  simple  tincture 
of  aloes,  which  may  be  given  in  doses  of  a  part  of 
a  teaspoonful  in  a  convenient  syrup,  as  the  elixir 
adjuvans  of  Caswell  and  Hazard,  or  in  coffee  ©r 
milk. 


THE   CANADA   MEDICAL   KECORD. 


THE  USE  AND  VALUE  OF  SALICYLATE   OF  SODA  IN 
CERTAIN  I  EBRILE  DISEASES  OF  CHILDHOOD.* 

Whilst  Ricgel,  Becker,  and  Brazina  speak  in 
high  terms  of  saHcylate  of  soda  as  an  antii)yretic 
remedy  in  typhoid  fever,  Riess,  regarding  the  same 
as  a  specific  in  this  disease,  Filatow  expresses  ex- 
actly opposite  views,  declaring  that,  with  the  ex- 
ception of  lowering  the  temi)erature,  all  the  other 
symptoms  remain  unchanged  or  are  more  devel- 
o])ed,  the  pulse  becoming  slower  and  at  the  same 
time  weaker,  and  that  of  thirty  cases  of  children 
sick  with  typhoid  fever  two  died.  Filatow  arrives 
at  the  conclusion  that  salicylate  of  soda  has  no 
effect  at  all  in  typhoid  fever,  and  can  therefore  not 
be  recommended  in  this  disease. 

On  account  of  this  diversity  of  opinion  the  writer 
instituted  a  series  of  experiments,  the  observations 
extending  to  over  two  hundred  cases. 

Salicylate  of  soda  was  administered  during  three 
years,  and  especially  cases  were  selected  of  febrile 
diseases  characterized  by  a  constant  and  typical 
fever  course.  Prominent  among  such  diseases 
belongs  typhoid  fever,  which  it  is  well  known  runs 
a  milder  course  in  childhood,  and  in  which  disease 
the  experiments  of  Riess  have  been  particularly 
conducted,  with  beneficial  results.  Moreover,  it  was 
used  in  diphtheritis,  inflammation  of  the  joints,  and 
malarial  fever.  1 

Durmg  these  three  years  there  were  one  hundred 
and  twenty-eight  cases  of  typhoid  fever,  of  which 
ninety-six  were  treated  with  salicylate  of  soda, 
thirty-two  partly  with  quinine  and  pardy  with  min- 
eral acids.  The  latter  circumstance  was  due  to 
the  fact  that  the  disease  was  not  recognized  in  its 
early  stages  on  account  of  its  irregular  appearance, 
or  on  account  of  complications,  or  because  the  chil- 
dren came  first  into  the  hospital  after  the  disease 
had  run  its  course,  and  consequently  needed  no- 
thing but  rest.  The  daily  dose  of  the  salicylate  of 
soda  was  two  to  four  grammes  (one-half  to  one 
drachm) ;  to  smaller  children  given  in  solution  in 
teaspoonful  to  dessertspoonful  doses ;  to  older 
children  this  amount  was  given  divided  into  ten 
powders,  which  one  was  taken  every  hour  in  wafers. 
Immediately  afterwards  the  children  were  given 
water  to  drink. 

The  author  directed  his  attention  principally  to 
the  course  of  the  fever,  and  for  this  purpose  the 
temperature  was  taken  night  and  day  every  two 
hours  so  long  as  the  temi)erature  continued  to  rise 
after  its  fall;  and  it  was  thus  easy  to  determine  in 
what  time  and  for  how  long  a  time  a  certain 
quantity  of  the  remedy  was  able  to  keep  down  the 
fever. 

The  beginning  and  duration  of  the  fall  in  tempera- 
ture was  very  various.  One  time  this  took  place 
half  an  hour  after  administering  the  remedy  ;  a 
second  time  one  hour  afterwards  ;  in  a  third  case, 
where  the  temperature  rose  to  105.8";  F.,  not   until 


•  Ign.  Weiss,  Emeritus  Assistant  in  the  Clinique  of  Pro- 
fessor Uokai,  in  the  Hudapest  Children's  Hospital.  AU- 
gemeine  Medicinische  Central  Zeitung,  April  7,  1880,  No. 
28. 


four  hours.      The  fall  was    generally  one    to  two 
degrees,  often  down  to    the  normal.    The  remission 
varied  in  length  on  an  average  ten  to  fifteen   hours  ; 
then  the  temperature  began    again  to  ascend,    and 
gradually  to  reach  its  former  height.   In  a  few  obsti- 
nate cases,  after    the  first  three  grammes,  there  was 
no,  or  only  a  very   ittle,  fall  in  the  temperature  ob- 
served ;and  it  was  only  after  this  dose  was   repeated 
the    second  or  third    time  that    the    working    vas 
observed.    There    was  generally  found  a  large  fall 
in  temperature  when  large  doses  were  given  in  rapid 
succession,  whilst  the  same  effect  was  not   produced 
once  where    the  same  doses  were    given  at    b 
intervals.     In  addition  to  the  fall   in    temperature 
other     effects    were    noticed     after    administering 
salicylate  of  soda.      In   a  small  number  of  the  pa- 
tients there  appeared,  especially  on  the    face  and 
thorax,  a  slight  transpiration,  which  lasted  fifteen  to 
thirty  minutes,  the   skin  then  becoming   dry  again. 
In  other  cases, — and  these  formed   the    majority 
— there  was  no  sweating  at  all.     With  the  youngest 
children  the  author  was  often  able  after  large  doses 
to  notice  a  certain  depressed    and  languid  condi- 
tion.    In  no  case  was  there    any  complaint   rrade 
of  noises  in  the  ears,  deafness,  headache,  or  vert.go, 
as  is  the  rule  with  quinine.     In  a  few  cases  where 
the  remedy  was  used  for  a  long    time    there  A^as 
nausea,  and  older  children  complained  of  a  t  ck- 
ling  in  the  throat  and  pain   in  the  stomach.     The 
symptoms,  however,  disappeared  rapidly  as  soon  as 
the  remedy  was  left  off  for  a  short  time.     There  vas 
no  noticeable  effect  produced  upon  the  pulse,  this 
becoming  slower  in  proportion  as   the  temperature 
fell.     A  marked  weakness  of  the  pulse,  as  described 
by  Filatow,  the  author  never  met  with.     Salicylite 
of  soda  seems  to  work  on  the  bowels  ;  and  in  several 
cases  where  there  was  a  diarrhoea   this  ceased  with 
the  use  of  this  remedy.     A  shortening  of  the  typhoid 
fever,  however,  was  not  noticed  in  a  single   ca^e, 
so   that  salicylate  of  soda  cannot  be  regarded  as 
a  specific  in  this  disease,  such    as    quinine  is  in 
intermittent  fever  ;  but  as  the  high   fever,    which  is 
always  present  in  typhoid   fever,  and  threatens  to 
exhaust  the  patient,  is   materially  and  permanently- 
kept  down  by   this  remedy,  in  this  way  apart^f 
the  danger  is  averted. 

In  addition  to  typhoid  fever  the  author  hts 
employed  salicylate  of  soda  in  cases  of  diphtheria, 
acute  inflammation  of  the  joints,  and  intermittent 
fever. 

'i'he  effect  upon  the  temperature  in  diphtheria 
was  in  no  way  so  striking  as  in  typhoid  fever,  nor 
was  there  any  effect  produced  upon  the  course  of 
the  disease  by  this  remedy. 

In  acute  articular  inflammations  there  were  seen 
about  the  same  changes  as  in  typhoid  fever ;  more- 
over, the  pain  was  relieved. 

As  an  example  the  author  relates  the  case  of  a 
young  girl,  ten  years  old,  who  was  attacked  with 
acute  articular  rheumatism  three  weeks  after  a 
scarlet  fever.  The  pains  were  so  intense  that  the 
patient  groaned  and  sobbed  continuously  day  and 
night.      After  the  first  three  grammes    (forty-five 


THE   CANADA   MEDICAL   RECORD. 


227 


grains)  of  salicylate  of  soda  the  pains  and  fever  both 
yielded  in  a  very  short  time.  The  temperature  fell 
from  104.3°  F.  to  loi.i"  F. 

In  intermittent  fever  a  paroxysm  was  prevented 
only  when  the  remedy  was  given  immediately  be- 
fore the  paroxysm  was  expected.  An  effect  was 
roticed  only  on  the  day  of  the  fever,  and  when  the 
remedy  was  not  given  on  the  fever  days  it  always 
returned  at  the  regular  time.  Quinine  has  this 
great  advantage  in  malarial  fever  that  it  has  the 
power  to  cut  short  the  disease  completely,  whilst 
sa.icylate  of  soda  is  only  effectual  to  cut  short  the 
pa-oxysm  when  given  just  before  it  is  expected. 
From  the  fever  curve  of  a  case  reported  it  is  seen 
that  the  paroxysm  returned  every  afternoon  at  the 
sane  hour :  the  high  temperature  lasted  three  hours, 
then  sank  gradually,  and  the  child  was  free  until 
the  next  day.  Immediately  before  the  expected 
attick  three  grammes  of  salicylate  of  soda  were 
given,  and  there  was  no  paroxysm.  On  the  two  fol- 
loving  days,  when  the  remedy  was  not  used,  there 
ws,  in  the  afternoon,  a  considerable  rise  of  tem- 
pe'ature 

On  the  third  day  eighty  centigrammes  of 
qunine  (twelve  grains)  were  given,  and  the  parox- 
yans  did  not  return. 

The  author  sums  up  the  result  of  his  observations 
in  the  following  conclusions  : — 

(i)  Salicylate  of  soda  is  a  powerful  antipyretic 
rmiedy  in  the  typhoid  fever  of  children,  which, 
whilst  it  does  not  shorten  the  course  of  the  dis- 
eise,  renders  it  much  milder. 

(2)  The  results  with  this  remedy  in  typhoid 
f<ver  are  better  than  have  hitherto  been  obtained 
ty  quinine,  cold-water  baths,  cold  wrappings,  and 
tie  various  mineral  acids. 

(3)  The  beneficial  effect  can  only  be  obtained 
vhen  large  doses  are  given  at  short  intervals,  and 
the  author  has  never  observed  any  ill  effects  fol- 
bwing  its  use. 

(4)  In  diphtheritis  salicylate  of  soda  has  no 
hfluence  upon  the  course  of  the  disease. 

(5)  In  acute  articular  rheumatism  the  effect 
)oth  upon  the  fever  and  upon  the  pain  is  a 
remarkably  favorable  and  quick  one. 

(6)  In  intermittent  fever  salicylate  of  soda  is  only 
of  service  when  given  immediately  before  the 
expected  attack.  As  quick  as  the  remedy  is  left  off 
the  paroxysms  return. 

TWO  CASES  OF  POISONING  BY  MORPHINE  AND  OPIUM 
RESPECTIVELY  IN  INFANTS.* 

Werthheimber  f  relates  a  case  of  poisoning  by 
one  centigramme  (one-sixth  grain)  of  morphine  in 
an  infant  fourteen  days  old.  For  an  hour  and  a 
half  al-cr  the  administration  of  the  above  dose  the 
child  was  cyanotic,  completely  comatose,  and 
pulseless,  the  heart's  beat  being  weak  and  inter- 
mittent. The  extreme  contraction  of  the  pupils  led 


;(;    Berliner  klinische  Wochenschrift,   April   19,    1880. 
t  Deutsches  Archivfdrklinische  Medicine,  Bd.  xxiv.  Heft  3. 


to  an  accurate  diagnosis  of  the  cause  of  the  child's 
condition,  which  had  previously  not  been  known. 

The  employment  of  artificial  respiration  by  a 
rhythmical  compression  of  the  thoracic  walls  con- 
tinued for  a  long  time,  combined  with  the  use  of 
black  coffee  and  of  liquor  ammoniae  anisatus,  led 
to  recovery. 

In  a  case  reported  at  the  meeting  of  the 
academy  of  Medicine,  held  February  17th  of  this 
year,  by  Le  Roy  de  Mirecourt,  and  observed  by 
Nicolas  and  Demony,  a  child  three  weeks  old 
took  by  mistake  a  teaspoonful  of  Sydenham's 
laudanum  (vinum  opii).  The  first  symptoms  of 
poisoning  made  their  appearance  two  hours  after- 
wards, and  consisted  of  a  deep  somnolence,  which 
was  interrupted  by  attacks  of  convulsions.  After 
such  an  attack  the  weakness  would  be  so  great  that 
at  times  the  heart  ceased  to  beat.  Here,  also,  arti- 
ficial respiration  was  resorted  to,  and  especially 
put  in  operation  during  the  convulsive  paroxysms. 

To  the  perseverance  in  these  measures  must  be 
attributed  the  fact  that  eight  hours  after  the 
appearance  of  the  first  symptoms  of  poisoning  the 
somnolence  seemed  to  diminish  a  little,  and  the 
infant's  condition  gradually  advanced  towards 
recovery. 

On  the  following  day  there  were  violent  reac- 
tionary symptoms.  There  was  not  complete  re- 
covery until  the  fourth  day.  Micturition  took  place 
forthe  first  time  twelve  hours  after  the  beginning 
ofthe  symptoms. 


WEAK  SPINES  IN  YOUNG  GIRLS    AND 
THEIR  TREATMENT. 

Read  before  tht  Philadelphia  County  Medical  Society,  Decern- 
ber  15,   1880. 

By  John  M.  Keating,  M.D. 

Lecturer  on  Diseases  of  Children  in  the  University  of  Penn- 
sylvania, Visiting  Accoucheur  to  the  Philadelphia  Hos- 
pital, etc. 

My  intention  this  evening  is  to  bring  before  you 
a  subject  that  may  at  first  sight  appear  a  trivial 
one,  but  which  more  extended  observation  and 
careful  study  have  led  me  to  consider  worthy  of 
the  attention  of  this  Society. 

Thousands  of  young  children  are  at  this  time 
bending  over  their  books  in  the  crowded  school- 
room, straining  their  eyes,  narrowing  their  chests, 
and  bowing  the  back  upon  whose  erectness  and 
resiliency  tiiey  should  in  future  depend  not  only  for 
support,  but  for  health,— even  life.  A  few  years 
hence,  these  very  spines,  now  strained,  weakened, 
and  probably  curved,  will  be  called  upon  without 
further  preparation  to  bear  the  brunt  of  the  great 
requirements  of  society,  and  soon  after  to  be  tor- 
tured by  the  physical  burden  of  maternity  ;  or  pro- 
bably the  store,  the  sewing-room,  or  the  factory, 
aided  by  some  inherited  taint,  will  determine  the 
lesion  and  give  us  the  cases  of  phthisis,  disea.ses  of 


228 


THE    CANADA    MEDICAL    KF:C0RD. 


the  heart,  carcinoma,  and  the  various  chronic  affec- 
tions that  fill  our  mortality  tables. 

I  call  particular  attention,  in  my  paper,  to  the 
girls,  because  they  are  by  far  the  more  important 
class,  and  the  out-door  games  and  occupations  of 
the  boys  tend  to  obviate  what  the  sedentary  tasks 
of  their  sisters  but  tend  to  increase. 

Once  free  from  the  thraldom  of  school,  the  boys 
break  loose  to  unbend  their  backs  and  free  their 
lungs  ;  the  girls,  to  saunter  home,  their  arms  bur- 
dened with  books,  to  aid  their  mothers  in  domestic 
duties. 

The  infantile  diseases  of  the  spinal  column,  those 
that  involve  the  structure,  have  received  careful 
study,  and  now,  thanks  to  Sayre,  the  body  is  at 
once  placed  in  splints  until  the  rickety  diathesis 
is  overcome  by  growth  and  a  full  supply  of  bony 
deposit.  Even  such  cases  of  structural  disease  as 
develop  later  in  life  are  now  easily  detected  at  their 
earliest  manifestation,  and  either  held  in  abeyance 
by  immediate  treatment  or  effectually  checked  in 
their  course. 

But  it  is  my  purpose  to  call  attention  to  another 
class  where  spinal  weakness,  due  to  the  strain  of 
position, — a  condition  so  insidious  in  its  onset  and 
masked  in  its  course, — escapes  attention  till  the 
frame,  fully  set  by  complete  bony  deposits,  cramps 
the  viscera,  and,  by  impeding  healthy  action,  forms 
a  nidus  for  disease.  The  development  of  the 
skeleton  is  undoubtedly  influenced  by  the  activity 
©f  its  muscles  :  symmetrically-developed  muscles 
will  produce  straight  bones.  We  read  much  of 
dystocia,  we  hear  of  pelvic  distortions,  of  narrow 
diameters.  Has  any  one  endeavored  to  mitigate 
these  evils  by  helping  Nature  to  make  normal  what 
the  requirements  of  dress  and  pursuit  have  tended 
from  early  life  to  deform  ?  The  remedy  for  those 
conditions  that  have  suggested  the  forceps,  the 
cranioclast.  or  "  version  by  the  feet  "  lies  in  the 
early  development  of  the  skeleton  by  proper  phy- 
sical training, — in  other  words,  by  educating  the 
female  child  to  be  a  mother,  and  if  its  diathesis  be 
rickety  train  its  pelvis  as  well  as  its  brain.  Far  be 
it  from  me  to  decry  anything  that  will  tend  towards 
the  most  thorough  education  of  the  intellect :  my 
object  is  simply  to  contend  that  study  can  be  ac- 
complished without  cramped  positions,  and  that 
weak  spines  are  not  essential  to  educated  women. 
My  attention  has  frequently  been  called  in  connec- 
tion with  dispensary  and  other  practice  to  a  series 
of  cases  that  forms  the  basis  of  this  paper.  For 
better  elucidation,  and  to  avoid  repetition,  I  shall 
group  them  under  two  heads, — the  first  comprising 
those  young  enough  to  go  through  the  daily  routine 
of  school  life  and  thereby  suffer  at  once  from  its  ill 
effects; the  second,  those  who,  after  having  spent 
years  in  developing  their  intellect  at  tlie  expense  of 
their  muscular  and  nerve  force,  suddenly  call  upon 
them  to  bridge  them  over  the  most  difficult  period 
of  their  lives.  The  first  group  you  recognize  by 
their  pale  faces,  bowed  backs,  and  rounded  shoul- 
ders, frontal  and  occipital  headache,  weak  eyesight, 
cardiac  palpitations,  disordered  digestion,  and  cer- 


tain nervous  combinations,  chorea  predominating.    • 
Stand  at  any  school-room  door  on  an  afternoon  in  ' 
the  early  spring,  and  you  will  not  fail   to   see  the 
cases  that  fill  our   dispensaries.     You    read   their 
remedy  in   their  very  faces, — a  proper  division  of 
study  and  recreation,  recreation    that   means  nol 
mere  rest  from  book-work,  but  muscular  exercise, 
good  food  and  fresh  air. 

To-night  to  the  second  group  I  wish  to  call  speciil 
attention  :    a  chapter  devoted  to  its  consideration 
might  most  appropriately  bear  for  its  heading  tie 
one  prominent  symptom,  ''  backache."     Free  from 
the  daily  restrain  of  school  life,  their  hours  are  de- 
voted to  the  absorbing  necessities  of  society  ;  and 
their  habits  either  become  extremely  active  or  2x- 
tremely  sedentary,  the  mania  for  violent  exerdse 
developingfrom  the  lassitude  that  follows  nervous 
excitement ;  and  from  one  extreme  to  the  other  vill 
these  girls  drag  out  years  of  miserable  existerce 
whose    monotony  will  be  relieved    only  by    the 
periodical  tortures    of  dysmenorrhoea.     That   (he 
functions  are  deranged  is  simply  in  accordance  wth 
the  general  physical  strain.     In  all  such   cases  he 
great  muscles  of  the  back  are  those  most  calhd 
upon,  and  soon  from  excessive  tension  or  want  of 
nutrition,  fail  in  their  most  important  duty.     Tie 
equilibrium  which  is  maintained  by  the  concerted 
action  of  those  of  either  side  is   lost  by  the  givirg 
way   of  the  muscles  that  malposition  has  tended 
to    weaken,  and    the    stronger    group    brouglt 
into  play  draw  the  spinal  column  where  they  wil 
Neuralgic  pains,  backache,  and  internal  congs 
tions  are  the  result,  to  say  nothing  of  the  occasions! 
permanent  lesion    in  long-standing   cases  by  the 
absorption  of  cartilage.     Weariness  from  anaemia 
chlorosis,  and  hysteria  in  all  its  forms  is  the  inevv 
table  sequence.     Let  me  picture  for  you  an  exam 
pie.     A  young  girl  comes   to  your  office  with  th( 
following  history.     Possessed  of  a  naturally  strong 
constitution  and  vigorous  intellect,   she  has  beer 
ambitious,  has  graduated  after  years  of  close  appli 
cation  and   with  the  highest  honors  in  her  class. 
Her  winters  have  been    spent   in  the    sedentary 
pursuits  of  the  school-room  ;  even  her  hours  of  lei- 
sure have  been  devoted  to  her  books.     Of  course, 
the    usual  result — "  break-down  " — has    followed, 
and  the    routine    treatment  of   tonics  has  been 
adopted,  and,  so  far  as  general  appearance  is  con- 
cerned, the  patient  has  been  benefited  by  them. 
But  the  principal  complaint  is  weariness,  a  contin- 
ual feeling  of  fatigue,  following  the  smallest  amount 
of  exercise,  brought  on  equally  well  by  standing 
and  by  sitting,  by  day  and  by  night.     This  feeling 
of  weariness  is  more  decided  in  the  back,  and  is  so 
uncomfortable,  not  to   say  painful,   as   to  require 
some  constant  form  of  pressure  in  the  lumbar  and 
sacral  regions,  which,  when  lying  in  bed,  is  brought 
about  by  placing  a  pillow  in  the  hollow.     There  is 
also  an  aching  in  one  of  the  shoulder-blades,  and 
a  feelinc  of  weakness  in  the  muscles  at  the  back 
of  the  neck.       Upon    examination,  your  patient 
appears  well    nourished,  but    the  muscles  upon 
pressure  are  found  to  be  soft  and  flabby.     It  will 


THE   CANADA   MEDICAL    RECORD. 


229 


be  noticed  when  the  back  is  examined  that   the 
patient  leans  more  or  less  to  one  side,  and  if  allowed 
to  assume  a  natural  and  (to  her)  comfortable  posi- 
tion that  the  difference  is  often  surprising.     As  a 
ru'.e,  the  aching  or  weariness  is  found  located  in  the 
muscles  that  form  the  convexity,  because  those  on 
the  concave  or  the  side  towards  which  the  spinal 
column  leans  seem  to  draw  it  in  that  direction,  and 
thereby  stretch  the  muscular  tissue  of  the  opposite 
side.     In  several  cases  that  I  have  seen  this  view 
appeared  to  be  strengtliened  by  the  fact  that  faradic 
contractility  was  slightly  diminished  on  the  outer 
convex  or  weaker  side.     I  have  seen  cases  where 
the  pressure  seemed  so  great  as  to  cause  absolute 
pain  from   the    curvature  alone,    and  I  have  no 
doubt   that,    without  any    distinct  disease  as   an 
initial  lesion,  a   permanent  tendinous   contraction 
can  take  place  after  a  time  identical  with  that  which 
requires  surgical  interference  in  other  parts  of  the 
body.     Certain  it  is  that   in  one   case  that   came 
under  my  notice  the  pressure  caused  all  the  symp- 
toms  of  phthisis  in  the  lung   pressed  upon,  all  of 
which  were  relieved  by   straightening  the  spinal 
column.     It   is  scarcely  necessary  to   enumerate 
further  the  complaints  of  a  patient  such  as  I  have 
described  if  the  condition  has  been  one  of  long 
standing  :  the  interference  with  circulation,  the  in- 
door life,  the  restlessness  from  nervous  irritability, 
the  reflex  nervous  disturbances,  the  loss  of  appetite 
and  want  of  nutrition,  will  be  shown  by  a  tangled 
chain  of  evidence  that  will  tax  the    power  and 
patience  of  the  most  accomplished  and  amiable  of 
diagnosticians.     Various  forms  of  uterine  disease, 
with  flexions,  versions,  and  prolapses,  ovarian  en- 
gorgements, enlarged  and  displaced  ovaries,  will 
add  to  the  confusion  by  their  perplexing  train  of 
symptoms.     Relaxation  is  the  word  expressive  of 
the  one  general  cause  of  such  conditions,  and  in 
our  treatment  we  must  bear  in  mind  the  atonic 
condition  of  every  muscle,  nerve,  and  fibre  of  the 
whole  body.     The  admirable  teachings  of  Dr.  S. 
Weir  Mitchell  have  enabled  us  to  value,  above  all 
things,  absolute  rest  in  all  such  and  allied  cases  ; 
and  to  insist  that,  in  the  majority  of  those  to  which 
I  now  allude,  it  is  the  primary  factor  in  their  treat- 
ment, is  simply   to  add   testimony  which  is   not 
required  to  the  great  success  that  has  attended  its 
trial. 

When  examination  shows  us  decided  weakness 
in  the  muscles  of  the  back,  I  have  of  late  adopted 
a  plan  calculated  to  give  the  support  which  is 
needful  until  the  nutrition  and  strength  of  the  mus- 
cle have  been  increased  by  local  treatment.  In- 
stead of  the  plaster  dressing,  which  is  so  valuable 
at  other  times,  I  would  suggest  the  use  of  some 
lighter  material,  cardboard  for  example,  which 
softened  by  hot  water,  easily  moulds,  and  when 
dry  and  hard  forms  a  light  and  admirable  splint. 
It  may  be  applied  in  this  way.  A  small  strip,  ex- 
tending fully  the  breadth  of  the  back  from  the  lower 
border  of  the  scapulae  to  the  most  prominent  por- 
tion of  the  sacrum,  covered  wi  h  linen,  is  applied, 
when  softened,  over   a  piece  of  canton  flannel  or 


some  such  material,  while  the  patient  is  sitting, 
care  having  been  taken  that  during  the  application 
the  spinal  column  is  erect.  A  few  turns  of  a  roller 
will  secure  it  in  place.  I  usually  cut  the  card- 
board heart-shaped,  with  the  base  upward  and  the 
apex  down.  When  dry,  the  support  will  be  found 
complete.  The  shoulders  will  rest  on  a  level,  the 
lower  borders  of  the  scapulae  firmly  fixed  upon  the 
upper  part  of  the  board,  this  position  being,  I 
think  most  important.  The  cardboard  can  be 
attached  to  the  corset,  taken  on  and  off  with  it, 
and,  as  the  clothing  fits  perfectly  without  giving 
the  least  hint  as  to  what  lies  beneath,  patients  will 
wear  it  with  comfort  and  willingly  for  any  length 
of  time.  But  above  all  things  I  believe  in  the 
daily  use  of  the  faradic  current,  applied  to  those 
muscles  or  groups  that  it  is  proposed  to  strengthen, 
and  to  them  alone  :  thus,  if  the  column  leans 
towards  the  right  side,  faradize  the  muscles  of  the 
left.  This,  I  believe,  is  of  far  greater  value  than 
we  have  been  accustomed  to  consider  it,  for 
single  muscles  can  thus  be  readily  exercised 
to  the  exclusion  of  others,  and  exercise  of  this 
kind  brings  with  it  increased  nutrition,  strength, 
and  development  in  size.  With  such  a  power, 
when  applied  with  the  perseverance  it  demands, 
what  are  we  not  capable  of  doing  ?  The  aurist 
will  tell  you  of  its  use  in  increasing  the  muscular 
tonicity  of  the  smallest  and  most  delicate  muscles 
of  the  inner  ear.  In  diseases  of  the  uterus  so 
powerful  is  its  local  action,  when  properly  applied 
on  muscular  fibre,  as  to  make  permanent  a  position 
in  many  cases  which  has  needed  for  years  the  sup- 
port of  the  pessary.  I  may  almost  predict  for  the 
oculist  its  value  in  restoring  accommodation  in- 
stead of  the  ever-fashionable  glasses.  It  is  the 
daily  systematic  use  of  a  well  contracting  current 
that  is  followed  by  the  beneficial  result,  just  as  it  is 
the  mildest  form  of  continued  exercise,  and  not 
the  spasmodic  muscular  effort,  that  makes  a  man 
powerful.  Recommend  your  patient  before  retir- 
ing to  hang  by  the  hands  from  a  horizontal  pole  for 
a  few  moments,  to  use  cold  sponging,  friction,  and, 
above  all,  when  possible,  massage,  to  exercise  daily 
in  the  open  air,  which  the  back-support  invites,  as 
the  want  of  it  before  discouraged.  When  strength 
is  gradually  accumulated,  encourage  that  most 
healthy  and  invigorating  exercise,  swimming,  which 
is  never  followed  by  the  ill  effects  so  often  seen  in 
women  from  the  overstraining  of  violent  walking  or 
horse  back-riding — Philadelphia  Medical  Times. 


FISSURE   OF  THE  RECTUM  WITH  CON- 
STIPATION. 

A  CLINICAL    LECTURE. 

By  Wm.  Goodell,  M.D.,  Philadelphia,  Pa. 

{Reported  expressly  for  the  Southern  Clinic.) 

This  woman  complains  of  bearing  down  pains 
and  menorrhagia  at  her  monthly  periods,  and  of 
excessive  leucorrhoea  between  times.     No  examin- 


230 


THE    CANADA    MFDICAI,    RKCORI). 


ation  has  been  made  thus  far,  and  treatment  has 
only  been  ihiough  the  mouth.  She  has  had  very 
obstinate  constipation.  Costiveness  of  a  very  pro- 
nounced character  is  common  in  women.  Men 
are  generally  glad  to  defecate  when  the  desire 
comes ;  but  women  do  everything  to  put  off  the 
act,  from  over-modesty  or  other  causes.  This 
statement  holds  good  not  only  with  reference  to  the 
bowels,  but  also  as  regards  the  bladder.  You  have 
no  idea  how  often  the  most  violent  cystitis  is  pro- 
duced by  continually  restraining  the  desire  to 
urinate.  This  patient  tells  me  that  her  bowels 
have  not  been  moved  freely  for  sa^en  years,  and  are 
never  moved  at  all  except  by  the  use  of  medicines. 
She  says  that  defecation  gives  her  so  much  pain 
that  she  puts  it  off  as  long  as  possible,  and  so  never 
tikes  purgative  medicine  except  once  in  ten  days 
or  so.  when  she  buys  an  ounce  of  sulphate  of 
magnesia. 

I  have  had  the  woman  put  thoroughly  under  the 
influence  of  ether,  so  as  to  allay  spasm  and  relax 
all  the  muscles,  and  shall  now  proceed  to  make  a 
most  careful  examination.  There  is  very  evident- 
ly a  post  uterine  tumor  of  some  sort  or  other, 
which  I  think  will  turn  out  to  be  a  hardened  col- 
lection of  faeces.  I  shall  also  probably  bring  to 
light  one,  if  not  more,  fissures  of  the  rectum.  Let 
us  see  what  goes  on  in  a  case  of  obstinate  constipa- 
tion. A  species  of  fermentation  ensues,  and  a 
large  part  of  the  faeces  are  reabsorbed,  giving  a 
yellowish  tinge  to  the  complexion,  and  bringing  on 
a  chronic  torpidity  of  the  liver.  With  my  finger  in 
the  vagina,  I  discover  the  womb  pushed  upward 
and  forward,  and  behind  it  a  hard  tumor  I  shall 
now  have  to  make  a  thorough  rectal  examin 
ation  ;  but  before  doing  so,  it  will  be  well  to  have 
my  hand  and  fingers  covered  with  carbolized  oil. 
I  am  going  to  use  my  left  hand  for  this  dirty  work 
(I  shall  jjrobably  have  to  remove  the  impacted 
faeces  by  hand),  and  I  want  to  enforce  upon  you 
all  the  necessity  of  being  able  to  work  as  well  with 
your  left  hand  as  your  right.  Suppose  that  I  were 
called  an  hour  hence  to  make  an  examination  of  a 
pregnant  woman.  I  might  produce  the  very  ^rav 
est  results  were  I  to  use  the  same  hand  that  I  am 
now  using,  for  I  could  not  be  absolutely  certain 
that  it  was  free  from  imi)urities.  However 
thoroughly  I  might  cover  it  with  carbolized  soap 
and  water,  some  little  taint  might  still  remain, 
enough  to  produce  septicaemia  in  a  pregnant 
woman.  So  all  of  you  should  learn  to  use  your 
left  hand  when  occasion  demands,  so  that  the  right 
hand  may  be  reserved  for  cleaner  and  more  deli- 
cate work.  Now,  what  do  I  discover  with  regard 
to  this  post-uterine  tumor  ?  I  can  indent  it  slightly 
by  pressure.  It  is  probably  a  collection  of  hardened 
fajces  Two  years  ago  the  woman  had  a  child, 
and  if  there  had  been  any  impaction  it  would  then 
have  been  forced  out  by  the  descending  head. 
There  are  three  points  in  the  large  intestine  where 
obstruction  may  occur  ;  it  rarely,  if  ever,  occurs  in 
the  small  intestines.  These  three  points  are — the 
caput  caecum  in  the  right  iliac  fcesa,  the  sigmoid 


flexure,  and  the  rectum.  Movements  of  the  bowels 
occur  in  some  women  only  after  very  long  inteivals. 
Dr.  G.  B.  Wood  speaks  of  one  case  where  there  had 
not  been  a  movement  for  the  space  of  six  months. 
Where  there  is  such  stubborn  constipation  ive 
generally  find,  upon  examination,  a  fissure  of  the 
rectum.  This  always  renders  defecation  very 
painful.  Constipation  would  give  rise  to  all  the 
symptoms  of  which  this  patient  complains.  Thus, 
the  menorrhagia  and  leucorrhcea  would  be  caused 
by  the  congestion  of  the  womb  consequent  upon  the 
stasis  of  the  blood  in  the  vessels  of  the  inlestmes. 
This  might  also  produce  fissures  and  bleeding  piles. 
The  frequent  tenesmus  may  be  very  easily  mistaken 
for  bearing  down  pains. 

I  am  going  to  set  to  work  and  break  down  and 
remove  this  collection  of  iiardened  faeces.  This 
sometimes  requires  the  handle  of  a  spoon,  but  I 
think  1  can  bring  them  down  with  my  hand  in  the 
present  case.  But  first,  let  me  see  if  1  can  discover 
any  fissure  in  the  rectum.  To  do  this  I  pass  one 
finger  into  the  vagina  and  evert  the  lower  portion 
of  the  rectum.  There  is  a  small  fissure  on  the 
posterior  wall.  Fissures  may  be  cured  in  two  ways, 
viz  :  (i)  By  cutting  through  the  adjacent  muscular 
fibres  ;  and  (2)  By  over-stretching  the  sphincter 
ani.  I  much  prefer  the  second  method.  To  do 
this,  insert  your  two  thumbs  into  the  rectum  and 
pull  them  apart  until  the  sphincter  begins  to  yield, 
or  you  feel  the  rami  of  the  ischia  on  each  side.  To 
do  this  requires  the  employment  of  considerable 
force.  Having  stretched  the  sphincter  I  am  now 
the  better  able  to  remove  the  faeces.  As  far  as  I 
can  reach  I  feel  lumps  of  hardened  faeces.  I  am 
able  to  push  them  down  by  the  aid  of  a  finger  in 
the  vagina.  Here  is  one  lump  which  has  entirely 
lost  its  faecal  odor  and  seems  to  be  covered  with  a 
sort  of  false  membrane,  so  long  has  it  been  retained. 
In  the  present  instance,  I  am  able  to  break  up 
these  lumps  with  my  hands,  but  in  some  cases  1 
have  found  them  so  hard  as  to  require  the  assis- 
tance of  a  pair  of  polypus  forceps  to  remove  them. 
I  have  now  removed  all  the  lumps,  and  am  glad  to 
see  that  the  womb  has  gradually  been  falling  back 
into  the  place.  Evidently  the  tumor  which  she  has 
felt  for  so  long  a  time  was  nothing  but  hardened 
faeces. 

Upon  what  treatment  shall  I  place  this  woman? 
To-night  I  shall  order  her  ten  grains  of  blue  mass, 
and  to-morrow  morning  two  tablespoonfuls  of  cas- 
tor oil.  I  think  that  I  have  removed  all  the  hard- 
ened faeces  ;  but  if  it  turns  out  that  the  transverse 
colon  is  obstructed,  she  must  be  given  a  'gravity 
injection."  filling  up  the  entire  lower  bowel.  Of 
course  this  must  not  be  given  while  she  is  under 
the  influence  of  ether,  or  we  should  have  no  guide 
as  to  the  quantity  of  water  injected,  and  thus  might 
inject  so  much  as  to  burst  the  bowel.  As  regards 
after  treatment,  the  patient  must  be  taught  to  go 
to  stool  regularly  every  day,  and  to  eat  certain 
kinds  of  food  only.  For  medicine  I  shall  order 
the  following  prescription  : 


THE   CANADA   MEDICAL    RECORD. 


231 


R.  — Ext.  colocynth  conip gr.  ii- 

Pulv.  rhei gr.   i. 

Ext.  belladon gr.  ){ 

Ext.  hyoscyami gr.  ss. 

M.— Et  in  pil  No.  i  div.  S.— To  be  taken  at 
bed  time. 

In  some  cases  .Jo  of  grain  of  strychnia  may  be 
added  to  the  above  with  advantage.  Iron  must 
not  be  employed  at  present,  as  it  tends  to  consti- 
pate. As  regards  local  treatment,  I  shall  advise  the 
patient  to  rub  her  groins  and  abdomen  with  a  flesh- 
brush  or  rough  bag  of  camel's  hair.  I  want,  just  here, 
to  say  a  word  in  strong  recommendation  of  the 
treatment  known  as  "  Massage."  While  under  this 
treatment,  one  of  whose  items  is  a  daily,  painstak- 
ing, kneading  of  the  muscles,  I  have  even  been  able 
to  administer  iron  without  constipating.  Indeed, 
during  the  second  and  succeeding  weeks  of  the 
method  by  "  Massage,"  I  have  noticed  a  consid- 
erable tendency  to  diarrhcea.  I  think  that  the 
above-mentioned  methods  of  treatment  will  relieve 
the  woman's  torpid  liver  and  congested  womb. 


THE   ABORTIVE  TREATMENT  OF    ERY- 
SIPELAS. 

Several  times  during  the  last  few  years  have  I 
succeeded  in  checking  facial  erysipelas,  by  painting 
a  broad  ring  of  collodion  around  the  attacked  part. 
Although  perhaps  other  physicians  may  have  used 
this  treatment,  I  have  nevertheless  been  unable  to 
find  any  mention  of  it,  nor  have  those  of  my  con- 
freres with  whom  I  have  spoken  in  regard  thereto, 
been  acquainted  with  this  mode  of  treatment. 

As  it  undoubtedly  is  quite  desirable  to  be  able 
to  check  a  facial  erysipelas,  at  least  a  very  disagree- 
able, even  if  not  dangerous^  disease,  and  having  of 
late  repeatedly  used  the  collodion  treatment  in  my 
own  practice,  as  well  as  received  reports  from  my 
colleague,  Doctor  Christie,  who  also  has  employed 
it  successfully,  I  make  mention  of  it  here,  in  order 
that  other  physicians  may  give  it  a  trial  in  their 
practice. 

I  consider  the  treatment  theoretically  correct  if, 
as  is  universally  admitted,  erysipelas  is  caused  by 
an  infectious  material,  whether  bacteria  or  some 
substance  setting  up  a  chemical  process*  extending 
through  the  loose  subcutaneous  cellular  tissue,  and 
we  can  prevent  its  extension  by  the  application  of 
collodion. 

I  have  only  seen  disappointment  from  the 
former  way  of  using  collodion,  that  is,  by  pencil- 
ling it  over  the  whole  diseased  surface,  while  a  ring 
around  the  attacked  parts  puts  a  check  to  the  ex- 
tension of  the  poison.  I  have  repeatedly  seen  how 
the  morbid  process  has  extended  to  the  obstruction, 
fought  against  it,  but  without  being  able  to  overcome 


(It  has  been  demonstrated  that  the  skin  at  the  margin 
of  the  inflammatory  redness  in  erysipelas  is  full  of  micro- 
cocci.—Translator's  Note.) 


it;  I  have  also  seen  it  break  through  a  weak  place  in 
the  ring,  but  compelled  to  stop  at  a  new  ring  drawn 
around  it.  I  will  relate  a  few  cases.  The  last 
one  occurred  in  January  this  year.  The  erysipelas 
commenced  as  usual  from  the  nose,  extending  to 
the  cheeks  on  both  sides  with  considerable  fever, 
foul  tongue,  and  general  malaise.  The  collodion  ring 
was  drawn  around  the  diseased  parts,  and  the 
following  day  the  erysipelas  was  checked,  except 
a  small  place  on  the  right  cheek,  where  it  had 
broken  through  the  ring  ;  here  a  new  ring  was 
formed  around  it,  on  the  third  day  the  erysipelas 
was  completely  checked,  and  the  tongue  was  clean 
and  moist  again. 

That  I,  in  this  case,  had  to  deal  with  a  severe 
attack,  was  proved  by  the  fact  that  the  patient  still 
for  several  days  suffered  from  debility,  and  was 
unable  to  attend  to  his  business.  It  may  be  said  it 
would  have  stopped  by  itself,  as  occasionally  hap- 
pens with  erysipelas  commencing  at  the  nose.  In 
reply,  I  will  relate  Dr.  Christie's  case.  It  happened 
about  the  same  time  as  my  own.  He  writes  as 
follows  : 

"  I  have  just  had  occasion  to  bring  into  practice 
your  method  of  treating  erysipelas  by  penciling  a 
ring  of  collodion  around  the  periphery  of  the  place 
attacked.  The  erysipelas  commenced  near  the 
nape  of  the  neck  and  rather  rapidly  spread  over 
both  ears,  forehead,  and  cheeks,  preserving  a  per- 
fectly symmetrical  figure.  I  drew  around  the  attack- 
ed parts,  about  a  quarter  of  an  inch  from  its  cir- 
cumference, a  rather,  broad  circle  of  collodion.  The 
following  day  the  erysipelatous  blush  had  reached 
the  collodion  at  nearly  every  point,  still,  it  no- 
where crossed  this  boundary,  although  it  ultimately 
reached  it  everywhere.  In  some  places,  particularly 
on  the  right  cheek,  the  swollen  erysipelatous  skin 
actually  rolled  out  on  the  collodion  ring.  During 
the  following  days  the  blush  gradually  faded  away. 
I  believe  the  collodion  prevented  the  further  spread 
of  the  disease,  as  the  boundary  line  was  not  passed 
at  any  point,  and  on  the  right  cheek  it  looked  as 
if  the  poison  was  held  in  check  like  a  stream  dam- 
med back." 

I  am  unable  to  say  if  this  treatment  will  prove 
equally  effective  in  checking  erysipelas  in  other 
situations.  The  face  offers  the  advantage  that  the 
compression  is  very  firm  against  the  closely  under- 
lying bones.  Some  years  ago  I  failed  in  arresting 
an  erysipelas  on  the  leg  ;  it  commenced  after  the 
ampufation  of  the  great  toe,  but  I  am  sure  I  did 
not  then  use  a  sufficient  quantity  of  collodion.  I 
had  some  fear  of  causing  gangrene  by  compressing 
the  whole  circumference  of  the  limb. 

In  conclusion,  I  will  request  to  make  the  col- 
lodion ring  both  broad  and  thick,  being  particularly 
careful  where  there  is  hair  or  beard. — Dr.  A.  G. 
NoRREGAARD,  in  Norwegian  Journal  of  Medicine. 


282 


TIIK    CANADA    MEDICAL    RECORD. 


TREATMENT  OF   MAMMARY  ABSCESS. 

In  the  last  number  of  the   Gazette  we  reprinted 
a  very  interesting  and  instructive  contribution  on 
this  subject,  made  by  Prof.  Taylor,  of  this  city,  to 
the  late  meeting  of  the  Tri-State  Society,  at  Louis- 
ville.    In  the  last  number  of  the  American  Jour- 
nal of  Obstetrics.  Dr.  Hiram  Carson  of  Coshocton, 
Pa.,  gives  his  views  and  some  personal  experience 
that  will  doubtless  prove  of  value  to  our  readers 
to  give  in  brief  abstract.      After  alluding  to  the 
usual   routine  of  cloths    steej)ed  in   hot  vinegar, 
plasters  and  poultices,  Dr.  Corson  states  that  for 
the  past  twenty-seven  years  he  has  used  no  other 
remedy  but  cold  applications.     His  mithod  being 
to  fill  a  bladder  part  full  with  cold  water  and  ice 
in  it,  and  apply  to  the  inflamed  part.     This  appli- 
cation of  ice-water  affords  almost  immediate  relief, 
and  if  suppuration  has  not  taken  place  will  always 
prevent  it.     And  indeed,  in  cases  which  have  al- 
ready •'  suppurated,  been  poulticed  and  broke,''  or 
been  lanced,  this  method  is  "just  as  aj)plicable, 
eft'icient  and  safe."     The  following  is  one  of  the 
illustrative  cases  given  : 

"  Mrs.  B .  a  few  days  after  confinement,  suf- 
fered from  a  chill,  followed  by  pain,  heat,  redness 
and  swelling  in  the  right  breast ;  the  nurse 
worried  with  it  in  the  usual  way,  but  the  great  suf- 
fering of  the  patient  induced  them  to  send  for  me. 
I  had  gone  away  for  a  week,  and  a  medical  friend 
took  charge  of  her  for  me.  He  found  her  suffer- 
ing from  a  large  abscess,  ready  to  be  opened.  It 
discharged  freely,  and  the  poultice  which  she  had 
on  at  the  time  was  replaced  He  saw  her  several 
times  before  my  return,  and  opened  another  ab- 
scess, and  continued  the  poultice.  My  first  visit 
to  her  was  with  the  physician.  She  was  suffering 
greatly.  The  breast  was  much  swelled,  was  solid 
and  heavy  in  some  parts,  and  a  red,  highly  inflam- 
ed surface  of  several  inches,  on  the  under  and  outer 
part,  gave  warning  of  a  third  abscess.  I  advised 
the  use  of  ice,  which  greatly  surprised  both  jiatient 
and  physician.  The  fact  that  she  had  been  kept 
very  warm  for  two  weeks  for  fear  of  getting  more 
chills,  and  that  she  had  had  warm  poultices  steadily 
applied  during  nearly  all  that  time,  was  to  their 
minds  strong  reason  for  objecting  to  its  application 
— the  change  from  heat  to  cold  they  deemed  most 
hazardous.  As  the  patient  was  a  new  comer  in 
the  place,  and  knew  nothing  of  cold  treatment,  and 
positively  refused  to  have  it  applied,  the  breast  was 
supported,  and  the  poultice  continued.  She  was 
truly  wretched  ;  half  sitting  up,  supporting  her  suf 
fering  side,  no  good  sleej),  no  appetite,  the  breast 
stinging  and  burning  night  and  day.  as  those  only 
know  who  have  suffered  like  torment,  she  was  a 
picture  of  distress.  .  .  .  In  a  few  days  I 
opened  the  third  abscess ;  the  other  openings,  too, 
were  still  discharging,  and  had  become  larger.  I 
then  prevailed  on  her  after  the  most  solemn  assur- 
ance that  no  harm  would  come  to  her,  to  have  the 
ice  applied.  A  large  bladder  was  partly  filled  with 
water  and  lumps  of  ice,  and  applied ;  two  thick- 


nesses of  wet  muslin  first  being  applied  to  the 
inflamed  breast.  The  relief  was  soon  aj^parenl  to 
her  by  the  speedy  removal  of  the  great  heat,  which 
night  and  day  had  tortured  her.  That  night  she 
had  comfort.  There  were  no  more  abscesses ;  the 
heat,  tension,  and  pain  of  the  inflamed  parts  sub- 
sided, and  in  a  few  days  the  hot,  tender,  angry 
breast  was  so  changed  that  she  rapidly  regained 
her  cheerfulness  and  health." 

Dr.  Corson  proceeds  to  say  further  :  "  I  have 
very  often  been  called  to  women  whom  I  have 
found  with  a  breast  painful,  swelled,  and  red  over 
the  swelled  part ;  the  result,  the  patient  would  tell 
me,  of  a  "chill,"  which  happened  in  the  night  and 
fell  right  away  on  the  breast,  since  which  time  she 
had  had  no  rest.  I  here  at  once  ajjplied  the  ice, 
and  in  no  instance,  if  suppuration  had  not  already 
taken  place,  have  I  failed  to  disperse  the  inflam- 
mation, at  the  same  time  that  I  brought  comfort 
to  the  patient.  In  some  cases  I  have  found  the 
suppurating  process  so  far  advanced  that  nothing 
could  prevent  it ;  but  even  here  I  apply  the  ice, 
knowing  that  it  will  give  the  woman  great  comfort, 
by  removing  the  heat,  allaying  the  inflammation 
and  thus  preventing  any  more  of  the  breast  from, 
becoming  involved  in  the  suppurating  process." — 
Obstetric  Gazette. 


HEMOPTYSIS. 

An  extract  from  Lecture  II  of  the  Harveian 
Lectures.  By  James  E.  Pollock,  M.D.,  F.R.C.P. 
(British  Med  Journal)  : 

Hemoptysis  has  a  leading  place  among  the 
events  of  chronic  disease  of  the  lung  ;  and  new 
doctrines  have  recently  been  enunciated  about  its 
influence,  both  as  a  cause  and  consequence  of 
such  affections. 

Hemoptysis  is  generally  a  symptom  of  conges- 
tion, which,  in  such  cases,  is  the  real  condition  to 
consider  and  to  treat.  It  is  only  another  word 
for  pulmonary  apoplexy  of  greater  or  less  extent. 
There  is  another  and  very  fatal  form,  which  is  a 
mere  leakage  fnim  a  broken  vessel,  and  almost 
always  the  result  of  the  rupture  of  a  small  aneu- 
rism of  the  pulmonary  artery. 

There  are  therefore  two  kinds  of  hemorrhage 
from  the  lung — the  congestive  and  the  passive. 

To  those  who  hold  that  chronic  changes  in  the 
lung  are  due  to  inflammation,  a  hemorrhage  aris- 
ing from  increased  atflux  of  blood  to  a  highly  vas- 
cular tissue,  is  no  unexpected  event.  It  is  in  fact 
a  part  and  a  symptom  of  congestion. 

On  the  other  hand,  the  school  who  believe  in 
tubercle  formation  being  the  essence  of  lung  in- 
duration are  puzzled  to  account  for  it.  I  would 
remark  that  acute  tuberculosis — by  which  I  mean 
an  invasion  of  a  large  tract  of  one  or  both  lungs 
by  the  gray  miliary  (millet  seed)  tubercle — is  not 
accompanied  by  hemoptysis.  The  acute  croupous 
pneumonia  has  its  colored  sputa  (colored,  that  is 


THE    CANADA    MEDICAL    RECORD. 


2as 


by  exuded  blood) ;  but  hemorrhage   as    such   is 
not  a  feature  in  the  case. 

I  think  we  need  not  discuss  the  question 
whether  hemoptysis  is  of  pulmonary  or  of  bron- 
chial origin.     It  is  almost  always  pulmonary. 

Whether  the  first  steps  in  the  lung  induration  be 
an  inflammation  or  tubercular,  we  may,  I  think, 
concede  that,  excepting  in  the  slowest  and  most  in- 
sidious forms,  it  is  accompanied  by  congestion  of 
lung-tissue,  and  hence  the  great  prevalence  of 
hemoptysis.  It  will  be  remembered  that  the  ear- 
liest changes  in  phthisical  lungs  are  shedding  of 
alveolar  epithelium  and  block  of  the  air-cells,  with 
consecutive  small  cell  changes  in  the  walls  of  the  cells 
and  in  the  intercellular  tissue,  in  which  lie  the  blood- 
vessels and  lymphatics  of  the  lung.  Engorgement  is 
sure  to  follow  an  impeded  return  of  venous  blood, 
while  the  tissues  become  softened  and  disorganized. 

The  occurrence  of  congestive  hemoptysis  at  the 
beginning  or  in  the  progress  of  phthisis  is  accom- 
panied by  a  high  temperature,  running  up  to  104° 
or  105°.  Its  persistence  may  also  be  gauged  by 
the  thermometer  and  by  the  pulse.  Should  a  more 
or  less  sharp  hemoptysis  subside,  the  temperature 
falls  and  the  pulse  becomes  soft. 

Should  the  bleeding  initiate  a  lung  attack — that 
is,  occur  to  a  person  apparently  in  good  health — 
we  may  expect  it  will  be  followed  by  the  signs  of 
consolidation  of  a  portion  of  lung  and  the  events  of 
phthisis.  There  is  a  form  of  rapid  phthisis,  of 
which  I  have  given  an  instance,  which  proceeds 
with  great  activity  after  an  initial  florid  hemop- 
tysis of  some  extent ;  and  we  must  be  on  the  look- 
out for  such,  and  remember  that  it  proceeds  by 
progressively  causing  patches  of  consolidation  in 
the  lung,  of  which  you  will  have  the  usual  physi- 
cal signs. 

Should  congestive  hemoptysis  occur  (as  it  gen- 
erally does  in  the  course  of  chronic  phthisis,  you 
may  have  a  long  pause,  or  suspension  of  the  active 
symptoms  following  its  cessation.  I  have  so 
often  had  occasion  to  observe  this  event  that  it 
seems  well  worth  bearing  in  mind  when  called  on  to 
deliver  an  opinion  on  the  result.  How  often  also  do 
we  witness  repeated  attacks  of  rather  profuse 
hemoptysis  at  long  intervals  in  the  same  patient  ? 
That  a  second  and  third  hemoptysis  may  succeed  is 
almost  certain,  and  that  an  appreciable  amount  of 
relief  to  the  lung  is  produced  by  the  bleeding  I 
have  no  doubt.  All  these  events  bear  strongly 
on  the  proposition  that  the  local  congestion  of  the 
lung  has  much  to  say  to  the  clinical  history  of 
phthisis.  I  shall  afterward  speak  of  its  bearing  on 
the  treatment. 


DIAGNOSIS  OF  ADHERENT   PLACENTA. 


Dr. 

5th:. 


A.  C.  Air  writes  to  the  Lancet,  February 


I  have  met  with  several  cases  of  morbidly  ad- 
herent placenta  during  the  last  fourteen  years,  and 
am  inclined  to  believe  that  the  diagnostic  problem 


may  be  solved  with  almost  absolute  certainty ; 
although,  from  my  experience  being  limited  to 
so  short  a  time,  I  would  desire  to  write  with  all 
becoming  modesty. 

The  diagnosis  is,  I  think,  to  be  founded  upon 
two  symptoms,  one  of  which  is  mentioned  by  Dr. 
Churchill,  the  other  by  Dr.  Barnes,  viz.,  that  at 
some  period  of  pregnancy,  generally  between  the 
third  and  fifth  month,  a  fixed  pain,  generally  of  a 
dull,  aching  character,  is  felt  over  some  part  of  the 
uterus  ;  and  this  is  converted  into  a  severe  drag- 
ging pain  when  the  patient  attempts  to  turn  over  to 
lie  on  the  side  opposite  to  the  placenta  site:  so 
much  so  that  patients  with  an  adherent  placenta 
will  never  (as  far  as  my  experience  goes)  voluntarily 
lie  on  that  side.  This  pain  I  believe  to  be  of  the 
same  nature  as  that  mentioned  by  Dr.  Barnes  as 
being  experienced  when  the  cord  is  drawn  upon  ; 
and  is  due  to  the  dragging  on  the  cord  by  the 
child,  when,  from  gravitation,  it  sinks  through  the 
liquor  amnii. 

Theoretically,  it  may  be  objected  to  this  ex- 
planation that  usually  the  cord  is  suflliciently  long 
to  prevent  any  such  dragging  ;  but  I  think  it  will 
generally  be  found  that  when  the  cord  is  long  it  is 
twis'ed  around  the  neck  or  limbs  of  the  child,  and 
produces  the  same  effect  as  a  short  cord  would. 

No  history  of  this  dragging  pain  on  the  patient's 
turning  to  the  side  opposite  to  the  placental  inser- 
tion will  be  obtained  when  the  retention  of  the 
after-birih  is  merely  due  either  to  the  inertia  of  a 
wearied  uterus,  or  from  irregular  contraction ;  if 
there  is  hemorrhage  in  either  of  these  cases,  one 
would  be  justified  in  trying  the  effect  of  cold,  com- 
pression, etc.,  before  introducing  the  hand,  but  in 
cases  of  true  placental  adhesion,  trying  these  and 
similar  means  leads  to  dangerous  loss  of  precious 
time. 


GLYCERINE    IN    THE    TREATxMENT  OF 
FLATULENCE,  ACIDITY,    AND  PYROSIS. 

Drs.  Sydney  Ringer  and  William  Murrel  write, 
in  the  Lancet,  for  July  3,  1880  : 

An  old  gentleman,  who  for  many  years  suffered 
from  distressing  acidity,  read  in  a  daily  paper  that 
glycerine  added  to  milk  prevents  its  turning  sour,, 
and  he  reasoned  thus  :  '•  If  glycerine  prevents 
milk  turning  sour,  why  should  it  not  prevent  me 
turning  sour?  "  and  he  resolved  to  try  the  efficacy 
ofglvcerine  for  his  acidity.  The  success  of  his 
experiment  was  complete,  and  whenever  tormented 
by  his  old  malady  he  cures  himself  by  a  recourse 
to  glycerine.  Indeed,  he  can  now  take  articles  of 
food  from  which  he  was  previously  compelled  to 
abstain,  provided  always  that  he  takes  a  drachm  of 
glycerine  immediately  before,  with,  or  directly  after 
his  food.  He  recommended  this  treatment  to  many 
of  his  friends — sufferers  like  himself — and  one  of 
these  mentioned  the  above  circumstances  to  us. 

We  have  since  largely  employed  glycerine,  and 
find  it  not  only  very  useful  in  acidity,  but  also  in 


234 


THE    CANADA    MKDICAL    RECORD. 


flatulence  and  pyrosis,  and  that  it  sometimes 
relieves  pain.  We  meet  with  cases  where  (laiu- 
lence,  or  acidity,  or  pyrosis  is  the  only  symptom  ; 
but  more  frequently  these  symi)toms  are  combined. 
Some  patients  rift  up  huge  cpiantities  of  wind  with- 
out any  other  symptoms  than  depression  of  spirits  ; 
in  others  we  get  tiatulence  and  acidity,  one  or  the 
other  predominating  ;  and  we  meet  with  others 
who  suffer  from  acidity,  and  also  pyrosis.  In  all 
these  various  forms  we  find  glycerine  useful,  and  in 
the  great  majority  of  cases  very  useful.  A\'e  do 
not  mean  to  .say  that  in  all  cases  it  is  superior  to 
other  remedies  for  these  complaints ;  indeed  in 
several  instances  it  has  only  partally  succeeded 
when  other  remedies  at  once  cured.  On  the  other 
in  some  cases  glycerine  speedily  and  completely 
succeeded,  where  the  commonly-used  remedies  for 
acidity  and  flatulence  completely  failed.  We  do 
not  pretend  to  estimate  its  relative  value  to  other 
remedies  ;  we  are  only  anxious  to  draw  attention 
to  its  virtues. 


TREATMENT   OF    MENORRHAGIA  AND 
METRORRHAGIA. 

By  R.   Tausky,    M.D.,  Attending  Physician   to 
Mt.  Sinai  Hospital. 

Resume.  In  the  treatment  of  the  above  and  of 
pelvis  congestion,  rest^  with  pelvis  elevated,  is  of 
the  utmost  importance.  Hot  water  injections 
and  scarifications  of  cervix  and  endometrium  are 
beneficial.  Salicylate  of  soda,  quinia,  digitalis  in 
large  doses  and  opium  (anodyne  and  nerve 
sedation)  are  invaluable.  Ergotin  in  large  doses 
every  hour  is  one  of  the  most  valuable  aids.  In- 
tra-vaginal  balls  of  astringents  (preferably  gr. 
iv.  alum  with  a  few  drops  of  iron  and  glycerine) 
introduced  every  hour,  if  the  hemorrhage  be 
alarming,  or  better  application  to  fundus  of  tannin 
and  glycerine  on  a  probe,  or  of  Monsel's  solution 
and  water  equal  parts,  have  checked  obstinate 
hemorrhages  of  months  standing.  Catarrhal  en- 
dometritis recpiires  cauterization  once  a  week ; 
Hexions  require  straightening  with  the  sound  and  a 
pessary,  and  if  adhesion  be  present,  by  Bozeman's 
method  of  tamponing  the  vagina.  In  submucous 
and  intramural  fibroids,  injecting  ergotine  daily 
often  for  months,  has  frequently  checked  long- 
continued  metrorrhagia.  In  carcinoma,  rodent, 
ulcer,  fungosities,  polypi  and  granulations,  the 
cutrette  and  Monsel's  solution  are  applicable.  If 
the  bleeding  be  from  an  rodent  cervix,  he  often  ap- 
plies the  Monsel  powder  or  strong  solution  of  alum. 
In  rare  and  obstinate  cases,  occasionally  he  ia])plies 
nitric  acid  or  hot  iron  to  endometrium  w  th  only 
good  results.  Compressing  the  abdominal  aorta  has 
saved  three  cases  in  his  hands,  when  the  patients 
were  moribund  and  all  else  had  failed. — Am. 
Journ.  Med.  Sci.yjan.,   1881. 


The  Canada  Medical  Record, 

a  iHontfjIn  Journal  of  iarHiciiir  aiilr  |)t)arinaci». 

J    DITOFi  : 
FRANCIS  W.  CAMPBELL, MA.,  M.D.,L.K.C.P.,  LORD 

AM-^IHTANT  KIMTOICf*: 

R.  A.  KENNEDY,  M.A.,  M.D. 

JAMES  PERRIGO,  M.D.,  M.R.C.S.  Eng. 

KDITOll  <)|f    IMIARMACKL'TICAI,    I)  KI"  A  KTM  BUT  : 

ALEX.  H.  KOLLMYER,  M.A.,  M.D. 

SUBSCRIPTION  TWO  DOLLARS  PBR  ANKUU  . 

All  nommunicationa  and  Exchanges  must  be  addrened  t* 
the  Kditor,  Drawer  356,  Pout  Office,  Montreal. 

MONTREAL.  JUNE.  1881. 


TO  OUR  SUBSCRIBERS. 
As  we  are  nearing  the  end  of  Volume  9,  we 
propose,  before  the  issue  of  another  number,  to 
send  accounts  to  all  our  Subscribers.     We  hope 
that  they  will  promptly  remit  the  amount  due. 


CANADA  MEDICAL  ASSOCIATION. 
We  again  would  remind  our  readers  that  the 
Canada  Medical  Association  will  meet  at  Halifax 
on  the  3rd  of  August.  Those  who  intend  to 
attend  must  procure  certificates  from  the  Acting 
General  Secretary,  Dr.  Adam  Wright,  Toronto. 


ELECTRICITY    IN   THE  TREATMENT  OF 
EXOPHTHALMIC  GOITRE. 

In  the  JVew  York  Medical  Journal  for  June, 
1881,  Dr.  A.  D.  Rockwell,  Electro-therapeutist  to 
the  New  York  State  Woman's  Hospital,  alludes  to 
eight  cases  of  exophthalmic  goitre  previously  re. 
corded  by  him  as  having  been  treated  with  elec- 
tricity— three  ending  in  recovery,  and  one  in  ap- 
proximate recovery,  and  gives  the  history  of  an 
additional  case  in  which  the  result  was  favorable. 
It  would  be  impossible,  he  thinks,  to  obtain  simi- 
lar residts  in  a  number  of  cases  by  any  one  method 
of  electrical  treatment.  In  some  cases  localized 
galvanization  by  the  ordinary  method  may  prove 
efficacious.  This  method  may  be  thus  described : 
Place  the  cathode  over  the  cilio-spinal  centre, 
above  the  seventh  cervical  vertebra,  and  the  anode 
in  the  auriculo-maxillary  fossa,  gradually  drawing 
the  latter  (after  a  few  moments  of  stabile  treatment) 
along  the  inner  border  of  the  sterno-cleido-mastoi- 
deus  muscle,  to  its  lower  extremity.  The  second  step 
in  this  process  consists  in  removing  the  anode  to 
the  position  occupied  by  the  cathode,  and  placing 
the  latter  over  the  solar  plexus,  using  for  a  ievr 
moments  longer  a  greatly  increased  strength  of  cur- 


THE    CANADA    MEDICAL    RECORD. 


235- 


rent.  In  other  cases  currents  alternately  increased 
and  diminished  may  prove  most  effective.  The 
general  application  of  the  faradaic  current  some- 
times proves  an  important  factor  in  the  method  of 
treatment.  It  is  not  very  difficult  to  believe,  he  re- 
marks, nor  to  understand'why  general  faradization 
is  so  effective  in  lowering  a  pulse  that  is  rapid  as  a 
result  of  nervous  excitement,  and  in  increasing  its 
strength  when  it  is  both  rapid  and  weak  through 
nervous  exhaustion.  It  is  more  difficult  to  explain 
why  this  result  is  so  pleasantly  obtainable  in  cases 
of  exophthalmic  goitre  in  which  the  galvanic  cur- 
rent, after  benefiting  up  to  a  certain  point,  fails  to 
do  more.  The  faradaic  certainly  does  not  affect 
the  sympathetic  so  directly  and  powerfully  as  the 
galvanic  current  does,  and  we  are  obliged,  for 
xn  explanation,  to  refer  to  its  well-known  superior 
tonic  properties,  and  to  the  fact  that  the  complete 
and  thorough  excitation  of  the  cutaneous  nerves  by 
general  faradization  is  followed  by  a  greater  and 
more  desirable  reflex  influence.  In  a  case  of  over 
thirty  years'  standing,  which  the  author  recently 
treated,  but  in  which  he  failed  to  cause  any  appre- 
ciable reduction  in  size,  this  power  of  one  current 
to  supplement  the  action  of  the  other  was  well 
illustrated.  The  pulse  of  the  patient  was  constant- 
ly at  or  above  115.  The  action  of  the  galvanic 
current  reduced  it  to  105,  but  failed  to  do  more 
than  this  after  considerable  effort.  General  fara- 
dization was  then  attempted,  with  the  result  of 
effecting  within  a  week  a  further  and  seemingly 
permanent  reduction  of  twelve  beats.  At  the  same 
time  the  patient's  general  condition  was  much  im- 
proved. 


BISHOP'S   COLLEGE   SCHOOL,   LENNOX- 

VILLE. 

We  are  pleased  to  hear  that  all  the  suggestions 
which  last  winter  were  made  by  the  Medical  Com- 
mission appointed  to  investigate  the  cause  of  the  out- 
break of  Typhoid  Fever  at  Bishop's  College  School 
have  been  carried  out,  and  are  now  completed. 
We  are  informed  that  the  School  will  re  open  at 
Lennoxville  in  the  autumn.  Confidence  is  being 
rapidly  restored,  and  we  hope  for  a  future  for  this 
school  which  will  far  exceed  its  past  success.  We 
are  glad  to  know  that  the  labors  of  the  Medical 
Commission  (consisting  of  Drs.  Simpson,  Osier 
and  Cameron)  are  warmly  appreciated  by  all  the 
friends  of  Bishop's  College.  The  resolution  given 
below,  and  which  was  carried  unanimously  at  a 
meetmg  of  the  Corporation  of  the  College,  held  on 


the  2nd  of  June,  is  but  the  formal  expression  of 
this  gratitude. 

It   was  moved  by  Revd.  Canon  Norman,  se 
conded  by  Mr.  John  S.  Hall,  and  resolved  : — 

''  That  the  sincere  thanks  of  the  Corporation  are 
due  and  are  hereby  tendered  to  Dr.  Simpson,  Dr. 
Osier  and  Dr.  Cameron,  the  Medical  Commission, 
for  their  services  rendered  gratuitously  in  relation 
to  the  investigation  as  to  the  recent  outbreak  of 
Typhoid  Fever." 


IODIDE  OF  ETHYL  IN  ASTHMA. 

The  JVe7C'  York  Medical  Journal  for  June, 
1 88 1,  publishes  three  cases  of  asthma  treated  with 
inhalations  of  iodide  of  ethyl,  with  remarkable  ben- 
efit. They  occurred  in  Dr.  R.  M.  Lawrence's 
service  at  the  Boston  Dispensary.  Following  the 
cases  are  some  remarks  by  Dr.  Lawrence,  in  which 
he  says  of  the  iodide  of  ethyl :  "  Its  speedy  absorp- 
tion into  the  blood,  its  antispasmodic  quality,  and 
prompt  reflex  stimulation  of  the  respiratory  mus- 
cles, may  reasonably  account  for  its  beneficial 
action  in  the  asthmatic  paroxysm,  while  its  power 
of  liquefying  and  detaching  accumulations  of 
mucus  sufficiently  explains  its  curative  influence 

in  chronic  bronchitis Experience  has  confirmed 

my  faith  in  its  remedial  worth  in  a  large  major- 
ity of  cases  of  labored  respiration  (whether  due  to 
bronchial  spasm  or  to  increased  mucous  secre- 
tion), and  also  in  certain  obstinate  cases  of  dysp- 
noea, not  due  to  organic  pulmonary  or  cardiac 
lesions,  where  other  remedies  may  have  proved 
inefficient.  In  a  small  minority  of  cases  it  has 
failed  to  afford  relief."  He  does  not  recommend 
it  as  a  substitute  for  internal  medication,  but 
rather  as  an  adjunct  thereto. 


TO  TEST  HOUSE  DRAINS. 

In  London  house  drains  are  tested  by  pouring 
in  at  the  highest  point  of  the  pipes  an  emulsion  of 
oil  of  peppermint  and  water,  following  this  up 
with  a  couple  of  buckets  of  water  to  wash  the 
emulsion  through  the  drains.  Should  there  be  any 
leaks  they  can  be  located  by  the  penetrating  smell 
of  the  peppermint.  The  same  system  is,  we  believe 
used  in  Boston  and  in  Montreal. 


1236 


THE    CANADA    MEDICAL    UECOKD. 


PERSONAL. 

Dr.  Fxlniond  Robillard  of  Montreal  has  had  the 
honorary  degree  of  Master  in  Surgery  conferred 
upon  him  by  the  Medical  Faculty  of  Victoria 
College.     The  honor  is  well  deserved. 

Dr.  McGillis  (CM.,  M.D.,  Bishop's  College, 
1881)  sailed  for  Europe  by  the  Dominion  S.S. 
-'  Ontario  "  on  the  3rd  of  June. 

Dr.  I'^ieuterio  Quinones^Cardona  (CM.,  M.D., 
Bishop's  College,  1881)  sailed  from  New  York  for 
his  home  in  Porto  Rico  the  second  week  in  June. 

Dr.  R.  I'almer  Howard  and  Dr.  Osier  of 
Montreal  sailed  for  Liverpool  by  the  Allan  S.S. 
*'  Parisian."  They  visit  London  to  attend  the 
meeting  of  the  International  Congress^  and  will 
be  absent  six  or  seven  weeks. 

Mr.  Bcmrose,  F.C.S.,  has  been  appointed 
Lecturer  on  Practical  Chemistry  in  the  Medical 
Faculty  of  Bishop's  College. 

Dr.  G.  E.  Gascoigne,  late  of  the  Royal  Artillery, 
and  who  was  for  several  years  located  at  Brock- 
ville,  but  for  the  last  year  in  Panama,  has  left  for 
Jamaica,  having  received  a  Government  Medical 
^.ppointment. 


COLLEGE  OF  PHYSICIANS  AND  SUR- 
GEONS. 
The  semi-annual  meeting  of  the  Board  of  Gov- 
ernors (Provincial  Medical  Board)  of  the  College 
of  Physicians  and  Surgeons,  Province  of  Quebec, 
was  held  in  Montreal,  on  the  nth  May,  1881, 
the  President,  Dr.  R.  P.  Howard,  in  the  chair. 

The  following  governors  were  present : — Dr. 
Howard,  President ;  Drs.  Trudel  and  Lemieux, 
Vice-Presidents ;  Drs.  F.  W.  Campbell,  Lacha- 
pelle,  Perreault,  R.  F.  Rinfret,  Come  Rinfret,  L. 
Larue,  Lanctot,  Robillard,  Marsden,  Austin, 
Church,  Mignault,  Lafontaine,  Gibson,  Laberge, 
Rousseau,  Kennedy,  Rottot,  T.  Larue,  Ladouceur, 
Rodger,  St.  George,  Marmette,  Desaulnier,  Hing- 
?ton  and  Prevost. 

The  Secretary  read  a  letter  from  the  Registrar 
of  the  Medical  Faculty  of  Bishop's  College,  stating 
that,  owing  to  continued  ill-health,  Dr.  David  had 
resigned  his  position  as  representative  to  the  Pro- 
vincial Medical  Board,  and  that  the  Faculty  had 
elected  Dr.  R.  A.  Kennedy,  to  replace  him. 

Dr.  Kennedy,  the  new  representative  from 
Bishop's  College  Faculty  of  Medicine,  was  intro- 
duced by  Dr.  (Jibson,  and  took  his  scat. 

It  was  th^n  moved  by    Dr.  Iklarsden,  seconded 


by   the  Hon.   Dr.   Church,    and    carried    unani- 
mously : 

"  That  this  Board  has  received  with  regret  the 
announcement  of  Dr.  David's  withdrawal,  owing 
to  ill-health,  from  this  Board,  and  that,  before 
accepting  such  resignation,  it  desires  to  put  upon 
record  its  high  sense  of  the  service  rendered  to  the 
profession  and  this  College  in  the  long  series  of 
years  during  which  Dr.  David  has  been  a  member 
of  the  former  and  an  active  worker  in  the  latter. 
His  thorough  early  and  professional  training,  his 
large  experience  and  active  nature,  enabled  him 
to  bring  great  power  to  the  consideration  and  dis- 
cussion of  all  matters  affecting  the  interests  of  the 
profession.  In  parting  with  him,  this  College 
ventures  to  express  the  hope  that  the  cause  is  only 
temporary,  and  that  Dr.  David  may  yet  be  spared 
many  years  to  bring  his  large  store  of  useful  know- 
ledge and  ripe  experience  to  the  assistance  of  the- 
profession,  and  to  forward  the  work  of  this  Col- 
lege." 

The  reports  of  the  assessors  from  the  LTniver- 
sities  of  McGill,  Bishop's  College,  Victoria  College, 
Laval,  Laval  (succursale),  Montreal,  were  then 
read. 

The  Secretary  then  read  the  report  of  the  Board 
of  Examiners  on  Preliminary  Education,  stating 
that  the  following  gentlemen  had  passed  the  re- 
quired examination  and  been  admitted  to  the  study 
of  medicine,  viz.,  W.  Gait  Johnston,  M.  Brophy, 
E.  Labonte,  H.  T.  Hurdman,  H.  Gaudreau,  D. 
B.  Darby,  H.  B.  Smith,  C  Bussiere,  B.  Smith,  W. 
H.  Leonard,  F.  Simard,  and  P.  Morin. 

The  following  gentlemen  passed  the  supplemen- 
tary examination  imposed  for  partial  failure  last 
year,  viz  :  J.  C.  Blanchet,  F.  Jeannotte,  J.  O.  Lam- 
bert, A.  Lamothe,  C  Prevost,  N.  Tessier. 

A.  Gaboury  was  passed  for  special  reasons,  the 
Board  two  years  ago  consenting  that  he  should 
pass  his  preliminary  examination  after  receiving 
his  degree. 

The  Board  for  Preliminary  Examination  report- 
ed that  twelve  gentlemen  had  been  remanded  for 
a  supjilementary  examination  on  certain  subjects  ; 
also,  that  twenty-four  gentlemen  had  been  entirely 
rejected, -having  failed  to  obtain  the  requisite  num- 
ber of  marks.  Three  gentlemen  were  rejected  for 
copying. 

Dr.  F.  W.  Campbell  raised  the  question  whether 
a  student  could  be  examined  upon  the  final  por- 
tion of  his  examinations  at  the  end  of  his  third 
session,  llien  go  and  study  a  year  with  a  physician, 


THE    CANADA    MEDICAL    RECORD. 


237 


returning  at  the  end  of  his  fourth  year  and  get  his 
diploma.  Dr.  Campbell  stated  tha  this  practice 
was  in  vogue  amongst  some  of  the  medical  schools, 
and  according  to  his  interpretation  of  the  by-law 
(chap,  viii.,  sec.  2),  such  practice  was  irregular. 

Considerable  discussion  ensued,  when  the  sub- 
ject was  adjourned  till  the  afternoon  session. 

Dr.  Marsden  raised  the  question  of  the  legality 
of  the  new  by-law,  restricting  the  attendance  of 
the  assessors  to  three  days.  He  stated  that  he  had 
consulted  counsel,  and  that  the  by-law  was  in  di- 
rect opposition  to  the  Act. 

It  was  then  unanimously  resolved  to  alter  and 
amend  the  by-law  sanctioned  by  His  Honor  the 
Lieut-Governor  on  the  3rd  September,  1880,  in 
relation  to  assessors,  as  follows  : — 

"  To  substitute  the  following  for  section  6,  chap. 
10,  of  the  said  by-laws  :  The  assessors  shall  attend 
during  the  medical  examinations  of  each  Univer- 
sity or  Medical  School  ;  within  eight  days  imme- 
diately following  these  examinations,  they  shall  send 
their  written  report  to  the  secretary  of  the  College 
residing  in  the  city  in  which  these  examinations 
have  been  held.  They  shall  be  paid,  in  addition 
to  their  travelling  expenses,  a  remuneration  of  ten 
dollars  for  every  day  that  they  shall  be  detained 
by  their  duties,  providing  it  does  not  exceed  three 
days,  in  which  case  only  five  dollars  shall  be  paid 
for  each  additional  day  that  they  shall  be  detained, 
but  in  no  case  shall  their  ^remuneration  exceed 
fifty  dollars." 

The  report  of  Mr.  Lamirande,  the  prosecuting 
officer  of  the  College,  was  read  by  Dr.  Lachapelle- 
The  Treasurer  also  read  a  statement  of  bis  receipts 
and  expenses  during  the  past  six  months  ;  also  a 
letter  from  him  with  regard  to  his  work. 

It  was  then  moved  by  Dr.  Lachapelle,  seconded 
by  Dr.  Larue  : — "  That  the  arrangements  made 
between  the  Medical  Board  and  Mr.  C.  E.  Lamir- 
ande, at  the  last  semi-annual  meeting,  be  contin- 
ued, moreorver  the  Board  engages  to  pay,  from 
this  date,  a  bonus  of  twenty  dollars  for  each  con- 
viction, which  he  obtains  against  a  charlatan,  and, 
furthermore,  that  this  bonus  shall  be  25  dollars  for 
each  such  conviction  where  the  charlatan  is  too 
poor  to  pay  the  fine^  and  goes  to  prison." — 
Carried. 

The  meeting  then  adjourned  till  2.15  p.m. 

When  the  afternoon  session  was  opened,  the 
President  in  the  chair,  the  Secretary  read  the 
names  of  the  candidates  for  License,  whereupon 
Dr.  Lanctot  asked  the  President  if  he  had  received 


a  protest  from  the  School  of  Medicine  and  Surgery^ 
(Victoria  College)  against  granting  licenses  to  the 
graduates  of  Laval  University,  in  Montreal.  The 
President  said  he  had  been  served  with  such  a 
protest.  At  the  request  of  Dr.  Lanctot  the  protest 
was  read. 

Proposed  by  Dr.  Lanctot,  seconded  by  Dr. 
Bonin,  That  the  protest,  now  before  the  Board,  be 
accepted,  and  submitted  for  discussion. 

Moved,  in  amendment,  by  the  Hon.  Dr.  Church 
seconded  by  Dr.  Marsden,  "  That,  inasmuch  as 
section  7  of  the  Act  incorporating  this  College- 
provides  that  the  holders  of  Diplomas  from  all  the 
Universities  mentioned  in  section  4  of  the  said. 
Act  shall  be  entitled  under  the  circumstances 
in  said  section  7,  to  the  License  of  this  College;; 
that,  pending  adverse  decision  rendered  in  the 
Courts,  this  College  continue  in  the  future,  as  in 
the  past,  to  grant  all  such  holders  of  Diplomas  the 
License  of  this  College." 

The  amendment,  being  put,  was  carried  by  a 
vote  of  18  to  6. 

The  main  motion,  on  being  put,  was  lost  on  the 
same  division,  and  the  amendment  declared 
carried. 

Licenses  were  granted  to  the  following  gentle- 
men : — 

Laval  University,  Quebec.—].  Pelletier,  M.D.^ 
Quebec;  A.  F.  Poulin,  M.D.,  Quebec;  J.  W.  H. 
Blagdon,  M.D.,  Quebec. 

Laval  University,  Montreal. — A.  Gaboury,. 
M.D.,  St  Martin ;  J.  A.  Cardinal,  M.D.,  Napierville^ 
Quebec  ;  A.  Savard,  M.D.,  St.  Eustache;  J.  H.  B. 
Jeannotte,  M.D.,  Brigham  ;  R.  Tranchemontagne, 
M.D.,  St.  Louis  de  Gonzague  ;  E.  Poirier,  St.. 
Cyrille. 

Bis  hop's  College,  Mo7itreal.—\\' .  C.  McGillis^ 
M.D.,  Montreal ;  E.  Quinones,  M.D.,  Porto  Rico^ 
S.A. 

McGill  University,  Montreal.— O.  W.  Gemon^ 
M.D.,  Marieville;  J.  C.  Shanks,  M.D.,  Huntingdon  ; 
W.  A.  Shufelt,  M.D.,  Knowlton ;  J.  W.  Ross,  M.D.» 
Winthrop,  Ont.;  H.  Lunan,  M.D.,  Litchfield,  Ont.; 
F.  W.  Newburn,  M.D.,  Drummondville,  Ont.; 
R.  T.  MacDonald,  M.D.,  Montreal ;  T.  L.  Brown^ 
M.D.,  Ottawa;  H.E.  Poole,  M  D.,  Kazubazua. 

Victoria  College,  Montreal. — H.  Legault,  M.D.,^ 
St.  Armas  ;  A.  J.  Prieur,  M.D.,  St.  Anicet ;  J. 
Asselin,  M.D.,  Joliette ;  E.  Fournier,  M.D., 
Montreal ;  A.  Martin,  M.D ,  Iberville ;  P.  E. 
Marier,  M.D.,  Terrebonne  ;  E.  Lalonde,  M.D.^ 
Montreal;  G.  L.  Laforest,  M.D.,  St.  Liboire  ;  J. 


238 


TUE    CANADA    MKDICAL    KECOUD. 


O.  Soulard,  M.D.,  Quebec;  N.  Bcaudet,  M.D.,  St. 
Gregoired'Ibervillc  ;  J.  CI.  Lcduc,  M.D.,  Montreal; 
J.  L.  Carignan,  M.l).,  Goubelle ;  K.  Voisart, 
M.D.,  Pointc  (hi  Lac  ;  T.  Hamelin,  M.I).,  Three 
Rivers;  C.  Faiitcaux,  M.I).,  St.  Simon;  S.  E. 
Bergeron,  St.  Etienne. 

The  hccnse  was  issued  to  James  Irwin, 
M.R.CS.  Eng.,  of  Pembroke,  Ont.,  on  his 
English  diploma;  also  to  A.  M.  Gibson,  M.D., 
(Queen's,  Kingston)  L.R.C.P.  &  S.,  Edin.,  of 
Massawippi,  on  his  Scotch  qualifications. 

The  following  gentlemen  submitted  to  the  pro- 
fessional examination,  and  being  found  duly 
qualified,  received  the  license  of  the  College  : 
C.  S,  Fenwick,  Montreal ;  E.  Tremblay,  Nicolet. 

Proposed  by  Dr.  Lachapelle,  seconded  by  Dr. 
Marmette,  "  That  at  the  opening  of  each  semi- 
annual meeting  of  the  Provincial  Board  of 
Medicine,  the  secretaries  shall  each  deposit  on 
the  table  a  list  containing  the  names  of  the  candi- 
•dates  for  the  license,  the  date  of  their  admission 
to  the  study  of  medicine,  the  origin  of  their 
certificates  of  admission  to  the  study,  the  date  o 
their  diploma  and  the  name  of  the  University, 
and  that  the  secretaries  be  authorized  to  have  the 
necessary  blanks  printed." — Carried. 

Dr.  Fred.  Church  applied  for  the  Liconse,  he 
being  a  graduate  of  McGill  University,  Montreal, 
but  not  having  his  diploma,  from  an  oversight  of 
the  Registrar ;  having  given  satisfactory  proof  of 
this,  it  was  on  motion  unanimously  resolved  that 
he  be  granted  said  license. — Carried. 

Moved  by  Dr.  Gibson,  seconded  by  Dr.  Prevost, 
"  That  in  view  of  certain  notices  of  application  to 
the  Legislature  for  private  bills,  authorizing  this 
Board  to  admit  certain  persons,  in  such  notice 
named,  to  examination,  this  College  is  of  opinion, 
and  respectfully  represents,  that  no  such  bills  be 
passed,  unless  first  submitted  and  recommended 
by  the  Board  of  Governors  of  this  College." — 
Carried. 

Moved  by  Dr.  Lachapelle.  seconded  by  Dr.  F. 
W.  Campbell,  "  That  a  copy  of  the  above  resolu- 
tion be  sent  to  every  medical  man  in  the  Provincial 
Legislature." — Carried. 

Moved  by  Dr.  Church,  seconded  by  Dr. 
Desaulnier,  "That  the  President,  Secretary  (Mon- 
treal), and  Treasurer  be  a  committee  authorised  to 
prepare  an  announcement  of  the  College,  contain- 
ing lists  of  all  the  text-books  recommended  by  the 
matriculation  examiners,  the  regulations  of  the 
College  as  to  the  medical  curriculum  ;  the  fees  ; 


the  time  and  places  of  holding  examinations,  etc., 
for  the  guidance  of  medical  students,  and  candi- 
dates for  the  license." — Carried. 

Moved  by  Dr.  Church,  seconded  by  Dr. 
lachapelle,  that  the  writing  in  all  diploma.s, 
documents,  records,  etc.,  intended  to  be  perma- 
nent, be  written  with  an  ink  which  will  not  affect 
the  material  upon  which  such  writing  is  made  nor 
become  illegible  from  decomposition. — Carried. 

On  motion  of  Dr.  I^fontaine,  seconded  by  Dr. 
Laberge,  it  was  unanimously  decided  that  the 
salary  of  the  Registrar  from  the  29th  of  September 
last  be  three  hundred  dollars  a  year. 

Dr.  Robillard  gave  notice  of  motion,  seconded 
by  the  Hon.  Dr.  Church,  that  at  the  next  semi- 
annual meeting  of  this  College,  he  will  move  that 
the  salaries  of  the  Secretaries  and  Treasurer  be 
increased  to  one  hundred  dollars. 

Moved  by  Dr.  Marmette,  seconded  by  Dr. 
Church,  "  That  the  members  of  this  College  have 
heard  with  deep  regret  of  the  death  of  Dr.  Michaud 
an  old  member  of  this  College,  and  they  desire  to 
express  deep  .sympathy  with  his  family  in  their 
bereavement;"  and  that  a  copy  of  the  above 
resolution  be  sent  to  the  family  of  the  deceased 
by  the  Secretary. —  Carried. 

Moved  by  the  Hon.  Dr.  Church,  seconded  by 
Dr.  Lafontaine,  "That  the  account  of  Dr.  Marmette 
and  other  witnesses  for  attendance  at  the  preli- 
minary investigation  of  the  charges  brought  by 
Dr.  Gilbert  against  Drs.  Fenwick  and  Worthington, 
after  having  been  revised  and  approved  by  the 
President  and  ex-President,  Dr.  Rottot,  be  paid." 
—  Carried. 

Dr.  Rodger  brought  before  the  College  the  fact 
that  large  quantities  of  obscene  medical  literature 
were  being  circulated  through  this  Province  by 
Dr.  A.  M.  Ross,  a  licentiate  of  this  College. 

Moved  by  Hon.  Dr.  Church,  seconded  by  Dr. 
Rodger,  "  That  the  documents  now  produced  by 
Dr.  Rodger  and  laid  on  the  table,  purporting  to 
have  been  issued  at  the  instance  of  Dr.  A.  M.  Ross 
of  this  city  and  circulated  through  the  city  and 
country,  be  referred  to  a  committee,  consisting  of 
Drs.  Rottot,  Trudel,  Craik,  and  F.  W.  Campbell, 
with  instructions  to  examine  them  and  to  enquire 
whether  these  documents  have  really  been  put  in 
circulation  by  Dr.  A.  M.  Ross  ;  that  if  the  com- 
mittee shall  be  of  opinion  that  he  put  them  in 
circulation,  the  said  committee  enquire  and  report 
whether  the  Act  incorporating  this  College  affords 
any  remedy  for  such  misconduct,  or  if  not,  whether 


THE   CANADA   MEDICAL   RECORD. 


2321 


the  criminal  law  affords  any  punishment  for  similar 
conduct ;  to  consult  counsel,  if  necessary,  for  the 
foregoing  purposes,  and  to  report  the  result  of 
their  deliberations  to  the  College." — Carried. 

Dr.  F.  W.  Campbell  moved,  seconded  by  Dr. 
Gibson,  "That  the  subject  with  regard  to  the 
legality  of  the  fourth  year  of  medical  study  being 
passed  with  a  practitioner,  after  he  has  passed  all 
the  examinations  for  his  degree,  introduced  by  Dr. 
F.  W.  Campbell,  at  the  morning  sitting  of  the 
Board,  be  referred  to  one  school  representative, 
from  the  medical  schools  in  Montreal,  and  the  two 
outside  governors  for  the  city  of  Montreal." — 
Carried. 

Moved  by  Dr.  Lanctot,  seconded  by  Dr. 
Marsden,  "  That  the  governors  of  the  College  of 
Physicians  and  Surgeons  be  notified  by  post  card 
of  the  time  of  holding  the  semi-annual  meeting." 
— Carried. 

A  vote  of  thanks  to  the  Laval  Faculty  of 
Medicine  (Montreal),  for  the  use  of  their  rooms, 
was  unanimously  passed. 


THE  NEW  YORK  SANITARY  ENGINEER. 

The  above  is  the  name  of  a  paper  published  in 
New  York,  and  although  but  in  its  fourth  year  it 
is  now  acknowledged  to  be  the  leading  Sanitary 
authority  on  this  Continent.  It  has  labored  for 
some  time  to  get  a  food  and  drug  adulteration  bill 
through  the  Legislature  of  New  York  State,  and 
success  has  at  last  crowned  its  efforts.  We  con- 
gratulate our  contemporary  on  this  practical 
evidence  of  its  being  "  a  power "  in  the  Legis- 
lative Halls  of  the  Empire  State. 


LACTOPEPTINE. 

This  is  a  remedy  which  is  constantly  gaining  in 
favor  with  the  profession.  Our  own  experience 
with  it  has  been  most  satisfactory.  In  the 
summer  complaint  of  children  we  have  used  it 
with  excellent  results.  Indeed  we  have  found  it 
very  valuable  as  a  preventative  of  this  affection. 
We  frequently  order  it,  with  this  object  in  view, 
and  we  believe  that  our  expectations  have  been 
realized. 


"NANA'S  DAUGHTER" 
Is   destined  to  make    a    deep    sensation   among 
novel  readers.     It  is  a  sequel  to  Zola's  famous 
"  Nana,"  but  is  in  many  respects  superior  to  it. 
Intense   and   continuous   action   characterizes   it 


throughout,  and  every  page  is  of  absorbing 
interest,  while  there  is  no  lack  of  refinement  and 
fine  feeling.  The  aim  is  to  show  that  evil  instincts 
are  not  hereditary.  All  the  characters  are  vividly 
sketched,  the  plot  is  of  unusual  strength  and 
merit,  and  the  style  of  composition  is  vigorous 
and  concise.  The  translation  of  "Nana's 
Daughter  "  is  by  John  Stirling,  who  has  done 
his  work  conscientiously  well.  It  is  published  in 
a  large  square  duodecimo  volume,  pajjer  cover, 
price  75  cents,  and  will  be  found  for  sale  by  all 
Booksellers  and  News  Agents,  and  on  all  Railroad 
Trains,  or  copies  of  it  will  be  sent  to  any  one,  to^ 
any  place,  at  once,  on  remitting  75  cents  in  a 
letter  to  the  Publishers,  T.  B.  Peterson  &  Brothers^ 
Philadelphia,  Pa. 


WYETH'S  VINUM  CIBI. 

Owing  to  the  type  of  debility  which  character- 
izes the  great  majority  of  the  diseases  now  pre- 
vailing, the  tonics  or  strength-giving  remedies 
have  assumed  an  increasing  importance  of  late 
years.  Much  attention  has  been  paid  to  prepara- 
tions of  this  class,  and  we  desire  to  bring  to  the 
notice  of  the  Medical  Profession,  Wyeth's  Wine  of 
Beef  (Vinum  Cibi).  In  each  tablespoonful  of  this 
preparation  there  is  the  essence  of  one  ounce  of 
beef,  in  solution  in  sherry  wine.  It  is  therefore  a 
refreshing  stimulant,  the  effect  of  which  is  not 
merely  to  quicken  the  circulation  and  impart  a 
temporary  excitement,  but  also  to  supply  actual 
strength. 


THE  MACKINNON  PEN  OR  FLUID 
PENCIL. 

We  direct  attention  to  the  advertisement  of  this 
pen.  We  have  now  been  using  one  for  the  past 
six  months,  and  consider  it  a  most  valuable  inven- 
tion for  medical  men.  The  profession  know  how 
difficult  it  is  to  get  good  ink  in  the  majority  of 
houses  with  which  to  write  prescriptions,  and,  if 
the  ink  is  generally  bad,  the  pens  are  nearly 
always  execrable.  Pencils  are  unsatisfactory,  for 
prescription-writing,  and  it  soon  fades  and  often 
gets  illegible.  The  Mackinnon  pen,  when  once 
charged  with  ink,  will  last  a  long  time  without 
replenishing.  It  is  always  ready  for  use,  and  not 
being  as  large  as  a  fair-sized  pencil  it  can  with 
perfect  ease  be  carried  in  the  vest  pocket. 


240 


THE    CANADA    MEDICAL   RECORD. 


SCRIBNER  FOR  JUNK. 
The  element  of  timeliness  which  is  found,   to 
some   extent,    in    every  numl)cr    of    Scribners' 
Monthly,  is  particularly  noticeable  in  the  June 
issue,  just  published.     The  first  paper  to  be  turned 
to  by  most   readers,  will  perhaps,  be  the  second 
])art  of  Col.  VVaring's   "Sanitary  condition  of  New 
York,"  entitled  "  The  Remedy,"  and  recommend- 
ing  a  complete  system  of  house  and  street  drain- 
age, applicable  to  any  house  or  locality.     "  An  Au- 
gust Morning  with  Farragut '' — a  vivid  account  of 
the  great  admiral's  famous  victory  at  Mobile,  by 
Lieutenant  J.   C.   Kinney,  who  was  on  board  the 
JIart/ord  throughout  the  fight,  and  tells  the  true 
story  of    the   lashing.     His  account  is  conrirmed 
iind  supplemented  in  a  letter  in  the  same  number 
from  Commander  J.  Crittenden  Watson,  who  was 
also   an    officer  under   Farragut.      Other   papers 
which  come  under  the  head  of  "  seasonable,"  are  : 
a  brief  sketch  of  the  late  Earl  of  Beaconsfield,  ac- 
com])anied  by  a  full-page    portrait,  engraved   by 
Cole,  together  with  an  unpublished  sonnet  written 
by  Disraeli  in  1839  ) 

Lovers  of  light  reading  will  find  plenty  to  inter- 
est them  in  this  number.  There  is  the  opening 
instalmcnL  of  several  pages  of  "  A.  Fearful  Res- 
ponsibility,' by  \V.  D.  Howells  (the  •'  fearful  res- 
ponsibility "  being  an  American  girl)  ;  "  A  Rainy 
Day  with  Uncle  Remus," — five  new  fables  told  in 
his  inimitable  style,  by  Joel  Chandler  Harris  ;  the 
second  instalment  of  George  VV.  Cable's  "  Madame 
Delphine,"  which  is  full  of  action  ;  "  Fritz,"  a  bright 
history  of  a  pet  bird  ;  "  Along  the  North  Shore  of 
Long  Island,"  describing  a  canoeing  trip  by  Char- 
les H.  Famham,  with  charming  illustrations  by 
Vanderiioof  and  Lungren  ;  a  description  of  lobster- 
fishing  and  lobster  canning,  contributed  by  W.  H. 
Bishop,  with  illustrations  by  J.  C.  Beard  and  Burns, 
a  travel  article,  by  Miss  Gordon  Cummin  j,  giving 
account  of  a  visit  to  "  The  Largest  Extinct  Vol- 
cano "  in  the  world,  with  an  illustration  of  the 
crater. 


ST.  NICHOLAS  FOR  JUNE. 
The  children's  magazine,  St.  Nicholas,  is,  in  the 
present  volume,  fully  satisfying  the  demands  of 
those  parents  who  desire  that  their  children's  read- 
ing shall  be  not  merely  interesting,  but  instructive. 
It  is  now  presenting,  in  serial  form,  two  "  features  " 
which  combine  entertainment  with  a  rich  stoic  of 
information. 


THE  POPULAR  SCIENCE  MONTHLY  FOR 
JULY,  1881. 
A    very   striking   article    on    "The    Races   of 
Mankind  "  opens  "  The  Popular  Science  Monthly  " 
for  July.     It   is  an  abstract  from    the    new  and 
admirable  work  of  E.  B.  Tylor,  F.R.S.,  on  popular 
anthropology.     The  paper  is  profusely  illustrated 
with  finely  executed    representations    of    all    the 
leading  modifications  of  the  human   family,   and 
we  have  nowhere  seen  so  excellent  a  summary  of 
the  distinctions  and  characteristics  of  the  races 
and  tribes  of  men  as  are  exemplified  in  this  com- 
prehensive article.     There  is  an  article  on  "  The 
Phenomena    of     Death"     by    Dr.    Thomas    D. 
Spencer,   who   clears   away  a   group   of  current 
superstitions    in    regard    to     this     physiological 
process.     He   shows    that  the   common   notions 
aboiit  "death-agonies,"  "death-struggles,"  and  the 
"pangs  of  death,"  are  grossly  erroneous,  and  that 
in  the  last  moments  of  life  pain  and  death  seldom 
go  together.    Death  is  generally  made  painless  by 
an  anaesthetic  kindly  provided  by  Nature.     The 
departments  are  full  and  varied,  and  the  number 
is  one  of  unusual  attractiveness.     New  York  :  D. 
Appleton  &  Company.     Fifty  cents  per  number  ; 
$5  per  year. 


CASCARA   SAGRADA. 

Dr.  R.  W.  Alexander,  in  the  Therapeutic  Ga- 
zette, describes  a  case  the  symptoms  in  which 
were  relieved  by  this  remedy.  He  says  of  the 
patient : 

Her  condition  at  this  time  was  as  follows  :  Sal- 
low complexion ;  general  emaciation  ;  broad,  flab- 
by tongue,  coated  with  a  thick,  yellow,  fur ;  foul 
breath  ;  cardialgia  ;  headache  ;  habitual  constipa- 
tion ;  liver  enlarged,  with  considerable  pain  upon 
pressure.  I  ordered  two  preparations  of  cascara 
from  a  druggist  in  this  city,  who  had  gotten  some 
for  my  special  use.  The  first  was  Dr.  Bundy's  prepa- 
ration, which  I  intended  should  meet  the  dyspeptic 
condition  of  her  system,  and  is  as  foIloVs  : 

3   Cascara  sag.  fl  ext.  (!'.  D.  c^'  Co.)  I  j; 

Acid  hydrocyanici  dil 3  j; 

Malt  extract fl.  |  ij  ; 

Berberis  aquifol.  fl.  ext fl-5j. 

M.  Sig.  A  teaspoonful  after  meals,  or  oftener, 
if  there  is  pain  or  distress  with  belching  of  gas  or 
wind  from  the  stomach. 

In  addition  to  the  above  I  ordered  the  second, 
as  follows  : 

IJ   Cascara  sag.  ext.  fl.  (P.  D.  &  Co.)  3  ij ; 

Syr.  hypophosphit.  co  ,  ad 3   iv. 

M.  Sig.  A  teaspoonful  at  night  when  the  bowel, 
fail  to  move  during  the  preceding  day. 


THE  CANADA  MEDICAL  RECORD 


Vol.  IX. 


MONTREAL,  JULY,  1881 


No.  10 


COlsTTEHsTTS- 


ORIGINAL  COMMUNICATIONS. 

Case  of  Chronic  Brighl's  Disease 
Treated  by  Nitro-Glycerine ....    241 

PROGRESS  OF  MEDICAL  SCIENCE 

Remarks  on  gome  points  in  the 
Treatment  of  Typhoid  Fever, 
243. — The  Advantages  of  Calo- 
mel in  the  Diseases  of  Childhood, 
247. — Incontinence  of  Urine  in 
Boys,  250. — Chlorate  of  Potash 
in  the  Haemorrhagic  Diathesis, 
252.  —  Treatment    of   Sprains, 


254. — Remedies  fer  Headache, 
256. — Hot  Water  Injections  for 
Post-Partum  Hemorrhage,  257. 
— The  Treatment  of  Consump- 
tion, 257. — On  the  Cause  and 
Treatment  of  the  Bad  Odour 
Sometimes  Associated  with  Ex- 
cessive Sweatingof  the  Feet,  258. 
— An  Opinion  on  Blood-Letting, 
258. — Treatment  of  Indigestion 
and  Heartburn,  259. — Therapeu- 
tic Uses  of  Tobacco,  259. — New 
Treatment  of  Abscesses,  260- — 
Benzoate  of  Sodium  in  the  Treat- 
ment of  Acute  Rheumatism,  260. 


— Compulsory  Vaccination  in 
France,  261. — To  Remove  Fish- 
Bones 261 


EDITORIAL. 

Important  Question, 26 1. — Univer- 
sity of  Bishop's  College,  262. 
— Death  of  Mr.  Stephen  S. 
Alford,  F.R.C.S.,  London,Eng., 
263.  —  Wyeth's  Dialised  Iron, 
263.  —  The  Popular  Science 
Monthly  for  August,  1 88 1,  263. 
— Reviews 263 


0ri^mu{  Boinnmnvm/tvoM . 


CASE   OF  CHRONIC    BRIGHT'S   DISEASE 
TREATED  BY  NITRO-GLYCERINE. 

By  James  C.  Cameron,  M.D., 

Professor  of  Medical  Jurisprudence,  Medical  Faculty, 
LTniversity  of  Bishop's  College,  Montreal.     (Con- 
densed from  a  paper  read  before  the  Medico- 
Chirurgical  Society  of  Montreal.) 

On  account  of  the  intractable  nature  of  Bright's 
disease,  the  discomfort  and  danger  of  extensive 
dropsical  effusion,  and  the  obstinacy  with  which, 
at  times,  it  resists  treatment,  we  are  always  ready 
to  welcome  a  new  drug  which  promises  any 
chance  of  success.  Nitroglycerine  was  first  used 
medicinally  by  Dr.  Hering,  a  homoeopathic  phy- 
sician of  Philadelphia;  it  has  lately  attracted 
considerable  attention,  and  has  been  employed 
with  marked  success  in  cases  of  migraine,  asthma, 
angina  pectoris  and  epilepsy.  Its  action  is  similar 
to  that  of  amyl  nitrite,  and  it  is  used  in  similar 
cases.  In  November  last,  Dr.  Robson  of  Leeds 
wrote  to  the  British  Medical  Journal,  advocating 
the  use  of  nitro-glycerine  in  acute  and  chronic 
Bright's  disease,  and  detailing  several  cases  in 
which  it  had  been  employed  with  advantage.    He 


employed  a  one  per  cent,  alcoholic  solution,  in 
doses  of  one  to  three  minims  every  three,  four  or 
six  hours  as  required  ;  when  the  urgent  symptoms 
subsided,  he  added  the  muriated  tincture  of  iron 
in  doses  of  fifteen  to  twenty  minims.  Dr.  Robson 
claims  that  in  Bright's  disease  nitro-glycerine 
rapidly  reduces  vascular  tension,  softens  the  tense 
corded  pulse,  relieves  labored  and  difficult  breath- 
ing, augments  greatly  the  quantity  of  urine,  raises 
its  sp.  gravity,  and  rapidly  removes  anasarca.  He 
thinks  that  it  is  particularly  useful  in  the  condi- 
tion of  arterio-capillary  fibrosis  described  by  Drs. 
Gull  and  Sutton. 

I  tried  nitro-glycerine  last  winter  with  marked 
benefit  in  a  desperate  case  of  Bright's  disease 
which  had  resisted  most  of  the  ordinary  methods 
of  treatment,  and  was  at  the  time  rapidly  sinking. 
My  patient  was  a  man  48  years  of  age,  an  old 
soldier,  a  hard  drinker,  and  one  who  had  under- 
o-one  much  exposure  to  wet  and  cold.  He  had  a 
tubercular  deposit  in  one  of  his  lungs,  had  suffered 
for  months  from  cough  and  night  sweats,  and  had 
several  mild  attacks  of  anasarca  during  the  past 
tvi'o  years.  Towards  the  close  of  September  last 
I  attended  him  for  an  acute  congestion  of  the 
kidneys,  the  result  of  a  heavy  spree  and  exposure 
to  cold.  The  acute  symptoms  soon  subsided,  but 
the  urine  remained  highly  albuminous,  and  oedema 


2i2 


THE    CANADA    MEDICAL    RECORD. 


persisted  in  the  legs  in  spite  of  purgatives  and 
diuretics,  hot  air  baths  and  an  exclusively  milk 
diet.  Pilocarpine  was  then  administered  hyj)oder- 
mically  with  the  happiest  results ;  the  albumen 
decreased  and  cedema  disappeared,  and  by  the 
end  of  October  he  was  quite  convalescent.  One 
cold  rainy  day  he  went  out  very  imprudently  and 
got  wet  and  chilled,  and  indulged  again  in  liquor. 
Acute  symjitoms  set  in,  and  then  even  jaborandi 
failed  to  afford  any  relief;  the  oedema  gained 
ground,  the  quantity  of  urine  gradually  diminished, 
the  albumen  increased,  and  the  tubecasts,  which 
had  formerly  been  granular  and  hyaline,  became 
studded  with  fat  globules.  Uraemic  symptoms  at 
last  set  in;  on  D,icember  nth,  the  total  amount 
of  urine  passed  in  twenty-four  hours  was  8  oz. 
with  a  sp.  gr.  of  1040;  the  ordinary  method"?  of 
treatment  were  ineffectual,  and  his  condition 
became  very  grave.  As  a  last  resort  I  determined 
to  try  the  nitroglycerine  treatment.  Mr.  Henry 
R.  Gray  prepared  for  me  a  one  per  cent,  alcoholic 
solution,  and  on  Dec.  12th  I  administered  one 
minim  of  this  solution  in  syr.  tolut.  every  four 
hours  ;  in  three  days,  the  dose  was  increased  to 
two  minims,  and  on  December  i6th  the  patient 
was  much  better,  and  passed  35  oz.  of  urine.  On 
the  19th  tinct.  fer.  mur.  M  xx.  was  added  to 
each  dose.  The  case  was  seen  by  Dr.  R.  P. 
Howard  in  consultation  on  the  26th,  and  the  dose 
of  nitro-glycerine  solution  was  increased  by  one 
minim ;  by  the  29th  the  cedema  had  so  far 
decreased  that  the  mixture  was  given  less  fre- 
quently. •  On  New  Year's  day  he  got  up  and 
dressed,  and  dined  with  his  family ;  that  day  he 
passed  49  oz.  of  urine.  On  January  loth  the 
mixture  was  reduced  to  three  doses  daily,  and  on 
the  15th  he  was  so  much  better  that  it  was  dis- 
continued altogether,  and  a  mixture  of  digitalis 
and  iron  substituted.  The  digitalis  soon  upset 
his  stomach,  so  that  on  the  22nd  I  returned  to 
the  old  mixture  of  nitro-glycerine  and  iron.  The 
oedema,  which  every  now  and  then  came  on  afresh 
after  some  indiscreet  exposure  to  cold,  slowly 
disappeared  as  the  urine  increased  in  quantity,  till 
on  February  14th  it  was  entirely  away;  that  day 
he  passel  100  oz.  of  urine.  I  then  stopped  the 
nitro-glycerine  and  continued  the  iron  alone  ;  but 
he  grew  rapidly  weaker,  on  the  19th  vomiting  set 
in,  on  the  21st  diarrhoea,  the  urine  speedily  dimin- 
ished in  quantity,  and  the  albumen  increased.  On 
the  25th  hiccough  began;  on  March  3rd  the  urine 
become    completely  suppressed,  and  on   the   6th 


he  died  exhausted.     Unfortunately  a  post  mortem 
examination  could  not  be  obtained.  "'er 

the  first  month  was  hopeless,  and  treaui. 
only  palliative.  In  carefully  reviewing  it,  my  opinion 
is  that  nitroglycerine  prolonged  life  for  neo  '  two 
months.  It  increased  markedly  the  quai.tity  of 
urine  passed  daily ;  but  although  the  relative 
amount  of  albumen  was  considerably  reduced, 
the  absolute  amount  was  not  much  affected.  Tlie 
cedema  and  labored  breathing  were  undoubtedly- 
relieved  by  its  use,  and  the  pulse  rendered  softer 
and  less  corded.  From  the  careful  and  daily- 
study  of  this  case,  I  am  convinced  that  in  certain 
conditions  nitroglycerine  is  a  valuable  remedy  in 
the  treatment  of  chronic  Bright's  disease,  and 
may  be  administered  with  perfect  safety  and 
without  unpleasant  symptoms  for  a  considerable 
length  of  time. 

The  following  table  shews  at  a  glance  the  efifect 
of  this  treatment  upon  the  daily  quantity  of  urine:, 

TABLE  SHOWING  THE  AMOUNT  OF  URINE 
PASSED  DAILY  DURING  THE  NITRO- 
GLYCERINE TREATMENT. 


1880 

1 85 

h 

Dec. 

II 

Voided  8  oz.  sp   gr.  1040 

Jan 

.    I 

Voided  49  or.. 

( ( 

12 

Sol.  Glonoin  M  i  4  q.  h. 

cc 

2 

«      36  •' 

Voided  15  oz. 

it 

3 

"      36  « 

>( 

13 

"      liyi  oz 

C( 

4 

"      24  '«^ 

(( 

14 

"      15       " 

<( 

5 

"      24  «' 

i( 

15 

"      21       " 

ee 

6 

"      27  " 

Sol  Glonoin  M  ii  4  q.  h. 

e< 

7 

"      47  " 

a 

16 

Voided  35  oz 

(C 

8 

"      31  " 

(.- 

17 

"      30  " 

(C 

9 

"      24  " 

(( 

18 

"      29  " 

" 

10 

"      25  " 

(1 

19 

"      24  " 
.Sol.  Glonoin.  M  ij 
Tr.  Fer.  Mur.  M.  xx 

Mist,  ter  die 

4q  h. 

(C 

II 

Voided  27  oz. 

20 

Voided  39  oz 

(< 

12 

"      36  " 

21 

"      30  •' 

« 

13 

"      37  " 

22 

C,          35     u 

(C 

14 

"      3G  « 

23 

u      28  " 

a 

15 

«      36  " 

24 

"      23  " 

Stop  Glon.  mist. 

25 

"      23  « 

and  substitute 
Tr.  Digital  M  x 

i( 

26 

«      18  " 
Consultation  with  Dr. 

Howard 
-Sol.  Glonoin  M  iii 
Tr.  Fer.  Mur.  M  xx 

Tr.  Fer.  Mur. 

M  xx 
Glyc.    3  i 

4  in  die 

4  q.  h. 

(( 

16 

Voided  38  oz-. 

(( 

27 

Voided  18  oz. 

<( 

28 

"      18    '^ 

(( 

29 

u      21    " 

(( 

17 

«      36  '^ 

Mist.  4  in  die 

(< 

18 

"      45  " 

i( 

30 

Voided  21  oz. 

ft 

'9 

"      39  " 

It 

3' 

"      24    « 

(< 

20 

"     42  " 

(< 

21 

"      36  " 

(( 

22 

"      30  " 
Stop  last  mist 

and  give 
Sol.  Glon.  M  iiji 
Tr.  Fer.  Mur.  M 

XX  ter  die 

THE    CANADA    MEDICAL    RECORD. 


243 


i8Si 
Jan. 


<< 

t  ( 


Feb, 


« 

(t 
ft 
it 
« 

« 


23 
24 

25 
26 

27 
28 
29 

30 

3' 
I 

2 

3 
4 

5 
6 

7 
8 

10 
II 
12 

13 

14 


15 
16 

J7 


Voided  42  oz, 
"      45    " 


(C 

I  ( 


36  " 

37 


a 

(C 

(( 

« 


33 
36 
36 
45 
37 
36 
36 
40 

45 

45 

51 
61 

60 

81 

63 

75   " 
io8   " 
«'     96   " 
"    100   " 
Stop  Sol.  Glon.  and 
give  Tinct.  Fer.  Mur 
M  XX  ter  die 
Voided  96  oz. 
"      96    " 
"      84    " 


« 
a 

<c 


c< 

(C 

(I 
ii 
ii 
<( 


I88I 

Feb.  18 
'      19 


(C 


20 

21 


22 

23 
24 

25 
26 

27 

28 

Mar.    I 

"       2 

"       3 

"       4 

5 
6 


(1 


Voided  96  oz. 

"      63  " 
Vomiting  began. 

Stop  mixture 
Voided  72  oz. 
60    " 
Diarrhcea  set  in 
Voided  60  oz. 
48    " 

39    " 
29   " 

13  " 
9  " 
6  " 
2  " 
I  " 
o  " 
o  " 
o    " 


Died 


J^/^qgV^^^  0/  JItedicai  iSdemt . 

REMARKS    ON  SOME    POINTS    IN    THE 
TREATMENT  OF  TYPHOID  FEVER. 

By  William  Pepper,  A.M.,  M.D., 

Professor  of  Clinical  Medicine  in  the  University  of  Pennsyl- 
vania. 

I  have  no  intention,  in  the  Hmited  time  at  my 
dispcsal,  of  entering  into  a  full  discussion  of  the 
treatment  of  typhoid  fever  in  its  various  forms 
and  with  all  its  complications,  but  simply  to  state 
in  a  brief  manner  the  results  of  my  observation  as 
to  the  management  of  the  ordinary  form  of  this 
fever,  as  I  have  met  with  it  both  in  hospital  and 
in  private  practice  in  this  city  and  its  neighbor- 
hood. 

Although  the  attempts  to  isolate  the  particular 
poison  of  typhoid  fever  have  not  met  with  full 
success,  it  seems  to  be  generally  accepted  that 
this  disease  is  caused  by  a  special  materies  morbi, 
for  the  most  part  admitted  to  the  system  through 
the  alimentary  canal,  although  capable,  also,  of 
gaining  admittance  by  inhalation.  I  am  disposed 
myself  to  believe  that  this  poison  is  capable  of 
being  produced  or  brought  into  activity  under 
conditions  much  more  varied  than  it  has  recently 
been  the  habit  to  assert. 

However  this  may  be,  the  poison  presents  cer- 
tain peculiarities  which  are  important  to  note  from 
their  bearing  upon  the  treatment  of  the  disease.  It 
is  undoubtedly  capable  of  retaining  its  power  of 


infection  for  a  long  time  latent,  so  that  as  soon  as 
proper  conditions  are  present  it  will  manifest 
activity. 

Carefully-observed  cases  also  establish  the 
fact  that  it  is  capable  of  producing  typhoid  fever 
although  admitted  to  the  system  in  very  minute 
quantities  and  much  diluted.  It  seems  that  the 
opportunities  for  the  admission  of  the  virus,  in 
such  small  amounts  as  have  been  known  to  pro- 
duce typical  typhoid  fever,  must  be  so  frequent 
and  general  that  a  vast  majority  of  the  community 
must  at  some  time  or  other  have  been  exposed  to 
it.  Probably,  therefore,  it  requires,  in  a  degree 
even  greater  than  do  other  zymotic  poisons,  suita- 
ble pabulum  for  its  development,  and  a  state  of 
system  predisposing  to  its  zymotic  action. 

At  times  the  virus  is  so  concentrated  and  active 
that,  in  whatever  way  it  gains  entrance  to  the  body, 
it  infects  the  system  in  nearly  every  instance  and 
causes  a  virulent  zymosis.  On  the  other  hand,  the 
virus  may  be  much  less  active  :  so  that,  supposing 
it  to  be  taken  into  the  alimentary  canal,  if  the 
secretions  are  normal  and  the  glands  of  the  mucous 
membrane  not  susceptible  or  vulnerable,  it  rnay 
be  thrown  off  without  the  production  of  the  disease. 
Again,  the  virus  may  be  more  active  or  more  fully 
propagated  in  the  intestinal  canal,  and  cause 
marked  irritation  of  the  enlarged  solitary  and 
Peyerian  glands  of  the  mucous  membrane,  so  that 
the  intestinal  lesions  become  considerable ;  and 
yet  the  virus  may  be  arrested  in  the  swollen 
mesenteric  glands  and  no  marked  infection  of  the 
system  occur.  This  agrees  with  the  well-known  fact 
that  no  constant  relation  exists  between  the  degree 
of  intestinal  lesion  and  the  intensity  of  the  primary 
constitutional  infection  or  zymosis. 

It  is  further  to  be  noted  that  even  in  cases 
where  primary  infection  of  the  system  has  not 
been  intense,  and  where  the  intestinal  lesions  have 
been  quite  marked,  it  is  quite  possible,  and  indeed 
probably  quite  frequent,  for  the  morbid  intestinal 
contents  to  favor  further  development  of  the 
specific  virus,  and  thus  endanger  continued  absorp- 
tion, or  else  for  the  putrid  debris  and  secretions  to 
give  rise  to  a  secondary  non-specific  septicaemia. 

It  thus  seems  to  me  that  we  must  recognize 
practically  the  following  different  primary  forms  : 
first,  ordinary  typhoid  fever,  with  moderate  intes- 
tinal lesions  and  moderate  zymosis ;  second, 
cases  with  grave  intestinal  lesions  and  moderate 
zymosis  ;  third,  cases  with  grave  zymosis  and  pro- 
found constitutional  symptoms  from  the  start. 

I  have  spoken  of  the  first  form  as  ordinary 
typhoid  fever,  because  my  own  experience  would 
indicate  that  this  and— to  a  less  degree — the 
second  form  are  by  far  the  most  common  in  this 
district,  although  far  too  frequently  individual 
cases  or  limited  outbreaks  of  the  grave  primary 
zymotic  type  occur. 

I  have  referred  to  these  familiar  views  simply  to 
call  attention  to  the  immense  importance  of  the 
role  which  the  gastro-intestinal  mucous  membrane 
plays  in  typhoid  fever  from  the  earliest  moment. 


244 


THE    CANADA    MEDICAL    RECORD. 


It  is  very  important,  also,  to  recognize  the  fact 
that  the  stadium  of  typhoi(l  fever  f)resent.s  two 
stages  theoretically  distinct, — namely,  the  primary 
true  zymotic  stage  and  the  subsequent  irritative  or 
secondary  septic  stage.  The  first  of  these  is  pro- 
bably the  more  definite  in  its  duration,  lasting:, 
}»erhai)s,  from  twelve  to  sixteen  days,  although  the 
data  do  not  exist  for  determining  its  duration 
accurately. 

Jn  speaking  of  the  actual  treatment,  I  would 
first  consider  ordinary  cases  of  typhoid  fever  in 
private  practice,  coming  under  observation  at  the 
first  development  of  syminoms  of  malaise.  It  is 
my  profound  conviction  that  in  a  great  majority 
of  cases  of  this  form — that  is,  of  course,  excluding 
those  of  grave  primary  zymosis — proper  treatment 
of  this  forming-stage  will  modify  and  moderate  the 
whole  subsequent  course  of  the  case,  and  will 
prevent  the  develo])ment  of  those  grave  and 
alarming  conditions  to  the  treatment  of  which  so 
much  time  and  attention  are  bestowed  in  most 
discussions  upon  this  disease. 

It  is  universally  recognized  that  continued  expos- 
ure and  efforts  during  the  forming-stage  of  typhoid 
fever  greatly  increase  the  gravity  and  danger  of 
the  subsequent  attack,  and  I  have  often  seen 
patients  who,  after  the  symptoms  have  actually 
developed  themselves,  have  been  allowed  to  leave 
the  bed  merely  to  use  the  close  stool,  or  to  sit  in  an 
easy-chair  while  the  bedclothes  were  being 
changed,  exhibit  early  and  alarming  exhaustion, 
tha^t  was  at  least  partially  due  to  these  injudicious 
efforts.  The  first  essential  to  secure  this  result 
should  be  absolute  rest  in  bed. 

I  have  been  surprised  to  find  that  some  writers 
who  begin  by  recommending  early  and  complete 
rest  make  later  allusions  which  show  that  their 
idea  of  such  rest  is  far  from  being  as  thorough  as 
I  believe  should  be  enforced.  Every  case  in 
which  the  .symptoms  justify  even  a  suspicion  of 
typhoid  fever  should,  in  my  opinion,  be  imme- 
diately consigned  to  bed,  and  the  use  of  the  urinal 
and  bed-pan  be  at  once  insisted  upon.  I  have 
even  seen  such  patients,  when  allowed  to  leave 
bed  merely  to  use  a  close-stool  or  while  the  bed- 
clothes were  being  changed,  exhibit  such  exhaus- 
tion at  a  subsequent  stage  of  the  disease  as  could 
only  be  explained  by  these  injudicious  efforts. 
More  frequently  still  have  I  seen  the  gastro- 
intestinal irritation  increased  seriously  by  the  im- 
projjer  exposure  to  currents  of  air  while  out  of 
bed. 

In  the  next  place,  a  most  rigidly  restricted  diet 
should  be  insisted  upon.  Later  in  the  case  more 
abundant  and  concentrated  nourishment  and  stim- 
ulants will  perhaps  be  called  for ;  but  in  this 
formii.g  stage  I  believe  that  a  very  limited  amount 
of  very  light  nourishment  is  sufficient,  and  that  its 
use  will  exert  a  happy  influence  upon  the  subse- 
quent course  of  the  case.  Not  only  should  all 
solid  food  be  at  once  forbidden,  but  the  liquid 
food  allowed  should  be  light  and  very  digestible. 

Equally  important  is  the  avoidance  of  all  irritat- 


ing medicines,  and  especially  purgatives,  at  this 
stage.  It  is  scarcely  possible  that  an  emetic  or  a 
purgative  should  remove  every  particle  of  the  virus 
from  the  intestinal  canal,  and  yet  we  know  that 
the  virus  will  act  even  when  present  only  in  min- 
ute quantity  and  very  dilute  state  if  favorable  con- 
ditions exist  ;  and  it  is  probable  that  the  morbid 
secretion  favored  by  the  action  of  a  purgative  in 
this  state  of  the  system  constitutes  the  best  possi- 
ble pabulum  for  the  propagation  of  the  virus,  while 
at  the  same  time  it  must  render  the  glandular 
apparatus  of  the  mucous  membrane  more  .sensitive 
and  vulnerable.  Digestion  is  disturbed  and 
strength  impaired,  the  intestinal  lesions  are  aggra- 
vated, and  the  case  is  rendered  more  serious.  If 
the  state  of  the  tongue  and  secretions  indicates  a 
laxative,  good  results  will  usually  be  obtained  from 
the  administration  of  the  following  : 

I^    Hydrargyri  chloridi  mitis,  gr.  ii ; 

Sodi  bicarbonatis,  gr.  xlviii ; 
M.,  ft.  mas.  et  div.  in  pil.  no.  xii. 

Of  these  one  may  be  taken  every  two  or  three- 
hours  until  the  bowels  are  moved,  or  until  all  have 
been  taken,  when  a  movement  can  be  secured  by 
an  enema  of  tepid  water  or  gruel. 

During  this  early  stage  the  remedy  which  seems 
to  me  most  constantly  called  for  is  quinia,  which  I 
am  in  the  habit  of  giving  in  larger  doses  than  at 
the  later  periods  of  the  disease,  except  in  a  partic- 
ular condition.  My  reasons  for  so  doing  are  the 
following  :  during  this  stage  the  irregular  febrile 
movement  frequently  simulates  a  mild  malarial 
attack,  and  undoubtedly  a  malarial  element  is  not 
unfrequently  present  when  true  typhoid  also  exists.. 
Again,  it  is  probable  that  the  use  of  quinine  may 
lessen  the  activity  of  the  virus  and  the  danger  and 
degree  of  infection. 

If  however,  the  gastro-intestinal  irritation  is  at 
all  marked,  I  invariably  administer  the  quinia  by 
suppository,  as  follows  : 

T^   Quiniae  sulph.,  ?  i ; 

Pulv.  opii,  gr.  iv  ; 

01.  theobromoe,  q.  s. 
M.  et  div.  in  suppositoria  no.  xii. 

S.  One  every  four,  six,  or  eight  hours,  ^vhile  the 
powders  above  mentioned  are  administered  by  the 
mouth. 

I  have  found  very  many  attacks  of  mild  gastro- 
intestinal catarrh,  with  or  without  malarial  com- 
plication, with  symptoms  closely  simulating  the 
early  ones  of  typhoid  fever,  subside  rapidly  under 
the  above  treatment,  together  with  a  diet  of  chick- 
en or  mutton-broth,  gruel,  skim-milk,  or  milk  and 
water  in  equal  proportions. 

If,  however,  the  symptoms  persist,  it  can  soon 
be  seen  that  a  true  typhoid  fever  is  developing, 
and,  if  so,  the  observance  of  the  course  above 
described  will  have  tended  much  to  les.sen  its 
gravity.  Of  course  the  same  alsolute,  scrupulous 
observance  of  rest  continues  essential.  The  diet 
should  now  be  as  nourishing  as  the  state  of  the  diges- 
tion will  permit.  I  believe,  however,  that  it  shotild 


THE    CANADA    MEDICAL    RECORD. 


245 


he  liquid  in  character  throughout  the  entire  course 
of  the  disease. 

I  have  repeatedly  seen  ill  results  from  the  in- 
fringement of  this  rule,  while  I  have  rarely  seen  a 
case  where  the  digestion  had  been  carefully  man- 
aged from  the  start  in  which  liquid  nourishment  did 
not  suffice  to  maintain  nutrition.  Indeed,  such  is 
my  conviction  of  the  supreme  importance  of  the 
condition  of  the  mucous  membranes  in  this  disease, 
and  of  the  necessity  of  giving  only  such  food  as 
can  be  fully  digested  and  absorbed,  that  I  am  in- 
clined to  believe  that  far  more  patients  are  over-fed 
than  under-fed  in  typhoid  fever. 

I  have  seen  manv  cases  where,  while  beef-tea 
and  pure  milk  were  freely  administered,  dryness  of 
the  tongue,  nausea  or  vomiting,  and  diarrhoea 
existed,  and  where  the  substitution  of  light  chick- 
en or  mutton  broth,  and  of  skim-milk,  or  milk  di- 
luted with  equal  parts  of  water,  has  led  to  the  sub- 
sidence of  these  symptoms  and  there-establishment 
of  good  digestion. 

With  regard  to  the  use  of  stimulants.  I  have 
been  led  to  feel  that  they  are  not  to  be  regarded  as 
.1  necessary  part  of  the  routine  treatment  of  typhoid 
fever.  During  the  early  stage  of  the  disease,  in- 
deed,— unless  exceptional  symptoms  arise  demand- 
ing them, — their  use  is  often  injurious,  and  tends 
to  increase  the  derangement  of  digestion  and  the 
gastro-intestinal  catarrh  then  existing.  When  the 
early  stage  is  carefully  managed,  stimulants  are 
often  not  called  for  throughout  the  whole  course 
of  the  case,  or  only  towards  the  close  to  hasten 
convalescence.  On  the  other  hand,  in  cases  where 
the  constitutional  infection  is  serious,  and  marked 
nervous  prostration  and  heart-failure  exist,  their 
free  use  may  be  demanded.  No  question  in  the 
treatment  of  typhoid  fever  has  seemed  to  me  to 
rival  in  difficulty  that  of  deciding,  in  cases  which 
do  not  come  under  notice  until  high  hyperpyrexia, 
serious  nervous  symptoms,  a  rapid  and  feeble  cir- 
culation, together  with  marked  derangement  of 
digestion,  have  supervened,  how  far  the  symptoms 
are  the  result  of  nervous  exhaustion  from  protract- 
ed surface  irritation  which  may  be  increased  by 
the  free  use  of  stimulants,  and  how  far  they  are 
the  result  of  poisoning  of  the  nerve-centres  and 
depression  of  the  vital  forces  by  the  zymotic 
poison. 

In  such  cases  it  is  probably  better  to  use  stimu- 
lants at  once,  but  with  the  greatest  caution  and 
with  a  mind  fully  awake  to  the  fact  that  their  use 
may  aggravate  the  very  symptoms  they  are  given 
to  relieve.  Where  the  case  has  been  under  observa- 
tion from  the  very  beginning,  and  stimulants  have 
been  withheld  until  the  appearance  of  symptoms 
actually  demanding  them,  it  is  generally  a  com- 
paratively easy  matter  to  determine  when  they  are 
called  for,  and  to  decide  in  what  form  and  to  what 
extent  they  shall  be  given. 

In  every  case  of  typhoid  fever  the  febrile  move- 
ment should  be  carefully  watched,  and  the  tem- 
perature be  recorded  two  or  three  times  in  twenty- 
four  hours, — say  at  9  a..m.,  2  p.m.,  9  p.m.  In  many 


cases  no  special  treatment  is  called  for  to  reduce 
the  temperature.  If  the  primary  zymosis  is  not 
violent,  and  the  gastro-intestinal  irritation  is 
moderated  by  proper  means,  the  febrile  movement 
preserves  its  well-known  course  without  the  max- 
ima attaining,  in  most  cases,  a  dangerous  point. 
So  long  as  the  temperature  fluctuates  2°  or  there- 
abouts within  each  twenty-four  hours,  and  the 
maximum  alone,  lasting  for  a  few  hours  or  less, 
reaches  102"^  to  103)^0,  while  the  nervous  symp- 
toms and  the  heart's  action  are  reasonably  favor- 
able, no  special  anxiety  need  be  felt  about  the 
pyrexia  This  is  especially  true  in  women  with 
sensitive  nervous  systems  and  in  children,  since 
in  them  high  temperatures  are  most  readily  pro- 
duced and  have  less  serious  significance.  It  is, 
however,  desirable  for  the  comfort  of  the  patient 
and  for  the  promotion  of  healthy  action  of  the  skin 
that  the  surface  should  be  sponged  several  times 
daily.  The  water  may  contaui  a  little  alcohol, 
vinegar,  or  carbolic  acid,  and  its  temperature  should 
be  determined  by  that  of  the  body  and  by  the 
sensations  of  the  patient.  For  instance,  in  a 
highly-nervous  and  delicately-organized  young 
woman  of  25  years,  with  marked  typhoid  fever  in 
which    the  maximum  daily  temperature    reached 


104°, 


1041^ 


even 


105°, 


for  ten   or  twelve  days 


successively,  sponging  even  with  tepid  water  pro- 
duced a  sense  of  chilliness,  so  that  it  was  entirely 
abandoned,  and  a  perfectly  satisfactory  recovery 
was  made.  I  am  entirely  convinced  that  any 
"cold-water  treatment"  of  typhoid  fever,  with 
rigid  rules  for  cool  bathing,  etc.,  as  soon  and  as 
often  as  the  temperature  reaches  a  certain  point 
(1 02^2°  to  io3>4°  or  so  on),  is  unphilosophical, 
unnecessary,  and  less  successful  than  the  simpler 
mode  of  treatment  here  advocated.  The  excel- 
lent results  obtained  by  .some  of  the  advocates  of 
frequent  cool  bathing  show  that  such  baths  are 
well  borne,  and  may  be  safely  conjoined  with  a 
scrupulous  attention  to  all  the  other  details  of 
rational  treatment.  But  I  have  preserved  the 
notes  of  the  last  one  hundred  cases  of  typhoid 
fever  of  whose  treatment  I  have  had  the  direction 
from  the  beginning  of  the  attack,  and  the  mortality 
has  been  but  three  per  cent.,  and  in  only  five  or 
six  of  these  cases  were  full  baths  employed.  In 
the  great  majority  of  cases,  then,  I  believe  that 
cool  bathing  can  be  dispensed  with,  and  sponging 
of  the  surface  be  found  sufficient.  But,  on  the 
other  hand,  there  are  certain  conditions  that  seem 
to  call  imperatively  for  rapid  reduction  of  temper- 
ature by  cold  baths.  The  first  of  these  is  when, 
early  in  the  case,  the  temperature  rises  very  high 
(io4>2°  or  over)  without  any  sufficiently  severe 
local  irritation  to  explain  it,  so  that  there  is  clearly 
a  grave  zymosis  present.  Again,  when  at  any 
period  of  the  disease  the  daily  maximum  reaches 
1051^°,  and  the  daily  average  is  very  high,  and  the 
hyperpyrexia  is  maintained  despite  the  free  use  of 
cool  sponging  and  the  judicious  use  of  antipyretics 
cool  bathing  should,  as  a  rule,  be  instituted.  I 
follow  this  rule  whether  the  hyperpyrexia  is  due 


246 


THE    CANADA    MEDICAL    RECORD. 


apparently  to  increased  septicaemia  or  to  the  fail- 
ure of  the  inhibitory  action  of  the  nervous  system  ; 
but  if  severe  pulmonary  inflammation  or  a  serious 
exacerbation  of  intestinal  inflammation  has  occurred 
to  cause  it,  I  do  not  advise  the  use  of  cool  baths 
until  thet  haracter  of  the  nervous  sym[)toms  or  the 
failure  of  the  force  of  cardiac  action  indicates  that 
the  exalted  temperature  is  producing  dangerous 
secondary  results.  A  few  words  must  be  added  in 
regard  to  the  use  of  other  means  for  reducing  hyjjer- 
pyrexia.  Undoubtedly,  quinine  is  the  most  reliable 
of  these.  I  have  already  spoken  of  its  use  in  the 
later  stages  of  the  disease,  either  by  mouth  or  rec- 
tum, and  I  think  its  judicious  use  thus  greatly  les- 
sens danger  of  hyperpyrexia  later.  When,  however, 
the  temperature  runs  up  as  the  disease  advances, 
it  does  not  seem  to  me  advisable  to  give  large 
single  doses  of  quinia,  but  to  persevere  with  the 
use  of  twelve  to  twenty-four  grains  given  in  di- 
vided doses  during  the  twenty-four  hours.  The 
elevation  of  temperature  is  so  frequently  connect- 
ed with  the  evolution  of  gastro  intestinal  lesions 
that  it  appears  desirable  to  avoid  any  measure 
liable  to  increase  this  surface  irritation.  The  ad- 
ministration of  colossal  doses  of  quinia  (twenty- 
five  to  forty  grains  at  a  single  dose),  while  capa- 
ble in  some  cases  of  lowering  the  excessive  tem- 
perature, it  seems  to  me  has  in  more  than  one  in- 
stance shown  itself  to  be  open  to  serious  objection. 
If,  however,  the  temperature  persistently  rises 
despite  absolute  rest,  judicious  diet,  the  regular 
use  of  quinine  in  moderate  doses,  repeated  spong- 
ing, and  if  any  special  reason  exist  why  cool 
bathing  should  not  be  used,  or  if  after  cool  baths 
have  been  used  the  dangerous  hyperpyrexia  per- 
sists, then  only  would  I  recommend  the  adminis- 
tration of  very  large  doses  of  quinia  ;  nor  would  I 
use  them  even  then  unless  the  state  of  the  stomach 
encouraged  the  hope  that  severe  gastric  irritation 
would  not  result.  Digitalis,  which  is  very  valuable 
where  failure  of  the  innervation  of  the  heart  exists, 
has  not,  in  my  experience,  proved  itself  reliable  as 
an  antipyretic  or  a  tonic  to  the  heart  when  its 
feeble  action  results  from  degeneration  of  the 
muscular  walls  from  hyperpyrexia.  Salicylic  acid 
and  its  salts  have  also  disappointed  me,  often 
failing  to  reduce  the  temperature  satisfactorily, 
aud  often  causing  a  most  unsatisfactory  amount  of 
gastro-intestinal  irritation. 

To  return  from  this  consideration  of  the  treat- 
ment of  the  pyrexia  in  typhoid  fever,  there  is  one 
other  condition,  and  only  one,  that  seems  to  me 
to  demand  attention  in  every  case  of  this  disease. 
Pulmonary  or  venous  complications  may  or  may 
not  exist  in  any  pronounced  degree,  but  unques- 
tionably there  is  wide-spread  irritation  of  the 
gastro-intestinal  mucous  membrane  in  every  case. 
This  may  or  may  not  be  so  intense  as  to  prove 
the  source  of  the  greatest  danger  in  the  case,  it 
may  not  be  associated  with  severe  diarrhcea, — nay 
there  may  not  be  the  slightest  diarrhcea  ])resent, — 
and  yet  there  is  always  hyperemia  and  follicular 
enlargement.       Differences     between    individual 


constitutions,  as  well  as  differences  in  the  degree 
of  these  local  lesions,  cause  them  to  exist  in 
different  degrees  of  reflex  irritation,  and  thus  to 
influence  very  differently  the  symptoms  and  course 
of  the  case  ;  but  the  essential  fact  is  that  they  are 
present  in  every  case  to  an  unknown  extent,  and 
the  obvious  inference  would  seem  to  be  that  they 
should  receive  suitable  treatment  in  every  case. 

My  own  feeling  is  that  this  treatment  should  be 
instituted  as  soon  as  reasonable  suspicion  exists 
that  the  case  is  one  of  typhoid  fever,  and  that  it 
should,  if  possible,  be  steadily  maintained  until  it 
may  be  thought  that  the  mucous  membrane  has 
returned  to  its  healthy  state.  It  seems  to  me 
altogether  probable,  even  despite  the  presence  of 
a  special  poison  in  the  intestinal  contents,  that 
some  control  can  be  exercised  over  the  extent  and 
progress  of  these  local  lesions  ;  and  I  must  add 
that  })rolonged  clinical  observation  has  convinced 
me  of  the  truth  of  this  view.  The  substances 
which  would  seem  most  appropriate  for  this 
purpose  are  the  salts  of  silver  and  of  bismuth  and 
creasote  or  carbolic  acid.  Of  these  my  own  pre- 
ference is  very  decidedly  for  nitrate  of  silver,  the 
use  of  which  now  constitutes  an  essential  and,  in 
my  judgment,  a  most  important  part  of  my  treat- 
ment of  typhoid  fever.  After  the  preliminary 
measures  before  described,  I  direct  nitrate  of 
silver  in  the  dose  of  one-quarter  or  one-sixth  of  a 
grain  for  an  adult,  usually  in  pill,  or  for  children 
in  solution  in  mucilage  of  acacia  three  or  four 
times  daily,  to  be  taken  soon  after  food.  If  the 
bowels  are  constipated,  extract  of  belladonna  is 
combined  ;  if  a  tendency  to  looseness  exists,  a 
small  amount  of  powdered  opium  is  added.  When 
given  in  solution,  the  opium  is  added  in  the  form 
of  a  few  drops  of  deodorized  laudanum.  Since  I 
was  led  to  the  adoption  of  this  remedy  by  the 
study  of  the  m.orbid  anatomy  of  typhoid  fever,  I 
have  acquired  a  constantly-increasing  confidence  in 
its  value  as  an  element  of  the  rational  treatment  of 
this  disease.  By  modifying,  as  I  believe  it  does, 
the  state  of  the  mucous  membrane,  it  modifies  the 
symptoms  that  are  dependent  on  the  irritation 
reflected  from  the  mucous  membrane ;  and  the 
result  has  seemed  to  me  to  be  that  in  a  long  series 
of  cases  treated  with  most  scrupulous  attention  to 
every  detail,  and  in  all  of  which  nitrate  of  silver 
was  administered,  there  has  been  a  remarkable 
freedom  from  grave  complications  and  a  most 
gratifying  percentage  of  recoveries  (ninety-seven 
per  cent.). 

As  may  be  inferred  from  the  above  remarks, 
there  does  not  seem  to  me  any  objection  to  the 
judicious  use  of  opium  in  typhoid  fever.  Not 
only  have  I  seen  it  useful  in  checking  diarrhoea, 
but  it  has  often  proved  the  most  valuable  remedy 
for  the  insomnia,  headache,  and  excessive  nervous 
excitability  that  may  be  present  in  this  disease. 
It  is  true  that  I  have  known  one  of  the  bromides 
or  chloral  or  spirit  of  chloroform  produce  good 
results  in  some  cases  where  such  symptoms  existed, 
but   far    more   frequently   I    have   succeeded   in 


THE   CANADA    MEDICAL    RECORD. 


247 


relieving  them  by  the  use  of  carefully  graduated 
small  doses  of  deodorized  laudanum,  given  alone, 
or  with  sweet  spirit  of  nitre,  or  with  a  moderate 
dose  of  bromide  of  potassium.  Not  until  opium 
has  failed,  unless  decided  constipation  exists,  do  I 
resort  to  the  use  of  chloral  or  the  bromides  alone. 

Time  will  not  allow  me  to  allude  in  detail  to 
the  measures  which  have  proved,  in  my  experience, 
most  valuable  in  the  treatment  of  the  numerous 
complications  of  typhoid  fever.  When  bronchitis 
becomes  severe  or  pneumonia  ensues,  I  substitute 
carbonate  of  ammonia  for  the  nitrate  of  silver, 
continuing  the  use  of  full  doses  of  quinia,  increas- 
ing the  amount  of  alcohol,  and  avoiding  the  use 
■even  of  sponging  with  cool  water  unless  the 
temperature  goes  over  105°  Fahr. 

By  the  observance  of  a  very  carefully  regulated 
diet  and  the  early  use  of  nitrate  of  silver  with 
minute  doses  of  opium,  the  occurrence  of  trouble- 
.some  diarrhoea  is  rendered  rare.  When  it  does 
occur,  the  diet  should  be  even  more  carefully 
guarded  and  the  amount  of  opium  be  increased, 
and,  if  necessary,  acetate  of  lead,  or  a  carefully 
prepared  mixture  of  chalk  and  bismuth,  with  an 
opiate,  be  administered.  Tympanitic  distention 
of  the  abdomen  often  results  from  the  fermentation 
of  excessive  or  unsuitable  food,  and  will  be 
relieved  by  modification  of  the  diet,  and  the 
administration  of  some  such  combination  as  the 
following  : 

9   Creasoti  purificat.,  gtt.  v  vel  x  ; 
Bismuthi  subnitratis,  3  i  vel  3iss  ; 
Tinct.  cardamomi  comp.,  f  3  iij  ; 
Aquae,  q.  s.  ad  f  5  v. 

M.  One  tablespoonful  every  six  hours. 

But  often  also  it  comes  from  a  quasi-paralytic 
condition  of  the  intestinal  coats  which  renders 
them  incapable  of  resisting  the  expansive  force  of 
the  gas  enclosed.  It  is  when  tympanitis  is  due  to 
this  latter  cause,  and  associated  with  the  general 
symptoms  of  prostration  and  with  wasted  develop- 
ment of  the  typhoid  state,  but  without  much 
diarrhoea,  that  the  internal  use  of  oil  of  turpentine 
in  emulsion  (ten  drops  every  three  or  four  hours) 
will  usually  produce  excellent  results. — Philadel- 
phia Medical  Times. 


THE    ADVANTAGES     OF     CALOMEL    IN 
THE  DISEASES  OF  CHILDHOOD. 

By  E.  Marlett  Boddy,  P.R.C.S.,  F.S.S. 

Calomel,  by  reason  of  its  purgative  properties, 
frequently  causes  green  evacuations,  and  so  does 
castor  oil  when  the  child  is  out  of  health ;  but  this 
phenomenon  of  disease  ceases  the  moment  the 
child  becomes  well.  Therefore  the  green  stools 
are  not  by  any  means  produced  by  the  calomel,  but 
are  caused  by  some  morbid  action  going  on  in  the 
intestines.  When  the  child  is  ill  the  mother  will 
almost  invariably  tell  you  that  the  evacuations  are 
green  and  slimy.    This  assertion  of  the  parent  alone 


proves  that  calomel,  when  given,  is  not  the  origin- 
ator of  green  stools,  but  that  they  are  produced  by 
some  morbific  influence.  I  think  the  color  is  very 
probably  caused  by  an  over-secretion  of  bile, 
which  will  to  a  certainty  show  itself  independently 
of  the  calomel. 

As  there  is  no  fear  of  mercurialization  arising 
from  calomel,  as  it  promotes  the  elimination  of  the 
over-secretion  of  bile,  and  as  it  restores  the  intestinal 
canal  to  its  ordinary  healthy  tone,  it  is,  without 
doubt,  the  best  purgative  we  can  possibly  administer 
in  «// diseases  appertaining  to  infancy,  ignoring  to  a 
certain  extent  those  of  a  congenital  nature.  Mer- 
curialization can  only  occur  when  the  drug  is 
allowed  to  remain  and  accumulate  in  the  system  ; 
and  to  accomplish  this  the  best  method  is  to  follow 
the  general  rule,  viz.,  the  administration  of  the 
hydrargyrum  cum  creta ;  by  so  doing  we  shall  be 
decidedly  successful.  But  as  this  result  is  not 
desired  we  shall  be  able  to  prevent  such  an  un- 
toward complication  by  administering  calomel  by 
itself  or  combined  with  a  small  amount  of  sugar. 
This  addition  is  not  at  all  necessary  ;  in  fact,  I  do 
not  understand  what  advantage  can  be  gained  by 
combinihg  the  two.  Calomel,  I  think,  is  quite  as 
efficacious  without  sugar  ;  therefore  it  can  be  well 
dispensed  with. 

Regarding  a  very  recent  sage  discovery  made  by 
a  certain  savant,  that  by  giving  to  an  infant  calomel 
and  sugar  we  may  very  likely  poison  it  through  the 
formation  of  corrosive  sublimate  while  the  com- 
pound remains  in  the  stomach,  though  chemically 
true,  yet  I  must  say  it  almost  verges  on  puerility. 
No  case  of  poisoning  has,  I  believe,  occurred 
through  the  combination  of  calomel  and  sugar,  and 
I  dare  say  never  will.  I  think  we  may  consider  it 
as  bordering  on  the  absurd  until  a  bona  fide  case 
of  poisoning  resulting  from  the  administration  of 
calomel  and  sugar  is  brought  before  the  profession 
and  thoroughly  substantiated  as  such.  The  dis- 
covery is  ingenious,  to  say  the  least  of  it ;  but  it 
is  of  no  practical  utility  when  one  considers  it  in 
the  abstract.  However,  it  is  not  for  this  chemical 
change  in  the  stomach  that  I  am  advocatirg  the 
non-administration  of  calomel  and  sugar,  but  be- 
cause I  do  not  see  what  can  be  possibly  gained 
from  the  combination  of  the  two.  In  such  matters 
we  can  only  judge  correctly  by  the  relative  value 
of  the  results  obtained  ;  and  if  calomel  produces 
that  which  is  to  be  desired  by  its  own  inherent 
quaUties  (which  are  not  in  the  least  enhanced  or 
diminished  by  the  sugar),  then  in  all  cases,  I  say, 
of  infantile  disease  we  may  with  safety  and  advan- 
tage administer  it  by  itself.  In  dropsy,  one  of  the 
sequels  of  scarlet  fever,  some  compound  jalap 
powder  may  be  combined  with  it  with  advantage, 
though  I  have  found  that  calomel  alone  is  equ  a 
as  eflicacious,  even  supposing  that  there  is  albu- 
minous urine.  Calomel  may  also  be  combined 
with  santonin  in  cases  of  worms  ;  but  of  this  anon. 

We  have  now  ascertained  conclusively,  I  think, 
that  it  is  highly  injudicious  to  give  infants  hydrargy- 
rum cum  creta,  owing  to  one  ingredient,  stultify- 


248 


TDE    CANADA    MEDICAL   RECORD. 


ing,  we  may  say,  the  action  of  the  other,  and  that 
it  may  be  left  to  discretion  whether  any  gain  may 
resuh  from  combining  calomel  with  sugar  ;  it  now 
remains  for  us  to  determine  how  we  may  i)romote 
its  action  to  a  greater  degree,  and  thereby  acce- 
lerate a  speedier  return  to  health. 

To  obtain  this  end  satisfactorily,  I  always  make 
it  an  invariable  rule  to  administer  the  calomel  at 
night,  and  the  next  morning  to  follow  it  up  with 
some  castor  oil,  which  practice  has  always  re- 
sulted by  my  expectations  being  realized.  Some- 
times, on  account  of  the  stubbornness  of  the 
bowels,  owing  to  neglect,  calomel  is  comparatively 
l^owerless  as  regards  its  purgative  qualities  ;  but  it 
never  fails  when  followed  by  the  castor  oil,  which 
seems  to  stimulate  it  to  fresh  exertions,  and 
entirely  prevents,  in  children  as  well  as  in  adults, 
the  much-dreaded  mercurialization. 

This  mode  of  treatment  is,  as  the  reader  may 
perceive,  remarkably  simple,  and  consequently  by 
some  may  be  impugned  as  being  too  much  so  ;  but 
simplicity,  to  my  mind,  is  or  should  be  the  goal  of 
all  things.  Complexity  and  abstruseness  show 
undeniable  and  unmistakable  ingenuity  and  tact, 
and  great  praise  is  due  to  those  who  can  obtain 
the  desired  end  through  the  media  of  such  chan- 
nels; but  the  great  fundamental  in  the  treatment 
of  disease  is  simplicity,  which,  if  carried  out 
successfully,  is  the  acme  of  medical  science  and 
the  perfection  of  medical  skill. 

Some  seem  to  have  a  grudge  and  a  determined 
ill-will  toward  calomel ;  no  words  and  terms  are 
too  strong  for  them  to  use  when  they  denounce  it ; 
in  fact,  they  abuse  it  with  a  hearty  good-will ;  and 
many,  I  know,  would  prefer  giving  no  medicine  at 
all  than  be  under  the  necessity  of  administering  it. 
Some  are  truly  fearful,  and  altogether  refrain  from 
using  it,  because  so  and  so  may  happen  ;  but 
what  catastrophe  one  cannot  without  great  diffi- 
culty elicit  from  them ;  and,  supposing  we  are 
successful  in  our  endeavors,  we  find  their  objec- 
tions and  reasons  very  vague  and  unsatisfactory. 
Some  will  honestly  tell  you  that  to  a  certainty 
mercurialization  will  occur,  and  that  i.s  the  sole 
reason  why  they  do  not  use  it. 

Assuming,  for  the  sake  of  argument,  the  correct- 
ness of  their  objections,  I  do  not  see  why  such  a 
result  should  necessarily  occur  if  it  be  given  with 
care.  If  a  man  chooses  to  cut  his  throat  with  a 
razor  there  is  no  reason  why  I  should  follow  his 
example,  for  I  may  use  the  very  same  implement 
for  other  purposes.  If  a  man  chooses  to  poison 
himself  with  opium,  the  same  drug  given  by  me 
may  save  another  man's  life.  So  it  is  with  calomel  ; 
if  a  man  administers  it  carelessly  and  injudiciously, 
evil  consequences  may  result ;  but  I  may  give  the 
very  same  drug,  and  good  results  will  ensue. 

This  dislike  to  calomel  is  sheer  prejudice,  and 
in  many  instances  approaches  the  whimsical.  I 
remember  being  told  by  a  great  enemy  to  calomel 
that  it  should  never  be  given  save  to  a  plowman, 
and  then  only  very  gingerly.  "  Colocynth  and 
hyoscyamus,"  said  he,  "  for  a  la  ly,  colocynth  and 


jalap  for  a  gentleman,  but  colocynth  and  calomel 
for  a  plowman."  This  absurd  injunction,  I  need 
hardly  say,  I  very  soon  found  to  be  the  quintes- 
sence of  erroneous  treatment ;  besides,  it  was 
entirely  antagonistic  to  all  common  sense  ;  for  the 
intestines  of  a  "  plowman  "  have  not  as  yet  been 
discovered  to  be  dissimilar  to  the  intestines  of  a 
"  lady"  or  "gentleman."  Perhaps  when  he  made 
the  above  remark  he  was  under  the  impression  that 
there  did  exist  a  dissimilarity,  and,  being  of  that 
opinion,  considered  that  a  different  course  of  treat- 
ment was  necessary  to  meet  the  various  peculiari- 
ties of  the  several  intestines. 

This  digression  serves  to  show  what  a  ground- 
less, illogical  abhorrence  some  have  to  calomel, 
for  no  reason  at  all  except  that  something  pre- 
judicial to  the  patient  may  possibly  occur,  but  of 
what  nature  they  are  entirely  undetermined  upon, 
unless  it  be  mercurialization,  which  is  the  only 
objection  its  opponents  can  reasonably  urge 
against  its  administration. 

In  what  diseases  or  morbid  conditions  of  infancy 
is  calomel  indicated,  and  how  should  it  be  adminis- 
tered, whether  alone  or  in  combination  ?  Infantile 
diseases  are  few  in  number  when  compared  with 
those  which  attack  the  adult,  for  the  following  very 
cogent  reasons  :  The  constitution  of  an  infant  or 
child  has  not  gone  through  the  wear  and  tear  of 
life  ;  the  lungs  have  not  yet  been  irritated  through 
inhalation  of  infinitesimal  carboniferous  matter  ; 
the  digestive  powers  have  not  yet  been  impaired 
through  the  ingestion  of  indigestible  food ;  nor 
have  the  coats  of  the  stomach  been  injured  by  the 
destructive  properties  of  alcohol,  which  is  regarded 
by  a  great  majority  as  a  necessary  staple  of 
nourishment,  and  neither  is  the  liver  disorganized 
by  habitual  drinking. 

The  most  prevalent  of  all  infantile  diseases  are 
convulsions,  proceeding  from  either  intestinal  or 
cerebral  irritation  or  from  dentition.  Those  arising 
from  intestinal  irritation  are  sometimes  induced 
primarily  from  dentition,  and  in  many  instances 
one  state  is  co-existent  with  the  other ;  and  the 
same  may  be  said  regarding  those  convulsive 
attacks  which  owe  their  origin  to  cerebral  irritation, 
though  the  latter  condition  may  exist  singly  and 
alone  ;  in  other  words,  we  may  find  one  state  com- 
plicated with  the  other. 

There  are  two  kinds  of  intestinal  irritation — that 
proceedmg  from  fecal  contents  and  that  resulting 
from  the  presence  of  worms  (which  generally  be- 
long to  the  round  variety,  though  sometimes  the 
thread-worms  are  also  provocative  of  convulsions, 
but  they  are  not  of  so  severe  a  nature,  and  they 
are  more  common  among  children  averaging  from 
two  years  and  upward,  but  rarely  found  among 
infants  at  the  breast).  Those  convulsions  proceed- 
ing from  irritation  produced  by  the  accumulation 
of  fecal  matter  are  easily  cured  if  treated  correctly, 
but  are  simply  aggravated  if  treated  in  the  usual 
style,  I.  e.,  two  or  three  grains  of  the  hydrargyrum 
cum  creta  administered  three  or  four  times  during 
the  day. 


TUE   CANADA    MEDICAL    RECORD. 


249 


All  that  these  infants  require  is  a  calomel  powder 
at  bedtime,  followed  the  next  morning  by  some 
castor  oil,  which  must  be  continued  till  the  alvine 
excreta  resume  their  normal  appearance,  which  is 
too  well  known — at  least  I  hope  so — to  my  readers 
to  need  specifying.  However,  as  it  is  the  gener- 
ally-received opinion  of  the  profession  that  calomel 
produces  green  stools,  irrespective  of  the  condi- 
tion of  the  patient,  I  do  not  think  I  shall  be  erring 
on  the  wrong  side  when  I  tell  them  that  when  an 
infant  is  in  health  the  ejecta  are  as  yellow  as  mus- 
tard, whether  it  is  administered  or  otherwise. 

When  the  convulsive  attacks  proceed  from  the 
presence  of  worms,  santonin  should  be  combined 
with  the  calomel,  and  should  always  be  given  at 
night-time,  to  be  followed  the  next  morning  by 
some  castor  oil.  This  course  should  be  per- 
severingly  persisted  in  till  the  motions  are  natural, 
which  will  very  soon  o  ccur  after  the  expulsion  of 
the  parasites.  There  is  not  the  slightest  fear  of 
mercurialization,  nor  will  the  santonin  cause  reten- 
tion of  urine,  and  neither  will  the  convulsive 
attacks  be  increased,  for  the  very  reason  that  the 
santonin  has  not  sufficient  time  to  resolve  itself 
into  xanthopsin,  on  account  of  its  being  eliminated 
by  the  castor  oil. 

If  the  convulsions  proceed  from  the  irritation 
produced  by  the  oxyuris  vermicularis,  or  the 
ascaris  vermicularis,  commonly  known  as  the 
thread  worm,  the  best  treatment  to  pursue  after 
the  motions  have  become  normal  (which  will  by 
no  means  take  place  till  the  worms  have  been  ex- 
pelled) is  to. inject  some  infusion  of  quassia  or  salt 
and  water  into  the  rectum.  This  is  comparatively 
useless  if  the  administration  of  calomel  and  its 
adjunct  (if  I  may  so  term  castor  oil)  is  omitted ; 
for  though  those  minute  parasites  are  supposed  to 
infect  the  rectum  only,  they  would  no  doubt  be 
found,  though  perhaps  fewer  in  number,  in  the 
sigmoid  flexure  and  descending  colon,  if  they  were 
searched  for  on  a  favorable  opportunity,  which 
could  only  be  in  a  post-mortem. 

Depending  simply  upon  an  injection  in  those 
cases  is  really  not  of  much  benefit ;  if  I  may  be 
allowed  to  make  a  comparison,  it  is  like  clearing 
out  the  lower  part  of  a  drain-pipe  and  leaving  the 
upper  portion  foul  and  impure. 

I  have  already  mentioned  the  treatment  which 
should  be  followed  out  during  teething,  and  I 
think  I  have  clearly  demonstrated  the  disadvan- 
tages accruing  from  the  administration  of  the 
hydrargyrum  cum  creta  and  the  advantages  result- 
ing from  calomel,  and  the  remarks  I  have  made 
regarding  them  will  also  apply  to  nearly  all  the 
diseases  which  are  prevalent  in  infancy. 

I  shall  now  pass  on  to  consider  those  other 
complaints  in  which  the  administration  of  calomel 
is  advisable.  The  most  common  after  convulsion 
is  diarrhea — a  medical  bugbear  which,  when  once 
it  commences,  frightens  the  mother  and  causes  the 
medical  man  to  resort  immediately  to  a  very  silly 
mode  of  practice,  but  which  at  the  present  day  is 
regarded  as  a  very  scientific  procedure;  and  the 


antidote  (presumed  to  be  such)  is  to  be  found  in 
the  British  Pharmacopeia,  and  accordingly  it  is 
given  with  great  faith  when  diarrhea  shows  its 
hideous  presence,  in  the  vain  hope  of — stopping  it. 

What  is  diarrhea  ?  and  what  causes  it?  and  why 
should  we  be  in  such  consternation  when  it  occurs  ? 
We  will  examine  and  answer  these  questions  from 
a  practical  common- sense  point  of  view. 

First.  What  is  diarrhea  ?  The  answer  is  simple, 
and  not  at  all  difficult  of  comprehension.  It  is 
the  endeavor  of  nature  to  get  rid  of  an  evil,  and 
the  evil  is  nothing  more  nor  less  than  a  collection 
of  fecal  matter  in  the  intestinal  canal.  In  the 
majority  of  cases  what  else  can  it  be?  If  the 
coats,  especially  the  muscular,  of  the  intestines  are 
weakened  to  any  extent  in  an  infant  there  are 
very  few  chances  of  its  ultimate  recovery,  because 
the  weakness  depends  upon  some  organic  mis- 
chief, which  is  not  to  be  remedied  by  human 
means.  Now  if  the  diarrhea  originates  from  such 
a  condition  all  the  chalk  mixture  in  the  world 
will  not  stop  it ;  and  most  probably  if  the  adminis- 
tration is  too  often  repeated  the  child  rather 
succumbs  to  the  pernicious  effects  of  the  astringent 
than  to  the  diarrhea.  Here  in  these  cases,  by-the- 
by,  we  administer  chalk  to  stop  the  action  of 
the  bowels,  and  in  other  cases  we  combine  chalk 
mercury  to  open  them — contradictory,  there  is 
no  denying ;  but  then  it  is  accounted  correct  treat- 
ment. 

Second.  What  causes  diarrhea?  The  contents 
of  the  intestinal  canal  and  the  efforts  they  make  to 
get  out — nothing  else.  They  have  done  their 
duty ;  all  nutriment  has  been  extracted  from  them  ; 
they  are  therefore  useless,  and  nothing  else  than 
an  incumbrance,  and  consequently  the  sooner  they 
are  ejected  the  better.  Nature  is  of  the  same 
opinion,  and  accordingly  sets  to  work,  and  would 
perform  her  duty  alone  and  single-handed  were 
the  fecal  contents  in  their  usual  amount  and 
normal  condition  ;  but  it  is  not  so  ;  the  infant  no 
doubt  has  been  previously  stuffed  or  rather  over- 
fed by  a  too  anxious  parent.  The  intestinal  canal 
is  too  full,  and  as  a  natural  consequence  diarrhea 
results,  which  is  the  strenuous  efforts  of  nature  to  rid 
herself  of  an  irritating  load,  which  we  scientifically 
endeavor  to  prevent  by  the  prompt  administration 
of  an  astringent  in  the  shape  of  chalk-mixture.  In 
these  cases  nature  requires  the  helping  hand  to 
lift  her  over  the  difficulty,  not  to  be  thwarted  or 
antagonized  by  the  administration  of  drugs  of  an 
astringent  tendency.  Such  treatment  is  not  only 
outrageous,  but  discreditable  to  medical  science ; 
and  I  regard  it  as  such,  however  strongly  and 
indeed  cleverly  it  may  be  advocated  by  those  who 
are  thought  more  competent  to  decide  than  others  ; 
for  the  arguments  they  advance  with  such  plausi- 
bility are  entirely  based  upon  theoretical  know- 
ledge (or  practical  ignorance)  rather  than  upon 
sound  principles  of  practice  and  careful  investiga- 
tion into  the  varied  phenomena  of  health  and 
disease.  I  am  afraid  that  we  regard  the  human 
organism  as  a  piece  of  workmanship  much  more 


250 


THE   CANADA    MFDICAL    RECORD. 


complex  in  its  design  and  working  than  it  really  is  ; 
and  again,  that  we  too  frcMiucntly  r;in  our  heads 
against  the  idea  that  we  can  mould  it  just  as  we 
please,  forgetting  that  nature  is,  on  the  average, 
able  to  conduct  her  own  proceedings  to  a  favor- 
able termination  without  the  aid  of  science,  but  is 
hindered  and  jjcrhaps  completely  impeded  by  our 
somewhat  too  great  a  hastiness  to  adopt  the  so- 
called  scientific  treatment  of  the  present  day,  and 
which,  in  infantile  diarrhea,  is  more  hurtful  than 
otherwise. 

One  question  now  remains  for  our  considera- 
tion. Why  should  we  look  upon  the  presence  of 
diarrhea  with  the  eye  of  suspicion  and  apprehen- 
sion ?  and  why  should  we  regard  the  efforts  of 
nature  to  relieve  herself  as  indicative  of  danger  ? 
I  think  we  can  easily  account  for  our  groundless 
fears  from  the  fact  that  we  clothe  simple  diarrhea 
in  so  many  technicalities  that  many  who  are  either 
too  indifferent  or  too  ready  to  take  for  granted  the 
opinions  of  others  neglect  investigating  and  prob- 
ing to  the  bottom  the  origin  of  a  condition  which 
is  quite  the  reverse  of  what  we  imagine  to  be  pre- 
judicial to  health. — Medical  Press  and  Circular. 


INCONTINENCE  OF  URINE  IN  BOYS. 

By  John  Morris,  M.D.,  of  Baltimore,  Md. 

Read  before   the   Baltimore    Medical  Association,    April 
25th,  1881. 

The  subject  to  which  I  shall  call  your  attention 
for  a  brief  period,  tonight,  is  one  of  a  practical 
character,  and  well  worthy,  I  think,  of  our  con- 
sideration. It  was  suggested  to  me  recently  by 
a  philanthropic  gentleman  of  the  city,  connected 
with  most  of  our  public  charities.  In  a  visit  with 
him  to  some  of  our  reformatories,  I  was  surprised 
to  find,  on  inquiry,  that  one  boy  in  every  twenty 
suffered  from  incontinence  of  urine.  At  the 
reformatory  for  colored  boys,  in  Prince  George's 
County,  the  ratio  is  still  greater.  On  further  in- 
quiry, too,  I  discovered  that  this  serious  trouble 
exists,  almost  to  the  same  extent,  in  many  of  our 
boarding  schools.  This  is  certainly  a  very  un- 
pleasant, if  not  a  startling  condition  of  things, 
and  has  been  entirely  overlooked  heretofore,  by 
those  having  charge  of  our  reformatory  institu- 
tions. It  may  be  possible  that  the  disease  was 
deemed  intractable,  and,  consequently,  received 
but  little  notice.  Incontinence  of  urine  in  chil- 
dren does  not,  I  think,  prevail  to  so  great  an 
extent  in  private  practice.  If  it  does,  it  is  a 
serious  reproach  to  parents  and  to  our  jjrofes- 
sion — a  reproach  which  should  at  once  be  wiped 
out,  by  proper  and  earnest  efforts  in  the  future. 
It  is  a  surprise  that  a  subject  of  so  grave  impor- 
ance  as  incontinence  of  urine  should  not  have 
received  greater  consideration  from  the  profes- 
sion. Our  text  books  afford  us  very  little  infor- 
mation in  regard   to  it,  and  every  medical  man, 


when  called  to  treat  a  case,  has  to  rely  almost 
solely  on  his  own  ex[x-ricnce.  I  shall,  in  my  ad- 
dress to-night,  confine  myself  to  nocturnal  enu- 
resis in  children,  because  we  are  more  frequently 
called  on  to  treat  this  disease  than  the  bladder 
troubles  of  old  people,  which  are  of  an  entirely 
different  character.  I  have  said  that  our  text 
books  afford  us  very  little  information  in  regard 
to  this  matter,  but  during  the  past  few  years  a 
number  of  articles  have  appeared  in  the  journals, 
containing  suggestions  of  more  or  less  value  on 
this  subject.  Before  the  api)earance  of  these 
articles  this  disease  had  been  treated  almost  at 
random,  and  nothing  of  a  scientific  character  was 
suggested  for  its  relief.  It  was  looked  on  as  one 
of  the  approbria  niedicorum,  and  its  poor  victims 
were  left  to  the  mercy  of  the  merest  empiricism. 

Incontinence  of  urine  in  old  people  is  fre- 
quently an  evidence  of  some  severe  nervous  lesion, 
but  it  is  not  so  in  the  young.  In  the  latter  it  is  a 
curable  disease,  and  exists  almost  always  indepen- 
dently of  brain  or  spinal  trouble.  It  may  result 
from  a  number  of  causes,  the  most  frequent  of 
which  are  intestinal  irritation,  acidity  of  urine, 
worms,  defective  nutrition,  feebleness  of  constitu- 
tion, and,  possibly,  teething.  A  very  frequent 
cause,  too,  is  a  nervous  temperament,  or  diathesis, 
independent  of  any  organic  disease  ;  but  the  most 
frequent  cause  of  all,  in  my  judgment,  is  a  condi- 
tion of  the  bladder,  or  rather  of  the  sphincter, 
brought  on  in  early  youth,  through  the  sloven- 
liness and  inattention  of  mothers  and  nurses. 
They  feed  the  child  with  improper  food,  and  suffer 
the  bladder  to  become  distended  before  putting  it 
to  bed.  No  attention  is  paid,  even  during  the  day, 
to  see  that  the  urine  is  voided  at  proper  intervals. 
The  consequences  of  this  inattention  are  daily 
recognized  by  medical  men  on  entering  dwellings 
and  rooms  occupied  by  these  poor,  forlorn  chil- 
dren. To  make  it  plainer,  it  is  enough  to  say  that 
the  odor  of  these  apartments  is  not  that  of  "  Araby 
the  blest." 

In  the  treatment  of  the  disease  it  is  necessary 
for  us  to  ascertain  its  origin.  The  history  of  the 
child,  and  its  habits  from  birth,  as  well  as  the 
family  history,  should  be  inquired  into.  The  urine 
should  be  tested  for  acidity,  and  the  bladder  and 
rectum,  if  needs  be,  examined.  Atony  of  the 
bladder  might,  by  causing  over-distention,  give 
rise  to  it,  or  undue  irritability  might  prove  suffi- 
cient to  overcome  the  resistance  of  the  sphincter. 
If  incontinence  be  due  solely  to  acidity  of  the 
urine,  it  is  easily  cured.  The  administration  of 
a  simple  alkali  in  combination  with  benzoic  acid 
is  all  that  is  necessary.  A  solution  of  benzoate 
of  soda,  combined  with  a  very  small  quantity  of 
belladonna,  will  be  found  very  useful  in  this  con- 
dition. This  form  of  the  disease  is  owing  to  per- 
verted secondary  assimilation.  If  the  disorder  is 
caused  by  worms,  some  anthelmintic  remedies 
will  be  required  ;  but  worms  in  this  aftection,  as 
in  many  others,  are  simply  a  bugbear.  Intestinal 
irritation,  no    matter  from  what   cause,  must  be 


THE   CANADA   MEDICAL    RECORD. 


251 


met  by  proper  agents  ;  defective  nutrition,  by  the 
use  of  cod-liver  oil,  iron,  and  a  judicious  general 
regimen,  embracing  the  cold  bath,  fresh  air, 
calisthenics,  etc. 

The  form  of  the  disease  most  amenable  to  treat- 
ment, and  which,  as  I  said  before,  is  very  common, 
is  the  purely  nervous  form.  It  is  most  frequently 
met  with  in  boys  and  girls,  of  a  lymphatic  or  scro- 
fulous temperament.  They  lose  the  co-ordinating 
power,  at  first,  from  the  will  not  being  called  on 
and  properly  exerted,  and  this  is  afterwards  kept 
up  by  habit.  In  these  cases  the  syrup  of  the 
iodide  of  iron  and  the  cold  sitz  bath  act  as  a 
specific,  particularly  if  aided  by  moral  means. 
Large  doses  of  the  iodide  of  iron  must  be  given 
to  the  big  and  strong  boys  in  public  reformatories. 
The  reason  that  syrup  of  the  iodide  of  iron  is  pre- 
ferable, in  cases  of  children,  to  other  preparations 
of  iron  is,  it  is  easily  decomposed  in  the  stomach. 
The  iodine  is  set  free,  as  Jacobi  states,  and  acts 
as  an  anti-fermentative  in  the  many  cases  of  dis- 
turbed gastric  digestion  occurring,  even  in  normal 
children  whose  circulation  has  been  disturbed,  or 
whose  gastric  secretions  are  certainly  below  their 
normal  amount,  in  consequence  of  a  deficient 
supply  of  blood.  If  nocturnal  enuresis  exists  with 
daily  incontinence,  belladonna  may  be  given  with 
the  iron  at  bedtime.  I  can  speak  with  great  con- 
fidence of  these  last  two  remedies.  I  have  given 
them  a  fair  trial,  and  in  every  instance,  save  one, 
have  they  proved  beneficial  ;  indeed,  in  my  judg- 
ment, they  are  the  only  drugs  which  have  any  real 
value  in  this  disease.  Strychnia  has  no  specific 
powers,  and  I  much  doubt  if  a  single  cure  has 
been  effected  by  it.  In  cases  of  atony,  or  paralysis 
of  the  bladder,  I  believe  it  might,  in  combination 
with  syrup  iodidi  ferri^  prove  highly  efiicacious. 
In  abnormal  irritation  of  the  bladder,  belladonna 
is  our  best  remedy,  and  far  preferable  to  conium 
or  henbane  ;  the  bromide  of  potassium  has  been 
recommended,  but  I  think  it  almost  useless.  Tinc- 
ture of  cantharides  has  no  virtue  whatever,  at 
least  I  have  obtained  no  good  results  from  its 
administration. 

In  the  purely  nervous  form  of  the  disease  that 
I  have  heretofore  described,  the  condition  of  the 
urine  is  very  singular.  It  is  voided  in  large 
quantities ;  it  is  limpid,  almost  colorless,  and  lacks 
the  normal  ingredients.  Hysterical  patients,  as 
you  all  know,  pass  enormous  quantities  of  limpid 
urine,  and  from  precisely  the  same  cause.  The 
diet  of  the  little  patients  suffering  from  this 
particular  kind  of  enuresis  is  an  important  matter. 
From  their  family  history,  peculiar  temperament, 
and  other  causes,  they  are  apt  to  be  over  indulged, 
and  the  loathsome  penalty  they  pay  is  oftentimes 
but  a  retribution  of  the  gods. 

In  mechanical  means  I  have  no  confidence 
whatever,  I  have  tried  Sir  Dominick  Corrigan's 
remedy,  the  application  of  collodion  over  the 
meatus,  but  obtained  no  good  results.  As  I  left 
it  to  the  patients  themselves  to  make  the  appli- 
cation, it  may  be  possible  that  it  was  ineffectively 


done,  or  perhaps  the  collodion  itself  was  defective 
in  quality.  I  think  it  possible  Sir  Dominick's 
suggestion  may  prove  useful  in  other  hands  and 
under  better  conditions,  and  I  shall  certainly  re- 
commend its  trial  in  the  public  institutions  I  have 
referred  to.  It  is,  at  least,  the  only  one  of  the 
mechanical  remedies  that  possesses  the  slightest 
trace  of  merit.  Of  course,  if  incontinence  of  urine 
can  possibly  be  superinduced  by  congenital  phi- 
mosis, an  operation  is  necessary.  I  invariably 
examine  the  prepuces  of  my  patients,  with  a 
view  to  the  discovery  of  any  local  trouble. 
Trousseau's  truss,  the  passage  of  a  catheter,  the 
injection  of  warm  water,  as  proposed  by  Dr. 
Braxton  Hicks,  Pluvier's  pads,  applying  a  nail  to 
the  back,  a  circular  band  around  the  pelvis,  etc., 
etc.,  are  not  only  useless,  but  injurious. 

As  to  the  kind  of  moral  means  to  employ,  I 
have  very  little  to  suggest  ;  the  judgment  of  the 
practitioner  must  be  exercised  in  each  particular 
case.  It  is  only  in  cases  of  a  purely  nervous 
character  that  the  old  mode  of  treatment,  by 
whippings  and  scoffing,  has  any  value,  if  it  has 
value  at  all.  Though  the  nervous  supply  of  the 
bladder  is  derived  from  various  sources,  and 
though  the  sympathetic  is  the  controlling  influ- 
ence, there  is  enough  of  voluntary  power  derived 
from  the  cerebro-spinal  system  to  play  an  impor- 
tant part  in  our  treatment.  It  is  this  power  that 
is  evoked  and  brought  into  action  by  the  moral 
means  before  indicated.  Hydrate  of  chloral  was 
suggested  some  years  ago,  to  be  given  in  ten-giain 
doses,  at  bedtime.  It  was  said  to  act  very  kindly, 
by  giving  rest  to  the  bladder  and  sphincter,  and 
thus  enabling  them  to  regain  their  normal  tone.  I 
have  given  it  a  trial,  but  with  no  satisfactory  re- 
sult. I  have  no  doubt  that  it  might  prove  useful 
in  cases  of  spasm  of  the  bladder.  I  shall  recona- 
mend  its  trial  on  a  larger  scale,  to  the  gentlemen 
having  charge  of  public  institutions  and  boarding 
schools,  in  a  lay  pamphlet  which  it  is  my  purpose 
to  prepare  at  an  early  day,  for  their  use.  The  pre- 
paration of  this  pamphlet  has  been  suggested  to 
me  by  the  philanthropic  gentleman  referred  to  in 
the  beginning  of  this  paper. 

I  am  convinced  that  a  fair  trial  could  be  given 
to  all  the  remedies  that  have  been  suggested  for 
incontinence  of  urine,  if  undertaken  properly  and 
systematically,  in  our  large  institutions  for  the  re- 
formation and  education  of  boys.  I  am  also  con- 
vinced that  if  the  medical  man  had  under  his  own 
immediate  charge  all  the  cases  he  is  called  to 
treat,  so  that  he  might  see  that  proper  food  was 
given,  tea  and  coffee,  or  other  slush  avoided ;  hard 
beds  and  light  bed  clothing  used  :  the  urine 
voided  at  certain  regular  hours,  particularly  before 
retiring,  in  addition  to  constitutional  remedies,  a 
far  greater  number  of  cures  would  be  effected.  As 
it  is,  he  has  to  rely  solely  on  the  few  means  that  I 
have  briefly  suggested. 

In  conclusion,  let  me  say  that  I  have  no  confi- 
dence in  any  treatment  that  is  not  constitutional 
Enuresis  is  always  a  sign  of  mental  or  physical 


252 


THE    CANADA    MKOICAL    RECORP. 


weakness  ;  the  strong  in  mind  and  body  are  never 
its  victims.  Let  our  efforts,  then,  be  directed  to 
the  building  up  of  the  physical  nature  of  our 
patients,  so  that  they  may  enjoy  that  greatest  of 
all  boons,  a  sound  mind  in  a  sound  body. — Medical 
and  Suri^ica/  Reporter,  Phtla. 


CHLORATE  OF   POTASH    IN   THK 
H/EMORRHAGIC   DL\THESL^. 

By  Alexander  Harkin,  M.I).,  Menibre  Associe  Ktrangtr 
de  la  Society  I'"ran9aisc  l''lijgiene.   I'aris. 

The  therapeutic  value  of  chlorate  of  potash  is, 
to  a  certain  extent,  recognized  by  the  profession. 
This  medicine  has  not,  however,  in  my  mind,  re- 
ceived the  attention  to  which  it  is  properly  enti- 
tled. Its  sphere  of  usefulness  has  a  much  wider 
range  than  has  been  accorded  to  it,  for  there  is 
not  in  the  catalogue  of  the  Pharmacopctia,  ac- 
cording to  my  experience,  a  single  remedy  so  many- 
sided,  whether  given  alone  or  in  combination,  as 
this  crystalline  body,  the  product  of  the  laboratory. 

At  its  introduction,  this  salt  was  principally 
recommended  as  an  antidote  to  scurvy.  It  is  now 
prescribed  for  throat  affections,  for  scarlatina,  for 
low  fevers,  for  blood-poisoning,  etc.  I  am  con- 
vinced, however,  that  it  will  yet  be  recognized  as  a 
most  potent  agent  in  the  treatment  and  cure  of  all 
maladies  dependent  on  suboxidation,  on  defective 
nutrition,  secretion,  excretion,  aeration,  and  mole- 
cular metamorphoses.  Nor  need  it  be  considered 
strange  that  important  results  should  follow 
its  administration,  when  we  remember  that  the 
elements  of  which  it  is  mainly  composed,  viz  :  oxy- 
gen and  potassium  are  indispensable  to  the  gene- 
sis of  healthy  arterial  blood,  and  to  the  recupera- 
tion of  its  nutritive  powers,  when,  after  making  the 
circuit  of  the  system,  it  returns  to  the  heart  as 
venous  blood  of  darkened  color  and  impaired 
coagulability. 

By  the  agency  of  the  first-named,  chiefly 
through  the  organs  of  respiration,  the  blood  is 
chemically  changed,  and  its  vitality  renewed  by 
the  metamori)hosis  of  the  corpuscles.  Oxygen  is, 
as  we  all  know,  required  for  other  important  pur- 
jjoses  ;  notably  for  the  conversion  of  the  phos- 
phorus and  sulphur  which  are  found  in  the  protein 
compounds  into  phosphoric  and  suljjhuric  acids, 
and  their  subsequent  combination  with  bases. 
The  other  elementary  substance,  potassium,  also 
operates  in  the  circulation  as  an  oxidizing  agent  ; 
for,  according  to  Bence  Jones,  "  alkalies  furnish, 
out  and  in  the  body,  the  most  marked  evidence  of 
assisting  in  oxidizing  actions."  This  alkali,  too, 
appears  to  subserve  another  important  purpose,  as, 
according  to  Franz  Simon,  the  basic  salts  of  potash 
and  soda  in  the  blood  serve  for  the  purpose  of  com- 
bining with  the  lactic,  fatty,  uric,  and  i)robably 
carbonic  acids  that  are  continually  secreted  during 
metamorphosis.  i^Vide  Simon's  Chemistry^  vol.  i, 
page  152). 


To  the  general  use  of  the  potato,  which  contains 
an  abundance  of  potash,  combined  with  a  vegeta- 
ble  acid,    may  fairly  be    attributed    the    rarity    of 
scorbutus  in  modern  times.     To  its  absence  as  an 
article   of  food   during   periods  of  scarcity   and 
famine   and   the  substitution  of  a  bread  and  tea 
or  rice  diet,  I  have  credited  many  cases  of  pur- 
jjura   and  scurvy   which   have   come   before  me. 
The  late  I  )r.  Baly  has  stated  that  scurvy  was  most 
prevalent  in  prisons  where  no  potatoes  were  used. 
Dr.  Garrod,  in   1848,  demonstrated  that  scorbutic 
blood  was  deficient  in  potash  ;  and.  more  recent- 
ly, Dr.    Dickinson,  in  the  pages  of  the   British 
Medical  Jourtial,  has    attributed  with   apparent 
probability,  the  existence  of  lardaceous  disease  to 
a  deficiency  of  potash   in  the  white  corpuscles. 
The  importance  of   those    elements,  considered 
singly,  will  not  be  questioned.     The  consideration 
then   arises  :    In  what  manner   do   those  agents, 
combined  as  chlorate  of  potash,  act  upon  the  sys- 
tem ?  This  can,  in  the  present  state  of  our  know- 
ledge, only  be  guessed  at ;  but.  judging  from  ana- 
logy, and  from  the  results  of  observation,  it  may 
be  surmised   that,  after  the  reception   of  a  solu- 
tion of  the  salt  in  the  stomach,  one  portion,  obey- 
ing the  law  that  governs  the  action  of  the  nitrate 
and  iodide  of  potassium,  is  immediately  carried 
out  of  the  system  by  the  kidneys,  and  may  be  de- 
tected unchanged  in    the  urine.     Another   part, 
borrowing  the  language  of  Bence  Jones,  as  applied 
to  soluble  salt  of  iron,  ''diffuses  in  the  liquor  san- 
guinis into  every  texture,  into  the  blood-globules 
and   white   corpuscles,  making   a  greater  forma- 
tion of  haemo-crystalline,  and  thereby  promoting 
that   combination   with    protagon,    on  which   the 
formation     of     new     blood-globules     depends." 
And,      further :      "  By   dialysis,     all     crystalloid 
medicines     act    as      directly     on     the    textures 
as  on  the  blood  ;  they  act  according  to  their  chem- 
ical power  when  they  enter  the  textures,  and  accord- 
ing to  the   chemical  and   physical    properties   of 
which  the  different  textures  are  composed."     The 
remainder  is   supposed  to  part  with  three  equiva- 
lents of  oxygen  in  the  blood,  leaving,  as  a  residu- 
um, chloride  of  potassium,  which  is  found  in  the 
urine  as  well  as  in    the  blood  of  which  it  is  a  nor- 
mal constituent.     The  probability  of  the  theory  of 
direct  absorjjtion  of  these  equivalents  of  oxygen  is 
strengthened  by  observation,  which  shows  that  the 
constitutional  changes  induced  by  the  persevering 
use  of  chlorate  of  potash  are  similar  to  those  as- 
cribed by  Beddoes,   Hill,  Thornton,   Birch,  and 
other  writers,  to  the  direct  inhalation  of  oxygen  gas, 
viz  :    an  improvement  in    color,  an    increase  of 
vital  and  nervous  energy  and  physical  power,  and 
the  more  healthful  performance  of  all  the  nutritive 
and  secretory  functions  of  animal  life. 

It  is,  however,  with  chlorate  of  potash  as  a  hae- 
mostatic remedy  that  we  are  at  present  concerned  ; 
and  it  shall  be  my  endeavor  to  demonstrate  that,, 
in  its  intelligent  use,  will  be  found  a  definite  re- 
medy for  a  specific  diathesis,  thus  fulfilling  with- 
in its  own  limits  the    prediction  of  John  Simon, 


THE    CANADA    MEDICAL    RECORD. 


253 


"  that  the  results  of  empirical  and  popular  observa- 
tion will  be  transcended  and  eclipsed  by  the  posi- 
tive results  of  rational  pathology ;  that  diseases 
will  presently  yield  to  philosophical  investigation 
what  they  have  refused  to  blundering  quackery  ; 
and  that  \viihin  the  lifetime  of  many  here,  there 
will  be  specific  treatment  of  each  diathesis,  found- 
ed on  an  exact  knowledge  of  the  physiological  laws 
of  its   manifestation."     (General  Pathology^    p. 

When  we  inquire  what  is  the  condition  of  the 
blood  in  the  ha;morrhagic  diathesis,  we  find  that 
it  coagulates  with  difficulty,  that  it  has  a  soft  clot, 
that  it  is  not  buffed,  that  it  shows  a  diminished  pro- 
portion of  fibrine  ;  and  that,  along  with  this  de- 
praved state  of  the  blood,  there  is  a  coresponding 
abnormal  delicacy  of  structure  in  the  capillaries 
and  minute  vessels,  which  are  easily  torn,  and  are 
wanting  in  contractile  power  and  tonicity. 

In  this  condition,  the  slightest  cut  or  scratch 
may  lead  to  excessive  hemorrhage  ;  a  trifling 
contusion  to  extensive  extravasation  under  the 
skin.  For  this  dyscrasia,an  antidote  is  needed  that 
shall  increase  the  fibrin  of  the  blood,  add  to  its 
plasticity  and  chemico-vital  constituents,  and  that 
shall  also  tend  to  restore  the  contractile  power  of 
the  capillaries  and  smaller  vessels.  That  chlorate 
of  potash,  whether  alone  or  in  combination  with  a 
soluble  salt  of  iron,  is  possessed  of  these  proper- 
ities,  and  has  the  power  of  controlling  the  various 
manifestations  of  the  htemorrhagic  diathesis  of 
the  human  system,  an  experience  extending  over 
more  than  twenty  years  has  thoroughly  convinced 
me.  To  detail  at  length  the  evidence  upon  which 
this  conviction,  is  founded  is  forbidden  by  the 
space  at  my  disposal.  It  shall  be  my  duty,  how- 
ever, to  report  some  examples  of  the  salutary 
influence  of  this  remedy  in  several  of  the  most 
important  lesions  of  this  group  ;  and  my  first  illus- 
tration shall  be  drawn  from  a  case  of  haemorrhage 
from  the  bowels. 

On  December  i8th,  1867,  F.  C,  a  constable, 
aged  27,  of  spare  habit,  residing  at  Boyne  Bridge, 
Belfast,  after  returning  at  night  from  the  music 
hall,  found  his  boots  full  of  blood,  the  source  of 
which  he  traced  to  the  rectum  ;  next  day  he  had 
medical  advice,  and  remained  under  the  care  of 
several  experienced  practitioners  in  hospital  till 
February  14th  following,  without  receiving  any  be- 
nefit. He  then  sent  for  me.  On  examination  I 
could  not  discover  any  sign  of  fissure  or  haemorr- 
hoids, the  blood  seeming  to  flow  from  a  congested 
state  of  the  mucous  membrane  of  the  rectum.  I 
prescribed  rest,  and  a  mixture  composed  of  one 
ounce  of  chlorate  of  potash  and  twenty  ounces  of 
water;  dose,  one  ounce  three  times  daily.  After  the 
first  day  he  began  to  improve,  and  on  the  third 
every  trace  of  the  disease  had  disappeared.  With 
the  exception  of  a  slight  return  after  an  interval  of 
two  years,  he  has  been  quite  free  ever  since,  one  or 
two  doses  of  the  mixture  having  sufficed  to  relieve 
him.  I  have  had  occasion  to  see  him  officially  very 
often  since  that  time.     He  is  now  a  strong,  robust 


man,  and  he  attributes  the  change  in  his  constitution 
to  the  use  of  the  mixture^  which  he  persevered  with 
for  a  time. 

Hccmophilia  :  Epistaxis. — A.  B.,  aged  18,  tall, 
of  florid  complexion,  engaged  in  a  large  concern 
near  Belfast,  established  for  the  manufacture  of 
the  textile  fabrics  for  which  that  town  is  remark- 
able, suffered  so  much  from  a  continual  dropping 
of  blood  from  the  nose,  caused  by  dust  from  the 
flax,  that  he  feared  he  should  have  to  relinquish  the 
business.  His  family  history  is  remarkable,  his 
father  having  been  subject  to  many  and  severe  at- 
tacks of  epistaxis,  sometimes  persisting,  in  despite 
treatment,  for  a  month  at  a  time.  Another  mem- 
ber of  the  family  suffered  in  the  same  way  after  the 
extraction  of  a  tooth  ;  a  wound  on  the  skin,  as  by 
shaving,  giving  rise  to  most  troublesome  bleeding. 
Having  been  asked  by  a  friend,  in  the  end  of  1874, 
to  prescribe,  in  absentia,  I  ordered  a  mixture, 
which  was  forwarded  to  him,  containing,  as  in  the 
previous  case,  an  ounce  of  the  chlorate  dissolved 
in  twenty  of  water,  but  with  the  addition  of  one 
drachm  of  the  tinctura  ferri  perchloridi ;  dose  as 
above.  A  fortnight  after,  the  young  man  called  to 
thank  me  for  his  cure.  Nearly  five  years  have  since 
elapsed  without  a  relapse,  save  on  one  occasion, 
when,  having  lost  a  train,  he  ran  a  distance  of  two 
or  three  miles,  when  a  slight  bleeding  occurred, 
which  was  staunched  by  his  pocket  handkerchief. 

Hccmaturia  Renalis. — W.  McN.,  aged  25,  a 
saddler  by  trade,  living  at  Albert  Bridge  Road, 
Belfast,  of  very  delicate  constitution  and  deform- 
ed spine,  and  subject  to  lumbar  pains,  consulted  me 
in  July,  1863,  for  a  very  profuse  discharge  of  bloody 
urine,  which  had  troubled  him  for  many  months, 
and  for  which  he  had  been  treated  ineffectually  by 
several  medical  men.  The  blood  came  in  large 
quantities,  mixed,  but  not  suspended,  in  the  urine, 
apparently  from  the  kidney ;  the  bladder  was 
healthy  and  free  from  calculus,  having  been  care- 
fully sounded  by  my  friend  Dr.  Murney.  I  tried 
for  a  time  a  number  of  styptics,  etc.,  in  vain  ; 
among  the  rest  the  tincture  of  iron ;  when  on  re- 
curring to  my  favorite  remedy,  and  joining  to  the 
iron  the  chlorate  of  potash  in  the  usual  dose,  im- 
mediate relief  was  the  result.  For  a  period  of 
twelve  years  the  man  was  subject  to  periodical 
returns  of  the  affection,  perhaps  twice  in  the  year. 
His  custom  was  to  have  the  prescription  renewed, 
generally  without  reference  to  me  and  with  the 
same  happy  result ;  he  was  thus  enabled  to  continue 
at  his  trade,  and  to  assist  his  friends,  until  the 
month  of  August,  1875,  when,  having  taken  a 
long  drive  upon  a  rough  road  the  hemorrhage  re- 
curred with  great  violence,  and  the  attack  termi- 
nated fatally  in  ten  days.  I  had  not  the  oppor- 
tunity of  post-mortem  examination. 

Purpura  Hcemorrhagica. — I  was  requested  by- 
some  charitable  ladies,  in  the  summer  of  1865,  to 
visit  a  factory  worker  named  Hagan,  who  lived  at 
58  Mary  street.  Falls  Road.  She  had  been  con' 
fined  to  bed  for  thirteen  weks,  and  been  carefully- 
attended  by  the  dispensary  doctor  of  her  own  and 


25  i 


THE    CANADA    MEDICAL    RECORD. 


the  Shankhill  districts.  I  found  her  much  ex- 
hausted by  a  continuous  drain  of  blood  proceeding 
from  the  gums,  nose,  bowels,  vagina  and  bladder. 
She  was  profusely  covered  with  purple  macuhie  on 
the  chest,  arms,  legs  and  abdomen.  Her  diet  had 
consisted  for  months  exclusively  of  bread  and  tea, 
alternated  with  rice,  with  little  milk,  potatoes  being 
scarce  and  dear,  and  not  having  any  one  to  cook 
them.  I  advised  a  complete  change  of  diet,  and 
prescribed  the  usual  mixture.  When  I  called  to 
see  her  at  the  expiry  of  a  week,  she  opened  the 
door  herself,  quite  recovered,  all  bleeding  having 
ceased  ere  the  mixture  was  finished.  As  a  later 
example,  I  may  give  the  case  of  Sarah  Flanagan, 
aged  12,  an  inmate  of  the  St.  Patrick  Industrial 
School,  Belfast,  whom  I  visited  on  May  8th,  1878, 
suffering  from  bleeding  from  the  nose  and  gums, 
her  body  being  dotted  freely  with  the  characteristic 
purple  spots.  In  her  case,  two  drachms  of  the  salt, 
with  thirty  minims  of  the  tincture  of  iron,  effected 
a  cure,  every  trace  of  the  disease  having  disap- 
peared within  a  week.  Her  diet  was  of  course 
looked  after. 

Afcnorr/iagia. — Miss  L.,  a  school  teacher,  aged 
38,wan  and  feeble,  very  tall  and  delicate,  consulted 
me  for  a  discharge  of  blood,  which  had  continued, 
with  short  intervals,  after  a  menstrual  period  sev- 
eral months  previous.  She  suffered  from  severe 
pain  in  the  back,  from  palpitation,  and  the  other 
constitutional  symptoms  consequent  on  a  con- 
tinuous drain.  She  had  tried  various  remedies 
prescribed  by  other  medical  men  without  effect.  I 
advised  relaxation  from  her  duties  for  a  time,  and 
the  chlorate  and  iron  mixture.  I  saw  her  some 
time  afterwards  ;  her  color  began  to  improve,  the 
discharge  diminished,  and  finally  disappeared. 
The  mixture  was  renewed,  and  taken  occasionally 
as  a  preventive. 

Hemorrhage  from  the  womb. — Mrs.  McS., 
mother  of  five  children,  called  my  attention  to 
a  profuse  discharge  of  blood,  which  had  recurred 
a  fortnight  after  her  previous  confinement.  On 
examination  with  the  speculum,  I  discovered  abra- 
sion of  the  OS,  from,  which  the  blood  flowed.  She 
was  treated  topically  by  the  application  of  strong 
perchloride  of  iron  and  by  the  internal  use  of  the 
mixture.  The  case  was  rather  tedious,  but  she  al- 
ways spoke  of  the  sustaining  power  of  the  mix- 
ture, and  the  sinking  feeling  which  occurred  when 
the  dose  was  intermitted.  She  recovered  in  about 
a  fortnight. 

Htcmatemesis  :  Heemoptysis. — There  yet  remain 
two  highly  important  lesions  for  consideration,  in 
the  treatment  of  which,  when  they  can  be  traced  to 
the  haemorrhagic  diathesis,  this  remedy  has  invar- 
iably proved  beneficial,  especially  as  its  adminis- 
tration need  not  contraindicate  the  use  of  more 
energetic  haemostatics,  such  as  ergot  of  rye,  ergot- 
in,  given  hypodermically  or  otherwise,  ice,  acetate 
of  lead,  tannic  or  gallic  acid,  etc.,  if  given  at  suffi- 
cient intervals.  In  cases  of  haematemesis  due  to 
malignantdisea.se  of  the  stomach,  liver  or  spleen, 
and  in  those  cases  of  heemoptysis  caused  by  hyper- 


trophy of  the  right  ventricle,  in    pulmonary  apc- 
[>lcxy   due    to  a    peculiar  condition  of  the  paren- 
chyma.or  from  haemorrhage  caused  by  the  breaking 
down  of  a  tubercular  deposit,  and  the  laceration  of 
an  artery  passing  through  the  deposit,  it  is  not  to 
be  expected  that  a  constitutional  remedy  .should  be 
solely  depended  on  ;  but  when  a  state  of  pulmon- 
ary plethora  exists,  evidenced  by  an  effusion   of 
blood  from  the  mucous  membrane,  in  the  absence 
of  pulmonary  disorganization,  and   in  those  cases 
where  a  sudden   cessation  of  an   accustomed  dis- 
charge, menstrual  or  otherwise,  causes  congestion 
of  the  mucous  membrane  of  the  stomach  or  of  the 
bronchial    tubes,    and    vicarious   discharge  from 
either,  then  the  liberal  administration  of  the  chlorate 
of  potash  and  iron  will  be. found  as  salutary  and 
satisfactory  as  in  the  other  phases  of  the  disease. 
Having  thus  presented  a  few  typical  cases,  be- 
hind which,  had   opportunity  permitted,  I  might 
have  marshaled  a  host  of  equally  striking  examples, 
I  have  but  to  remark  that, while  it  is  the  duty  and 
the  instinct  of  the  physician,  after  obtaining  satis- 
factory results  from  any  remedy  to  seek  for  and  to 
theorize  upon  the  modus  operandi  of  that  remedy 
it  is  wise,  while  he  remains  steadfast  and  immov- 
able  upon  the  basis  of  practical  experience,  to 
advance   with  diffidence  and  reserve  the  solution 
which  to  him  appears  satisfactory  but  which  others, 
equally  or  better  fitted  to  judge,  may  not  believe  to 
have  passed  beyond  the  region  of  hypothesis,  lest, 
in  condemning  the  superstructure,  the  foundation 
itself    may   suffer  in    their    estimation. — British 
Medical  Journal. 


TREATMENT  OF   SPRAINS. 

Mr.  R.  Dacre  Fox,  Surgeon  to  the  Manchester 
Southern  Hospital,  in  a  communication  to  the 
British  Medical  Journal,  Sept.  25,  1880,  makes 
the  following  interesting  observations,  on  the  treat- 
ment of  sprains  : — 

The  frequency  with  which  sprains  occur  in  gene- 
ral practice,  and  the  somewhat  unsatisfactory  results 
of  the  treatment  ordinarily  adopted,  induce  me  to 
bring  forward  a  method  that  I  have  used  in  a  great 
many  cases  with  considerable  success.  Sprains 
may  be  broadly  divided  into  two  kinds,  mild  and 
severe  ;  the  former  consisting  merely  of  a  temporary 
over-distension  of  the  parts  around  a  joint,  which 
rest  and  anodyne  applications  usually  soon  cure  ; 
the  latter  involving,  as  I  believe,  much  more  seri- 
ous pathological  results,  which  the  following  plan 
is  especially  contrived  to  obviate. 

'i'he  effects  of  a  severe  sprain  are,  that  the  fi- 
brous ligaments  controlling  the  movements  of  the 
joint  and  binding  the  tendons  in  their  grooves 
become  over-stretched,  swollen,  and  softened ;  the 
cellular  tissue  about  the  ligaments  and  in  the  ten- 
don-grooves becomes  cedematous  ;  and  plastic 
material  is  exuded  ;  while,  as  a  consequence  of 
these  changes,  the  tendons  are  displaced  in  their 


THE    CANADA    MEDICAL    RECORD. 


255 


beds.  If  this  condition  be  not  actively  treated,  it 
may,  and  often  does,  lead  to  continued  lameness 
due,  in  all  probability,  partly  to  a  diminution  in  the 
calibre  of  the  tendon-groove,  with  impaired  mus- 
cular action,  and  partly  to  the  torn  ligaments  and 
bruised  cellular  tissue  having  undergone  changes 
which  render  them  incapable  of  adapting  them- 
selves to  the  movements  of  the  joint,  which  are 
consequently  impeded.  I  believe  this  result  may 
be  prevented  by  the  application  of  firm,  direct 
equal  pressure,  applied  manually  at  first,  and  kept 
up  and  controlled  by  pads  placed  in  the  line  of 
the  tendons,  and  kept  in  position  by  properly- 
shaped  plasters  and  bandages,  and  sometimes  by 
splints.  This  pressure  helps  to  disperse  the  oede- 
ma, to  replace  the  tendon  in  its  normal  position, 
to  hasten  the  absorption  of  any  plastic  exudation, 
and  thus  to  prevent  diminution  in  the  calibre  of 
the  tendon-groove.  I  cannot  say  this  is  a  novel 
method  of  treatment ;  but  I  think  it  is  one  not 
usually  practised,  partly  because  it  entails  the 
expenditure  of  much  time  and  trouble,  and  partly,  I 
feel  sure,  because  there  is  and  has  been  a  tendency 
to  underestimate  the  inconvenience  and  distress 
arising  from  a  badly  sprained  joint. 

The  common  practice,  in  treating  a  sprain,  is  to 
put  on  a  bandage,  telling  the  patient  to  take  it  off 
if  the  joint  becomes  painful,  and  to  substitute  warm- 
water  fomentations.  When  the  swelling  has  sub- 
sided, if  the  injury  be  not  so  slight  as  to  be  already 
cured,  a  liniment  or  the  application  of  iodine  is 
generally  ordered.  Very  frequently  the  tight  ban- 
dage causes  inflammation,  while  the  rubbing  and 
painting  are  practically  useless.  There  are  num- 
bers of  cases  of  slight  sprain,  indeed,  which  will 
get  well  with  comparatively  little  treatment  or  none 
at  all ;  but  in  that  more  severe  form  where  after  an 
inflammatory  or  at  least  exceedingly  hypergemic 
stage,  swelling  takes  place  with  the  results  I  have 
described,  the  application  of  these  remedies  does 
not  prevent  the  joint  from  being  left  rigid,  painful, 
and  unfit  for  use  for  a  very  long  period.  Now  it 
is,  as  I  have  said,  in  preventing  all  this,  that  the 
plan  of  treatment  by  direct^  equal,  and  continuous 
pressure  will  be  found  exceedingly  valuable  ;  for, 
where  it  has  been  properly  carried  out,  I  have 
always  found  that  the  joint  returns  quickly  to  its 
normal  condition — pain  being  speedily  relieved, 
and  rigidity  prevented.  The  treatment  may  be 
divided  into  two  stages  ;  the  first  lasting  from  a 
day  to  a  week  or  longer,  during  which  the  treat- 
ment has  to  be  directed  to  averting  inflammation 
by  rest,  warm  applications,  anodyne  lotions,  etc.  ; 
the  second  commencing  when  the  joint  has  become 
cold,  swollen,  and  painful  on  movement — in  fact, 
when  the  injury  has  assumed  a  more  or  less 
chronic  character.  It  is  during  this  second  period 
that  I  believe  the  active  treatment  I  advocate 
ought  to  be  employed.  It  is  important  not  to 
commence  this  until  the  surface-heat  is  normal  ; 
for  undoubtedly,  when  any  tendency  to  inflamma- 
tion exists  in  the  tendon-sheath,  pressure  aggra- 
vates it,  and  I  have  known  it  to  lead  to  untoward 
results. 


It  is,  of  course,  impossible,  within  the  limits  of 
this  paper,  to  describe  the  special  adaptation  of  this 
method  to  each  joint;  but  I  will  take  as  an  illustra- 
tion the  ankle.  If  a  wire  be  passed  round  the 
joint  so  as  to  impinge  on  the  two  malleoli  and  the 
tendo  Achillis,  it  will  define  three  or  four  well- 
marked  hollows :  one  on  each  side  of  the  tendo 
Achillis  behind  each  malleolus,  one  in  front  of  the 
fibula,  with  a  fourth  shallower  one  in  front  of  the 
tibia.  When  the  ankle  is  severely  sprained  these 
fossae  become  obliterated,  and  are  filled  up  with 
effusion,  over-stretched  ligaments,  and  displaced 
tendons. 

Observation  has  led  me  to  believe  that  there  are 
very  k\v  sprained  ankles  in  which  muscular  dis- 
placement to  some  degree  does  not  take  place.  It 
most  commonly  occurs  in  front  of  the  outer  malleo- 
lus, involving  the  outer  part  of  the  annular  liga- 
ment, the  extensor  longus  digitorum,  and  the  ante- 
rior fasciculus  of  the  external  lateral  ligament; 
next,  perhaps,  the  posterior  peroneo-tarsal  ligament 
and  structures  behind  the  external  malleolus.  Cases 
of  similar  over-stretching  and  displacement  on  the 
inner  side  of  the  ankle  are  happily  rare ;  but  in 
gravity  they  bear  much  the  same  relation  to  the 
former  as  a  Pott's  dislocation  does  to  a  simple 
fractured  fibula.  I  will  assume  an  ankle-joint  has 
sustained  a  severe  sprain  all  round,  and  has  arrived 
at  the  chronic  stage :  modifications  of  the  treat- 
ment of  such  a  case  will  meet  all  that  are  likely  to 
occur.  To  carry  out  the  first  principles  of  treat- 
ment by  direct,  equal,  and  continuous  pressure,  it 
is  clear  the  fossae  mentioned  above  must  be  filled, 
or  rather  their  sites  covered  by  pads  so  as  to  cause 
the  retaining  plasters,  bandages  and  splints  to 
exercise  equal  pressure  everywhere.  By  making 
pressure  with  the  thumb  from  below  upwards  in  the 
line  of  the  fossae,  a  good  deal  of  the  oedema  may  be 
sqeezed  away  and  the  displaced  tendons  in  some 
degree  restored.  I  make,  as  a  rule,  five  pads  (of 
tow  and  lint  or  leather)  :  two  about  four  inches 
long  by  one  inch  wide  (one  a  little  shorter  than 
the  other,  so  as  to  be  better  adapted  to  the  curve 
extending  upwards  from  the  dorsum  of  the  foot  to 
the  crest  of  the  tibia)  another  shorter,  broader,  and 
thinner,  to  place  over  the  tibialis  anticus  and  ex- 
tensor proprius  pollicis ;  and  two,  three  or  four 
inches  long,  and  bolster-shaped,  to  fill  in  the  poste- 
rior fossae  on  each  side  of  the  tendo  Achillis.  It  is 
often  advisable,  in  old-standing  cases,  to  supple- 
ment the  pads  by  strips  of  plaster  to  insure  firmer 
pressure.  Both  pads  and  strips  of  plaster  should 
be  made  exactly  to  fit,  as,  if  too  large,  they  are 
useless,  from  the  pressure  being  too  diff'used  ;  and, 
if  too  small,  they  exercise  too  little  pressure.  A 
moment's  consideration  will  render  this  obvious. 
If  too  large  a  pad,  for  instance,  be  placed  over  the 
outer  post  malleolar  fossa,  its  edges  rest  on  the 
tendo  Achillis  and  outer  malleolus  like  the  piers  of 
an  arch,  leaving  the  fossa  itself  untouched.  To 
keep  these  pads  in  their  place,  I  use  along  extend- 
ed half-moon  shaped  piece  of  plaster  (emplastrum 
saponis,  spread  on  leather),  long  enough  for  the 
ends  to  overlap  in  front  when  the  heel  is  placed  in. 


256 


TUE    CANADA   MEDICAL   KECORD. 


the  centre,  and  a  narrow  oblong  piece  above  this, 
placed  round  the  lower  part  of  the  leg,  to  cover 
the  upper  part  of  the  pads.  The  handiest  way  to 
apply  the  pads  is  to  place  an  India-rubber  band 
above  the  ankle,  to  slip  the  pads  under  it,  and  then, 
planting  the  heel  in  the  centre  of  the  curved  plaster 
to  bring  the  two  ends  across  the  front  of  the  joint 
so  as  to  overlaj).  'i'he  pads  having  been  secured 
in  position,  the  elastic  ring  is  to  be  cut,  and  the 
oblong  piece  of  plaster  i)ut  on  so  as  to  encircle 
their  upjier  ends  ;  lastly  the  whole  ankle  is  to  be 
firmly  bandaged.  Amongst  the  working  classes, 
or  in  the  case  of  an  uncontrollable  patient,  it  is 
advisable  to  apply  two  thin  splints  over  the  ante- 
rior ])ads,  keeping  them  in  position  by  a  long  strip 
of  adhesive  plaster.  Where  there  is  much  superfi- 
cial ecchymosis,  where  there  are  buUce,  or  where 
there  is  unhealthy  looking-skin,  instead  of  using 
soap-plaster,  the  pads  may  be  kept  in  position  and 
pressure  maintained  by  a  piece  of  lint  on  which 
ointment  has  been  spread.  Calamine  ointment, 
made  stiffly,  is  clean,  and  not  uncomfortably  greasy. 
If,  as  occasionally  happens,  even  this  should  cause 
irritation,  warm  wet  lint,  covered  by  oiled  silk, 
may  be  advantageously  used  over  the  pads,  and 
secured  by  a  firm  bandage  ;  but  neither  of  the.se 
applications  can  compare  in  eflnciency  with  the 
soap-plaster  sj)read  on  leather. 


REMEDIES  FOR  HEADACHE. 

The  following  recipes  and  suggestions  for  the 
treatment  of  different  forms  of  headache  are  col- 
lected from  a  variety  of  trustworthy  sources  : 

Two  grains  citrate  of  caffeine,  in  capsule,  taken 
every  halfhour,  is  a  very  effectual  remedy  in 
nervous  and  sick  headache.  One  or  two  doses 
are  often  sufficient  to  give  complete  relief  The 
only  objection  to  its  use  is  sleeplessness,  which 
sometimes  results  if  it  is  taken  in  the  evening. 
It  is  preferable  to  guarana,  as  being  hardly  ever 
rejected  by  the  stomach. 

The  following,  according  to  Dr.  W.  W.  Carpenter, 
is  very  effectual  in  most  forms  of  headache  : 

Muriate  of  ammonia,  3  drachms  ;  acetate  of 
morphia,  i  grain  ;  citrate  of  caffeine,  30  grains  ; 
aromatic  spirits  of  ammonia,  i  drachm  ;  elixir  of 
guarana,  4  ounces  ;  rose  water,  4  ounces.  Mix. 
Dessert-spoonful  every  ten  or  twelve  minutes. 

In  nervous  headache.  Dr.  W.  A.  Hammond 
states  the  value  of  various  drugs  as  follows  : 

Oxide  of  zinc  is  of  great  value.  Ordinary  dose, 
2  grains  three  times  a  day,  after  meals  ;  maximum 
dose,  5  grains.     It  is  best  given  in  form  of  pills. 

Nux  vomica  is  preferable  to  strychnia.  The 
dose  is  l^  grain,  after  meals.  If  the  i)atient  is 
chlorotic,  it  is  well  to  comV)ine  a  grain  of  reduced 
iron  and  3^  grain  sulphate  of  quinine. 

Bismuth,  in  the  form  of  subcarbonate,  will  often 
take  the  place  of  oxide  of  zinc.     Dose,  2  grains 
after  each  meal.    Bismuth  probably  aids  digestion 


more  than  any  mineral  tonic,  and  is  of  use  when 
there  is  gastric  disturbance. 

The  bromides  are  serviceable  when  the  nervous 
system  has  been  irritated  ;  when  it  is  exhausted, 
they  do  harm. 

Phosphorus  is  very  useful  in  most  forms  of  ner- 
vous headache.  The  best  results  are  obtained 
from  dilute  phosphoric  acid,  in  doses  of  30  drops, 
largely  diluted,  three  times  a  day,  after  eating,  or 
phosphide  of  zinc,  I'o  grain,  in  pill,  three  times  a 
day. 

Arsenic,  as  a  nerve  tonic,  stands  next  in  value 
to  zinc.  Dose,  5  drops,  three  times  a  day,  after 
meals. 

Galvanism  is  sometimes  valuable,  but  by  no 
means  a  specific.  The  constant  current  should 
always  be  used,  being  careful  to  avoid  too  great 
intensity,  lest  amaurosis  be  produced. 

Dr.  T.  Lauder  Brunton,  editor  of  the  London 
Practitioner,  says  : 

The  administration  of  a  brisk  purgative,  or 
small  doses  of  epsom  salts,  three  times  a  day,  is  a 
most  effectual  remedy  for  frontal  headache  when 
associated  with  constipation  ;  but  if  the  bowels  be 
regular,  the  morbid  processes  on  which  it  depends 
seem  to  be  checked,  and  the  headache  removed 
even  more  effectually,  by  nitro-muriatic  acid, 
diluted,  10  drops  in  a  wine-glass  of  water,  or 
bicarb,  soda,  10  grains,  in  water,  before  meals. 
If  the  headache  be  immediately  above  the  eye- 
brows, the  acid  is  best ;  but  if  it  be  a  little  higher 
up,  just  where  the  hair  begins,  the  soda  appears  to 
be  the  most  effectual.  At  the  same  time  that  the 
headache  is  removed,  the  feeling  of  sleepiness  and 
weariness,  which  frequently  leads  the  patient  to 
complain  that  they  rise  up  more  tired  than  they 
lie  down,  generally  disappears. 

A  writer  in  the  London  Lancet  remarks  : 
At  the  Middlesex  Hospital,  female  ])atients  who 
have  suffered  many  years  from  sick  headache, 
evidently  of  an  hereditary  character,  have  been 
greatly  benefited,  if  not  cured,  by  the  administra- 
tion of  ten  minimum  doses  of  tincture  of  Indian 
hemp,  three  times  daily,  between  the  attacks. 
This  is  well  worthy  of  trial  in  those  cases  of  never- 
living,  ever-dying,  martyrdom-like  suffering. 

In  headache  due  to  determination  of  blood  to 
the  head  and  in  fever,  the  following  simple  treat- 
ment is  to  be  commended  : 

Put  a  handful  of  salt  into  a  quart  of  water,  add 
an  ounce  of  spirits  of  hartshorn  and  half  an  ounce 
of  spirits  of  camphor.  Cork  the  bottle  tightly,  to 
prevent  the  escape  of  the  spirit.  Soak  a  piece  of 
soft  cloth  with  the  mixture  and  apply  it  to  the 
head  ;  wet  the  rag  fresh  as  soon  as  it  gets  heated. 
Soaking  the  feet  in  very  warm  water,  in  which 
a  spoonful  t)f  mustard  has  been  stirred,  is  also 
beneficial   n  drawing  the  blood  from  the  head. 

Two  caspoonfuls  of  powdered  charcoal,  well 
stirred  in  half  a  glass  of  water  and  drank  at  once, 
is  a  valuable  remedy  in  sick  headache  from  sour 
stomach,  flatulence,  etc. 

Tincture  of  nux  vom  ca    is    recommended  by 


THE   CANADA    MEDICAL    KECORD. 


257 


Ringer  as  possessed  of  real  curative  powers,  when 
given  in  drop  doses,  repeated  every  five  or  ten 
minutes  for  eight  or  ten  doses,  and  then  continued 
at  longer  intervals,  for  sick  headache,  accompanied 
with  acute  gastric  catarrh,  whether  due  to  error  in 
diet,  constipation,  or  no  apparent  cause. — Boston 
fourna!  of  Chemistry. 


HOT    WATER    INJECTIONS    FOR    POST- 
PARTUM HEMORRHAGE. 

This  use  of  hot  water,  as  recommended  by 
Emmet,  appears  to  be  more  and  more  appreciated 
across  the  Atlantic.  Dr.  Atthill,  Dublin  Jourtial 
of  Medical  Science^  says  that  this  treatment  has 
proved  eminently  satisfactory.  It  has,  indeed, 
much  to  recommend  it,  for  not  only  is  it  a  power- 
ful hemostatic  and  excitant  of  uterine  contraction, 
but  it  is  also  a  general  stimulant.  If  used  with 
ordinary  care,  it  is  not  only  harmless,  but  bene- 
ficial, by  thoroughly  cleansing  the  uterus  from 
clots,  portions  of  membrane,  etc.,  which  may  have 
been  left  in  its  cavity.  It  will  not,  in  Dr.  Atthill's 
opinion,  be  found  altogether  to  displace  the  use 
either  of  cold  water  or  of  the  perchloride  of  iron, 
but  rather  to  be  appHcable  to  a  distinct  class  of 
cases,  in  which  the  former  of  those  remedies 
would  be  unsuitable,  and  the  latter  unnecessary. 
The  method  of  carrying  out  the  practice  is  exceed- 
ingly simple.  An  ordinary  syphon  syringe  is  the 
only  instrument  required,  though  we  now  use  one 
with  a  long  vulcanite  nozzle,  specially  constructed 
for  vaginal  and  intra-uterine  injection.  This  is 
carried  up  to  the  fundus,  and,  with  the  usual  pre- 
cautions against  injecting  air,  and  securing  a  free 
return,  we  inject  water  as  hot  as  can  be  con- 
veniently borne  by  the  hand,  i.  e.,  about  112°  F., 
in  a  full  stream  into  the  cavity,  continuing  this 
until  a  good  contraction  is  secured,  and  the  water 
returns  quite  clear  and  colorless.  Dr.  Atthill 
gives  the  following  as  some  of  the  results  of  his 
experience  in  the  use  of  hot  water : 

I.  In  cases  of  sudden  and  violent  hemorrhage 
in  a  strong  and  plethoric  woman,  it  is  better  first 
to  use  cold. 

II.  Where,  from  the  prolonged  and  injudicious 
use  of  cold,  the  patient  is  found  shivering  and 
depressed,  the  beneficial  effect  of  injecting  hot 
water  is  rapid  and  remarkable. 

III.  In  nervous,  depressed  and  anaemic  women, 
hot  water  may  at  once  be  injected  without  pre- 
viously injecting  cold. 

IV.  In  cases  of  abortion,  where,  from  uterine 
inertia,  the  ovum,  although  separated  from  the 
uterine  wall,  is  wholly  or  in  part  retained,  the 
injection  of  hot  water  is  generally  followed  by  the 
most  satisfactory  results. 

V.  Where  the  injection  of  the  perchloride  of 
iron  is  considered  necessary,  previous  injection  of 
hot  water  clears  the  uterus  of  clots,  etc.,  permit- 
ting the  fluid  to  come  directly  in  contact  with  the 
bleeding  surface,  and  lessening  the  danger  of 
septic  absorption. —  Chicago  Medical  Rroiew. 


THE  TREATMENT  OF  CONSUMPTION. 

In  a  paper  on  the  treatment  of  pulmonary  con- 
sumjjtion,  Prof  Peter,  of  Paris,  insists  strongly  on 
the  value  of  hydrotherapy.  He  begins  with  fric- 
tions with  dry  flannel,  then  passes  to  rubbing  with 
cloths  dipped  in  aromatic  alcohol,  cologne  water^. 
or  vinegar,  followed  by  dry  friction  for  five  or  six 
minutes,  and  finally  advances  to  the  use  of  the  cold 
sponge.  The  process  is  repeated  twice  daily,  im 
mediately  after  rising  and  before  retiring.  He 
believes  sponging  to  be  better  than  the  douche, 
because  it  is  more  easily  carried  out.  The  chief 
points  to  be  observed  are,  to  accustom  the  patien- 
gradually  to  the  use  of  cold  water,  and  not  to  pro- 
long the  bath  too  much  at  first.  Prof.  Peter 
divides  the  sweats  of  phthisis  into  three  classes^ 
according  to  their  cause,  viz.  :  ordinary  night 
sweats,  which  depend  not  so  much  on  the  pulmo- 
nary trouble  as  on  the  general  condition  and  the 
tubercular  fever,  the  sweating  which  follows  high 
evenings  exacerbations  of  the  fever,  and  colliqua- 
tive sweats.  To  control  the  first,  he  recommends 
especially  sponging  with  vinegar,  combined  with 
the  usual  internal  remedies,  such  as  acetate  of  lead, 
tannin,  etc.  Atropine,  he  considers  unreliable^ 
Quinine  is  useful  for  the  second  form,  because  it 
controls  the  fever.  For  the  colliquative  sweats, 
there  is  no  remedy.  For  the  cough,  he  gives  opium 
and  belladonna  in  small  doses ;  he  orders  pills 
containing  one-sixth- of  a  grain  of  opium,  and  one- 
twelfth  of  a  grain  of  ext.  belladonna,  and  gives  at 
first,  one  at  a  dose,  increasing  afterward  if  neces- 
sary. When  the  cough  causes  vomiting,  he  gives 
one  or  two  drops  of  tincture  of  opium  before  meals,, 
with  good  effects.  When  the  vomiting  seems  to  be 
due  more  to  dyspepsia  than  to  the  cough,  he  gives 
a  few  drops  of  hydrochloric  acid  after  the  meals. 
In  such  cases,  alcohol  in  some  form  is  also  useful, 
but  it  must  be  given  freely.  For  the  diarrhoea,, 
when  it  is  due  to  simple  intestinal  catarrh,  as  is 
usually  the  case  at  the  outset  of  the  disease,  he 
employs  subnitrate  of  bismuth,  in  connection  with. 
a  carefully  regulated  diet.  When  it  is  due  to  the 
use  of  cod-liver  oil,  or  to  the  milk  or  grape  cure, 
the  exciting  cause  must  be  discontinued,  and  the 
stomach,  if  overloaded,  be  emptied  by  an  emetic. 
When  it  is  due  to  inflammation  of  the  stomach  and 
intestines,  he  prescribes  opium,  nitrate  of  silver, 
perchloride  of  iron,  etc.,  and  employs  also  deriva- 
tives to  the  skin.  For  colliquative  diarrhoea  there 
is  no  remedy.  For  controlling  the  expectorations,, 
he  has  found  the  balsams,  glycerine,  and  kermes,  to 
be  the  best  remedies.  For  haemoptysis,  he  recom- 
mends, in  the  first  place,  the  use  of  emetics,  and 
explains  their  action  on  the  theory  that  they  excite 
a  reflex  action  through  the  sympathetic,  which 
causes  anaemia  of  the  lungs,  and  controls  the 
hemorrhage.  When  patients  have  been  greatly 
reduced  by  the  haemoptysis,  he  has  found  quinine 
and  ergotine  useful. — All§.  med.  Cent.  Zeit,^ 
February  25,  1880. — Med.  Record. 


258 


THE   CANADA    Mf:i)ICAL    RECORD. 


ON  THE  CAUSE  AND  TREATMENT  OF 
THE  HAD  ODOUR  SO.\na'IMES  ASSO- 
CIATED WITH  EXCESSIVE  SWEATING 
OF  THE  FEET. 

Dr.  George  Thin  has  recently  made  a  fruitful 
investigation  of  this  subject,  the  report  of  which  is 
published  in  the  British  Medical  Journal  iox  Sept. 
18,  1 880,  and  from  which  the  following  is  abstract- 
ed :— 

The  patient  who  has  afforded  me  the  opportu- 
nity of  investigating  the  cause  of  the  smell  is  a 
young  woman,  aged  22,  who  has  suffered  from 
evil-smelling  feet,  with  soreness  of  the  heels,  for 
several  years.  Her  hands  are  usually  moist,  or 
even  wet,  but  are  always  odourless.  The  smell 
from  the  feet  is  not  constant,  disappearing  in  dry 
bracing  weather,  and  reappearing  when  the  weather 
is  moist  and  depressing. 

The  first  experiment  I  made  was  to  subject  the 
soles  of  the  stockings  and  boots  to  the  action  of 
an  antiseptic  solution.  The  success  was  complete, 
the  odour  being  entirely  banished.  The  antisep- 
tic precautions  having  been  soon  neglected,  the 
smell  returned,  and  I  took  the  opportunity  of  in- 
vestigating its  cause  more  minutely. 

The  sole  of  the  stocking,  a  few  hours  after  it  was 
put  on,  was  found  to  be  quite  wet ;  and  a  stocking 
if  worn  for  a  whole  day  was  so  extremely  offensive 
that,  when  held  close  to  the  nostrils,  its  overpower- 
ing fetor  was  comparable  to  that  of  putrid  blood. 
The  inside  of  the  boot  was  equally  wet  and  offen- 
sive ;  but  at  the  very  time  that  the  stocking  and 
boot  smelt  so  strongly,  the  heel  itself,  exuding 
moisture  profusely,  had  no  disagreeable  odour.  The 
sole  of  the  heel  was  reddened  and  tender,  and 
macerated  around  the  edge,  like  a  washerwoman's 
palm. 

The  reaction  of  the  moisture  in  the  stocking  and 
in  the  sole  of  the  boot  was  alkaline,  that  of  the 
moisture  exuding  from  the  skin  of  the  sole  of  the 
heel  faintly  alkaline,  whilst  that  of  the  perspiration 
of  other  parts  of  the  body  was  acid. 

The  fluid  from  the  sole  of  the  heel  was  thus 
shown  to  be  not  pure  sweat,  the  faintly  alkaline 
reaction  being  doubtless  due  to  the  serous  dis- 
charge accompanying  the  eczema  set  up  by  the 
local  hyperidrosis. 

The  fluid  in  the  sole  of  the  stocking  was  found 
to  be  teeming  with  bacteria  forms,  the  nature  and 
development  of  which  I  have  carefully  investigated. 
These  investigations  have  i)roduced  results  of 
some  scientific  interest,  which  I  have  communi- 
cated to  the  Royal  Society  *  The  rapid  develop- 
ment of  bacteria  in  the  fluid  which  exudes  from 
the  soles  is  doubtless  favored  by  the  alkaline 
reaction  i)roduced  by  the  mixture  of  serous 
exudation  with  the  sweat. 

The  treatment  instituted  in  this  case  is  as  simple 

*  On  Uactcrium  futidum  :  an  organism  associated  with 
profuse  sweating  of  the  soles  of  the  feet.  (Proceedings  of 
the  Royal  Society,  No.  205,  1880.) 


as  it  has  been  effective.  The  stockings  are  changed 
twice  daily,  and  the  stocking-feet  are  placed  for 
some  hours  in  a  jar  containing  a  saturated  solu- 
tion of  boracic  acid.  They  are  then  dried,  and 
are  fit  for  wear  again  if  it  be  desired.  The  boracic 
acid  effectually  destroys  the  smell.  But  to  kill  the 
bacteria  in  the  stocking  is  not  enough.  The  leather 
in  the  bottom  of  the  boot  is  wet  and  sodden,  and 
smells  as  vilely  as  the  stocking.  This  diflliculty  is 
got  over  by  the  use  of  cork  soles.  I  directed  my 
patient  to  get  half  a  dozen,  which  she  finds  suffi- 
cient. A  pair  must  only  be  worn  one  day  un- 
changed ;  at  night,  they  are  placed  in  the  boracic 
jar,  and  are  put  aside  the  next  day  to  dry.  If  these 
directions  be  accurately  carried  out,  the  evil  smell 
is  jjerfectly  destroyed. 

The  boracic  acid  solution  is  an  excellent  appli- 
cation to  the  painful  skin  in  these  cases.  When 
the  tender  skin  of  the  soles  is  washed  with  it,  a  sen- 
sation of  coolness  succeeds  the  feeling  of  heat  and 
tension  which  are  the  usual  accompaniments  of  the 
eczematous  condition  associated  with  the  smell, 
and  the  skin  becomes  harder  and  loses  its  abnor- 
mal redness. 

The  bacteric  fluid  would  seem  to  act  as  a  direct 
irritant  to  the  skin.  My  patient  assures  me  that 
if  she  wears  stockings  which  have  been  dried  with- 
out being  disinfected,  irritation  is  speedily  felt ; 
and  that  the  cork  soles,  if  worn  a  second  day 
without  having  been  purified,  act  in  a  similar 
way. 


AN  OPINION  ON  BLOOD-LETTING. 

It  requires  no  little  courage  to  confront  the  popu- 
lar prejudice  as  Dr.  Hiram  Corson  does  in  the 
following  passage,  taken  from  a  paper  on  pneu- 
monia communicated  to  the  Philadelphia  Medical 
Reporter  : 

"  I  have  been  in  active  practice  continuously  for 
fifty-two  years,  and  during  all  that  time  have  not 
once  had  occasion  to  believe  that  there  was  any 
change  in  the  human  system  or  in  the  climate, 
which  made  it  more  hazardous  to  treat  acute  in- 
flammatory affections  by  means  of  cups  or  leeches 
and  other  anti-febrile  remedies,  than  it  was  in  the 
beginning  of  my  career.  I  am  therefore  free  to 
declare  that  it  is  just  as  safe  to  use  them  now,  and 
they  are  quite  as  efficient,  as  they  were  in  the  days 
when  the  physicians  of  Philadelphia  were  using 
them  so  freely,  with  so  much  confidence  and  with 
so  great  success.  Surgeons  now  perform  fearful 
operations,  by  which  not  only  is  a  great  amount  of 
blood  lost,  but  the  patient  is  also  injuriously  affected 
by  the  shock  to  the  neivous  system,  yet  the  reco- 
veries are  oftentimes  astonishingly  rai)id.  Women 
in  time  of  childbirth  often  flood  until  they  are  in 
the  very  presence  of  death,  and  yet,  when  it  is  ar- 
rested, the)'  will  in  a  few  days  be  found  as  brighi: 
and  cheerful  as  if  nothing  had  hai)pened,  soon 
regain  their  usual  strength  and  have  no  disability 
from  their  loss  of  blood.     They  bear  it  as  well  now 


THE    CANADA    MEDICAL    RECORD. 


25^ 


as  they  did  fifty  years  ago.  Even  those  who  would 
not  bleed  a  woman  in  labor  to  save  her  from 
convulsions  have  no  fear  that  she  will  suffer  from  a 
flooding  which  happened  after  the  delivery  of  the 
placenta.  A  man  may  cut  his  leg  and  bleed  till  he 
faints,  but  no  one  feels  that  the  mere  loss  of  blood 
will  do  him  any  permanent  injury  ;  and  yet  what  a 
hue-and-cry  from  these  same  people  if  a  physician 
should  bleed  a  person  to  remove  a  congestion  of  the 
brain,  or  relieve  a  pain  in  t  he  head  or  a  pleurisy.  I 
have  rarely  met  with  a  graduate  of  the  last  fifteen 
years  who  has  ever  used  a  lancet,  and  yet  these  are 
the  very  persons  who  are  so  opposed  to  its  use.  They 
regard  the  older  physicians  who  do  use  it  as  per- 
sons who  are  ignorant  of  the  "  valuable  new  reme- 
dies "  (which  they  believe  were  discovered  about 
the  time  they  began  to  study  medicine),  when  the 
truth  is  they  are  themselves  ignorant  of  nearly  all 
the  means  of  cure  save  veratrum  viride,  aconite, 
digitalis,  a  few  cathartics,  morphine,  chloral  and — I 
was  near  forgetting  them — poultices  ;  poultices  for 
croup ;  poultices  for  diphtheria  and  scarlet  fever  ; 
poultices  for  the  liver^  and  poultices  for  the  kidneys  ; 
poultices  for  the  chest,  and  poultices  for  the  belly  ; 
and  when  you  ask  them  what  effect  they  expect 
from  these  means,  they  have  no  answer  but  this  : 
'  They  are  very  much  used  in  the  hospitals  now.' 
Is  there  any  reason  why  physicians  who  practised 
forty  years  ago  should  not  know  as  much  of  all  the 
above  remedies  as  these  men  educated  during  the 
crusade  against  blood-letting  ?  Digitalis  was  much 
used  long  since  ;  forty  years  ago  I  used  tincture 
aconite,  with  good  effect  in  many  cases,  as  did 
others  who  then  practised ;  and  as  for  newer  reme- 
dies, does  any  one  suppose  that  such  men  as  Dr. 
John  Atlee,  Dr.  Trail  Green,  Professor  Gross  and 
hosts  of  others — practitioners  and  close  students — 
are  ignorant  of  the  reputed  merits  of  these  cham- 
pion medicines  ?  " 


TREATMENT  OF  INDIGESTION  AND 
HEARTBURN. 

In  the  course  of  an  article  in  the  Practitioner, 
January,  1881,  Dr.  J.  Milner  Fothergill  writes  : 

For  the  purpose  of  whetting  the  appetite,  and 
thus  acting  reflexly  upon  the  gastric  secretion,  we 
employ  the  class  of  agents  known  as  bitters.  To  these 
we  add  hydrochloric  acid.  Ringer  has  pointed 
out  how  an  alkali  taken  into  the  stomach  before  a 
meal,  when  the  stomach  is  alkaline,  produces  a 
freer  flow  of  acid  afterwards.  Consequently  we 
comprehend  the  value  of  that  well-known  prepara- 
tion indifferently  termed,  "  Haust.  Stomach,"  or 
"  Mist.  Mirabilis,"  or  '•  Mist.  Rhei  et  Gentian,"  in 
the  various  hospitals  ;  a  combination  of  world-wide 
fame.  One  drawback  to  this  combination  of  rhu- 
barb, gentian  and  soda  is,  that  the  studeut 
becomes  familliar  with  it  and  its  virtues,  bnt 
remains  ignorant  of  its  exact  composition,  and  so 
loses  sight  of  it  when  he  enters  upon  practice  for 


himself.  Such  a  mixture  before  meals,  followed 
by  ten  drops  of  hydrochloric  acid  after  the  meal, 
will  often  make  the  difference  betwixt  imperfect  di 
gestion,  producing  discomfort,  and  digestion  so 
perfect  that  it  does  not  provoke  consciousness. 
Or,  where  there  is  much  irritability  in  the  stomach,. 
i.  e.,  when  a  bare,  red  tongue,  imperfectly  covered 
with  epithelium,  suggests  a  like  condition  of  the 
internal  coat  of  the  stomach,  then  bismuth  is  most 
soothing.  The  mixture  of  soda,  bismuth,  and 
calumba  is  in  use  for  such  indigestion  with  good 
results.  The  dietary  in  such  a  case  .should  con- 
sist of  the  blandest  food,  milk,  with  or  without 
baked  flour  in  it,  beef  tea  with  baked  flour ;  nothing" 
more,  till  an  improved  condition  of  the  tongue  tells 
of  a  more  normal  condition  of  the  stomach.  In 
such  cases  a  plain  opium  pill  at  bedtime  often 
soothes  the  stomach  very  nicely.  Then  there  are 
cases  where  imperfect  digestion  is  accompanied  by 
the  production  of  fatty  acids,  butyric  and  others, 
which  add  the  phenomenon  of  "  heartburn  "  to 
the  symptoms ;  or  there  may  be  later  products- 
formed  which  cause  the  bitter,  hot  taste  in  the 
mouth  on  awakening  in  the  morning  or  after  a 
post-prandial  nap.  It  is  usual  to  treat  "  heartburn  " 
by  the  exhibition  of  an  alkali ;  but  this  is  not  good 
practice.  In  union  with  an  alkali  the  offending 
matter  is  nearly  as  objectionable  as  in  the  form  of 
free  acid.  It  is  much  better  to  give  a  mineral  acid^ 
as  the  hydrochloric,  or  phosphoric,  which  breaks 
up  the  feebler  organic  acid.  By  such  means  vvc 
can  aid  the  digestive  act.  Then  at  other  times  the 
indigestion  is  due  to  lithiasis,  where  the  presence 
of  uric  acid  impairs  the  efficiency  of  the  gastric 
juice.  In  these  cases  all  measures  which  do  not 
entertain  the  causal  relations  of  the  dyspepsia  are 
of  little  use.  By  the  administration  of  potash  in  a. 
bitter  infusion,  well  diluted,  taken  half  an  hour 
before  a  meal,  this  element  of  trouble  is  removed. 
In  all  cases  of  gouty  persons  suffering  from  dys- 
pepsia, do  not  forget  this  cause  of  impairment  of 
the  gastric  juice. — Philadelphia  Medical  and  Sur- 
gical Reporter. 


THERAPEUTIC  USES  OF  TOBACCO. 

In  looking  up  the  medical  uses,  etc.,  of  tobacco^ 
I  find  that  very  little  mention  is  made  in  the 
various  therapeutics  of  its  employment  as  a  con- 
stituent of  poultices.  Believing  it  to  be  a  means 
of  great  value  in  certain  painful  affections,  I 
desire  to  bring  its  use  to  the  attention  of  physi- 
cians. Tobacco  poultices  were  at  one  time  rather 
generally  used,  but  for  some  reason  or  other  their 
eflSicacy  has  of  late  been  lost  sight  of.  I  hope 
that  the  slight  resurrection  which  I  may  occasion 
may  prove  of  service  to  the  profe->sion. 

A  case  or  two  from  my  note  book  will  serve  to 
illustrate  the  good  effects  of  tobacco  poultices. 

Mrs.  M.,  last  fall,  had  intermittent  fever,  con- 
tracted through  the  ignorance  of  her  physician  iti 


260 


THE   CANADA    MEDICAL    RECORD. 


directing  her,  on  the  tenth  day  after  confine- 
ment, to  sit  up  the  greater  part  of  the  day,  and  for 
nearly  an  hour  to  remain  by  an  open  window 
overlooking  a  large  lot  full  of  decaying  leaves, 
weeds,  animal  matter,  etc. 

I  was  called  in  on  the  following  day.  Among 
the  symptoms  which  presented  themselves,  1  found 
over  the  chest  great  tenderness  and  pain  on  the 
slightest  pressure.  I  diagnosed  this  to  be  due  to  an 
irritated  condition  of  the  nerves  or  nerve-endings  ; 
and  ordered  flaxseed,  mush  and  other  poultices, 
one  after  another,  but  without  avail.  The  ]>ain 
still  continued.  I  then  gave  medicine,  belladonna 
ointment,  etc.  I  exhausted  the  list  without  giving 
relief. 

1  mentioned  the  case  to  my  friend,  Dr.  J.  V. 
Myers,  of  this  city,  who  advised  me  to  use  a  poul- 
tice of  flaxseed  and  tobacco,  equal  j>arts,  care  to 
be  exercised  as  to  the  toxical  effects  of  the  latter. 
I  took  advantage  of  the  advice.  The  alleviation 
of  the  pain,  which  before  the  application  was  ex- 
■cruciating,  was  immediate  and  permanent.  The 
relief  was  beyond  my  expectations.  On  the  same 
patient,  this  same  poultice  has  on  one  or  two  occa- 
sions since  done  equally  good  and  effective  work. 

Mrs.  J.  had  an  attack  of  perityphlitis.  For  the 
pain,  I  ordered  the  usual  medicines,  together  with 
mush  and  flaxseed  poultices.  These  had  no  effect. 
I  then  had  applied  the  poultice  of  flaxseed  and 
tobacco.  There  was  an  almost  instantaneous  ces- 
sation of  the  agonizing  pain  from  which,  for  two 
•days,  the  patient  had  suffered. 

1  cite  the  two  above  cases,  because  I  know  that 
there  can  be  no  mistake,  but  that  the  tobacco  was 
instrumental  in  doing  the  good  work. 

In  all  instances  when  a  simple  poultice  does 
not  meet  with  the  success  desired,  I  add  tobacco 
to  it,  in  the  proportion  of  one  half.  The  leaves  are 
the  best  for  the  purpose  ;  but  the  various  kinds  of 
clippings  in  the  manufacture  of  cigars,  etc.,  will 
answer.  The  tobacco  should  be  cut  up  finely, 
and  then  well  mixed  with  the  flaxseed  ;  the  poultice 
is  made  in  the  usual  manner.  A  fine  piece  of 
linen,  or  gauze,  is  to  be  placed  between  the  poul- 
tice and  the  body.  Care  must  be  taken  that  the 
part  to  which  the  poultice  is  to  be  applied  is  not 
denuded  of  its  skin,  for  the  tobacco  may,  in  such  a 
case,  give  rise  to  symptoms  of  poisoning.  I  think 
that  with  ordinary  care,  there  can  be  no  danger  ; 
in  my  hands  this  j;oultice  has  proven  of  great 
value. 

I  would  ask  that  the  readers  of  the  Reporter 
employ  this  poultice  when  indicated,  in  the  stead 
of  the  sinple  flaxseed  j)ou]iice,  and  report  tiieir 
success  or  failure,  as  the  cases  may  prove  to  be. 
Phil.  Med.  H  Surg.  Reporter. 


NEW  TREATMENT  OF  ABSCESSES. 

Jn  the  wards  of  Dr.  Steven  Smith,  a  new  treat- 
ment of  abscesses  has  been  very  successful.  When 
the  abscess  points  it  is  opened  and  the  contents 
evacuated.     The  cavity  is  then  injected  with   car- 


bolized  water,  and  over-distended  for  two  or  three 
minutes.  'Jhe  water  is  then  pressed  out,  and  over 
the  whole  area  undermined  by  the  cavity,  small, 
dry,  compressed  sponges  are  laid  and  bound  down 
with  a  bandage.  Carbolized  water  is  then  applied 
to  the  bandage  and  injected  between  its  layers  un- 
til the  sponges  are  thoroughly  wet,  after  which  a 
dry  bandage  is  applied  over  all.  The  sponges  by 
their  expansion  make  firm  and  even  compression 
upon  the  walls  of  the  abscess,  and  hold  them  in 
j)erfect  apposition,  thus  favoring  a  union.  The 
dressing  is  left  on  for  five  or  six  days,  unless  there 
is  a  constitutional  disturbance  or  pain  in  the  seat 
of  the  former  abscess.  It  is  found,  in  most  cases, 
when  the  bandage  is  removed,  that  the  abscess 
has  completely  closed  by  an  approximation  of  its 
walls,  and  the  external  wound  heals  readily  under 
a  simple  dressing  of  carbolized  oil.  A  case  was 
recently  seen  where  this  admirable  result  was  se- 
cured in  a  child,  although  the  abscess  was  a  large 
one,  originating  in  caries  of  the  head  of  the  femur, 
and  opening  on  the  outside  of  the  thigh.  No 
constitutional  disturbance,  no  discharge,  no  reac- 
cumulation,  and  no  pain  followed  its  use.  Mam- 
mary and  sub-mammary  abscesses  have  been 
treated  by  this  method  with  excellent  results. — 
Chicago  Afed.  Re- new. 


BENZOATE  OF  SODIUM  IN  THE  TREAT- 
MENT OF  ACUTE  RHEUMATISM. 

Dr.  David  MacEwen  {Brit.  Med.  four.,  vol.  i., 
i88i,  p.  336)  observing  that  benzoic  acid  is 
closely  similar  to  salicylic  acid  in  chemical  com- 
position, and  somewhat  the  same  in  physiological 
effects,  endeavored  to  determine  whether  it,  like 
the  latter,  possesses  anti-rheumatic  properties. 
He  publishes  notes  of  five  cases  in  which  the 
remedy  was  employed  in  the  form  of  benzoate  of 
sodium.  On  the  first  occasion  in  which  he  used 
it,  the  relief  of  pain  and  subsidence  of  fever  were 
so  immediate,  and  the  recovery  was  so  ra{)id  and 
complete,  that  he  had  no  hesitation  in  adopting 
the  same  treatment  in  subsequent  cases.  The 
dose  was,  in  the  earlier  cases,  fifteen  grains  of  the 
salt  every  three  hours  :  in  the  later  cases,  twenty 
grains  every  two  hours.  In  all  the  cases  the 
sym])toms  passed  off  in  periods  varying  from  three 
days  to  a  week  after  the  commencement  of  the 
medicine  ;  in  none  did  cardiac  complications  arise 
in  the  course  of  treatment,  and  Dr.  MacEwen 
thinks  the  convalescence  was  more  rapid  than  in 
cases  he  had  seen  treated  with  salicylate  of  sodium. 
Benzoate  of  sodium  {)ossesses  this  advantage,  that 
it  does  not  give  rise  to  the  nausea  and  depression 
or  the  unpleasant  head-phenomena  which  the 
salicylate  frequently  produces.  It  is  most  conve- 
niently prescribed  in  the  form  of  a  mixture,  and  it 
may  be  given  in  doses  of  fifteen  to  twenty  grains 
every  two  or  three  hours.  It  should  also  be  con- 
tinued in  diminished  doses  for  twenty-four  to 
forty-eight  hours  after  the  rheumatic  symptoms 
have  disappeared. 


THE    CANADA   MEDICAL    RECORD. 


261 


COMPULSORY  VACCINATION  IN 
FRANCE. 

The  following  are  the  conclusions  of  the  com- 
mittee appointed  by  the  Academic  de  Medicine 
upon  this  subject :   i.  Vaccination,  with  extremely 
rare  exceptions,  is  an  inoffensive  operation  when 
practised  with  care  and  on  a  subject  in  good  health. 
2.  Without  vaccination,  hygienic  measures  (isola- 
tion, disinfection,  &c.)  are  of  themselves  insuffi- 
cient  for  preservation   from    small-pox.     3.  The 
belief  in  the  danger  of  vaccinating  or  revaccinating 
during  the  prevalence   of  an  epidemic  is  without 
any  justification.     4.  Revaccination,  the  necessary 
complement  of  vaccination  for  assuring  immunity 
against  variola,   should  be  practised  ten  years  at 
least  after  a  successful  vaccination,  and  repeated 
as  often  as  possible,  when  it  has  not  been  follow- 
ed by  the  characteristic  cicatrices.     5.  The   Aca- 
demy is  of  opinion  that  it  is  urgent  and  of  high 
public  interest  that  a  law  should  be  passed  render- 
ing vaccination   obligatory.     6.  As  to  revaccina- 
tion,  it  should  be  encouraged   in  every  possible 
manner,  and  even  imposed  by  administrative  regu- 
lations under  all  circumstances  where  this  is  possi- 
ble.— Gazette  dcs  Hopiteaux,  March  ^ist,  1881. 


TO  REMOVE  FISH-BONES. 

Fish  bones  lodging  in  the  pharynx  are  rendered 
flexible  and  are  finally  broken  up  by  a  mixture  of 
hydrochloric  acid  (four  parts)  or  nitric  acid  (one 
part  to  two  hundred  and  forty  parts  of  water)  used 
as  a  gargle,  the  teeth  being  protected  by  oil  or 
lard.  So  says  Professor  Voltolini  in  Monatsschrift 
fur  Ohrenheilkunde. 

The  Canada  Medical  Record, 

^  ittoutfjin  Journal  of  fHcUiciiic  anlr  i3f)arinac» 
FRANCIS  W.  CAMPBELL,  M.A..M.D.,L.li.C. P.,  LOND 

ASSISTAKT  EDITOUS  : 

R.  A.  KENNEDY,  M.A.,  M.D. 

JAMES  PERRIGO,  M.D.,  M.R.C.S.  Eng. 

KDITOR   OK   PHABMACEUTICAI,    DEPARTMENT: 

ALEX.  H.  KOLLMYER,  M.A.,  M.D- 

SUBSCRIPTION  TWO  DOLLARS  PER  AXXLM  . 

All  communications  and  Exchanges  must  le  addressed  to 
the  Editor,  Drawer  356,  Post  Office,  Montreal. 

MONTREAL.  JULY,  1881. 


important  QUESTION. 

At  the  last  meeting  of  the  College  of  Physicians 
and  Surgeons  of  the  Province  of  Quebec  Dr.  F. 
W.  Campbell,  one  of  the  University  representatives, 
raised  a  most  important  question,  as  to  the  period 
when  it  was  permissible  for  a  student,  under  the  pre. 
sent  law,  to  pass  a  year  in  study  with  a  meiical  man. 
Dr.  Campbell  stated  that,  to  his  knowledge,  students 


had  presented  themselves  at  the  end  of  the  third  year 
and  passed  their  examination  ;  that  the  end  of  the 
following  year  these  students  had  returned,  with  a 
certificate  of  having  studied  during  that  year  with 
a  medical  man,  and  had  then  been  presented  with 
their  Diploma.     This   is,  in  our  opinion,  opix>sed 
not  only  to  the  spirit  of  the  law,  but    to   its  letter. 
Students,  according  to  the  Act,  have  to  study  four 
years.     They  must  take  three  sessions  at  a  Medical 
School,  the  first  whereof  must  be  that  succeeding 
the  passing  of  their  preliminary  examination — and 
they  are  allowed  to  study  one  year  with  a  medical 
man.     All  this  period  of  study  is,  of  course,  pre- 
sumed to  show  its  effect  by  the  knowledge  which 
the  student  exhibits  when  undergoing  his  examin- 
ation.    But  if  he  is  allowed  to  pass  the  year  with  a 
physician  after  he  has  undergone  his  examination,, 
and  to  a  large  extent  has   become  independent  of 
the    University,    can  he  be    truly  said    to   have 
studied  four  years  ?     We  do  not.  think  that  he  can.. 
Unfortunately,  such    certificates    are    too    easily 
obtained,  but,  even    if  the   attendance  has   been 
faithful,  in  many  cases — the  stimulus  of  a  subse- 
quent examination    being  wanting — the   time  so- 
passed  is  time  absolutely  lost.     Far  better  at  once 
let  it  be  understood  that  only  three  years   is  re- 
quired, for  when  the  diploma  is  obtained,  and  the 
graduate    enters    practice,     he  has    the    stimulus 
of  competition  to  urge  him  to  keep  up  the   know- 
ledge he  has  acquired.     To  allow  him  to  go  to  a 
Physician  after  his  examinations  are    over,   and 
count  it  as  a  portion  of  his  period  of  study,  is  ab- 
surd.    He  has  no  immediate  incentive  to  work, 
and  the  result,  in  nine  cases  out  of  ten,   is   that 
the  graduate  finds  himself  with  his  diploma,  but 
minus  much  of  that  information  which  he  had  a 
year  before,  when  up  for  examination.     And  this 
lost  material   is  matter  on  which  he  would   have 
kept  himself  posted  had  he  gone  from  College  to 
the  struggle  for  a  livelihood,  amid  the  keen  com- 
petition of  Medical  practice.     So  much  for  the 
common-sense  reasons  against   such   a  procedure. 
But  Dr.   Campbell  claimed,  and  we  think  he  was 
right,  that  any  such   arrangement  of  a   student's 
studies  is  contrary  to  the  Bye-laws  of  the  College, 
founded  on  the  Medical  Act  of  1879.  Chap,  viii., 
section  11,    of   the  College  Bye-laws  says  :    ''  A 
certificate  of  study  from  a  licensed  practitioner  for 
the  period  intervening  between  the  courses  which 
the  student  has  attended  will  be  required."  This,  to 
our  mind,  is  clear  as  it  is   possible  for  language  to 
make  it.  We  have  italicised  the  word  intervene,  anl 


262 


THE   CANADA    MEDICAL    RECORD. 


we  ask  how  can  a  period  of  study  taken  after  Zi%X\\- 
dent  has  completed  his  courses  l)e  said  to  inter- 
vene. It  is  an  absurdity  to  try  and  make  it 
appear  that  what  Dr.  Campbell  condemns  is  in 
accordance  with  the  law.  We  are  glad  to  know 
that  the  members  of  the  College  seemed  to  agree 
■with  him,  but  to  give  the  matter  full  consideration 
it  was  referred  to  a  Committee  of  Governors  of 
the  College  connected  with  the  various  schools,  and 
they  will  report  the  result  of  their  deliberations 
at  the  meeting  which  will  take  place  in  Quebec  on 
the  28th  September  next. 


UNIVERSITY  OF  BISHOP'S  COLLEGE. 

The  Annual  Convocation  of  the  Faculties  of 
Divinity,  Arts  and  Law  of  the  University  of 
Bishop's  College  was  held  at  Lennoxville  on  the 
24th  of  June.  The  attendance  was  very  large, 
and  among  several  distinguished  gentlemen 
present  was  Dr.  Dawson,  the  highly-gifted  prin- 
cipal of  McGill  University,  who  received  the 
degree  of  D.C.L.  Dr.  Cameron  represented  the 
Medical  Faculty  of  the  University,  and  addressed 
the  Convocation,  speaking  substantially  as  follows  : 

"  It  is  a  matter  of  great  regret  on  my  part  that  Dr. 
F.  W.  Campbell,  'our  Registrar,  has  been  unavoid- 
ably prevented  from  being  here  to-day  to  represent 
the  Medical  Faculty.  In  filling  his  place  I  am 
pleased  to  have  had  an  opportunity  of  seeing  so 
much  of  your  work  and  hearing  such  glowing 
accounts  of  your  prospects  and  success." 

"  I  have  been  commissioned  by  the  Faculty  of 
Medicine  of  Bishop's  College  to  express  to  you 
not  only  the  deep  interest  we  feel,  individually 
and  as  a  Faculty,  in  the  prosperity  of  the  sister 
Faculties,  but  also  our  sympathy  with  you  in  the 
severe  trials  and  discouragements  of  the  past  few 
months.     We  believe  that  you  have  acted  wisely 
in  endeavoring  to  make  the  sanitary  condition  of 
these  fine  buildings  as  perfect  as  possible ;    and, 
though  the  cost  has  been  heavy,  and  the  loss  and 
inconvenience  great,  we  believe  that,  in  grappling 
with   your   difficulties   fairly   and   honestly,    and 
striving  as  far  as  possible  to  eradicate  disease  and 
prevent  its  return,  you  have  merited  and  gained 
the  heartfelt  sympathy  and  active  support  of  most 
right-minded    men.       Too    often    under    similar 
circumstances   have  subterfuge  and  deceit   been 
resorted  to,  and  too  often  have  ajjathy,  indiffer- 
ence   and   masterly   inactivity   characterized   the 
action    of    trustees    and   corporations ;     but    the 


frankness,  candor  and  zeal  displayed  by  the 
authorities  of  Bishop's  College  throughout  their 
trying  ordeal  have  been  alike  creditable  to  them- 
selves and  the  University." 

"  The  Medical  Faculty  of  Bishop's  College  has 
just  comi)]eted  its  tenth  session  ;  like  most  new 
undertakings  we  have  had  our  fair  share  of  toil 
and  trouble,  discouragement,  disappointment  and 
financial  embarrassment  and  constant  struggling 
against  heavy  odds,  and  keen  competition  ;  but 
we  have  come  safely  through,  and,  pausing  now  at 
the  end  of  our  first  decade  to  look  back  upon  the 
past  and  look  out  into  the  future,  we  are  proud  to 
tell  you  that  we  are  now  upon  a  firm  basis  and 
our  prospects  were  never  brighter  :  our  students 
are  increasing  in  numbers,  enthusiasm  and  esprit 
de  corps — they  have  won  recognition  and  honors 
at  home  and  abroad — our  hospital  advantages 
have  been  much  enlarged,  our  facilities  for  clinical 
teaching  improved,  and  we  are  now  in  a  position 
to  offer  to  those  who  desire  to  obtain  a  good, 
sound,  practical  education,  advantages  and  facili- 
ties surpassed  by  no  medical  school  in  the 
Dominion.  But  in  the  future,  as  the  Medical 
Faculty  of  the  University,  we  look  to  our  sister 
Faculties  for  sympathy,  co-operation  and  support. 
The  success  of  a  University  is  really  the  sum 
total  of  the  success  of  its  various  Faculties  ;  each 
Faculty  shines  partly  by  its  own  and  partly  by 
reflected  light  ;  the  prosperity  of  one  is,  to  a 
certain  extent,  the  prosperity  of  all ;  in  unity  of 
purpose  and  unity  of  action  lie  the  secret  of 
University  success." 

''  In  the  early  history  of  a  University,  especially 
in  a  new  country,  the  Medical  Faculty  aids  mate- 
rially in  spreading  the  name  and  flime  of  the  Uni- 
versity throughout  the  length  and  breadth  of  the 
land ;  and  it  is  a  well-known  fact  that  the  noble 
Faculty  of  Medicine  of  McGill  College  has  been 
one  of  the  chief  means  of  building  up^the  world- 
wide reputation  of  that  Institution,  attracting 
students  to  her  halls,  and  indirectly  aiding  in 
building  up  and  strengthening  the  other  Faculties. 
Now,  gentlemen,  what  the  Medical  Faculty  of 
McGill  has  done  for  McGill  College,  the  Medical 
Faculty  of  Bishop's,  if  properly  encouraged  and  sup- 
ported, may  and  can  do  for  Bishop's  College.  All 
that  we  ask  is  that  you,  our  sister  Faculties,  would 
remember  that  your  own  Medical  Faculty  is  in 
active  operation  in  the  city  of  Montreal,  and  needs 
your  active  assisUince  and  support.  But  when  we 
see   so    many  boys    who  have    been  trained  in 


THE    CANADA    MEDICAL    RECORD. 


26a 


Bishop's  College  School,  and  have  perhaps  taken 
out  their  Arts'  Course  in  Bishop's  College,  drift- 
ing away  from  their  Alma  Mater  as  soon  as  they 
commence  their  professional  studies,  and  swelling 
the  ranks  of  other  medical  schools,  we  naturally 
feel  as  if  we  were  being  left  somewhat  out  in  the 
cold,  and  we  sometimes  are  inclined  to  fear  that 
our  sister  Faculties  have  forgotten  the  important 
fact  of  our  existence." 

"As  we  take  an  interest  in  your  success,  we  hope 
and  trust  that  you,  in  tiu-n,  will  take  an  interest  in 
ours  ;  and  when  we  know  each  other  better  we 
will  be  able  to  work  together  more  unitedly  and 
harmoniously  for  the  general  welfare  of  our  "Qni- 
versity." 

"Asa  Faculty  we  feel  that  we  need  but  to  explain 
our  position  and  wants,  and  to  lay  our  claims  fair- 
ly before  you  in  order  to  obtain  for  them  that 
courteous  consideration  which  has  always  been 
manifested  towards  us  by  the  authorities  of 
Bishop's  College." 


DEATH    OF    MR.  STEPHEN   S.  ALFORD, 
F.R.C.S.,  LONDON,  ENGLAND. 

We  deeply  regret  to  have  to  chronicle  the  death 
of  Mr.  S.  S.  Alford,  6i  Havestock  Hill,  Verdon, 
and  brother  of  the  late  Dean  Aiford,  as  the  result 
of  injuries  received  on  the  Midland  Railway. 
Two  years  ago  he  paid  a  visit  to  Canada  and  the 
United  States,  with  a  view  to  acquire  all  the  infor- 
mation possible  in  the  treatment  of  Dipsomaniacs. 
Since  his  return  he  has  been  actively  at  work  in 
his  favorite  cause,  and  was  at  the  time  of  his  death 
about  to  assume  the  medical  management  of  the 
first  Inebriate  Home,  just  ready  to  be  occupied, 
near  Verdon.  A  few  days  previous  to  his  death 
he  wrote  to  Dr.  Bessey  of  Montreal,  with  whom, 
as  a  co-worker  in  the  same  cause,  he  had  kept  up 
a  correspondence  since  his  visit  here,  two  years  ago, 
in  which  he  spoke  hopefully  of  being  soon  able  to 
visit  Canada  again.  It  was  otherwise  ordained ; 
and  a  good  physician  and  whole-souled  philan- 
thropist has  gone  to  his  rest. 


We  have  received  from  Wm.  Wood  &  Co.,  of 
New  York,  a  copy  of  the  catalogue  of  their  works, 
which  has  been  prepared  for  presentation  to  the 
Members  of  the  International  Medical  Congress, 
which  assembles  in  London  on  the  2nd  to  the  9th 
August.     It  is  beautifully  printed,  is  bound  in  satin, 


and  is  altogether  an  excellent  specimen  of  Ameri- 
can enterprise.  It  will  undoubtedly  redound  to» 
the  profit  of  a  most  successful  fimi. 


WYETH'S  DIALISED  IRON. 

Wyeth's  Dialised  Iron  is  a  pure  neutral  solution 
of  oxide  of  iron  in  the  colloid  form,  the  result  of 
endosmosis  and  diffusion  with  distilled  water.  It 
possesses  great  advantages  over  every  other  ferru- 
ginous 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  endos- 
mosis, according  to  the  law  of  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  ad- 
ministering iron. 


THE  POPULAR  SCIENCE  MONTHLY  FOR 
AUGUST,  1 88 1. 

The  August  "Popular  Science  Monthly"  weU 
maintains  its  standard  of  excellence.  Those  who 
have  read  and  admired  the  pungent  papers  of  Dr. 
Oswald  on  "  Physical  Education "  have  a  treat 
before  them  in  the  present  article  on  "  Recreation." 
So  intelligent  and  impressive  a  statement  of  its 
needs,  importance,  and  general  neglect,  and  the 
evils  that  follow  from  the  lack  of  due  recreation, 
and  so  scathing  and  terrible  a  denunciation  of 
that  asceticism  in  society  which  still  finds  its 
religious  apologists,  we  have  never  seen.  Dr. 
Fairchild  continues  his  popular  physiological 
articles,  and  this  month  takes  up  the  subject  of 
"  The  Blood  and  its  Circulation."  Dr.  Dyce 
Duckworth  has  a  short  but  ver}'  practical  article 
on  "  The  Insufficient  Use  of  Milk  "  in  our  dieta- 
ries.    There  are  many  valuable  hints  in  it. 


REVIEWS. 

The  Hygiene  and  Treatment  of  Catarrh.     Part 

I.  Hygienic  and  Sanative  Measures.     Part  2. 

Therapeutic  Measures^  with  forty  illustrations. 

By    Thos.    F.    Rl'mbold,    M.D.,    St.    Louis; 

George  O.  Rumbold  «S:  Co.,  1881. 

Dr.  Rumbold  has  written   a  book  which  can  be 
studied  with  profit  by  every  medical  man.     He 


1264 


TUE    CANADA    MEDICAL    RECORD. 


has  avoided  much  of  the  beaten  track   travelled 
hy  others  before  him,  and  has  struck  out  for  him- 
self.    Finding  that  the  new  route  produced  much 
that  was  novel,  he  has  thrown  aside  many  of  the 
opinions  of  writers    upon  diseases   of  the   nasal 
cavity,  and  has  expressed  views  often  at  variance 
with  those  generally  accepted  at  the  present  day. 
Whether  he  is  correct  is  a  matter  on  which  we 
express    no    opinion,    but,    as    an    independent 
observer,  he  is  entitled  to  respectful  consideration. 
We  agree  with  him,  however,  in  believing  that  no 
class  of  diseases  depend  so  much   upon  general 
sanitary  measures  for  remaining  well  after  being 
•cured  as  do  diseases  of  the  nasal  cavity.     We  are 
likewise  heartily  with  him  in  his  views,  that  it  is 
bad  practice  to  apply  strong  solutions  to  catarrhal 
mucous  membranes,  and  that  solutions  for  use  in 
■catarrhal  inflammations  of  that  membrane  are  best 
applied  by  means  of  an  atomizer.     So  much  in 
commendation,  a  word  or   two  of  fault  finding. 
We  quote  from  the  preface.     "  /  have  spared  no 
pains  to  make  the  armamentarium  of  my  offices, 
including  7ny  operating  table,  as  perfect  and  con- 
^etiient  as  possible."      What  this  fact  has  to  do 
with   a  work  on    the   hygiene   and   treatment  of 
■catarrh,  we   are  at   a  loss   to  discover.     We  are 
forced  therefore  to  think  that  this  is  a  little  bit  of 
personal  advertising — a  fault  too  evident  in  many 
of  the  works  issued  at  the  present  day. 
A  Treatise  on  Diseases  of  the  Nervous  System.  By 
William  A.  Hammond,  M.D.,    Surgeon  General 
U.S.  Army  (Retired  list),  Professor  of  Diseases 
of  the  Mind  and  Nervous  System  in  the  Medical 
Department  of  the  University  of  New  York.  With 
one  hundred  and  twelve  illustrations.     Seventh 
Edition — re-written,    enlarged   and    improved. 
New  York,  D.Appleton  &  Co.,  i88r,  Montreal, 
Dawson  Bros. 

Few  men  have  obtained  such  a  world-wide  cele- 
brity in  comparatively  so  short  a  time  as  the  author 
of  this  book.  Leaving  the  service  of  his  country — 
in  which  he  held  an  exalted  i^o.st — under  considera- 
ble of  a  cloud,  he  commenced  practice  in  the  city 
ofNew  York,  with  some  friends  and  many  enemies. 
For  a  couple  of  years  his  progress  was  slow,  but 
after  that  he  rajjidly  came  to  the  front,  and,  ere 
long,  began  to  be  known  as  an  excellent  authority 
upon  diseases  of  the  Nervous  .System,  to  which  spe- 
cialty he  has  devoted  his  life.  He  is  now  the 
recognized  authority  on  this  branch  of  Medicine  in 
the  United  States.  A  book  from  his  pen,  as  can  be 
well  conceived;  must  be  a  standard  one,  and  so  in 


truth  it  is.  Not  only  has  its  merits  been  fully 
recognized  on  this  continent,  but  its  reputation  has 
spread  to  Europe,  and  in  1879  ^  translation  of  it 
appeared  in  Paris,  and  at  the  present  moment  an 
Italian  translation  is  going  through  the  press  under 
the  direction  of  Professor  Diodato  Borrelli,  Profes- 
sor of  Pathology  and  Clinical  Medicine  in  the 
Royal  University  at  Naples.  The  book  is  a  large 
one,  consisting  of  over  900  pages,  and  is  divided 
into  six  sections,  embracing  :  i,  diseases  of  the 
Brain  ;  2,  Diseases  of  the  Spinal  Cord  ;  3,  Cere- 
bro-spinal  Diseases ;  4,  Diseases  of  the  Peripheral- 
Nervous  .System  ;  5,  Diseases  of  the  Sympathetic- 
Nervous  System  ;  6,  Toxic  Diseases  of  the  Nervous 
System.  Under  each  of  these  sections  the  various 
diseases  combined  are  described  and  the  treatment 
given.  The  style  of  the  author  is  pleasant,  the 
printing  is  clear,  and  the  book  altogether  is  one 
which,  externally,  will  look  well  in  any  library  ; 
while  its  contents  will  many  a  time  prove  exceed- 
ingly valuable  to  the  practitioner,  perplexed  as  he 
often  is  with  many  of  the  symptoms  of  obscure 
Nervous  affections. 

A  Treatise  on  Bright' s  Disease  and  Diabetes,  with 
Especial  Reference  to  Pathology  and  Therapeu- 
tics. By  James  Tyson,  A.M.,  M.D.,  Professor  of 
General  Pathology  and  Morbid  Anatomy  in  the 
University  of  Pennsylvania,  with  illustrations  : 
including  a  section  on  Retinitis  in  Bright's 
Disease  by  William  F.  Norris,  A.M.,  M.D., 
Clinical  Professor  of  Ophthalmology  in  the 
University  of  Pennsylvania.  Philadelphia, 
Lindsay  and  Blakiston ;  Montreal,  Dawson 
Bros.     Price  $3.50. 

For  several  years  Dr.  Tyson  has  been  looked 
upon  as  a  close  and  thoughtful  observer  in 
urinary  diseases.     His  studies  have  been  largely 

in  that  direction,  and,  as  can  well  be  supposed,  he 
must  have  collected  a  considerable  amount  of 
material  l)earing  upon  the  disease,  the  considera- 
tion of  which  occupies  the  principal  part  of  this 
volume.  The  accumulation  of  this  material  has 
given  him  an  experience  which  he  believes  may 
be  useful  to  ot'iers.  This  is  his  reason  for  pre- 
senting this  book  to  the  Profession.  We  have 
read  several  chapters  of  it,  and  believe  we  have 
derived  profit  from  their  perusal.  Several 
original  drawings  are  given  in  the  section,  giving 
the  histology  of  the  kidney.  They  are  from  the 
pencil  of  Dr.  George  C.  Piersol.  The  illustrations 
are  all  admirable,  and  are  beautifully  executed, 
and  add  much  to  the  value  of  the  Treatise.  The 
Pathology  of  the  disease  is  brought  down  to  date, 
and  the  work  is  one  which  we  feel  assured  will 
meet  with  much  favor. 


THE  CANADA  MEDICAL  RECORD. 


Vol.  IX. 


MONTREAL,  AUGUST,  1881 


No. 


II 


C  OISTTEISTTS. 


ORIGINAL  COMMUNICATIONS. 

The  Canada  Medical  Association...  265 

CORRESPONDENCE. 

Editor  "  Canada  Medical  Record, 
271. — Malto-Pepsyn 273 

PROGRESS  OF  MEDICAL  SCIENCE 

Headache,  and  the  Remedies  pro- 
posed, 273. — The  Inunction  of 
Castor  Oil  as  a  purgative,  276. 
— On  a  new  method  of  arresting 
Gonorrhoea,  277.  —  To  disguise 
the  Taste  of  Tincture  of  Iron, 
278. — Treatment  of  Post-Partum 
Hemorrhage,  279. — Ophthalmia 


Neonatorum,  279.  —  Iodide  of 
Potassium  in  Cardiac  Dyspnoea, 
280. — A  Menstruum  for  Salicylic 
Acid,  280. — Prevention  of  La- 
cerated Perineum,  280. — Treat- 
ment of  Sprains,  280. — Anti- 
pruritic Remedies,  281. — Treat- 
ment of  Ulcers,  281. — Causes  of 
Displacements  of  the  LUerus  in 
general,  281. —  Elixir  Chloro- 
formi  Compositus,  283.  —  Va- 
ricocele and  its  Treatment,  284. 
— Tuberculosis  and  Pregnancy, 
184.  —  Treatment  of  Cystitis, 
284. — Treatment  of  Fissure  of 
the  Anus,  284. — Pruritus  Vul- 
vae, 285 — Scour  Weed,  285. — 
Hypodermic  Injection  of  Er- 
gotin  as  a  Cough- Sedative,  285. 


— Carbolic  Acid  for  Carbuncles, 
285. — The  Treatment  of  Bright's 
Disease,  286.  —  Ammonio-Sul- 
phate  of  Copper  in  Tic  Doulou- 
reux, 286 — Cure  of  Ozsena  by 
Iodoform,  286,  —  The  Wonders 
of  Telephony 286 

EDITORIAL. 


The  issue  of  the  August  number, 
287. — Literary  Note  from  the 
Century  Co.,  N.Y.,  287.— Col- 
lege of  Physicians  and  Surgeons, 
Province  of  Quebec,  287. — The 
Bridal  Eve,  287.  —  Wyeth's 
Elixir  of  Gentian  with  Tincture 
of  Chloride  of  Iron,  288. — Re- 
views   


288 


0r4§ma't  Bomnmnkadt^on^ 


THE  CANADA  MEDICAL    ASSOCIATION. 

The  fifteenth  annual  meeting  of  the  Canada 
Medical  Association  was  held  in  the  City  of  Hali- 
fax on  the  3rd  and  4th  of  August.  The  attend- 
ance of  members  was  fair,  and  a  number  of  inter- 
esting papers  were  read.  Not  being  able  to  be 
present,  we  are  indebted  to  our  contemporary,  the 
Canada  Medical  and  Surgical  Journal,  for  a  large 
portion  of  our  report  of  the  proceedings. 

Dr.  Canniff,  of  Toronto,  the  President,  occupied 
the  chair. 

Dr.  Strong,  Superintendent  of  the  Cleveland, 
Ohio,  Lunatic  Asylum ;  also  the  Military  and 
Naval  Surgeons  stationed  at  Halifax,  were  elected 
members  by  invitation. 

Dr.  Reid,  Halifax,  read  the  report  on  Medicine. 
Special  attention  was  drawn  to  the  disease  known 
as  General  Paralysis  of  the  Insane — a  malady  of 
most  fatal  character  and  on  the  increase,  and  not 
receiving  sufficient  attention.  The  report  was 
received  for  discussion. 

Dr.  Stewart,  of  Brucefield,  Ontario,  read  the  re- 
]  ort  on  Therapeutics. 


The  President  of  the  Association,  Dr.  Canniff, 
read  a  paper   on  .  "  Vital   Statistics   and    Public 
Health."    The  President  stated  that  the  Committee 
appointed  at  the  last  meeting  had  waited  upon  Sir 
John  A.  Macdonald,  and  had  been  accompanied 
and  assisted  by  many  of  the  medical  men  now  in 
Parliament,  that  the  Government  are  heartily  in- 
clined to  assist  in  forwarding  the  movement   to 
provide  for  the  public  health,  and  that  if  it  had  not 
been  for  the  very  indifferent  health  of  the  Premier 
himself,   it   is    probable  that   legislation   on   this 
important    matter   would,  before  this,  have  been 
introduced   into   the  Dominion  Parliament.     He 
believed  that  the  Association  was  doing  a  good 
work  in  keeping  the  subject  before  the  country, 
and  hoped  they  would  continue  their  efforts  until 
brought  to  a  satisfactory  issue. 

Hon.  Dr.  Parker  considered  this  a  most  impor- 
tant matter ;  hoped  that  further  action  of  a  decided 
nature  would  soon  be  taken.  His  dea  is  that  our 
aim  should  be  to  have  a  committee  formed  of  good 
representative  men  from  each  Province  to  initiate 
and  watch  the  progress  of  a  bill  for  this  object. 
This  law-making  should  begin  with  the  separate 
Provinces,  each  for  itself,  and  the  whole  should  be 
consolidated  under  some  Act  governing  the  entire 
Dominion,  and  passed  by  the  House  of  Commons. 


266 


TUB    CAXADAMEDICAL    liECOKD, 


Sir  J.  A.  Macdonald  used  formerly  to  say  that  all 
matters  connected  with  statistics  belonged  to  the 
Provincial  Legislatures,  but  he  has  seen  reason  to 
change  tliis  opinion,  and  would  be  ready  to  admit 
the  control  of  the  general  government  over  statis- 
tics and  such  like  matters  which  are  necessarily 
intimately  connected  with  sanitary  legislation. 
ITiey  had  recently  held  a  meeting  of  the  profession 
of  Nova  Scotia  at  Antigonishe,  and  had  been  able 
to  lay  the  foundations  for  taking  their  share  in  the 
proposed  plan  of  concerted  action.  The  report  of 
the  President  was  received,  and  laid  on  the  table 
for  future  discussion. 

Moved  by  Dr.  Botsford,  seconded  by  Dr. 
Steeves,  that  the  following  compose  the  Nominat- 
ing Committee  :  Drs.  Robillard,  Ross  and  Fenwick 
of  Montreal,  Dr.  Eccles  of  London,  Drs.  D.  Clark 
and  A.  H.  Wright  of  Toronto,  Drs.  Lawson  and 
K.  F.  Black  of  Halifax,  Dr.  Steeves  of  St.  John, 
and  Dr.  Atherton  of  Fredericton. — Carried. 

Dr.  Hill  of  Ottawa  then  read  for  Dr.  Grant  of 
Ottawa  a  short  paper  descriptive  of  a  method  of 
using  the  ordinary  enema-syringe  for  a  stomach- 
pump. 

Some  members  objected  to  the  method,  that  it 
would  be  found  very  difficult  to  introduce  a  flex- 
ible and  soft  tube  down  the  esophagus,  but  Dr. 
Hill  said  that  he  had  been  assured  by  Dr.  Grant 
that  in  trying  the  instrument  he  had  not  exper- 
ienced this  difficulty. 

The  Association  adjourned  at  r  p.m. 

Afternoon  Session. 

The  President  took  the  chair  at  2.30  p.m.,  and 
proceeded  to  read  his  address  on  "  Medical 
Ethics."  He  stated  that  it  was  with  some  diffi- 
culty he  had  selected  a  subject  for  an  address 
which  might  be  of  practical  interest  to  tltfe 
Association,  and  he  finally  determined  to  review 
the  present  code  of  ethics  by  which  we  are  guided, 
and  make  some  remarks  upon  certain  of  the  clauses. 
He  entered  fully  into  the  duties  of  the  members  of 
the  profession  towards  the  public,  towards  each 
other,  and  towards  themselves.  Towards  the  pub- 
lic, in  leaving  nothing  undone  tending  to  the  res- 
toration to  health  of  those  entrusted  to  their  care ; 
towards  each  other,  in  the  most  delicately  honor- 
able bearing ;  towards  themselves,  in  not  neglect- 
ing those  much  needed  recreations  and  moments 
of  rest  which  the  generally  over-worked  practitioner 
so  much  requires.  He  strongly  deprecated  any 
assumption   of  superiority,  pointing  out   that  the 


proper  line  of  conduct  for  a  physician  was  that  of 
the  unobtrusive  gentleman  ;  advised  free  untram- 
nieled  consultations  in  all  cases  when  difficulty  or 
doubt  presented  themselves ;  and  endeavored, 
throughout  his  address,  to  show  that  a  code  of 
medical  ethics  could  not  be  othenvise  than  in  har- 
mony with  a  Christian  code  of  ethics.  But  char- 
latanism, in  or  out  of  the  profession,  received  a 
severe  castigation.  The  address  was  of  a  very 
practical  character,  and  cannot  fail  of  having  a 
beneficial  tendency  in  recalling  attention  to  many 
of  those  points  upon  the  strict  observance  of  which 
depends  the  existence  of  harmony  amongst  our 
confreres. 

The  report  on  Therapeutics,  read  by  Dr.  Stew- 
art, was  next  discussed.  Several  members  gave 
their  views  on  the  comparative  safety  of  chloro- 
form and  ether,  the  former  being  the  favorite. 

Dr.  Atherton  said  that  in  his  opinion  the  bad  re- 
sults in  Great  Britain  from  chloroform  were  chiefly 
to  be  attributed  to  two  causes,  ist,  the  complicated 
apparatus  frequently  made  use  of ;  and  2nd,  the 
dread  which  they  appear  to  have  of  it.     In  Edin- 
burgh it  is  given   freely  and  he  thinks  carelessly. 
In  judging  of  the  comparative    merits  of  various 
anaesthetics    we   should  be   guided  more  by  the 
opinions  arrived  at  by  those  who  are  in  the  habit  of 
daily  administering  it,  and  not  so  much  from  the 
results  obtained  by  experiments.     He  gave  some 
particulars   concerning  a  case   (published  in   the 
Canada  Lancet)  where  he  had  performed  tracheo- 
tomy for  the  purpose  of  resuscitation  from  chloro- 
form poisoning. 

Dr.  Hingston  asked  why,  in  this  case,  a  tube 
might  not  have  been  passed  per  vias  naturales, 
avoiding  the  operation.  The  answer  was,  that 
opening  the  trachea  was  the  idea  which  first  pre- 
sented in  the  urgency  of  the  moment,  and  it  was 
fortunately  successful. 

Dr.  Fitch  spoke  strongly  in  favor  of  ether,  which 
he  uses  exclusively.  He  thinks  that  drawing  the 
tongue  forcibly  forward  should  always  answer 
every  purpose  for  admission  of  air  into  the  tra- 
chea. 

Dr.  Stewart  said  that  many  were  in  the  habit  of 
entirely  neglecting  the  pulse,  regarding  the  respira- 
tion only.  He  thought  that  this  was  a  mistake, 
that  the  pulse  should  be  carefully  observed. 
Kepler  has  shown  by  sphygmographic  tracings 
that  in  all  dangerous  cases  there  is  great  fall  in 
the  blood-pressure.  He  knew  of  three  deaths 
in  three  years  in  Edinburgh  alone.     French  exper- 


THE   CANADA   MEDICAL    RECORD. 


26' 


imenters  have  shown  that  the  application  of  very- 
hot  water  to  the  cardiac  region  is  of  great  service 
in  stimulating  the  heart's  action. 

Dr.  Oldright  referred  to  the  ancemia  observed  in 
chloroform  administration  as  indicative  of  synco- 
pal tendency,  and  to  the  frequency  of  accidents  in 
dentists'  chairs,  the  latter  being  due  perhaps  to 
two  causes,  the  semi-erect  position,  and  the  known 
danger  of  interference  with  the  fifth  nerve.  He 
had  made  one  trial  with  bromide  of  ethyl,  using 
f .  i  .  He  entirely  failed  to  anaesthetize  the  patient, 
and  has  never  used  it  again. 

Dr.  Oldright  then  exhibited  his  method  of  treat- 
ing  empyema.  After  the  chest  is  punctured  with 
a  trocar^  and  the  pus  drawn  off,  he  attaches  a 
tubing,  passing  through  a  vessel  containing  an 
antiseptic  solution,  and  held  some  distance  above 
the  patient ;  the  pleural  cavity  is  then  washed  out 
and  fluid  is  passed  through  until  it  returns  quite 
clear,  and  this  is  repeated  every  few  days.  Br.  O. 
gave  several  cases  treated  in  this  way,  in  which  the 
results  had  been  very  satisfactory.  In  one  the 
expansion  of  the  lung  had  been  such  that  sabse- 
quently  no  difference  could  be  detected  between 
the  two  sides. 

Dr.  Jennings  preferred  a  counter  opening,  but 
also  advocated  washing  by  syphon. 

Dr.  Fenwick  thought  the  plan  had  no  advantage 
over  simple  incision.'  This  plan  was  now  used  by 
him  in  the  Montreal  General  Hospital,  and  was 
very  satisfactory.  He  employed  Lister's  dressings. 
Never  advises  aspiration,  for  the  pus  always  re- 
collects. Does  not  think  recovery  is  ever  com- 
plete, but  that  there  always  remains  some  shrinking 
of  the  affected  side. 

Dr.  Atherton  formerly  treated  it  by  washings,  but 
had  abandoned  the  plan,  finding  it  inconvenient, 
and  reaching  as  good  results  by  incision  and  dress- 
ing of  carbolized  oil.  He  agreed  with  Dr.  Fenwick 
as  far  as  concerned  operations  on  adults  or  aged 
persons,  but  believed  that  in  the  young  perfect 
expansion  of  a  lung  could  be  obtained.  He  alluded 
to  the  fact  that  sudden  death  had  occurred  from 
injecting  the  pleura. 

Dr.  Farrell  advocated  draining  by  a  tube  with 
the  extremity  beneath  an  antiseptic  solution,  as 
being  cleanly  and  effectual.  Always  used  an  oval 
and  not  a  round  tube,  as  fitting  better  between  the 
ribs. 

Dr.  Geo.  Ross  said  that  the  procedure  of  Dr. 
Oldright  contained  nothing  novel.  It  was  better 
than  syringing,  as  giving   a  less  forcible  stream. 


The  principle  of  very  copious  washings  was  that 
taught  by  Fraentzel  and  the  Germans.  He  alluded 
to  the  plan  by  valvular  drainage  advocated  by  Dr. 
Phelps,  of  Chateauguay,  N.  Y.,  but  could  not 
admit  that  any  other  procedure  ever  gave  better 
results  than  a  large  incision  and  Lister's  dressing 
without  any  injections. 

Evening  Session. 

The  President  took  the  chair  at  7.3  p.m. 

Dr.  Bessy,  of  Montreal,  read  a  very  interesting 
paper  on  "  Vaccination  from  Animal  Vaccine.' 
In  the  paper  he  referred  to  the  prominence  which 
vaccination  with  lymph  direct  from  the  animal  had 
already  attained.  He  called  attention  to  the  bad 
results  which  had  followed  vaccination  in  the  past, 
especially  in  former  years  in  the  city  of  Montreal, 
when  done  with  long-humanized  lymph,  which  had, 
in  spite  of  every  care  used  in  its  collection,  con- 
veyed various  materies  morbi  associated  with  the 
vaccinal  disease. 

He  took  it  for  granted  that  certain  propositions 
were  now  accepted  by  the  profession  from  which 
other  propositions  naturally  followed,  ist.  That 
vaccination  was  our  best  prophylactic  against 
small-pox.  2nd.  Tha4:  not  to  be  disappointing  it 
must  be  well  and  thoroughly  done  with  lymph 
capable  of  reproducing  a  per  feet  vaccine  vesicle 
3rd.  That  to  avoid  "  accidents  "  the  lymph  must  be 
pure.  That  to  fulfil  the  obligation  resting  upon  the 
practitioner  it  was  necessary  to  avoid  the  use  of 
either  degenerated  lymph  from  too  long  human 
transmission,  or  lymph  containing  blood  impur- 
ities, which  it  could  hardly  fail  to  do  if  taken  pro- 
miscuously from  human  subjects.  He  shewed,  by 
drawings  of  the  disease  when  in  full  bloom  and  the 
resulting  scars,  15  varieties  of  typical  vaccinal 
cicatrices  here  given.  That  bovine  lymph  or  heifer 
transmitted  lymph  induces  a  development  of 
vaccinia  in  a  greater  state  of  perfection,  and  of  more 
protective  efiicacy,  in  consequence,  than  humanized 
lymph.  That  the  calf  lymph  was  benigner  in 
its  action,  and  gave  all  the  results  of  true  Jen- 
nerian  vaccination.  He  would  not  deny  that 
humanized  lymph  might  by  carefulness  in  selection, 
in  the  hands  of  careful  men,  be  used  for  even  30 
or  40  years  with  apparently  satisfactory  results  as 
regards  accidents,  but  it  was  now  established 
beyond  cavil  that  each  remove  a  greater  distance 
from  the  animal  perceptibly  shortened  the  period 
of  duration  of  the  disease  and  diminished  its  effect 
on  the  constitution,  thus  lessening  the  amount  of 


268 


THE   CANADA    MEDICAL   RECORD. 


protection  afibrded  by  the  operation.  That  vac- 
cine, being  indigenous  to  the  heifer,  does  not  j 
degenerate :  the  painting  of  the  arm  shown  is  i 
from  a  child  vaccinated  from  lymph  taken  from 
the  240th  heifer,  from  the  original  spontaneous 
cases  which  occurred  at  Longue  Pointe,  near  j 
Montreal,  in  Nov.,  1877,  during  which  year  an  i 
epidemic  of  animal  pox  prevailed  among  cows  and 
horses.  He  traced  the  progress  of  animal  vaccina- 
tion, and  mentioned  the  various  new  stocks  of 
animal  lymph  that  have  been  introduced  to  the 
profession  since  the  time  of  Jenner,  1798,  which 
were,  Woodville  in  1800,  Passey  of  France  in  1836, 
Galbeata's  retro- vaccination  in  Italy,  1810,  followed 
later  by  Prof.  Negri  ;  the  introduction  of  animal 
vaccination  into  France  by  Janvix,  discovery  of 
the  Beaugency  stock  in  1868  by  Prof.  Depaul,  the 
Longue  Pointe  stock  by  himself  in  1877,  and  the 
progress  of  animal  vaccination  under  Dr.  Warlo- 
mont  in  Brussels,  and  last  of  all  its  introduction 
into  England  by  Act  of  Parliament  in  1 88 1 .  That 
he  had  vaccinated  three  children  of  a  family  with 
lymph  from  a  case  of  horse  pox,  and  two  of 
the  same  family  with  the  cow  pox,  as  an  experi. 
ment,  upon  the  same  day:  the  result  was  in 
both  cases  the  development  of  typical  vaccinal 
vesicle,  the  horse  pox  producing  rather  more 
local  disturbance,  but  running  its  course  and 
terminating  satisfactorily.  That  accidents  follow 
vaccination  and  lack  of  prophylactic  effect,  are 
directly  traceable  to  an  imjicrfect  vaccination  with 
imperfectly  developed  or  impure  lymph.  That  a 
perfect  vaccination  consisted  in  the  reproduction 
of  a  perfect  vaccine  vesicle  with  its  attendant  con- 
stitutional fever,  and  nothing  else  ;  that  he  feared, 
and  believed  in  the  possibility  of  conveying  syphilis, 
skin  affections,  scrofulous  taints,  etc.,  with 
humanized  lymph.  He  described  a  number  of 
spurious  vaccinations  which  might  result  from  the 
operation,  none  of  them  protective,  and  suggested 
revaccination  at  an  early  date  in  all  doubtful  cases, 
which  is  not,  like  past  vaccinal  inoculation,  illegal. 
He  concluded  by  instancing  the  following  advan- 
tages to  be  derived  from  the  use  of  heifer  lymph  : 
I  St.  It  guarantees  against  the  possibility  of  trans- 
mitting any  other  blood  contamination.  2nd.  The 
advantages  of  constant  sujjplies  of  reliable  lymph. 
3rd.  It  gives  the  greatest  possible  guarantee  of 
protection  by  emulating  perfectly  spontaneous  vac- 
cination, as  observed  by  Jenner  on  the  hands  of 
milker^,  and  which  1  as  always  been  found  to  give 
absolute   security  against   future  contagion.     4th. 


It  enables  the  practitioner  to  be  independent  of  his 
patients  as  to  his  stock  of  lymph.  It  had  been 
objected  to  it  that  it  was  hard  to  take,  this  objec- 
tion would  be  entirely  removed  with  due  care  in 
its  propagation  and  use,  which  he  very  fully  ex- 
plained, showing  that  both  producer  and  user  must 
use  considerable  judgment  in  the  matter  to  secure 
success.  He  concluded  a  most  interesting  paper 
with  the  hope  that  the  Association  would  press 
upon  the  attention  of  the  Government  the  duty  of 
establishing  a  National  Vaccine  Institution  for  the 
benefit  of  the  whole  country. 

Dr.  Slayter  does  not  believe  that  syphilis  can  be 
communicated  by  vaccination.  He  has  always 
used  lymph  supplied  by  the  Royal  Institution,  and 
has  never  been  dis.satisfied  with  the  results.  He 
thinks  with  Dr.  Bessey  that  there  should  be  some 
means  by  which  the  public  could  be  supplied  with 
pure  vaccine  lymph. 

Dr.  Robillard  said  that  in  1874,  during  an  epi- 
demic of  small-pox,  he  vaccinated  two  children  with 
lymph  procured  in  Liverpool  from  the  Royal  Insti- 
tution. In  both  of  these,  eruptions  showed  them- 
selves, one  of  which  he  felt  satisfied  was  a  syphi- 
litic nature,  and  which  disappeared  under  mercu- 
rial treatment.  He  had  never  felt  safe  with  that 
lymph  since. 

Dr.  McDonald  (Londonderry)  procured  his  vac- 
cine from  Boston.  He  found  that  animal  lymph 
was  more  insoluble  than  humanized  lymph,  and 
gnorance  of  this  fact  probably  led  to  some  of  the 
failures  when  the  former  was  used.  He  would  also 
urge  on  the  Government  the  importance  of  their 
taking  charge  of  this  matter. 

Dr.  Cowie  said  that  formerly  the  lymph  used  in 
Halifax  was  perfectly  satisfactory.  In  i860  he  had 
in  one  day  vaccinated  1 20  persons  ;  only  six  or 
seven  failed,  and  in  none  were  there  any  trouble- 
some symptoms.  During  the  past  two  or  three 
years  it  had  not  been  so  satisfactory.  There  were 
now  many  more  failures,  and  he  had  recently  seen 
a  man,  vaccinated  a  month  before,  with  large  un- 
healed ulcers  and  enlarged  glands. 

Dr.  Geo.  Ross  said  that  he  would  like  to  bear 
testimony  from  his  own  observation  to  the  excel- 
lent results  which  had  followed  the  introduction  of 
animal  vaccine  in  Montreal.  Previous  to  this 
with  the  ordinary  crust  and  lymph  which  were 
passed  along  from  one  to  another,  nor  only  were 
failures  comparatively  frequent,  but  unpleasant 
consequences  were  often  met  with.  He  had  seen 
long-standing  ulcers,  axillary  abscesses,  erysipelas 


TH3   CANADA   MEDICAL    RECORD. 


269 


and  cellulitis,  and  even  in  rare  cases,  pyaemia  with 
multiple  abscesses.  These  unfortunate  occur- 
rences had  led  to  the  widespread  opposition  to 
vaccination  which  had  prevailed  in  Montreal.  Now> 
however,  we  had  a  supply  of  pure  animal  lymph, 
which  we  used  with  perfect  confidence,  and  could 
say  that  such  accidents  as  the  above  never  occur- 
red. He  was  satisfied  that  animal  lymph  should 
always  be  used  when  procurable,  and  that  to  that 
end  it  was  highly  desirable  that  the  Government 
should  arrange  some  plan  for  perpetuating  and 
disseminating  a  generous  supply  of  the  pure  article. 

Dr.  Bessey,  in  reply  to  certain  enquiries  by 
members,  said  that  he  was  in  the  habit  of  person- 
ally selecting  perfectly  healthy  young  animals  ex- 
posed for  sale  for  the  purpose  of  inoculation.  He 
keeps  always  two  in  the  stable — one  in  the  later 
stages  and  the  other  partly  vaccinated.  He  once 
used  a  lean,  poor  heifer,  but  found  that  the  lymph 
was  bad,  and  caused  weak,  unhealthy  sores.  He 
was  obliged  to  recall  all  the  results  of  that  inocula- 
tion. He  found  from  experience  that  for  human 
vaccination  it  was  better  to  charge  points  on  the 
sixth  day,  and  not  wait  till  the  vesicles  were  at  their 
height  on  the  eighth  day ;  but  that  for  inoculating 
another  heifer,  he  would  wait  till  the  eighth  day  or 
later.  The  reason  for  this  is,  that  in  tlie  first  ca  e, 
for  complete  absorption,  you  require  a  thinner 
lymph  than  in  the  latter  case.  Full  ma.u- 
rity  also  implies  a  larger  size  of  the  lymph  vesicles, 
which  renders  them  unsuitable  for  use  on  the 
human  subject,  but  has  no  effect  when  used  for 
bovine  inoculation. 

Dr.  Worthington  (^Clinton,  Ont.)  then  read  a 
paper  on  "  The  Treatment  of  Scarlatina  Maligna 
by  Cold  Water  and  Ice."  He  selected  a  number 
of  instances  where,  during  the  epidemic  prevalence 
of  this  disease  in  his  locaUty,  he  had  adopted  this 
treatment  in  apparently  very  desperate  cases, 
accompanied  by  high  temperatures  and  the  usual 
concomitants  of  deHrium  or  coma,  and  had  saved 
many  cases  thereby.  In  these  frightful  attacks, 
such  is  his  confidence  in  these  antipyretic  mea- 
sures, that,  if  he  cannot  gain  the  consent  of  the 
friends  to  their  employment,  he  prefers  to  retire 
from  the  responsibiUty  of  their  treatment.  He 
urged  very  strongly  the  more  general  adoption  of 
these  very  valuable  measures  of  combating  this 
formidable  complaint. 

Dr.  Jennings  spoke  highly  of  the  plan  of  inunc- 
tion for  reducing  fever. 

Dr.  Fitch  said  that  he  had   latterly  employed 


glycerine  for  the  same  purpose,  and  found  it 
answer  well. 

Dr.  Coleman  advocated  the  repeated  cold-water 
bathing  in  this  as  well  as  typhoid  fever. 

Dr.  Eccles  remarked  that  the  same  principle  as 
advocated  in  the  paper  appHed  to  all  febrile  dis- 
eases when  violent  symptoms  seemed  purely  due 
to  fever  heat. 

Dr.  Fenwick  then  read  a  paper  on  "  Antiseptics 
in  Ovariotomy  and  other  surgical  Operations." 

The  next  paper  was  by  Dr.  Kingston,  "  On  cer- 
tain features  in  Ovariotomy." 

The  Association  adjourned  at  ii.io  p.m. 

Morning  Session,  Aug.  4. 

The  Association  met  at  9  a.m. 

The  Secretary,  by  direction  of  the  President, 
exhibited  some  spruce  shaving  splints  sent  by  Dr. 
Grant,  of  Ottawa. 

Dr.  Slayter  exhibited  an  ingeniously-contrived 
self-retaining  speculum,  which  enables  the  surgeon 
in  certain  cases  to  dispense  with  the  service  of  an 
assistant. 

Dr.  J.  W.  Macdonald,  of  Londonderr}^  read  a 
paper  on  "  Water  Analysis,"  and  at  the  same  time 
exhibited  a  case  containing  chemicals  and  appara- 
tus for  the  examination  of  water. 

Dr.  Stewart,  of  Brucefield,  read  a  paper  on 
"  Treatment  of  Exophthalmic  Goitre  by  Ergot." 

Dr.  Coleman  read  a  paper  on  "  The  use  of  the 
Ophthalmoscope  in  the  diagnosis  of  Brain  Disease." 
He  cited  several  cases  and  their  mode  of  treat- 
ment, and  his  success  in  such  treatment. 

Dr.  Jennings  read  a  report  of  3ome  cases  in 
practice,  shewing  the  effect  on  the  temperature  of 
a  patient  on  a  water  bed  by  using  hot  or  cold 
water ;  also  some  cases  shewing  the  effect  of  con- 
stant irrigation  with  carbolized  water  as  compared 
with  the  ordinary  Listerian  spray  and  gauze.  At 
the  same  time  he  exhibited  an  instrument  used  in 
the  process  of  irrigation,  which  was  worked  on  the 
syphon  principle. 

Dr.  Slayter  gave  notice  of  the  following  resolu- 
tion : 

'■  Whereas, — The  system  of  specialism  and 
specialists,  which  at  present  obtains  to  a  certain 
extent  in  the  Dominion,  and  which  has  developed 
to  a  very  large  proportion  in  the  neighboring  Re 
public,  is  for  the  most  part  the  outgrowth  of  super- 
ficial professional  education  and  want  of  success 
as  practitioners  of  medicine  and  surgery  ; 

"Therefore    resolved, — That  it  is  the  opi- 


270 


TIJE    CANADA    MEDICAL   RECORD. 


nion  of  this  society  that  specialism  should  be  dis- 
countenanced by  the  members  of  this  society,  and 
that  specialists  should  be  treated  and  looked  upon 
as  irregular  jjractitioners,  except  in  rare  cases 
where  long  experience,  extended  study,  and  pecu- 
liar aptitude  have  placed  a  medical  man  in  a  spe- 
cial position  towards  his  brethren  ; 

'•Be  it  therefore  resolved, — That  the  mem- 
bers of  this  society  pledge  themselves  to  do  all  in 
their  power  to  check  the  growth  of  this  species  of 
evil." 

In  supporting  his  resolution,  Dr.  Slayter  said  the 
evil  comiilained  of  was  ruining  their  profession  in 
America. 

Dr.  Farrell  spoke  of  the  difficulty  of  the  doctors 
getting  together  in  these  annual  meetings,  as  now 
held,  and  thought  the  smaller  societies  in  the  Mari- 
time Provinces  should  be  consolidated  into  a 
branch  of  the  Dominion  Association.  He  moved 
that  a  committee  be  appointed  to  consider  the 
matter,  and  confer  with  the  various  provincial 
medical  societies  for  the  purpose  of  bringing  about 
a  plan  of  organization  of  the  medical  societies  in 
the  Dominion  in  connection  with  the  Canada  Medi- 
cal Association.  Drs.  Clark,  Canniff,  Hill,  Fen- 
wick,  Hingston,  Steeves,  Atherton,  J.  F.  Black, 
J^arrell  and  the  Secretary  were  appointed  sucli  com- 
mittee. 

Dr.  Fenwick,  of  Montreal,  for  Dr.  Howard, 
brought  up  a  notice  of  motion  made  at  last  session 
to  amend  chap.  7.  sec.  2,  of  the  by-laws,  so  as  to 
impose  a  fee  of  $2,  to  be  paid  by  each  member 
only  at  every  annual  meeting  attended. — The 
motion  passed. 

Dr.  Page  made  a  short  speech  on  sanitary  legis- 
lation, and  moved  that  Drs.  Canniff,  Oldright, 
Grant,  Hill,  Bruce,,  of  Ontario  ;  the  President-elect 
(Dr.  Fenwick),  Drs.  Osier,  Larocque,  of  Quebec ; 
Botsford  and  Atherton,  New  Brunswick;  and  Hon 
Dr.  Parker  and  J.  W.  Macdonald,  of  Nova  Scotia, 
be  a  committee  to  seek  from  the  Dominion  Gov 
emment  improved  legislation  in  resjject  to  sanita- 
t;on  and  vital  statistics,  and  to  insist  upon  the 
organization  of  the  profession  as  a  condition  of 
political  supi)ort  at  the  next  election. — The  motion 
passed. 

On  motion  of  Dr.  J.  F.  Black,  seconded  by  Dr. 
Slayter,  the  Committee  on  Public  Health  was  in- 
Etructcd  to  hold  a  conference  with  the  Committee 
on  the  same  subject  of  the  Nova  Scotia  Medical 
Society. 

The  President  of   the  Association   havinc:  an- 


nounced that  Dr.  A.  H.  David  had  withdrawn  from 
the  office  of  General  Secretary  of  the  Association, 
a  resolution  was  passed  expressive  of  the  Associa- 
tion's deep  regret  that  any  cause  should  prevent 
him  from  continuing  his  services,  and  more  espe- 
cially that  this  cause  should  depend  upon  personal 
indisposition.  The  success  of  the  Association  had 
heretofore  largely  arisen  from  the  steady  and  per- 
severing efforts  of  Dr.  David,  and  the  Association 
trusted  that  he  might  for  many  years  witness  the 
continued  success  of  an  institution  to  which  he  had 
been  so  devoted. 

Dr.  Oldright  gave  notice  that  at  next  meeting 
he  would  move  that  clause  18  of  by-laws  should  be 
amended  by  substituting  the  words  "  Public  health, 
vital  statistics  and  climatology,''  for  the  words, 
"  Climatology  and  epidemic  diseases." 

On  motion  of  Dr.  Slayter,  a  vote  of  thanks  was 
passed  to  the  railway  companies  for  reduced  fares. 

On  motion  of  Dr.  Atherton,  a  vote  of  thanks 
was  passed  to  the  Sandy  Cove  Bathing  Com- 
pany and  the  Local  Government,  the  former  for  the 
use  of  baths,  and  the  latter  for  the  use  of  the  Pro- 
vincial building. 

On  motion  of  Dr.  Hill,  a  vote  of  thanks  was 
passed  to  the  medical  profession  of  Halifax  for 
their  kindness  to  visiting  members. 

The  following  is  the  report  of  the  Nominating 
Committee  which  was  read  by  the  Chairman,  Dr. 
Robillard  : 

President — Dr.  Fenwick,  Montreal. 

General  Secretary — Dr.  W.  Osier,  Montreal. 

Treasurer — Dr.  E.  Robillard,  Montreal. 

Vice-President  of  Ontario — Dr.  D.  Clarke, 
Toronto. 

Local  Secretary  of  Ontario — Dr.  A.  H.  Wright, 
Toronto. 

Vice-President  of  Quebec — Dr.  F.  W.  Campbell, 
Montreal. 

Local  Secretary  of  Quebec — Dr.  Bclleau,  Quebec. 

Vice  President  of  Nova  Scotia — Dr.  R.  S.  Black, 
Halifax. 

Local  Secretary  of  Nova  Scotia— T)v.  C.  D. 
Rigby,  Halifax. 

'  Vice-President  of  Neu>  B runs-wick— Dr.    P.  R. 
Inches,  St.  John. 

Local  Secretary  of  New  Brunswick — Dr.  C. 
Holden,  St.  John. 

Committee  on  Arrangements — Drs.  D.  Clarke, 
Oldright,  Temple,  A.  A.  McDonald,  of  Toronto, 
with  power  to  add  to  their  number. 


THE    CANADA    MEDICAL    RECORD. 


271 


Committee  on  Necrology— Vix^.  Fulton,  Toronto  ; 
Atherton,  Fredericton  ;  Lachapelle,  Montreal. 

Committee  on  Education— V>x%.  Eccles,  London  ; 
Holmes,  Chatham,  and  Bessey,  Montreal. 

Committee  on  Climatology  and  Public  Health 
— Drs.  Botsford,  St.  John  ;  Worthington,  Clinton, 
Ont. ;  Larocque,  Montreal ;  McDonald,  London- 
derry, and  Coleman,  St.  John. 

Committee  on  Ethics— Dxs.  Canniff,  Toronto  ; 
Malloch,  Hamilton ;  Gardner,  Montreal ;  Marsden, 
Quebec ;  Bayard,  St.  John  ;  Parker  and  W.  J.  Al- 
mon,  Halifax  ;  Steeves,  St.  John  ;  Beaudry,  Mon- 
treal, and  Chas.  Moore,  sen.,  London. 

Committee  on  Publication— V>x%.  Ross,  Mon- 
treal ;  Cameron  and  Fulton,  Toronto  ;  the  General 
Secretary  and  Treasurer. 

Committee  on  Practice  and  Medicine — Drs.  Law- 
son,  Halifax  ;  Graham,  Toronto ;  Duncan,  Bath- 
urst. 

Committee  on  Surgery  — Drs.  Shepherd,  Mon- 
treal ;  J.  F.  Black,  Halifax,  and  McFarlane,  To- 
ronto. 

Committee  on  Obstetrics— Dr?,.  Temple,  To- 
ronto ;  Trudel,  Montreal,  and  McKarren,  St.  John. 

Committee  on  Therapeutics — Drs.  Tye,  Thames- 
ville ;  Wilkins,  Montreal,  and  Somers,  Halifax. 

The  Committee  recommended  that  the  n  xt 
meeting  be  held  in  Toronto,  the  time  to  be  deci  ed 
by  the  Association. 

The  report  was  adopted  e}i  bloc. 

On  motion  of  Dr.  Hingston,  a  vote  of  thanks  was 
passed  to  the  retiring  President  for  his  able  con- 
duct in  the  chair  and  his  admirable  address,  con- 
taining many  useful  and  practical  hints.  This  was 
acknowledged  by  Dr.  Canniff  amidst  applause. 

The  Association  then  adjourned  to  meet  in  To- 
ronto on  the  first  Wednesday  of  September,  1882. 

BoUe^^ondmm. 

Editor  "  Canada  Medical  Record." 

Sir, — It  maybe  regarded  as  extremely  doubtful 
whether,  amid  the  infinity  of  practical  questions  to 
which  the  medical  man  may  direct  his  attention) 
the  time  devoted  to  the  consideration  of  such 
subjects  as  evolution  and  kindred  problems  of 
mind  and  life  is  not  spent  in  vain.  Yet  shall  we 
never  vary  the  "  pleasing  monotony  "  of  work  in 
the  terra  mcdica  by  an  occasional  holiday  trip 
into  the  adjoining  territory  of  biology  and  mental 


philosophy  ?  No  doubt  Dr.  Henry  Howard  had 
in  view  recreative  pleasures  of  this  kind  when  he 
treated  your  readers  to  his  very  able  paper  on 
''  Man's  Two  Natures  "  and  his  review  of  Ernest 
Hceckel's  "  History  of  the  Evolution  of  Man." 

I  have  tried  to  follow  him  during  this  retro- 
spective journey,  and  I  felt  that  somebody  ought  to 
present  the  ''other  side  of  the. story,"  as  regards 
the  scope  and  plan  of  evolution,  in  so  far  as  Dr. 
Howard  has  touched  upon  it.  The  writer  accepts 
evolution.  He  recognizes  ''that  the  evolution 
theory  of  creation  is  more  in  accord  with  nature's 
laws  as  we  now  understand  them  than  that  God 
called  man  and  all  other  animals  in  perfect  order 
in  a  moment  of  time  out  of  the  earth  ;  "  nor  can 
he  see  that  "  the  evolution  theory  takes  anything 
from  the  honor  and  glory  of  God  as  first  Cause 
and  Creator."  So  far,  so  good.  The  truth  of  the 
theory  of  evolution  is  certainly  not  bound  up 
with  that  of  the  existence  of  Deity.  But  from  a 
third  position  which  Dr.  Howard  takes,  and  the 
one  upon  which  he  lays  great  stress,  it  seems  to 
me  every  unbiassed  lover  of  truth  must  instantly 
dissent.  Mark  the  conciseness  of  these  state- 
ments : — "  opponents  [of  evolution]  assume  that 
the  theory  is  contrary  to  the  teachings  of  Moses 
as  recorded  in  the  book  of  Genesis  ****** 
yet  to  my  reading  of  the  first  chapter  of  Genesis 
—the  whole  of  it— is  evolution."  And  again— 
''  suppose  that,  in  accordance  with  God's  estab- 
lished natural  laws,  the  grain  of  dust  or  slime 
from  which  man  was  evolved,  and  all  other 
animals  evolved— but  I  will  only  speak  of  man, — 
suppose,  then,  that  this  grain  of  dust  was  first 
evolved  into  an  ovum  whose  seed  was  in  itself, 
and  that  it  took  millions  of  years,  in  fact  the 
whole  of  the  6th  period  of  time,  before  it  became 
a  perfect  animal,  and  then  that  God  endowed  this 
animal  with  a  human  nature,  by  which  it  became 
man, — there  is  nothing  in  such  a  supposition 
contrary  to  the  teachings  of  Moses,  yet  it  would 
be  evolution." 

Let  us  see.  Firstly,  this  is  hovs^  the  Mosaic 
biologist  accounts  for  the  origin  of  woman  :  "  And 
the  Lord  God  caused  a  deep  sleep  to  fall  upon 
Adam,  and  he  slept :  and  he  took  one  of  his  ribs, 
and  closed  up  the  flesh  instead  thereof ;  and  the 
rib  which  the  Lord  God  had  taken  from  the  man 
made  He  a  woman,  and  brought  her  unto  the  man."' 
Is  that  the  Darwinian  version?  Does  Haeckel 
thus  explain  the  origm  of  sexual  differentiation  in 
the  higher  vertebrates  ? 


272 


THE   CANADA    MEDICAL   RECORD. 


In  following  the  long  chain  of  organic  life, 
which  probably  began  with  Bathybios  Ilaeckelii 
and  culminated  in  man,  each  link  fits  in  with 
generally  received  scientific  theories,  and  among 
these  none  have  been  so  unhesitatingly  accepted 
as  the  nebular  hypothesis  of  the  origin  of  our 
planet — as  taught  by  Kant  and  Laplace — and  the 
explanation  of  the  complex  relations  existing 
between  the  members  of  our  solar  world — known 
as  the  Copernican  system. 

But  evolution,  even  when  restricted  in  its  appli- 
cation to  animal  life,  has  a  yet  closer  connection 
with  these  theories,  for  the  simple  protoplasmic  mass 
that  finally  assumed  the  shape  of  living  amoeboid 
masses  originated  from  the  earth's  crust ;  and  the 
earth  itself  is  the  product  of  an  inorganic  evolution 
— unfolded  from  that  fiery  cloud  which  rolled  for 
untold   ages   the  mother-nebula  of  solar  worlds. 
If,  then,  the  one  of  these  theories  be  not  true  the 
sister   theory   of    evolution   will   require    serious 
remodelling  ;  if  the  other  be  wholly  a  delusion, 
geology  is  a  lie  ;  if  only  a  partial  truth,  then  a 
blow  will  have  been  struck  at  the  very  foundation 
of  the  theory  of  evolution,  and  that  philosopher 
who  in  his  musings  on  the  weather-beaten  Matter- 
horn  saw  in  primordial  matter  the  promise  and 
potency    of    all    earthly    things,    had    a    mental 
hypochyma,  and  the  "  nebulous  haze  "  he  speaks 
of  was  a  purely  subjective  phenomenon  of   his 
imperfect  vision.     I  am  obliged  to  insist  upon  this 
because  no  twistings  of  the  translation  and  no 
perversion  of  the  evident  meaning  of  the  text  will 
reconcile  the  ancient  Jewish    cosmogony  to  the 
present  teachings  of  science.     When  (Genesis  i. 
3)  God  said,  "  Let  there  be  light ;  and  there  was 
light,"   that   light   must   have    existed    countless 
centuries  anterior  to  his  making  of  the  heavenly 
bodies  during  the  fourth  "  day."     And  yet  all  this 
time  vegetation  flourished  and  actinic  energy  from 
some   source   was    storing    away    the    boundless 
wealth  that   constitutes  our   coal-measures !     On 
the  first  day  He  created  the  effect  of  solar  light, 
but  postponed  for  innumerable  cycles  the  creation 
of  what  we  know  to  be  the  one  great  source  to  us 
of  light  and  life  ! 

Similarly  the  evolution  of  vegetation,  which  is 
now  as  firmly  insisted  upon  and  as  fairly  shown 
as  the  evolution  of  animal  life — how  does  it 
accord  with  this  statement  in  Genesis  ii.  4,  6  : 
"  These  are  the  generations  of  the  heavens  and  of 
the  earth  when  they  were  created,  in  the  day  that 
the  Lord  God  made  the  earth  and  the  heavens, 


and  erery  plant  of  the  field  before  it  was  in  the 
earthy  and  ez'cry  herb  of  the  field  before  it  grew  : 
for  the  Lord  God  had  not  caused  it  to  rain  upon 
the  earth  "  1     That  is  to  say,  while  the  doctrine  of 
evolution   teaches  the   gradual    development,    in 
the  course  of  ages,  by  means  of  natural  selection, 
the  survival  of  the  fittest,  and  other  processes,  of 
all  plant  life  from  inorganic  matter,  the  account 
in    Genesis   portrays   an   anthropomorphic   God- 
gardener  who  performs  a  sort  of  will  jugglery  and 
lo  ! — ex  nihilo — the  plants  are  there  !     For  once 
the    sacred  writer  is   explicit.     The    plants    are 
created  "  brand  new,  and  bearing  the  stamp  of  the 
manufactured  article."     And  no  rain  ?     Why  the 
most  violent  storms  that  traverse  our  earth  are 
ethereal    mildness    itself    when    compared    with 
primeval  downpours  !     If  the  rain-drop  markings 
on  the  oldest  stratified  rocks  were  not  preserved 
to  this  day  to  totally  disprove  the  assertion  of  this 
verse  the  very  fact  of  the  existence  of  Eozoic  seas 
implies  rain  and  thunder  storms  as  plainly  as  if 
we   possessed  authentic   meteorologic  reports  of 
those  primitive  eras.     But  Dr.  Howard  goes  still 
further.     He  would  constitute  these  crude  concep- 
tions the  patron  saints  of  modern  science,  for  he 
says: — "We  then  may  read  the  passages  thus — 
the  evening  and  the  morning  was  the  first  period, 
instead  of  first  day,  a7id  much  of  the  trouble  will 
be  overcotne  towards   establishing  the  theory    of 
a'olution  to  be  a  scientific  fact.     The   italicized 
sentence  leads  one  to  ask,  which  has  the  more 
trying  task  to  accomplish,  he  who  measures  out 
his  science  to  suit  his  religious  creed  or  the  man 
who  stretches   upon   the  procrustean  bed  of  his 
science   the    tortured    remains    of    his    religious 
corpus  ?     In    this  particular   instance  one  would 
wish  for  the  former  that  the  writers  of  the  Pen- 
tateuch    had     been     disciples     of     Pythagoras, 
Hod  that  been  the  case,  we  should  not  now  be 
obliged  to  witness  the  mental  gymnastics  of  those 
sincere  but  much-to-be-pitied  searchers  after  truth 
who   consider    it    possible    to    "  reconcile "    the 
mythical  Ptolemaic  system  with  the  more  reason- 
able conception  of  the  former  philosopher.     And 
for  the  latter  class — well,  they  are  at  least  allowed 
the  pleasure  which  comes  from  the  unrestrained 
use  of  their  reasoning  faculties.     There  is,  finally, 
one  matter   to  which   Dr.   Howard  alludes   that 
Hceckel's  sympathizers,  as  well  as  his  opponents, 
seem  to  have  recognized,  and  that  is  his  bigotry 
on  theological  questions.     Prof.   Huxley,  writing 
in  a  late  review,  mourns  over  this  lack  of  charity, 


TUE   CANADA   MEDICAL    RECORD. 


273 


f 


and  insists  upon  it  that  respect  for  an  adversary's 
opinions  and  a  desire  to  avoid  sources  of  ill-feeling 
are  far  more  productive  of  good  results  than 
impatience  and  uncharitableness.  In  this  sense 
Hoeckel  deserves  the  rebuke  administered  to  him 
in  Dr.  Howard's  second  paper.  Still,  while  admit- 
ing  Prof.  Hoeckel's  evident  ignorance  of  the  real 
significance  of  the  dogma  of  the  Immaculate 
Conception,  I  cannot  but  think  Dr.  Howard  is 
mistaken  in  supposing  that  he  proceeded  on  the 
assumption  that  the  "  Virgin  Mary  had  no  father, 
but  was  procreated  assexually  by  her  mother." 
There  is  no  "  glimmer  of  hidden  truth  "  here. 
The  most  natural  conclusion  is,  as  it  seems  to  me, 
that  he  confounded  the  dogma  of  the  Incarnation 
(see  Luke  i.  34,  35)  with  that  of  the  Immaculate 
Conception. 

But   a  far  more  ironical  commentary  on   this 
tendency   is   the   inconsistency   which   the    man 
shows  himself  to  be  guilty  of.     "  Where  science 
ends,  then  faiih  begins,"  is  what  he  affirms  in  that 
"  History  of   Evolution "  which  he  wrote  some 
years  previous  to  his  work  on  the  "  Evolution  of 
Man."    Had  he  kept  this  maxim  in  view  he  would 
not  have  been  guilty  of  the  blunder  referred  to 
And  here  let  it  be  noticed  is  the  only  safe  gauge 
by   which    to    measure    the    scope   and    mutua 
relations  of  science  and  religion.     Many  difficul 
ties   w^ould   be    ov^ercome,  and   much    ill-feeling 
prevented;  if,  to  use  the  pregnant  words  of  the 
Lord  Bishop  of  Carlisle,   science   were   regarded 
not  as  either  atheistic  or  theistic  but  as  atheous; 
that  is,  as  preserving  an  absolute  neutrality  on  all 
questions  of  religious  faith.     It  would  eliminate 
two  very  manifest  and    important   errors  which, 
curiously  enough,  Dr.  Howard  mentions,  and  one 
of  which   he  unconsciously  falls  into.     Because 
(following  this  train  of  thought)  while  it  is  a  mis- 
taken notion  that  "  the  science  of  evolution  leads 
to  infidelity  and  atheism  "  it  is  just  as  incorrect  to 
repeat  the    much-employed  statement   that  "  the 
more  a  man  knows  of  natural  science  the  nearer 
is  he  to  the  supernatural  Creator."    If  the  Bishop's 
suggestion  were    universally  received  and   acted 
upon,  scientific  men,  on  the  one  hand,  might  carry 
on  their  researches  undisturbed  by  timid  question- 
ing of  the  tendency  of  their  work  ;  and,  on  the 
other  hand,  men  of  all  shades  of  religious  opinion 
would  have  a  sure  harbor  of  refuge,  where  they 
would  be  unaffected  by,  and  might  be  indifferent 
to,  the  tempest  raging  without   on  the   troubled 
ocean  of  analogous  and  inductive  reasoning. 


Like  Faraday,  each  of  us  would  be  able  "  on 
entering  his  laboratory  to  shut  to  the  door  of  his 
oratory ;  on  passing  into  his  oratory  to  close  the 
door  of  his  laboratory." 

Yours  truly, 

H.  Sapiens,  M.D. 
Montreal,  June  26th,  i88r. 


MALTO-PEPSYN. 

We  direct  attention  to  the  letter  of  Dr.  Burns  of 
Toronto,  concerning  this  preparation,  which  we 
publish  below.  Knowing  Dr.  Burns,  we  place 
much  reliance  upon  his  testimony.  Our  own  ex- 
perience is  that  Malto-Pepsyn  is  a  very  valuable 
preparation,  and  we  recommend  its  use  by  our 
readers. 

Toronto,  26th  July,  1881. 
Hazen  Morse,  Esq. 

Dear  Sir, — In  reply  to  your  letter  of  the  12th 
inst.,  asking  our  experience  of  the  use  of  Malto- 
pepsyn  in  the  Infants'  Home,  I  beg  to  say  on  my 
own  account,  and  for  Doctors  McDonald  and 
Pyne,  to  whom  I  have  spoken  on  the  subject,  that 
much  benefit  has  been  derived  from  the  employ- 
ment of  your  preparation  wherever  the  use  of 
agents  required  to  promote  digestion  were  in- 
dicated. 

It  has  been  found  beneficial  also  in  vomiting 
accompanying  diarrhoea  among  the  infants  of  the 
Home,  and  is  advantageously  administered  in 
certain  fornis  of  diarrhoea. 

Yours  truly, 

J.  H.  Burns,  M.D. 

Consulting  Physician  at  In/ants'  Home. 

3^m§Miiof  Jitediml  Science. 

HEADACHE,  AND  THE  REMEDIES  PRO- 
POSED. 

There  is  scarcely  any  other  complication,  to 
which  the  human  system  is  heir,  which  causes  the 
patient  more  continued  misery,  and  the  physician 
more  annoyance  and  disgust  with  his  powers  of 
diagnosis,  and  with  the  workings  of  his  remedies, 
than  headache.  The  medicine  which  has  been 
acting  so  nicely  proves  inert,  and  the  patient  suf- 
fers all  his  former  torments  unrelieved. 

It  has  been  thought  that  it  would  be  of  value  to 
the  young  pratitioner  to   present  in  one  article  all 


274 


THE   CANADA   iltUlCAL   KECORD. 


the  remedies  which  have  within  recent  years  been 
found  valuable  in  this  comjjlaint,  that  from  them 
he  may  continue  to  select  until  he  finds  one  adapt- 
ed to  his  patient.  With  this  view  and  hope  the 
present  article  has  been  prepared. 

Dr.  Henry  Hartshorne,  in  his  "  Essentials  of 
the  Principles  and  Practice  of  Medicine,"  says 
that  pain  in  the  head,  cephalalgia,  may  be  consid- 
ered as  depending  essentially  upon: — 

"Neuralgia;  rheumatism  of  the  scalp;  conges- 
tion of  the  brain  ;  toxaemia  (e.  g.,  by  narcotics, 
alcohol,  etc.)  ;  fever  (remittent,  yellow,  typhoid, 
etc.)  ;  chronic  disease  of  brain  (tumors,  etc.) ; 
uterine  irritation,  etc. 

"  The  distinction  between  these  different  forms 
of  headache  is  by  no  means  always  easily  made  out. 
As  a  general  statement  it  may  be  said  that  neu- 
ralgic headache  is  mostly  on  one  side  (hemicrania), 
and  extends  more  or  less  to  the  face  ;  it  is  usually 
accompanied,  also,  by  sensitiveness  of  the  scalp, 
and  is  shooting  or  darting  in  its  character.  Rheu- 
matism of  the  head  is  attended  by  stiffness  of  the 
muscles  which  move  the  head  from  side  to  side. 
Congestive,  febrile,  and  toxaemic  headaches  are 
accompanied  by  heat  of  the  head,  and  are 
throbbing  or  pulsating.  That  of  uterine  irritation 
is  on  the  top  of  the  head.  The  pain  of  chronic 
cerebral  disease  (tumors,  etc.)  is  commonly  con- 
stant or  periodic  in  one  spot,  and  is  attended  by 
some  functional  disorder  of  the  brain." 

Although  the  physician  will  often  be  baffled  in 
his  search  for  a  cause  of  headache  in  a  patient, 
yet  many  causes  will  often  be  patent.  One,  es- 
pecially in  females,  is  constipation,  by  which 
habit  the  blood  is  poisoned  and  the  nervous  cen- 
ters unbalanced.  Irritating  foods  are  a  frequent 
cause  of  headache  ;  all  such  should  be  avoided ; 
gastric  catarrh,  irritability,  acidity,  and  flatulence 
are  all  excellently  corrected  by  abstaining  from 
food  for  one  or  more  meals  when  headache  is 
threatened.  Acidity  of  stomach  should  be  correct- 
ed by  magnesia,  soda  bicarbonate,  or  blue  pill. 
Impure  gases  in  living  rooms  and  bed-chambers, 
due  to  defective  or  insufficient  ventilation,  are 
constant  causes  of  headache.  Tumors  in  the 
brain,  when  suspected,  should  be  treated  with 
potassium  iodide.  Persons  troubled  with  nervous 
or  sick  headache  should  go  to  bed  after  drinking 
a  cup  of  tea,  and  remain  as  quiet  as  possible. 
The  remedies  which  follow  are,  for  headache, 
toxsemic  and  congestive,  though  they  may  be 
sometimes  applicable  in  other  cases. 

In  nervous  headache,  Dr.  W.  A.  Hammond 
gives  proference  to  the  following  drugs  : 

Oxide  of  zinc,  in  pill.     Dose,  two  to  five  grains. 
Nux     vomica.     Dose,    one-fourth    grain    after 
meals,  frequently  best   combined  with   iron  and 
quinia,  especially  in  chlorotic  patients. 

Bismuth  subcarbonate  and  sulmitrate  may  both 
be  u'-ed  in  place  of  zinc  oxide.  Dose,  two  grains, 
after  each  meal.  It  acts  by  allaying  any  gastric 
disturbance,  and  thus  promotes  digestion. 

The  bromides,  especially  bromide  of  potassium. 


are  valuable  in  all  cases  of  headache  from  nervous 

irritability  ;  if  one  bromide  does  no  good,  try  an- 
other. In  cases  of  nervous  exhaustion  they  often 
do  harm. 

Phosphorus  is  often  found  useful  in  cases  of 
nervous  headache.  An  excellent  form  is  phos- 
phoric acid,  thirty  drops,  largely  diluted,  three 
times  a  day  after  eating,  or  phosphorus  in  pill,  one- 
sixtieth  grain,  or  the  phosphide  of  zinc  may  be 
used  in  pill,  one-tenth  grain,  three  times  a  day  ; 
or  phosphorus  dissolved  in  ether  one-sixtieth 
grain.  Arsenic  is  highly  valued.  An  excellent 
preparation  is  Fowler's  solution,  five  to  ten  drops 
after  each  meal. 

Galvanism  has  in  many  cases  been  found  to  give 
relief ;  use  the  constant  current  and  avoid  too  great 
intensity. 

The  solution  of  acetate  of  ammonia  is  unrivaled 
in  treatment  of  nervous  and  sick  headache. 
Dose,  a  teaspoonful  or  two,  repeated  every  hour. 

Morphia  sulphate,  one-fifth  grain  in  a  cup  of 
coffee,  has  been  found  to  be  an  excellent  occa- 
sional remedy  for  nervous  headache  of  females, 
occurring  about  the  menstrual  epochs.  It  is  un- 
safe for  constant  use.  The  acetate  and  muriate 
of  morphia  have  a  similar  action,  and  may  be 
tried. 

Hydrate  of  chloral  has  a  transient  effect  in  ner- 
vous headache,  dose  ten  to  twenty  grains  in  pepper- 
mint water,  or  it  may  be  applied  locally,  made  into 
an  ointment,  with  lard  ;  chloral  seven  parts,  lard 
twenty-seven. 

Butylchloral  hydrate  has  lately  been  recommend- 
ed for  nervous  headache  in  anaemic  girls  and 
women.  It  must  be  administered  in  glycerine  or 
syrup  strongly  flavored  with  essence  of  pepper- 
mint, or  syrup  of  liquorice  root,  to  cover  up  its 
bitter  taste. 

Tea,  coffee  and  Paraguay  tea,  from  the  contain- 
ed caffeine,  are  found  valuable  in  nervous  head- 
aches produced  by  cerebral  congestion  ;  hence, 
when  the  face  is  flushed  they  are  indicated,  but 
when  the  face  is  pale  and  the  pain  is  simple  neu- 
ralgic, these  substances  seem  to  aggravate  the 
trouble. 

Two  grains  of  citrate  of  cafieine,  in  capsule- 
taken  every  half  hour,  is  said  to  be  a  very  effectual 
remedy  in  nervous  and  sick  headache,  one  or 
two  doses  usually  being  sufiicient  to  give  relief. 
It  is  seldom  rejected  by  the  stomach,  but  in  some 
patients  it  produces  sleeplessness.  It  is  indicated 
in  the  cases  mentioned  as  suitable  for  tea  and 
coffee. 

The  following  is  said  to  lie  frequently  prescribed 
by  Dr.  W.  W.  Carpenter,  for  headache. 

R  Muriate  ammonia  3  iii. 
Acetate  morphia,  gr.  j. 
Citrate  caffeine,  grs.  xxx. 
Aromatic  spirits  ammonia,  f  3  j. 
Elixir  of  guarana,  f  z  iv. 
Rose  water,  f  :   iv. 


THE    CANADA   MEDICAL   llECORD. 


275 


M.  Sig.  Dose,  dessertspoonful  every  ten  or 
:welve  minutes. 

Monobromated  camphor  has  been  found  valua- 
ble in  headaches  brought  on  by  over-stimulation 
of  the  brain  through  study  or  excitement.  Dose, 
tvo  to  five  grains  in  sugar-coated  pills. 

Linden  flowers  in  infusion,  thirty  to  sixty  grains 
of  the  flowers  to  a  pint  of  water,  is  a  common 
dcmestic  remedy  for  nervous  headache  ;  it  may  be 
taien  either  cold  or  warm,  whichever  is  the  more 
ag'eeable.  The  linden  trees  are  variously  known 
as  Ume  trees,  bass-wood,  and  whitewood  ;  they  are 
stately  noble  trees.  All  species  are  valuable,  both 
American  and  European. 

Ammoniated  tincture  of  valerian  has  been  used 
in  nervous  headache.  Also  the  elixir  of  valerian- 
ate of  ammonia.  Dose,  a  fluid  drachm.  These 
are  among  the  most  reliable  remedies  for  this 
troublesome  affection. 

Valerianate  of  zinc  was  formerly  much  praised 
for  its  influence  over  nervous  headache,  but  is  now 
only  employed  in  cases  of  excitable  or  hysterical 
females. 

On  the  authority  of  Schumacher,  ergot  is  said  to 
be  valuable  in  cases  of  nervous  headache  or  mi- 
graine. It  is  administered  in  powder,  six  grains  a 
day,  gradually  increased  to  fifteen  grains. 

The  inhalation  of  ether  frequently  relieves  ner- 
vous headache. 

In  nervous  headache,  faintness  or  drowsiness, 
the  stimulating  effects  of  strong  vinegar,  or  dilute 
acetic  acid  are  useful ;  the  best  results  are  obtained 
by  snuffing  the  fumes,  and  by  placing  a  wet  cloth 
with  them  upon  that  portion  of  the  head  in  which 
the  pain  is  most  acute.  The  effect  is  increased  by 
the  addition  of  camphor,  and  other  aromatics. 

The  headache  produced  byquinia  and  iron  is 
prevented  when  these  medicines  are  combined  with 
hydrobromic  acid,  a  substance  which  appears  to 
act  upon  the  nervous  system,  much  in  the  same 
way  as  does  potassium  bromide.  The  acid  also 
prevents  the  tinnitus  aurium,  and  disorders  of 
vision  which  often  follow  the  continued  use  of  lar- 
ger doses  of  quinine.  Dose,  thirty  drops,  diluted. 
Flavor  with  lemonade. 

Headache  depending  upon  acidity  of  the  stom- 
ach is  often  relieved  by  carbonate  of  ammonia.  It 
may  be  administered  by  inhalation  and  internally. 
Dose,  two  or  three  grains  in  water  solution,  with 
mucilage  or  sugar  to  destroy  taste. 

Aromatic  spirit  of  ammonia  is  employed  almost 
exclusively  for  the  relief  of  headache,  and  especially 
those  forms  depending  upon  acidity  of  the  stomach, 
and  accompanied  with  flatulent  eructations.  It 
probably  corrects  the  acidity,  and  provokes  the 
expulsion  of  the  gases,  and  at  the  same  time 
gently  stimulates  the  nervous  system  in  a  manner 
which  allays  pain.  Dose,  thirty  minims,  diluted, 
repeated. 

Nitrate  of  amyl  has  been  found  to  relieve  ner- 
vous headache.     Dose,  three  to  five  drops  inter- 


nally, taken  in  some  aromatic  spirit,  or  by  inhala- 
tion, about  five  drops  being  inhaled  from  the  hand 
or  handkerchief. 

The  delicate  and  refreshing  perfume  of  orange- 
flower  water  will  be  gratefully  received  by  many 
afflicted  with  nervous  or  sick  headache.  It  may  be 
administered  by  inhalation,  or  by  the  mouth. 

Camphor  water,  in  doses  of  a  tablespoonful,  is 
valuable  in  nervous  headache.  Camphor  may  also 
be  given  in  substance. 

Many  patients  gratefully  take  peppermint  water 
in  doses  of  a  tablespoonful  or  more  for  headache. 
It  acts  in  the  same  manner  as  other  diffusible  and 
aromatic  stimulants.  An  infusion  of  the  fresh  herb 
may  also  be  administered,  also  the  spirit. 

For  periodical  headaches,  the  sulphate  of  berbe- 
rina  has  been  found  valuable.  The  dose  is  one  to 
two  grains,  dissolved  in  aromatic  sulphuric  acid, 
well  diluted  with  water.  Its  efficacy  seems  to  be 
due  to  its  anti-periodic  virtues. 

Owing  to  its  anaesthetic  properties  the  extract 
of  cannabis  indica  has  been  tried  with  some  success 
in  cases  of  recurrent  headache,  or  migraine.  In 
such  cases  it  is  recommended  to  take  it  habi- 
tually in  doses  of  one-third  of  a  grain  twice  a  day, 
during  the  attacks,  to  be  increased  to  grain  one- 
half  or  more.  This  remedy  is  said  to  be  especially 
valuable  in  cases  of  hereditary  headache,  and  is 
w^ell  worthy  of  trial  in  all  these  cases  of  "  ever- 
hving,  never-ending,  martyrdom-like  suffering." 

Berberina  has  been  much  praised  for  its  control 
of  periodical  headaches.  Dose,  grains  five  to  fif- 
teen, gradually  increased. 

Guarana,  in  its  control  of  headache,  much  resem- 
bles tea  and  coffee.  It  is  especially  valuable  in  the 
various  forms  of  recurring  nervous  sick  headache, 
especially  in  females  at  the  menstrual  periods,  and 
the  headache  which  follows  a  debauche,  when  the 
head  throbs  and  the  eyes  are  bloodshot.  It,however 
soon  loses  its  power  in  most  cases ;  it  is  best 
administered  in  infusion  or  alcohoHc  extract.  The 
elixir  of  guarana  is  an  excellent  preparation. 

Primulla  officinalis,  primrose,  and  convallaria, 
lily  of  the  valley  (officinal  parts,  the  roots),  have 
been  used  as  sternutatories  for  relief  of  headache, 
and  they  probably  have  some  value. 

Sneezeweed  {helenium  autumnal  e),  a  native 
plant  of  the  natural  order  compositag,  has  been  used 
as  an  errhine  in  incipient  coryza,  and  to  relieve 
headache.  The  flowers  and  leaves  are  officinal, 
and  are  administered  in  powder. 

Exhaustion  of  Nervous  System. — Valerianate 
of  ammonia,  in  doses  of  two  to  ten  grains,  dissolved 
in  water,  with  some  flavoring  tincture,  continues 
to  be  administered  with  considerable  success  in 
nervous  headache.  It  is  most  valuable  when  the 
nervous  system  is  exhausted. 

Valerianate  of  quinia  has  probably  some  value 
in  sick  headache. 

In  headache  brought  on  by  nervous  exhaustion, 
cubebs,  by  stimulating  the   nervous  centers,  has 


270 


THE    CANADA    MEDICAL    RECORD. 


been  tlioiight  to  be  beneficial.  The  action  of  the 
drug  is  jirobably  indireit,  by  imi)ro\  ing  the  digos 
tion,  and  hence  the  blood.  Dose,  ten  grains,  in 
water  with  sugar,  or  in  wafers. 

Local  applications. — IjisLilj)hide  of  carbon,  from 
its  anaesthetic  properties,  has  been  used  as  a  local 
application  in  headaches.  It  is  made  into  an  oint- 
ment with  from  five  to  ten  ])arts  of  lard. 

Chloroform  is  also  used  topically  and  by  inhala- 
tion. Covered  with  oiled  silk  it  quickly  blisters. 
It  should  always  be  inhaled  by  a  patient  when 
alone,  with  care,  and  always  discontinued  before 
insensibility  is  reached. 

Oil  of  lavender  may  be  used  topically  to  calm 
nervous  headache.  It  may  be  given  internally  in 
doses  of  four  or  five  drops.  Best  administered  in 
the  simple  or  compound  spirit  of  lavender. 

Oil  of  peppermint  was  used  by  the  ancient 
Romans,  and  from  the  remotest  antiquity  by  the 
Chinese,  as  a  local  analgesic  remedy.  It  is  of 
special  value  in  neuralgic  headache.  It  should  be 
applied  on  a  saturated  cotton  compress,  covered 
with  a  piece  of  oiled  silk,  waxed  paper,  or  sheet 
caoutchouc,  and  placed  over  the  supra -orbital,  the 
temporal,  or  other  nerve  in  which  the  pain  is  most 
severe.  Frequently  merely  painting  the  skin  with 
the  oil  from  a  small  brush  or  feather  will  answer. 

Oil  of  origanum  may  be  used  in  the  same  way, 
and  for  the  same  purpose,  as  oil  of  peppermint. 

Black  pepper  may  be  applied  locally  in  the  form 
of  a  plaster,  for  headache  ;  and  to  improve  the 
digestion,  and  thus  relieve  headache.  Dose,  five 
grains,  in  pill. 

Spirit  of  nitrous  ether  is  recognized  as  a  sooth- 
ing application  to  the  forehead,  in  cases  of  neural- 
gic headache.  It  should  always  be  recently  pre- 
pared, as  old  preparations,  sometimes,  when  fre- 
quently applied,  irritate  the  skin. 

Spirit  of  lavender  is  an  agreeable  lotion  for  bath- 
ing the  forehead  in  nervous  headaches.  Dose, 
internally,  thirty  minims,  diluted. 

Bay-rum  (spirit  of  myrica)  is  used  in  the  same 
way  as  spirit  of  lavender,  as  a  lotion. 

Ginger,  for  its  rubefacient  and  anodyne  quali- 
ties, is  much  employed  in  cataplasms  and  fomen- 
tations for  the  relief  of  headache.  It  is  not  without 
value. 

Still  other  Remedies. — Dr.  T.  Lauder  Brunton, 
editor  of  the  London  Practitiofier,  says  :  "  The 
administration  of  a  brisk  purgative,  or  small  doses 
of  epsom  salts,  three  times  a  day,  is  a  most  effec- 
tual remedy  for  frontal  headache,  when  associated 
with  constipation  ;  but  if  the  bowels  be  regular,  the 
morbid  processes  on  which  it  depends  seem  to  be 
checked,  and  the  headache  removed  even  more 
effectually  by  nitro-muriatic  ac  id,  diluted,  ten  drops 
in  a  wine-glass  full  of  water  ;  or  bicarbonate  of 
soda,  ten  grains  in  water,  before  meals.  If  the 
headache  be  immediately  above  the  eyebrows,  the 
acid  is  the  better  ;  but  if  it  is  a  little  higher  up,  just 
where  the  hair  begins,  the  soda  seems  to  be  the 
most  effectual.  'J'he  removal  of  headache  invi- 
gorates the  whole  system." 


Tincture  of  nux  vomica  is  given  by  Ringer,  in 
drojj  doses  every  five  or  ten  minutes,  for  eight  or 
ten  doses,  and  then  continued  at  longer  intervals, 
for  sick  headache,  accompanied  by  acute  gastric 
catarrh,  whether  due  to  error  in  diet,  constipation, 
or  no  api)arent  cause. 

An  excellent  local  ai)plication  is  made  of  a  quart 
of  water,  half  ])int  of  common  salt,  one  ounce  harts- 
horn, and  a  half-ounce  ofs[)iritscam{)hor  ;  mix  and 
keep  in  a  tightly  corked  bottle.  Saturate  a  cloth 
and  apply  to  seat  of  jjain. 

When  the  head  is  filled  with  blood  and  the  tem- 
ples throb,  soak  the  feet  in  very  hot  water,  in  which 
a  spoonful  of  ground  mustard  has  been  stirred. 
In  the  same  way  use  a  salt  foot-bath.  The  blood 
will  be  drawn  from  the  head  to  the  feet  and  relief 
obtained. 

A  tablespoonful  of  cliarcoal,  powdered,  stirred 
into  a  glass  of  water  and  drank  at  once  is  excellent 
in  many  cases  of  headache  from  sour  stomach, 
flatulence,  etc. 

Digitalis,  by  moderating  the  heart's  action,  is 
often  valuable  in  headache  with  cerebral  congestion. 
Dose,  one  grain,  in  powder. 

Oil  of  turpentine,  in  moderate  doses,  has  been 
much  praised  as  a  remedy  for  headache. — Prof. 
Geo.  B.  Groff,  M.D.,  SB.,  in  the  Physician  and 
Surgeon. 

THE   INUNCTION   OF  CASTOR  OIL  AS  A 
PURGATIVE. 

Dr.  John  McNicoU,  L.R.C.P.,  etc.,  Ormskirk, 
writes  in  the  British  Medical  Journal  October, 
1 6th,  as  follows  : 

In  a  case  of  acute  dequamative  nephritis  in  a 
child  five  years  old,  where  I  wished  to  act  speedily 
upon  the  bowels,  and  had  tried  to  administer  the 
usual  purgative  powders  and  draughts  (but  had 
failed  owing  to  the  struggles  of  the  child,  which 
neither  promises  of  rewards  nor  of  punishments 
would  subdue),  I  ordered  the  inunction,  with  a 
warm  hand  over  the  abdomen,  of  one-third  of  an 
ounce  of  castor  oil.  The  result  was  a  free  action 
of  the  bowels  five  hours  afterward,  followed  by 
two  other  movements  during  the  day. 

Dr.  Ringer,  at  page  318  of  the  latest  edition  of 
his  Therapeutics,  does  not  appear  quite  satisfied 
as  to  the  possibility  of  the  oil  acting  in  this  man- 
ner ;  having  tried  and  found  it  so  successful,  I  wish 
to  record  the  fact,  believing  that  we  have  in  this 
method  a  means  of  purging  children  (and  possi- 
l)ly  adults)  which  must  be  valuable  to  those  who 
suffer  from  the  horrible  nausea  which  usually 
attends  the  administration  of  castor  oil  by  the 
mouth. 

That  any  one  should  doubt  the  possibility  of 
introducing  medicines  epidermically  is  marvelous. 
They  have  but  to  try  it  to  be  convinced.  To 
children  with  delicate  stomachs  this  is  the  best 
way  to  give  antiperiodics.  The  remedy  should  be 
thoroughly  mixed  in  petrolina,  vaseline,  or  lard. 


THE   CANADA    MEDICAL   RECORD. 


277 


ON  A    NEW    METHOD     OF    ARRESTING 
GONORRHEA. 

Under  this  title  Mr.  W.  Watson  Cheyne,  Assis- 
tant Surgeon  to  King's  College  Hospital,  describes 
{.British  Med.  Journal,  July  24,  iSSo)  an  antisep- 
tic treatment  of  gonorrhoea.  An  examination  of 
gonorrhccal  pus  disclosed  the  presence  of  micro- 
cocci in  large  numbers,  and  Mr.  Cheyne  thinks 
it  probable  that  the  essence  of  disease  consists  in 
the  growth  of  these  or  allied  organisms. 

In  the  case  of  gonorrhoea,  Mr.  Cheyne  supposes 
that,  at  the  time  of  infection,  a  small  number  of 
the  specific  organisms,  which  in  all  probability 
possess  a  considerable  resisting  power  to  the  des- 
troying action  of  the  healthy  living  tissues,  are 
retained  in  the  urethra,  that  these  go  on  develop- 
ing, that  the  products  of  their  growth  irritate  and 
weaken  the  mucous  membrane  in  their  vicinity, 
that  the  organisms  can  then  penetrate  into  and 
live  in  that  weakened  tissue,  and  that  the  extension 
of  this  process  over  a  portion  of  the  mucous  mem- 
brane of  the  urethra  is  the  cause  of  the  inflam- 
matory symptoms. 

Now,  granting  that  this  view,  Mr.  Cheyne  says, 
which  I  think  must  be  admitted  to  be  very  prob- 
able, Avere  proved,  the  problem  to  be  solved  for 
the  cure  of  gonorrhoea  would  be,  how  to  destroy 
these  organisms  without  at  the  same  time  injuring 
the  inflamed  and  highly  sensitive  mucous  mem- 
brane. If  they  were  destroyed,  one  would  expect 
the  extension  of  the  disease  to  cease,  and  the  in- 
flamed mucous  membrane  to  return  more  or  less 
rapidly  to  a  normal  state.  On  thinking  this  mat- 
ter over,  two  substances  appeared  to  me  suitable 
for  this  purpose,  being  both  powerfully  antiseptic, 
and  at  the  same  time  but  little  irritating.  These 
are  iodoform  and  oil  of  eucalyptus. 

The  next  question  was,  how  to  apply  them.  It 
is  quite  clear  that,  if  used  as  an  injection,  there 
would  be  no  certainty  that  they  would  be  brought 
into  contact  with  the  whole  of  the  inflamed  sur- 
face, partly  because  the  swollen  mucous  membrane 
would  interfere  with  the  passage  of  the  fluid,  and 
partly  because  the  patient  would  not  in  many  cases 
apply  it  effectually.  At  the  same  time,  an  injec- 
tion could  not  be  expected  to  do  much  good,  for  it 
would  flow  out  very  quickly,  and  the  antiseptic 
would  not  have  suflicient  time  to  act.  I  therefore 
use  these  antiseptics  mixed  with  cacoa  butter,  and 
made  into  bougies  of  various  lengths.  These 
bougies  are  introduced  well  into  the  urethra,  and  a 
strap  and  pad  over  and  around  the  orifice  retain 
them.  The  bougie  rapdidly  melts,  and  the  mucous 
membrane  of  the  urethra  remains  bathed  in  the 
antiseptic  material  for  any  length  of  time  desired. 
Those  bougies  possess  an  additional  advantage 
over  injections  in  that,  from  their  size  (they  have  a 
diameter  of  a  No.  9  or  10  catheter,  tapering  at  the 
point),  they,  so  to  speak,  unfold  the  swollen  mu- 
cous membrane,  and  thus  cause  the  antiseptic  to 
be  more  thoroughly  applied. 

I  have  tried  the   two  antiseptics  separately  and 


also  combined,  and  T  find  that  they  are  most 
effectual  wlien  used  in  combination  (possibly  be- 
cause iodoform  is  soluble  to  a  considerable  extent 
in  oil  of  eucalyptus,  and  is  thus  brought  into  more 
perfect  contact  with  the  mucous  membrane).  The 
formula  which  seems  best  is  five  grains  of  iodo- 
form *  and  ten  minims  of  oil  of  eucalyptus  in  a 
bougie  of  forty  grains.  These  bougies  have  been 
made  for  me  by  Mr.  Martindale,  of  New  Caven- 
dish Street. 

The  specific  cause  of  the  disease  being  eradi- 
cated by  this  means,  the  question  of  further  treat- 
ment arises  It  seems  to  me  that,  although  the 
development  of  the  gonorrhoea  'is  arrested,  yet,  if 
the  discharge  be  allowed  to  become  septic  and 
irritating,  urethritis  might  be  kept  up  for  some 
time.  I,  therefore,  order  an  injection  of  boracic 
lotion  (saturatecf  aqueous  solution  of  boracic  acid), 
or  an  emulsion  of  eucalyptus  oil  (one  ounce  of 
eucalyptus  oil,  one  ounce  of  gum  acacia,  water  to 
forty  or  twenty  ounces)  to  be  used  for  two 
or  three  days.  At  the  end  of  that  time,  injections 
of  sulphate  of  zinc,  two  grains  to  the  ounce, 
may  be  begun.  At  the  same  time,  the  great 
tendency  of  the  urethral  mucous  membrane, 
when  once  inflamed,  to  remain  in  a  state  of  inflam- 
mation, must  be  kept  in  mind,  and  everything 
which  might  tend  to  keep  up  the  inflamed  state 
must  be  removed.  Notably,  the  patient  must  be 
cautioned  against  drinking,  and  it  is  well  to  order 
diluents  and  alkalies. 

The  method  may  be  summed  up  as  follows.  The 
patient  is  first  told  to  empty  his  baldder,  partly  to 
clear  out  his  urethra,  and  partly  to  prevent  the 
necessity  of  expelling  the  antiseptic  from  the  canal 
for  several  hours.  He  then  lies  down  on  his 
back,  and  a  bougie  from  four  to  six  inches  long 
is  introduced,  and  the  orifice  of  the  urethra  closed 
by  strapping.  The  bougie  ought  to  be  dipped  in 
eucalyptus  oil,  or  in  carbolic  oil  (1-20)  before 
insertion.  The  patient  is  instructed  to  refrain 
from  passing  water,  if  possible,  for  the  next  four 
or  five  hours.  If  the  case  be  severe  and  advanced, 
he  takes  another  bougie  home,  and  is  instructed  to 
introduce  it  in  the  same  manner  after  he  next 
passes  urine.  On  that  evening,  or  on  the  follow- 
ing day,  he  commences  the  antiseptic  injection, 
which  he  uses  four  or  five  times  daily.  On  the 
third  or  fourth  day,  when  the  symptoms  have 
entirely  subsided,  an  injection  of  sulphate  of 
zinc,  two  grains  to  the  ounce,  is  begun  f.  At  the 
same  time,  the  other  points  mentioned  are  attend- 
ed to. 

*  A  considerable  number  of  the  cases  have  been  tr*>ated 
with  bougies  containing  ten  grains  of  iodoform  ;  but  Mr. 
Martindale  informs  me  that  during  the  warm  weather  it  is 
almost  impossible  to  make  them,  I  find,  however,  that 
bougies  containing  five  grains  are  quite  satisfactory,  and  I 
have  had  no  symptoms  of  irritation  following  their  use. 

t  In  hospital  practice,  where  the  patient  is  only  seen  once 
a  week,  and  where  there  is  no  great  necessity  for  arresting 
the  discharge  quickly,  I  do  not  order  the  sulphate  of  zinc 
injection  till  the  week  following  the  introduction  of  the 
bou"ies. 


278 


THE   CANADA    MEDICAL   RECORD. 


I  have  now  used  this  mctliod  in  about  forty 
cases,  and  in  all  the  result  has  been  the  arrest  of 
the  progress  of  the  gonorrhcea.  For  a  day  or  two 
the  purulent  discharge  continues  ;  but  afterwards 
it  steadily  diminislies  in  amount,  becoming  in  four 
or  five  days  mucous,  and  ceasing  altogether  in  a 
week  or  ten  days.  At  the  same  time,  the  scald- 
ing and  ]iaiii  and  the  symi)toms  of  intlammation 
rapidly  diminish,  and  disappear  completely  in 
about  thirty-six  to  forty-eight  hours.  In  fact,  the 
case  becomes  no  longer  one  of  virulent  gonor- 
rhoia,  but  one  of  simple  urethritis,  rapidly  pro- 
gressing towards  recovery,  if  properly  treated.  J 

I  have  used  this  treatment  only  in  the  early 
stages  of  the  disease,  from  the  first  to  the  seventh 
day  after  the  commencement  of  the  symptoms ; 
but  it  has  answered  equally  well  in  all.  Thus  the 
following  is  the  case  in  which  it  was  used  seven 
days  after  the  cDmmencement  of  the  symptoms. 
The  patient  presented  himself  on  June  19th,  stat- 
ing that  the  symptoms  of  gonorrhoea  had  existed 
for  seven  days.  There  was  a  profuse  purulent 
discharge  from  the  urethra  ;  the  penis  was  some- 
what swollen  and  red;  there  was  intense  scalding 
when  urine  was  passed,  and  a  constant  feeling  of 
heat  and  uneasinesss ;  no  chordee.  A  bougie 
containing  ten  grains  of  iodoform  and  ten  minims 
of  eucalyptus  oil  was  passed  down,  and  the  orifice 
closed  in  the  usual  manner.  The  patient  was  also 
ordered  an  injection  of  an  ounce  of  oil  of  eucalyp- 
tus and  an  ounce  of  gum  acacia  in  a  pint  of 
water,  to  be  commenced  in  the  evening,  and  to  be 
used  four  or  five  times  daily.  On  the  19th  he 
again  presented  himself,  and  stated  that  he  had 
not  passed  water  till  five  hours  after  the  introduc- 
tion of  the  bougie  ;  that  the  scalding  and  feeling 
of  uneasiness  rapidly  subsided,  and  had  com- 
]>letely  ceased  in  forty-eight  hours;  that  the  dis- 
charge had  steadily  decreased  from  the  second 
day,  and  was  now  very  small  in  quantity.  He  was 
ordered  the  sul]jhate  of  zinc  injection,  which  com- 
pleted the  cure  in  three  days. 

In  one  case,  there  was  a  recurrence  of  the 
symptoms.     The  patient,  a  hospital  patient,  first 


*  The  course  described  here  is  that  usually  followed  when 
boracic  lotion  has  been  employed  as  the  injection  ;  but 
since  I  have  begun  the  use  of  the  eucalyptus  emulsion,  the 
cessation  of  the  discliarrje  has,  as  a  rule,  been  more  ra])id. 
Thus,  to  give  an  example,  a  patient  came  to  the  hospital 
on  July  3d  with  symptoms  of  gonorrhcea,  which  had  lasted 
four  days.  He  was  sulTering  from  a  very  acute  attack, 
having  severe  scalding  and  commencing  chordee.  He  had 
not  previously  suffered  from  grmDrrhcea.  A  bougie  con- 
taining five  grains  of  iodoform  and  ten  minims  of  eucalyp- 
tus oil  was  introiluced ;  and  he  was  ordered  to  begin  an 
injection  of  the  eucalyjitus  emulsion  (i  in  40)  in  the  evening. 
The  patient  showed  himself  again  on  July  7lh,  and  stated 
that  in  twenty-four  liours  the  jiainful  symptoms  had  en- 
tirely disappeared,  and  that  the  discharge  diminished 
rapidly,  and  ceased  altogether  on  July  6th.  I  have  since 
that  time  had  several  nearly  as  rapid  cases.  I  have  tried 
in  three  cases  injections  of  eucalyptus  emulsion  without 
previous  introduction  of  a  bougie,  but  without  any  appre- 
ciable effect  on  the  progress  of  ilie  disease. 


presented  himself  on  June  5th,  stating  that  on 
Jime  2d,  five  days  after  connection,  a  discharge 
had  commenced,  which  had  steadily  increased,  and 
was  now  jjrofuse  and  accompanied  with  consider- 
able uneasiness  and  scalding  in  passing  urine.  A 
bougie  containing  ten  minims  of  oil  of  eucalyptus 
alone  was  inserted ;  no  other  treatment  was 
ordered.  On  June  9th  he  returned,  stating  that, 
after  the  introduction  of  the  bougie,  the  scalding 
and  uneasiness  had  diminished,  and  had  almost 
disaj)peared  on  the  evening  of  the  6th  ;  but  that 
on  the  afternoon  of  the  7th  they  began  to  return, 
and  were  now  more  severe  than  on  the  5th.  I  in- 
troduced a  bougie  containing  ten  grains  of  iodo- 
form and  ten  minims  of  eucalyptus  oil,  and  gave 
the  patient  another  to  insert  at  bedtime.  At  the 
same  time,  I  ordered  the  injection  of  boracic  lotion 
to  be  commenced  on  the  following  day.  When 
seen  again  on  the  16th,  he  stated  that  this  time 
the  treatment  had  been  successful,  and  that  now 
the  discharge  was  very  slight.  An  injection  of 
sulphate  of  zinc  and  a  mixture  containing  copaiba 
were  ordered,  and  the  discharge  ceased  entirely 
on  the  20th. 

In  two  or  three  cases  there  has  been  slight  in- 
crease in  the  scalding  on  the  first  or  second  occa- 
sion on  which  the  patient  passed  urine  after  the 
introduction  of  the  bougies  ;  but  this  has  only  been 
temporary,  and  these  cases  were  as  rapid  as  the 
others.  In  four  instances,  however,  there  has  been 
considerable  increase  in  the  symptoms  for  twenty- 
four  or  thirty-six  hours.  In  three  of  these  the 
bougies  had  been  made  with  beeswax,  and  they 
did  not  melt  properly,  and  consequently  came  out 
of  the  urethra  at  various  periods  as  small  cakes. 
Further,  it  seems  that  some  iodine  had  been  set 
free  from  the  iodoform,  probably  during  their 
manufacture.  In  the  fourth  case,  four  bougies, . 
each  containing  10  grains  of  iodoform,  were  in- 
troduced in  succession.  In  all  these,  however, 
the  s}'mptoms  passed  off  in  about  three  days  ;  and 
then  the  gonorrhcea  was  found  to  be  checked,  just 
as  in  the  other  instances. 

Such  are  the  results  as  yet  obtained  by  this 
method.  I  do  not  claim  any  specific  power  for 
the  two  substances  I  have  mentioned.  It  may  be 
that  there  are  other  antiseptics  which  would  be 
more  suitable,  and  I  intend  to  test  any  which  seem 
likely  to  yield  good  results.  Whatever  substance 
be  used,  however,  I  venture  to  think  that  the 
results  already  obtained  show  that  the  principle 
on  which  it  ought  to  be  applied,  and  on  which  it 
will  prove  most  satisfactory,  is  that  which  I  have 
attempted  to  indicate  in  this  paper. 


TO  DISGUISE  THE  TASTE  OF  TINCTURE 
OF  IRON. 

Dr.  Hager  recommends  that  tincture  ferri 
chloridi  be  mixed  with  simple  syrup  and  ther  with 
milk.  This  mixture  will  not  affect  the  teeth  nor 
will  the  styptic  taste  be  apparent. 


THE    CANADA    MEDICAL    RECORD. 


279 


TREATMENT  OF  POST-PARTUM  HEMOR- 
RHAGE. 

Dr.  George  J.  Engelmann,  of  St.  Louis,  thus 
briefly  outlines  (Sf.  Louis  Med.  and  Surg.  Jour- 
nal, Aug.,  1880)  that  treatment  of  post-partum 
hemorrhage  which  seems  to  him  the  most  rational, 
as  suggested  by  his  own  experience,  and  a  care- 
ful analysis  of  the  recent  experience  of  able  and 
judicious  obstetricians. 

A. — Preventive  treatment  after  induction  of 
labor. — I.  Careful  attention  to  every  detail,  and 
strict  observance  of  obstetric  rules  in  every  case  of 
labor. 

2.  The  administration  of  a  full  dose  of  ergot  as 
the  head  enters  the  vaginal  orifice. 

3.  Should  hemorrhage  threaten,  follow  the  ute- 
rine fundus  with  the  firmly  superimposed  hand. 

4.  Express  the  placenta  by  Crede's  method,  and 
retain  a  firm  grasp  upon  the  fundus. 

B. — Treatment  of  an  existing  hemorrhage. — i. 
External  manipulation,  pressure,  and  friction  with 
the  cold  hand,  or  with  ice. 

2.  Ergot. — best  subcutaneously,  one  or  two 
large  doses,  whilst  other  manipulations  are  in  pro- 
gress. 

3.  Introduction  of  the  hand  into  the  vagina, 
and  if  no  contractions  follow,  into  the  uterus  ;  re- 
moval of  clots  and  irritation  of  the  surface,  in 
order  to  stim.ulate  contractions. 

4.  The  subcutaneous  administration  of  ether. 
4<r.  Ice  or  vinegar,   if  at  hand,  may  now  be 

tried  in  the  uterine  cavity,  but  if  they  fail  must 
not  be  persisted  in. 

5.  The  hot-water  douche,  which,  if  it  is  not 
followed  by  the  desired  contraction,  will  at  least 
stimulate  the  patient,  and  cleanse  the  cavity,  so 
that  the  final,  safest,  and  most  reliable  remedy 
may  be  resorted  to. 

6.  The  iron  swab — this  may  be  used  at  once,  if 
the  introduction  of  the  hand  and  the  subcutaneous 
injection  of  ether  fail,  or  after  the  trial  of  the  hot- 
water  douche ;  but  in  desperate  cases  must  be 
resorted  to  at  once,  without  losing  time  with  other 
less  reliable  methods. 


OPHTHALMIA  NEONATORUM. 

In  a  "  special  article "  in  '•  The  New  York 
Medical  Journal  and  Obstetrical  Review "  for 
July,  1 88 1,  Dr.  Charles  Stedman  Bull,  Surgeon  to 
the  New  York  Eye  and  Ear  Infirmary,  writes  of 
the  ophthalmia  of  new-born  infants,  dividing  the 
affection  into(i)  purulent  (2)  croupous  or  mem- 
branous, and  (3)  diphtheric  conjunctivitis.  P.e- 
cognizing  the  purulent  form  of  the  disease  as  due 
in  the  great  majority  of  instances  to  inocula- 
tion with  the  muco-purulent  or  purulent  discharge 
from  the  mother's  vagina  during  parturition,  the 
pactical  question  is  one  of  prophylaxis ;  and  to  this 
end  the  care  of  the  disease  must  be  placed  in  the 
hands  of  the  obstetrician  and  those  of  the  nurse, 


and  on  them  must  rest  the  responsibility  of  the 
results.  The  prophylactic  measures  recommended 
by  the  writer  are  as  follows  :  In  all  cases  of  vaginal 
discharge  in  parturient  women,  whether  specific  or 
not,  the  vagina  should  be  carefully  cleansed  and 
disinfected  repeatedly  before  parturition  begins. 
As  soon  as  the  child  is  bom  the  external  surface  and 
edges  of  the  eyelids  should  be  carefully  cleansed 
with  a  one  or  two  per  cent,  solution  of  carboHc  acid, 
and  then  the  conjunctival  cul-de-sac  washed  out 
with  some  of  the  same  solution,  or  with  a  saturated 
solution  of  boracic  acid.  This  must  be  done  by  the 
attending  physician,  or  by  a  skilled  nurse  under  his 
supervision.  The  eyes  of  all  new-born  children 
should  be  carefully  watched  for  the  first  week  or 
ten  days,  and,  whenever  any  signs  of  an  ordinay 
catarrhal  conjunctivitis  appear^  the  conjunctiva 
should  be  thoroughly  brushed  over  with  a  solu- 
tion of  nitrate  of  silver,  from  two  to  five  grains 
to  the  ounce  of  water.  If  the  conjunctivitis  has 
become  purulent,  and  the  case  is  one  of  real  oph- 
thalmia neonatorum,  the  child  should,  if  possible, 
be  isolated  from  all  healthy  infants,  and  have  its 
own  bath-tub.  If  this  is  not  possible,  the  diseased 
infant  should  be  bathed  last,  and  no  sponges 
should  be  used,  but  only  cloths,  which  can  after- 
ward be  destroyed.  If  one  eye  only  is  affected, 
do  not  apply  the  hermetically-sealed  bandage  to 
the  sound  eye,  but  envelope  the  arms  or  hands  of 
the  baby,  so  as  to  prevent  the  secretion  from  being 
carried  to  the  fellow-eye,  and  lay  the  child  upon 
the  side  corresponding  to  the  diseased  eye.  The 
most  important  feature  in  the  treatment  is  enforced 
cleanliness.  This  requires  constant  attention  and 
the  frequent  use  of  some  soft  cloths  and  plenty  of 
water.  The  use  of  cold  cloths,  dipped  in  cold 
water  or  even  iced  water,  and  laid  on  the  eyelids, 
must  be  regulated  by  the  amount  of  swelling  of 
the  lids  and  heat  of  the  parts.  As  soon  as  the 
lids  can  be  everted,  the  proper  treatment  is  a 
thorough  application  of  nitrate  of  silver  to  the  con- 
junctiva of  the  lid  and  retrotarsal  fold,  daily,  and 
sometimes  twice  a  day.  If  this  is  thoroughly  done, 
a  five-grain  solution  will  in  most  case  suflice  ;  but, 
where  there  are  profuse  secretion  and  considerable 
swelling  of  the  conjunctiva,  a  ten  grain  solution 
becomes  necessary.  When,  owing  to  marked 
hypertrophy  of  the  papillary  structure  of  the  con- 
junctiva, a  stronger  caustic  becomes  necessary,  it 
is  better  to  discard  solutions,  and  employ  the  lapis 
mitigatus  (one  part  nitrate  of  silver  to  two  parts 
nitrate  of  potassium),  and  neutralize  its  eftect  by 
a  subsequent  washing  with  a  solution  of  common 
salt.  It  is  well  to  employ  a  one-grain  solution  of 
sulphate  of  atropia  in  a  saturated  solution  of 
boracic  acid  in  ever)-  c?.se  of  purulent  ophthalmia, 
as  the  great  danger  in  this  disease  is  purulent 
infiltration  and  perforation  of  the  corne?.  Should 
this  infiltration  occur  at  the  center  of  the  cornea, 
the  atropia  should  be  instilled  frequently,  for,  if 
perforation  occurs,  the  dilatation  of  the  pupil  will 
prevent  a  large  prolapse  of  the  iris  through  the  per- 
foration.    If  the  infiltration  of  the  cornea,  on  the 


280 


TUE   CANADA    MEDICAL    RECORD. 


contrary,  be  at  or  near  the  margin,  it  is  better  to 
employ  a  two-grain  solution  of  the  sulphate  of 
cserine,  as  thus  an  extensive  prola])se  of  the  iris 
may  be  prevented  if  the  ulcer  perforate.  In  all 
cases  the  cleansing  and  washing  of  the  lids  and 
conjunctiva  should  be  done  with  a  saturated  solu- 
tion of  boracic  acid,  and  the  atropine  and  eserine 
should  be  dissolved  in  the  same.  As  regards 
the  membranous  form  of  the  disease,  Dr.  Bull  dis- 
sents decidedly  from  Saemisch's  statement  that  in 
a  small  number  of  cases  it  merges  into  the  diph- 
theritic variety,  holding  that  the  two  are  distinct 
diseases.  The  diphtheritic  form  is  very  rare  in  the 
United  States  and  Great  Britain.  Out  of  more 
than  twenty  thousand  case  of  eye  disease  the 
author  has  seen  but  ten  cases.  The  prognosis  is 
almost  always  bad  in  this  variety,  owing  to  the 
very  rapid  strangulation  of  the  tissues.  The  author 
agrees  with  von  Graefe  that  while  in  many  cases 
diphtheritic  conjunctivitis  is  a  symptom  of  a 
general  disease,  yet  there  are  cases  in  which  it  is  a 
local  disorder,  caused  by  infection  with  the  secre- 
tion from   a  purulent  ophthalmia. 


IODIDE    OF    POTASSIUM    IN    CARDIAC 
DYSPNCEA. 

Iodide  of  potassium  has  been  found  by  Pro- 
fessor See  to  work  well  in  all  cases  of  continuous 
cardiac  dyspnoea,  particularly  when  this  is  con- 
nected with  some  structural  lesions.  It  is  very 
useful  in  valvular  lesions.  No  evil  result  can  occur 
from  its  use,  even  if  a  mistake  is  made  and  the  affec- 
tion is  asthmatic.  The  iodine  liquifies  the  bronchial 
secretion.  The  dose  is  twenty  grains  a  day,  gra- 
dually increased  to  two  or  two  and  a  half  scruples. 
A  good  formula  is  : 

5     Potas.  iod 3  vss. 

Syr.  aurantii  cort  f.  ^  iv. 

Sig. — Two  to  four  teaspoonfuls  a  day  in  a 
tumbler  of  water. 

Patients  suffering  from  heart  disease  are  more 
tolerant  of  iodide  of  potassium  than  other  patients. 
The  contra-indications  to  its  use  are  :  i,  tendency 
to  hemorrhage  ;  2,  loss  of  flesh  ;  3,  loss  of 
strength  ;  4,  loss  of  appetite  ;  Opium  may  be 
added  to  prevent  iedism.  Another  useful  com- 
bination is  digitalis  with  iodine,  as  one  has  a  sooth- 
ing influence  on  the  dyspncea  by  acting  on  the 
lungs,  and  the  other  increases  the  action  of  the 
heart  and  modifies  the  arterial  tension.  The  follow- 
ing formula  will  be  found  to  answer  well  : 

IJ      Potas.  iod 3  ss. 

Tinct.  digitalis f.   3  ss. 

Syr.  Acaciae f.  3  iv. 

Sig. — Dessertspoonful  four  times  a  day. 
When   digitalis   is   unsuitable,  chloral   may   be 
substituted. 


A   MENSTRUUM  FOR  SALICYLIC   ACID, 

In  the  Louisville  Medical  News,  Dr.  Sj^ringer 
states  that  salicylic  acid  is  readily  soluble  in  eflcr- 
vescing  Vichy  or  Seltzer  water,  the  former,  from 
containing  an  excess  of  alkaline  carbonates,  being 
preferable.  The  acid  is  put  into  a  tumbler  first 
and  mixed  thoroughly  with  a  small  quantity  of 
water,  to  prevent  its  floating,  and  the  glass  is  then 
filled  with  the  effervescing  water  and  the  liquid 
drank  off.  When  perfectly  dissolved  it  is  said  to 
have  a  very  pleasant,  exhilarating,  pungent,  and 
sweetish  taste. 


PREVENTION     OF    LACERATED      PERI- 
NEUM. 

B.  E.  Mossman  advocates  artificial  dilatation  of 
the  perineal  structures  before  the  head  reaches 
the  floor  of  the  pelvis,  in  order  to  prevent  lacera- 
tion. He  claims  that  his  method  has  never  failed 
in  uncomplicated  labor  in  normal  primiparae  to 
prevent  rending  so  much  as  even  the  mucous  mem- 
brane covering  the  inner  sides  of  the  fourchette. 

He  anoints  the  external  parts  and  vagina  as  far 
as  the  finger  will  go,  with  melted  lard  with  extract 
of  belladonna  ;  and  if  the  first  stage  of  labor 
occupies  one  or  two  hours,  he  makes  two  or  three 
such  applications.  As  soon  as  the  womb  has  di- 
lated sufficiently  so  that  the  cervix  is  safe  against 
laceration,  he  begins  at  once  artificial  dilatation 
of  the  perineum.  He  applies  the  belladonna 
ointment  freely,  and  then  places  one  or  two  fin- 
gers within  the  vagina,  making  pressure  lightly 
but  continuously  downward  and  forward. 

When  the  head  descends  so  as  to  press  upon  the 
perineum,  he  removes  the  fingers  from  the  vagina, 
and  introducing  them  into  the  rectum  and  placing 
the  thumb  upon  the  occiput  of  the  child,  pulls  the 
perineum  forward  and  upward,  and  presses  the 
head  upward  under  the  pubes  whenever  a  pain 
comes  on,  Goodwell's  method  of  protecting  the 
jjerineum. 

When  the  pain  ceases  and  the  head  recedes,  he 
applies  the  dilating  force  with  the  fingers  in  the 
vagina  as  before,  alternating  the  pressure  from 
within  with  the  forward  traction  during  the  pain, 
and  retarding  the  expulsion  of  head  until  the  di- 
latation is  sufficient  to  allow  the  escajte  of  head 
without  laceration. 

He  thinks  that  it  is  very  rare  that  shoulders 
cause  laceration  after  the  head  has  safely  passed. 
— American  /our.  of  Obstetrics. 


TREATMENT  OF  SPRAINS. 

Dr.  Brinton  (Philadeli)hia  J/<-//.  and  Surg.  Re- 
portct)  orders  the  injured  limb  to  be  placed  in  hot 
water,  and  boiling  water  added  slowly  until 
the  highest  endurable  temperature  is  attained. 
The  limb  should  be  retained  in  the  water  fifteen 
or  twenty  minutes,  when  the  pain  will  be  found 
to  have  disap])eared  in  most  cases. 


THE   CANADA   MEDICAL   RECORD. 


281 


ANTI-PRURITIC  REMEDIES. 

For  some  we  have  employed  a  remedy  locally 
which  has  given  much  satisfaction.  It  is  the  yel- 
low of  the  egg  beat  up  and  applied  to  the  part  by 
means  of  surgeon's  lint.  The  lint  is  to  be  cut  in 
small  pieces,  dipped  in  the  egg,  and  applied  to 
the  part.  The  itching  and  soreness  generally 
yield  quickly  to  the  application — the  application 
to  be  made  several  times  a  day  till  the  disease 
yields. 

Of  course  constitutional  treatment  must  be 
employed  to  reheve  any  diseased  condition  of  the 
uterus  or  vagina,  which  may  give  rise  to  it. 

This  remedy  we  obtained  from  Dr.  Semple,  of 
Wilkinsburgh.  He  had  long  employed  it,  with 
some  members  of  the  profession  in  that  section, 
with  marked  advantage. 

While  giving  a  local  remedy  for  a  disease  of 
which  itching  proves  its  chief  symptoms,  it  may  not 
be  amiss  to  say  a  word  or  two  in  reference  to  the 
itching  which  accompanies  some  other  forms  of 
disease.  In  chronic  eczema  and  other  varieties  of 
skin  disease,  especially  of  the  anus  and  the  genitalia 
occurring  in  old  people,  and  accompanied  by  dis- 
tressing itching,  chloral  and  camphor  mixed  with 
vaseline  quickly  gives  temporary  relief.  The  pre- 
paration should  only  be  employed  when  there  is 
no  abrasion  of  the  skin. 

In   the    January    number  of  the    New   York 
^fedical  Journal,  Dr.  A.  D.  Buckley  recommends 
the  tincture  of  gelsemium,  given  internally,  as  an 
excellent  and  efficient  anti-pruritic   remedy.     He 
gives  it  chiefly  to    adults,  and  carefully  watches 
its     physiological      effects.     Generally      he     has 
observed  its  effects  after  the  exhibition  of  one  or 
two  doses.     First  ten  drops   are  exhibited,   and 
this   may  be  repeated  in  a  half  hour   in   slightly 
increased    doses  for  two  hours,  or  until  relief  or 
some     physiological   effect     appears.     Generally 
about  one  drachm  or  so  of  the  tincture  may  be 
given   in   two   hours.     This   often    gives   perfect 
relief  to  the   itching    when  the  remedy  must   be 
discontinued.     It  is  mostly  given  at  night,  and  that 
only  when  the  pruriant  symptoms  are  troublesome. 
Relief  cannot    be  expected  in    all  cases,    but  in 
many  it  gives  great  relief. 

The  fluid  extract  has  also  been  employed  with 
advantage.  From  three  to  ten  drops  are  adminis- 
tered every  two  or  three  hours  till  its  characteris- 
tic effects  are  observed. — Pittsburgh  Med.  Jour- 
71  a  L 


CAUSES    OF    DISPLACEMENTS    OF    THE 
UTERUS  IN  GENERAL.— 

1.  Conditions  producing  increase  in  the  bulk 
or  weight  of  the  uterus,  as — 

I.— Uterine  tumors. 

II. — Subinvolution  of  uterus 
after  labor  or  abor- 
tion, 

III. — Congestion  of  uterus. 

2.  Conditions  producing  diminution  in  the  COU' 
sistence  of  the  uterus,  as — 


I 


TREATMENT  OF  ULCERS. 


IV. — Inflammations  of 

uterus. 
V. — Hypertrophy  of  uterus. 
VI. — Pregnancy. 


IV. — Uterinelnflammations . 
v.— Feeble  health. 
VI, — Mal-nutrition. 

of 


I. — Pregnancy; 

II. — Subinvolution. 

III. — Uterine  congestion. 

3.  Conditions  tending  to  produce  relaxation 

uterine  supports  and  general  loss  of  tone  in 
adjacent  structures,  vagina,  perineum,  &c., 

as — 

I. — EiTects    of     pregnancy,  III. — Feeble  health. 

and  parturition.  IV,— Mal-nutrition. 
II. — Vaginitis. 

4.  Mechanical  causes  pushing  or  dragging  the 

uterus, 

III. — Excessive    intra-abdo- 
minal     pressure,     as 
from  tight   lacing. 
IV.— Distended  Bladder. 


.  ^S — 
I. — Tumors,    either   uterine 

or  non-uterine. 
II. — Inflammatory    deposits 

or  effusions. 


5.  Accidents,  injuries,  &c.,  as- 


I.— Falls. 

II. — Concussions. 


III. — Sudden  exertion. 
IV. — Injuries  of  partuiition, 
as  ruptured  perineum . 


6.  Muscular  effects,  as — 


I. — Violent  coughing. 
II. — Straining  at  stool. 


By  E.  Fiebig.  Berlin  Klin  Wochenschr,  1880. 
^^o-  35- — After  cleansing  the  surface  of  the  ulcer 
by  treatment  with  carbolic  acid  or  iodoform,  con- 
tinuous compression  by  means  of  a  thin  plate  of 
lead,  such  as  is  used  in  packing  tea,  contributes 
materially  to  the  cure  of  callous  or  torpid  ulcers 
of  the  leg. 


III. — Occupations  which  ne- 
cessitate much  stand- 
ing as  shop  women, 
or  prolonged  muscu- 
lar exertion  in  the 
standing  position  as 
laundresses. 

7.  Congenital  peculiarities  of  the  uterus. 

Remarks  on  Displacements  of  the  Uterus. — 

1.  When  no  symptoms  are  present,  treatment  is 
quite  unnecessary ;  but  it  must  not  be  forgotten 
that  sterility  may  be  the  only  symptom. 

2.  When  the  displacement  is  fixed  by  inflamma- 
tory adhesion  or  deposits,  mechanical  treatment^ 
as  a  rule,  must  not  be  undertaken. 

3.  Displacements  may  either  be  the  cause  or  the 
consequence  of  chronic  hyperaemi,  inflammation, 
or  hyperplasia  of  the  uterus.  In  these  cases — rest 
in  bed,  local  depletion,  vaginal  douches,  and  mild 
saline  purgatives,  are  often  necessary  before  me- 
chanical treatment  can  be  commenced. 

4.  Displacements  act  in  three  ways,  producing 
three  sets  of  s}'mptoms  : 

I. — Functional,  relating  to  the  organ  itself. 
IL — Mechanical,  by  pressure  upon  neighbor- 
ing organs. 
III. — Remote   or  constitutional,  due  to  the 
reaction  of  the  two  former. 

5.  Displacements  tend  to  get  worse,  and  there 
is  little  tendency  to  spontaneous  reposition.     They 


282 


THE   CANADA   MEDICAL    RECORD. 


are  nearly  always  secondary  affections,  and  gene- 
rally occur  during  the  child-bearing  period  ;  preg- 
nancy and  parturition  being  the  most  important 
factors  in  their  causation. 

6.  A  pessary,  when  in  sitH,  ouglit  to  cause  no 
inconvenience  or  pain.  A  properly  fitting  pessary 
generally  affords  immediate  relief,  and  may  be  left 
in  sitft  for  .several  weeks  or  months. 

7.  A  stem-pessary  should  never  be  left  in  the 
uterus  for  a  longer  period  than  a  month  or  six 
weeks  without  removal. 

S.  Displacements  frequently  cause  sterility  or 
abortion. 

Retroflexion  and  Retroversion  of  tJie  Uterus. — 
The  former  occurs  when  the  uterus  is  bent  back- 
wards at  the  fundus  only,  the  os  uteri  remaining 
very  nearly  in  its  normal  situation. 

The  latter  exists  when  the  whole  uterus  is  in- 
clined backwards,  the  uterine  axis  not  being  alter- 
ed. 

Retroflexion  0/  the  Uterus  is  probably  the  most 
common  displacement  to  which  the  uterus  is  liable. 
It  may  occur  in  young  or  advanced  age,  and  it  is 
usually  a  secondary  affection,  being  generally  de- 
veloped out  of  a  partial  retroversion. 

The  causes  producing  the  condition  most  likely 
to  result  in  this  displacement  are  mentioned  more 
especially  under  Nos.  i,  2,  6,  7,  "Causes  of  Dis- 
placements in  General." 

Symptoms. — They  vary  much  in  different  cases. 
The  catamenia  may  be  profuse,  scanty,  or  painful. 
Dr.  Atthill  says,  that  when  the  displacement  is  due 
to  congestion  or  chronic  inflammation  of  the  ute- 
rus, terminating  in  hypertrophy,  the  catamenia  are 
diminished  in  quantity,  and  frequently  painful ;  but 
that  when  retroflexion  is  the  result  of  subinvolution 
of  the  uterus,  following  labor  or  abortion,  the  cata- 
menial  discharge  is  increased  in  quantity,  some- 
times to  an  alarming  degree. 

Pain  in  the  back,  and  a  sense  of  weight  in  the 
pelvis,  are  generally  present,  as  well  as  various 
other  symptoms  due  to  pressure  and  reflex  irrita- 
tion, as  difficult  and  painful  defcecation,  bladder 
trouble,  vomiting,  &:c. 

By  vaginal  examination,  5cc. : — 

I  St.  Cervix  uteri  will  be  found  in  sitft. 

2nd.  The  fundus  uteri  will  be  felt  behind  the  os 
as  a  rounded  tumor. 

3rd.  The  rounded  tumor  will  disappear  if  the 
sound  be  passed  with  its  concavity  backwards,  and 
then  a  half-turn  be  given  to  the  instrument. 

Retroflexion  has  a  two-fold  action  on  the  uterus. 

I  St.  The  veins  are  compressed  by  the  bending 
of  the  organ,  producing  congestion  and  hindering 
the  exit  of  the  menses  and  other  secretions. 

2nd.  Hypertrojihy  and  inflammation  are  set  up. 

Treatment. — The  uterus  must  be  restored  to  its 
normal  situation.  This  can  usually  be  done  by 
one  of  the  different  kind  of  pessaries,  the  uterus 
l)eing  first  replaced  by  the  finger  if  possible. 
When  the  pessary  fails  to  raise  the  uterus,  or  when 
the  uterus,  although  raised,  still  remains  bent  on 
itself,    it  will  be  necessary  in   the   first   place   to 


replace  the  organ  either  by  means  of  a  stem-pes- 
sary, pressure  per  rectum,  or  by  tlie  use  of  the 
sound  as  a  repositor  (vide  Nos.  i,  2,  3,  "  Remarks 
on  Displacements  in  General.") 

Retroversion  of  the  Uterus  is  a  rare  affection, 
and  is  nearly  always  associated  either  with  preg- 
nancy or  prolapse  of  the  uterus.  It  produces,  un- 
less extreme,  comparatively  little  effect  upon  the 
uterus  itself;  the  symptoms  being  chiefly  those  due 
to  pressure  and  dragging,  and  those  which  belong 
to  the  hypera^mia  and  inflammation  present  {iiide 
No.  4,  "  Remarks  on  Displacements  in  General.") 

On  vaginal  examination  : — 

I  St.  The  OS  uteri  will  be  found  to  be  tilted  for- 
ward and  elevated. 

2nd.  The  fundus  uteri  \y\\\  not  be  in  sitfi. 

3rd.  No  angle  can  be  felt  behind  the  os  between 
it  and  the  cervix. 

Retroversion  and  retroflexion  have  to  be  distin- 
guished from  : — 

1.  A  tumor  in  the  posterior  wall  of  the  uterus. 

2.  A  retro- uterine  hasmatocele. 

3.  A  small  ovarian  tumor  in  Douglas's  pouch. 
Retroversion  of  the  gravid  uterus  usually  termi- 
nates in  one  of  three  ways  : — 

1.  Utero-gestation  may  proceed  normally,  the 
uterus  rising  out  of  the  pelvis  in  due  time. 

2.  Abortion  may  occur — three  or  four  months. 

3.  Death  may  take  place. 

Treat?nent. — The  uterus  must  be  kept  in  its 
normal  position  by  means  of  a  pessary  ( Vide  Nos. 
I,  2^  3,  "  Remarks  on  Displacements  in  General.'') 
In  retroversion  of  the  gravid  uterus  it  is  necessary 
to  keep  the  bladder  empty,  and  to  raise  the  fundus 
uteri  above  the  brim  of  the  pelvis.  The  latter  can 
often  be  accomplished  by  means  of  two  fingers  in 
the  vagina,  care  being  taken  to  avoid  the  promon- 
tory of  the  sacrum.  After  the  fundus  has  been 
raised,  it  will  be  necessary  to  confine  the  patient 
strictly  in  the  recumbent  position  for  some  time,  as 
a  relapse  or  abortion  is  very  liable  to  occur.  The 
catheter  must  also  be  used  regularly.  When 
reposition  cannot  be  accomplished,  abortion  must 
be  performed. 

Antcversion  and  Anteflexion  of  the  Uterus. — 
These  are  the  forward  displacements  of  the  uterus. 
In  anteversion,  the  whole  uterus  inclines  forward, 
without  alteration  of  the  uterine  axis. 

In  anteflexion,  the  uterus  is  bent  forwards  upon 
itself.  The  former  is  frequently  a  primary  affec- 
tion ;  but  the  latter,  like  retroversion  and  retro- 
flexion, is  usually  secondary. 

The  factors  producing  the  conditions  most  likely 
to  result  in  the  forward  displacements,  are  enume- 
rated under  Nos.  i,  2,  3,  4,  &c.,  "  Causes  of  Dis- 
placements in  General." 

Anteversion  of  Uterus. — Dr.  Barnes  states  that 
coitus  is  not  an  unfrequent  cause  of  this  displace- 
ment. 

Symptoms. —  F/V/«'  Nos.  4  &:  8,  "  Remarks  on 
Displacements  in  General." 

Physical  examination  will  reveal : — 

I  St. — By  vaginal  examination,  the  os  uteri  high 


THE   CANADA   MEDICAL    RECORD. 


283 


up,  under  the  promontory  of  the  sacrum,  and  gene- 
rally pointing  backwards. 

2nd.  In  front  of  os  uteri  the  vaginal  wall  will  be 
felt  tense  and  stretched,  and  through  it  the  rounded 
mass  of  the  uterus  can  be  made  out. 

3rd.  By  combined  vaginal  and  abdominal 
examination,  the  fundus  uteri  can  be  felt  above  or 
behind  the  symphysis  pubes. 

The  sound  will  also  give  diagnostic  signs,  but  it 
must  not  be  used  if  pregnancy  is  present. 

Treatment.  — Some  mechanical  support  is  neces- 
sary to  keep  the  uterus  in  its  normal  situation. 
The  sound  will  rectify  the  displacement,  but  it 
usually  quickly  returns  to  its  malposition  without 
a  support.  \Vhen  the  abdomen  is  very  prominent 
a  good  abdominal  belt  is  indicated.  (  Vide  Nos. 
I,  2;  3,  "  Remarks  on  Displacements  in  General.") 
Antejlexion  of  the  Uterus. 
Symptofns. — (Vide  No.  4-8,  "  Remarks  on 
Displacements  in  General.") 

Treatment. — The  rectification  of  the  anteflexed 
uterus  is  more  difficult  than  that  of  the  anteverted 
one.  It  is  most  important  that  the  fundus  should 
be  raised  to  its  nomial  position  and  retained  in  it. 
The  former  can  generally  be  easily  effected  by 
means  of  the  uterine  sound,  but  the  latter  is  a 
matter  of  much  difficulty.  A  stem-pessary,  when 
it  can  be  borne,  often  accomplishes  the  latter  pur- 
pose. When  the  abdominal  walls  are  very  flaccid, 
a  good  belt  ought  to  be  worn.  {Vide  Nos.  i,  2, 
3,  7,  "  Remarks  on  Displacements  in  General.") 
Prolapsus  Uteri,  or  downward  displacement  of 
the  uterus.  There  are  different  degrees  of  descent 
of  the  womb.  The  minor  degrees,  in  which  the 
uterus  only  drops  in  the  vagina,  are  usually  dis- 
tinguished as  prolapsus  ;  whilst  the  extreme  ones, 
in  which  the  uterus  passes  forth  through  the  vulva, 
.  bear  the  name  of  procidentia.  In  a  large  propor- 
tion of  cases  of  prolapsus  the  history  is  a  con- 
tinuous one,  beginning  with  labor,  and  marked 
successively  by  uterine  engorgement,  subinvolu- 
tion, inflammation,  prolapsus,  retroversion,  and 
hypertrophy. 

Prolapsus  is  called  acute  when  it  is  produced 
_  suddenly,  as  by  violent  coughing,  from  a  fall,  ttc. 
\  Causes. — Especially    those  enumerated    under 

Nos.  I,  2,  3.  and  5,  ••  Causes  of  Displacements  in 
General."  In  a  large  majority  of  cases,  this  dis- 
placement is  associated  with  elongation  of  the 
supra-vaginal  cervix. 

Symptoms. — They  vary  much  in  different  cases, 
and  in  aggravated  examples  there  may  be  much 
sufferirg.  Dragging  pain  in  the  back,  hypogas- 
trium  and  groins,  is  generally  present,  as  well  as 
a  sense  of  bearing  down.  Micturition  and  defoeca- 
tion  are  difficult.  Menorrhagia  may  exist,  and 
there  is  nearly  always  leucorrhoea.  In  cases  of  old 
standing,  when  the  prolapse  is  complete,  the  mass 
hanging  outside  the  vulva  is  frequently  enormous  ; 
in  them  the  surface  of  the  tumor  is  covered  with 
patches  of  ulceration,  while  the  mucous  membrane 
of  the  vagina  is  so  altered  by  exposure  and  the 
effects  of  friction  as  to  resemble  true  skin. 


Treatment. — Prolapse  is  always  a  very  trou- 
blesome affection,  the  tendency  of  which  is  to 
become  slowly  worse.  The  prolapse  can  usually 
be  replaced  by  manual  treatment,  the  patient  being 
placed  in  the  horizontal  position.  In  favorable 
cases,  if  reposition  is  followed  by  prolonged  rest, 
a  cure  may  result  :  but  generally  some  kind  of 
pessary  is  necessary  to  retain  the  uterus  in  its 
proper  position.  Astringent  injections  must  be 
used  if  the  vagina  is  relaxed.  Operative  measures 
are  often  necessary  in  this  displacement,  but 
palliative  treatment  should  always  first  be  tried. 
Much  can  be  done  by  postural  treatment,  by 
astringent  injections,  and  by  the  judicious  use  of 
pessaries.  For  an  irreducible  procidentia,  the  only 
available  treatment  is  a  suspensory  bandage,  which 
may  support^  and  by  gradual  pressure  eventually 
diminish,  the  displaced  mass.  When  the  perineum 
is  much  relaxed,  or  if  it  has  been  lacerated  from 
parturition,  it  will  be  necessary  to  narrow  the 
vagina.  In  these  cases  a  V-shaped  portion  of  the 
mucous  membrane  of  the  anterior  vaginal  wall 
must  be  removed  on  Sim's  plan.  If  there  is  con- 
siderable elongation  of  the  cervix  uteri,  amputa- 
tian  of  the  cervix  is  indicated.  This  is  not  a 
difficult  operation,  and  is  best  performed  by  means 
of  the  ecraseur,  care  being  taken  not  to  remove 
any  portion  of  the  vaginal  wall.  "When  there  is 
considerable  rectocele,  with  impairment  of  the 
perineum,  the  perineal  operation,  or  posterior 
colporrhaphy,  must  be  performed.  —  London 
Hospital  Gazette. 


ELIXIR  CHLOROFORMI  COMPOSITUS. 

By  W.  F.  McNuTT,  M.D.,  L.R.C.L.,  Etc.,  Etc.,  Etc, 
Professor  Principles  and  Practice  of  Medicine,  Universitv 
of  California. 

I  have  been  in  the  habit  for  several  years  of 
prescribing  Collis  Browne's  chlorodyne,  in  certain 
cases  of  asthma,  colic,  diarrhoea,  neuralgia,  rheu- 
matism, hysteria,  etc.  It  has  seldom  failed  to  be 
of  some  benefit,  and  often  acted  like  a  charm  ;  in 
fact,  I  found  it  a  most  excellent  and  reliable 
anodyne,  antispasmodic  and  sedative. 

On  account  of  several  objections  to  its  use,  I 
have,  after  a  great  deal  of  experimentation, 
adopted  the  following  formula  as  a  substitute  for 
chlorodyne,  viz. : 

5     Morp.  mur gr-  ^ 

Chloral  hyd 

Chloroform aa  3  ss. 

Tinct.  cinnab.ind 

Tinct.  capsici 

Acid  hydrocyan.  dil aa  M  xx. 

Spt.  menth.  pip M  x. 

Syr.  sassafras  co.  ad. 5   j. 

Dose — 3  j- 

This  I  have  named  elixir  chloroformi  compositus, 
and  can  heartily  recommend  it  to  those  who  have 
been  in  the  habit  of  using  chlorodyne.  To  those 
who  have  never  used  chlorodyne  I  may  say  that 
they  will  find  elix.  chlorof  comp.  a  most  efficient 


234 


THE   CANADA   MEDICAL   UECORD. 


remedy  for  many  purposes  and  under  many 
circumstances  ;  for  instance,  in  whoojMng  cough, 
asthma,  emphysema,  cough  of  many  jJithisical 
patients,  in  many  cases  of  hysteria,  and  especially 
in  many  cases  of  dysmenorrhea  it  certainly  has  no 
equal.  Given  as  an  anodyne,  it  seldom  produces 
headache  or  disturbance  of  the  digestion,  as  does 
mor)^)hine,  or  depresses  the  heart's  action  as  does 
hydrate  of  chloral.  In  diarrhoea  accompanied 
with  cramping  pains  and  tormina,  in  teaspoonful 
doses,  repeated  every  two  or  three  hours,  it  gener- 
ally acts  quickly  and  satisfactorily. 

In  many  cases  of  diarrhoea  in  children,  a  few 
drops  of  the  elixir,  together  with  a  few  drops  of 
castor  oil  and  vini  ipecac,  in  syrup  of  acacia,  make 
a  most  efficient  remedy. 

The  objections  to  chlorodyne  are — 

1.  It  is  very  expensive  in  this  country  ; 

2.  It  is  not  a  perfect  mixture,  as  it  separates ; 

3.  It  is  too  concentrated  to  be  safe  for  general 
use  ; 

4.  And  principally  it  is  a  patent  medrcine,  the 
exact  formula  of  which  is  unknown. — San 
Francisco  IVesfern  Zancef,  August,  1880. 


VARICOCELE    AND    ITS    TREATMENT. 

C.  Nebler  {Inang.  Diss.,  Breslau,  1880  ;  Cbl. 
J  Chir.,  1880,  p.  635)  urges  the  radical  operation, 
— double  ligature  after  laying  open  and  excision 
of  a  section  of  the  venous  plexus, — with  antiseptic 
precautions.  He  says  this  is  absolutely  without 
relapse  and  usually  harmless.  His  views  are 
based  on  five  cases  operated  upon  by  Fischer. 
Nebler  also  concludes  that  atrophy  of  the  testicle, 
which  was  observed  as  the  result  of  two  operations 
in  Halle  and  once  by  Miflet,  is  not  necessarily  the 
result  of  the  operation,  but  of  the  simultaneous 
wounding  and  ligature  of  arteries.  Experiments 
on  animals  are  brought  forward  by  Nebler  in 
support  of  this  view.  He  regards  the  older  oper- 
ations as  frequently  dangerous. 


TUBERCULOSIS  AND  PREGNANCY. 

Gaulard  {T/iese   de   Paris.  Le  Progres   Med., 
1880,  p.  670)  says  that  pregnant  women  are  far 
from  enjoying  that  immunity  from  acute  and  chro- 
nic disease  which  used  to  be  supposed.  Pregnancy 
exercises  anything  but  a  salutary  influence  on  the 
course  of  tuberculosis.     The  puerperal  condition 
aggravates   phthisis,   as    does   nursing.     Gaulard 
brings  forward  a  large  number  of  cases  in  support 
of  this  view.     In  one  series  of  thirty-two  cases, 
phthisis  existed  before  pregnancy ;  the  aggravation 
of  the  disease  was,  so  to  speak,  constant.     In  a 
second  series,  tuberculosis  apj)eared  at  a  more  or 
less  advanced  stage  of  pregnancy,   and   became 
M'orse  and  worse  until  its  termination.     Finally,  in 
a   third  series  of  cases,  plithisis  d/d  not  seem  to 
show  itself  until  a  period  more  or  iess  pro/on;;fed 
after   accouchement.     It   seems    to   Dr.   Gau/ard 


that  in  these  last  cases  the  puerperal  condition 
exercised  considerable  influence  on  the  appearance 
of  the  disease.  On  the  whole,  the  influence  of 
j)regnancy,  as  shown  by  Gaulard's  statistics,  is 
unfavorable  :  in  pregnant  women  phthisis  runs  a 
more  rajjid  course  than  in  other  women. 


TREATMENT  OF  CYSTITIS. 

Diday  {La  France  Med.,  1880,  p.  523)  recom- 
mends patients  suffering  with  this  disease  to  drink 
daily  a  large  glass  of  flaxseed  tea  mixed  with 
orgeat  or  other  flavor,  or  with  some  mineral  water. 
A  stimulating  plaster  twice  the  size  of  the  palm  is 
to  be  placed  over  the  kidneys,  and  if  necessary 
retained  in  position  until.it  produces  an  eruption. 
The  patient  should  take  great  care  to  resist  the 
inclination  to  pass  the  last  drops  of  urine.  This 
is  very  important,  and  exercises  an  immediate 
happy  influence  on  the  tenesmus  and  the  exudation 
of  blood.  In  addition,  a  pint  of  an  infusion  con- 
taining the  following  powder  is  to  be  taken  twice 
daily  :  9  Folii  hyoscyami,  gr.  xii.;  sacch.  alb.,  gr. 
ii. — M.  A  slight  narcotic  effect  is  produced  by 
this  infusion,  which  is  favored  by  inunctions  in 
the  perineum  with  belladonna  ointment,  or  by 
rectal  suppositories  containing  one  and  a  half  to 
three  grains  of  extract  of  belladonna.  If  the  pain 
persists,  the  narcotics  can  be  increased  to  a  toxic 
degree,  carefully  watching  their  effect.  During 
the  morning  the  patient  drinks  every  half-hour  a 
tablespoonful  of  an  infusion  of  forty-five  grains  of 
hyoscyamus  in  three  ounces  of  water.  In  a  few 
hours  relief  is  almost  always  obtained.  The 
medicine  may  be  begun  again  after  a  few  days  if  the 
trouble  returns.  Ice  is  indicated  in  anal  tenesmus 
and  enlargement  of  the  prostate.  For  the  preven- 
tion of  ammoniacal  urine  the  following  prescription 
is  recommended : 

3  Acid,  benzoic,  gr.  xv.  ad  xl ; 

Glycerinse,  f  3  i  ad  3  iss  ; 

Syrupi  acaciae,  f  3  v. — M. 

Sig.  Half  a  teaspoonful  to  a  teaspoonful  daily. 


TREATMENT  OF  FISSURE  OF  THE  ANUS. 

In  an  unusually  painful  case  of  this  character 
Dr.  Glenerau  {Bull.  Gen.  de  Therap.,  vol.  ii., 
1880,  p.  269)  used  the  following  means  of  relief. 
The  patient  took  about  a  drachm  of  calcined 
magnesia  in  syrup  every  evening  before  retiring. 
In  the  morning  she  was  seated  upon  a  commode 
containing  a  boiling-hot  decoction  of  belladonna 
leaves  kept  hot  by  fresh  additions  of  the  same, 
and  the  vapor  confined  by  a  wrap  around  the 
seat  and  body  of  the  patient.  After  a  few  minutes 
efforts  at  defecation  were  made,  which  at  first 
were  very  painful.  When  the  pain  began  to 
lessen,  the  efforts  were  again  made,  and  the  pain 
became  less  and  less.  After  the  stool  was  finally 
passed,  a  few  minutes  more  were  spent  over  the 


THE   CANADA    MEDICAL    RECORD. 


285 


belladonna  vapor,  and  then  the  following  suppo- 
sitory was  placed  in  the  rectum  : 

^  01.  theobrom.ne,   3  ijss  ; 

Ext.  belladonnas,  gr.  iij  ; 

01.  amyg.  dulcis.  q.  s. — M. 

The  ointment  was  smeared  upon  a  wisp  of  lint, 
and  this  formed  the  suppository,  which  was  renew- 
ed if  it  fell  out  during  the  day,  and  was  changed 
every  morning  after  the  fumigation.  After  eight 
days  of  this  treatment  the  patient  was  much  better : 
the  magnesia  was  stopped  on  the  tenth  day,  the 
suppository  on  the  fourteenth,  and  the  fumigation 
at  the  end  of  the  third  week,  though  the  patient 
was  recommended  to  use  the  latter  from  time  to 
time. 


PRURITUS  VULV/E. 

According  to  Martineau  (Le  Progrh  Medical, 
i88o,  p.  530)  pruritus  vulvae  may  be  due  to 
general  causes,  such  as  glycosuria,  pregnancy,  and 
nervous  perturbation,  or  it  may  originate  in  mere 
local  disorders,  as  intestinal  worms  (oxyuris), 
pediculi,  tinea  tonsurans,  vesical  calculi,  vegeta- 
tions or  polypi  of  the  urethra,  or  vulvitis.  The 
general  condition  of  the  patient  should  be  very 
closely  looked  after,  and  appropriate  remedies 
should  be  applied  to  remove  the  remote  cause  of 
the  trouble,  whatever  that  may  be  found  to  be. 

In  the  acute  stage  of  pruritus  accompanying 
vulvitis,  emollient  apphcations  are,  of  course, 
indicated.  Starch  poultices  (not  linseed,  for  this 
decomposes  too  easily),  lotions  of  infusion  of 
belladonna,  aconite,  or  poppy-heads,  or  of  a  weak 
solution  of  bromide  of  potassium  or  of  chloral 
(three  grains  to  the  ounce),  may  be  used.  They 
should  be  hot  rather  than  cold.  Washes  of  cor- 
rosive sublimate  of  one-per-cent.  strength  may  be 
employed  when  the  stage  of  acute  inflammation  is 
passed. 

Fifty  parts  of  perfectly  neutral  glycerole  of 
starch,  containing  one  part  of  the  following  sub- 
stances, tannin,  calomel,  extract  of  belladonna,  or 
oil  of  cade,  according  to  circumstances,  may  be 
used  with  advantage.  Now  and  then  light  cauteri- 
zations  with  nitrate  of  silver  prove  advantageous. 
Revillout  has  occasionally  found  that  the  insertion 
of  slices  of  citron  between  the  vulva  will  allay  the 
itching.  In  chronic  cases  Dr.  Gueneau  de  Mussy 
anoints  the  vulva  night  and  morning  with  the 
following  : 

5  Glycerol,  amjli,   3  j ; 
Potassii  bromidi, 
^  Bismuthi  subnit.,  aa  gr.  xxv ; 

Hydrarg.  chlor.  mite,  gr.  x  ; 
Ext.  belladonnce,  gr.  v. — M. 

The  vulva  are  to  be  washed  with  a  dilute  solu- 
tion of  borax  containing  a  little  emoUient,  as 
starch, 

Delioux  de  Savignac  follows  the  lotion  just 
mentioned  with  a  powder  : 


IJ  Pulv.  lycopodil,  5j; 

"     bismuthi  subnit,  3  iss  ; 

"     radicis  belladonnaei  3  ss. — M. 

In  very  rebellious  cases,  hip-baths,  each  con- 
taining two  to  three  drachms  of  corrosive  sublimate 
first  dissolved  in  dilute  alcohol,  may  be  employed. 


SCOUR  WEED  {Equisetum  hyemale). 

A.  B.  Woodward,  M.D.,  writes  in  the  Thera- 
peutic Gazette  : 

No  case  of  inflammation  of  the  kidneys  can  be 
so  successfully  treated  as  with  this  simple  remedy. 
It  is  also  valuable  in  all  inflammation  wherever 
located.  If  there  is  a  specific  for  children  wet- 
ting the  bed  at  night,  it  is  equisetem  hyemale  ;  and 
I  have  treated  the  worst  cases  of  diabetes  melli- 
tus  successfully  when  other  remedies  had  failed  to 
render  any  assistance  whatever.  The  specific  in- 
dication for  its  use  are  a  fissured  tongue  with  pain 
and  tenderness  in  the  region  of  the  kidneys.  If 
the  tongue  is  fissured  both  transversely  and  longi- 
tudinally, and  has  a  dark,  shiny  redness,  add 
tincture  of  iron.  Say  to  two  thirds  of  a  goblet  of 
water  add — 

Fft  Tinct.  equiseti  hy 3  j  ; 

Tinct.  ferri.  chlor gtt.  xxiv.  M. 

Sig.    Teaspoonful  every  two  hours  for  an  adult. 


HYPODERMIC  INJECTION  OF  ERGOTIN 
AS  A  COUGH-SEDATIVE. 
Dr.  James  Allen,  in  a  communication  to  the 
British  Medical  Journal  (vol.  i.,  1881,  p.  158), 
says  that  ergotin,  injected  hypodermically  in  doses 
of  from  one  to  three  grains,  is  a  remedy  of  notable 
power  in  allaying  coughs  of  various  lung-condi- 
tions, and  in  diminishing  sputum.  Unlike  some 
potent  drugs,  that  occasion  general  distress  out  of 
proportion  to  possible  good  results,  ergotin  is  not 
followed  by  any  constitutional  disturbance.  How- 
ever injected,  there  is  local  irritation  :  if  into  the 
subdermal  connective  tissue,  suppuration  may 
take  place  ;  it  should  be  thrown  deeply  into  a 
muscle,  as  the  deltoid.  In  a  small  proportion  of 
cases  it  entirely  fails.  Sedative  effect  persists  for 
a  day  or  two,  and  is  likely  to  control  a  cough  that 
has  defied  even  the  most  cunningly  de\-ised  linctus. 
In  the  severe  harassing  cough  of  advanced 
phthisis,  not  unfrequently  exciting  sudden  fatal 
haemoptysis,  ergotin  is  indicated  as  a  prophylactic. 
The  internal  administration  of  the  hquid  extract 
of  ergot,  in  moderate  or  tolerably  large  doses,, 
does  not  seem  to  have  the  same  effect. 


CARBOLIC  ACID  FOR  CARBUNCLES. 

Dr.  J.  T.  Woods  gives  the  results  of  several 
experiments  with  carbolic  acid  in  the  treatment  of 
carbuncles,  in  a  recent  issue  of  the  Medical  and 
Surgical  Journal.  He  describes  the  treatment  on 
a  patient  suffering  with  two  carbuncles,  one  on 


286 


THE    CANADA   MEDICAL    RECORD. 


the  back  of  the  head,  the  other  below  it  on  the 
neck.  He  loaded  a  hy[)odermic  syringe  and,  pass- 
ing the  point  through  the  openings  and  into  the 
sloughing  mass  in  every  direction,  completely 
saturated  it  with  the  pure  acid  and  awaited  results. 
In  a  minute  the  smarting  disappeared,  and  with  it 
all  pain  and  all  sense  of  soreness.  He  again  charged 
the  instrument,  and  thrusting  it  through  the  skin 
over  the  other  carbuncle,  in  a  variety  of  places, 
soaked  the  whole  carbunculous  mass  beneath  the 
skin,  enough  of  necessity  escaping  to  fully  bathe 
the  borders,  modify  inflammation,  and  destroy 
any  septic  elements  then  developed.  In  a  few 
moments  all  the  pain  and  soreness  was  gone  in  this 
also.  The  skin  over  the  mass  became  quickly 
white,  hard,  and  dead,  and  in  a  few  days  detached, 
in  the  form  of  a  slough,  the  interior  mass  also 
becoming  rapidly  loosened,  only  requiring  the 
cutting  of  a  few  shreds  to  remove  it,  when  the 
cavity  was  found  to  present  a  satisfactory  appear- 
ance and  rapidly  filled  up,  leaving  an  exceedingly 
small  cicatrice.  The  remarkable  feature  in  this 
case  was  that  after  the  complete  saturation  of  the 
carbunculous  mass  no  pain  occurred,  the  patient 
going  about  his  ordinary  labor  without  discomfort. 
Dr.  Woods  advises  the  use  of  the  pure  acid  only, 
and  to  complete  saturation.  Dilution  would  in- 
crease, if  not  create,  danger  of  absorption  of  the 
acid,  converting  a  very  simple  procedure  into  a 
condition  of  great  danger,  and  insufficient  quantity 
defeat  the  purpose  for  which  it  is  used. 


THE  TREATMENT  OF  BRIGHT'S  DIS- 
EASE. 

Dr.  W.  T.  Gairdner  devotes  a  long  article  to  this 
subject,  having  special  reference  to  the  employ- 
ment of  diuretic  remedies.  He  refers  to  the  elim- 
ination or  evacuant  method  of  Osborne,  in  which 
the  skin  was  powerfully  acted  upon  ;  and  says  in 
regard  to  it  that  he  believes  the  care  of  the  func- 
tion of  the  skin  within  reasonable  limits  to  be  ex- 
ceedingly important,  and  the  means  proposed  for 
exciting  its  activity  in  transpiration  well  adapted  for 
the  purpose.  Moreover  he  is  not  opposed  to  the  spe- 
cially English  practice  of  using  strong  purgatives  ; 
but  he  ventures  to  affirm  that  these  means  do  not 
need  to  be  employed  merely  to  save  or  spare  the 
kidney,  and  that  the  employment  of  the  milder 
diuretics,  even  when  not  per  se  effective  or  suffi- 
cient, is  by  no  means  to  be  avoided  or  in  most 
cases  postponed  to  other  methods  of  treatment.  In 
other  words,  he  holds  as  the  result  of  simple  clinic- 
al experience,  apart  altogether  from  theory,  that 
diuresis  in  Bright's  disease  is  not  a  thing  to  be 
avoided,  but  to  be  promoted  if  possible,  and  there- 
fore that  diuretics /<:r  se,  so  far  from  being  proscri- 
bed, should  in  most  cases  form  a  part  of  all  good 
treatment,  even  of  the  acute  and  subacute  forms  ; 
and  further,  that  diuresis  is  commonly  at  once  the 
index  and  the  result  both  of  successful  treatment 
by  other  therapeutic  methods  and  of  the  s])onta- 
neous  resolution  of  the  disease.     His  experience 


entirely  confirms  the  early  statement  of  Christison, 
that  when  the  mOre  mild  saline  diuretics  can  be 
brought  to  act  at  all  in  renal  diseases  they  by  no 
means  tend  to  increase  but  rather  greatly  to  dimi- 
nish the  proportion  of  albumen  in  the  urine,  while 
the  total  excretion  of  the  normal  solids  is  notably 
increased. — Glasgow  Med.  Journal. 


AMMONIO-SULPHATE     OF    COPPER     IN 
TIC  DOULOUREUX. 

Doctor  Fereol  of  Lariboisiere  has  used  the  above 
old  ahd  long  forgotten  remedy  in  four  cases  of  tic 
douleureux,  with  results  so  satisfactory,  that  he 
strongly  recommends  its  re-introduction.  He  pre- 
fers the  following  formula  : 

I^.  Cupric-ammonio-sulphate.  grs.  1^-2  ; 
Syr.  I  i  ; 

Aq.  3  iii.       M. 

This  quantity  is  to  be  taken  during  the  24  hours, 
preferably  after  vegetable  food.  If  the  pain  con- 
tinue, increase  the  dose.  In  one  case  as  much 
as  nine  grains  were  used  during  the  day,  giving 
rise,  however,  to  gastro-intestinal  disturbance  ;  even 
the  administration  of  the  usual  doses  will  cause 
fetor  ex  ore  and  a  metallic  taste,  nevertheless  con- 
tinue with  i)^  gr.  daily  for  12  to  14  days. — Medi- 
eal  Times  and  Gazette — Norwegian  Journal  oj 
Afedicine. 


CURE  OF  OZ^NA  BY  IODOFORM. 

Dr.  Letzel  prescribes  iodoform,  mixed  with  gum 
Arabic,  so  as  to  form  a  smelling-powder,  in  the 
proportion  of  two  grains  of  the  former  to  ten  of  the 
latter  ;  from  three  to  six  of  the  powders  to  be 
used  dailv.  In  six  cases  of  ozaena  so  treated  the 
result  was  extremely  satisfactory.  In  two  of  these, 
which  had  been  under  various  treatments  for  two 
months,  this  effected  a  cure  in  from  ten  to  fifteen 
days.  In  the  other  four  cases,  which  were  less 
serious,  a  cure  resulted  in  six  to  eight  days.  Before 
administering  the  powder,  the  nasal  douche  is  to 
be  used. — Allg.  Wiener  Med.  Zeitutig. 


THE  WONDERS  OF  TELEPHONY. 

Punch  has  the  following,  which  is  good  enough, 
to  be  true  :  The  Principal  (from  the  city,  through 
the  telephone,  to  the  Foreman  at  the  "  Works")  : 
"  How  do  you  get  on,  Pat  ?  "  Irish  Foreman  (in 
great  awe  of  the  instrument)  :  "  Very  well,  sir  ; 
the  goods  is  sent  off."  The  Principal  (knowing 
Pat's  failing)  :  "  What  have  you  got  to  drink 
there?"  Pat  (startled)  :  "  Och  !  Look  at  tha! 
now  !     It's  me  breath  that  done  it  !  " 


Small  boy  to  rustic  parent  :  "  I  say,  pa,  what 
kind  of  medicine  is  P.  P.  P.  P.,  which  I  see  painted 
on  the  fences  ?  "  Parent  :  "  Well,  I  don't  'zactly 
know  ;  but  I  suppose  it  is  something  to  act  on  the 
kidneys." 


THE    CANADA    MEDICAL    RECtRD. 


287 


The  Canada  Medical  Record, 

m  ^ontf)Iti  Journal  of  factritinc  nnU  iJTjntrinac? 

EDITOR,  : 
FRANCIS  W.  CAMPBELL, M. A. ,M.D,,L.K.C. P.,  LCKD 

ASSISTANT  EDITOllS  : 

R.  A.  KENNEDY,  M.A,,  M.D. 

JAMES  PERRIGO,  M.D.,  M.R.C.S.  Eng. 

EDITOR  OF  PHABMACEUTICAL   DEPAUTMEJiT  : 

ALEX.  H.  KOLLMYER,  M.A.,  M.D- 

SCBSCRIPTIOK  TWO  DOLLARS  PER  ANNUM  . 

All  communications  and  Exchanges  must  le  addressed  to 
the  Editor ,  Drawer  356,  Post  Office,  Montreal. 

MONTREAL,  AUGUST,  1881. 


The  issue  of  the  August  number  has  been  delayed 
by  the  absence  of  the  editor  upon  his  annual  vaca- 
tion. Early  in  August  we  sent  a  statement  of 
account  to  every  subscriber.  The  replies  have 
not  been  what  they  should.  We  propose  at  the 
end  of  the  volume  to  cut  off  all  those  in  arrears  for 
a  considerable  period.  In  the  meantime  we  ask 
our  friends  to  think  that  the  Record  has  to  be  paid 
for  regularly,  and  to  send  us  without  delay  the 
amount  of  their  indebtedness. 


LITERARY  NOTE  FROM  THE  CENTURY 
CO.,  N.Y. 

A  PORTRAIT  OF  DR.  HOLLAND. 

There  is  hardly  a  literary  man  in  America  whose 
writings  have  been  more  widely  read  than  those  of 
Dr.  J.  G.  Holland,  nor  one  whose  name  is  better 
known  among  the  people.  It  is  said  that  nearly 
600,000  copies  of  his  books  have  been  sold,  to  say 
nothing  of  the  enormous  sale  each  month  of  Scrib- 
ner's  Mofithly,  over  which  he  presides  as  Editor-in- 
chief.  The  Century  Co.,  publishers  of  Scribner's 
(to  be  known  as  "  The  Century  Magazine"  after 
October),  will  soon  issue  a  portrait  of  Dr.  Holland, 
which  is  said  to  be  a  remarkably  fine  likeness  ;  it  is 
the  photograph  of  a  life-size  crayon-drawing  of  the 
head  and  shoulders,  recently  made  by  Wyatt  Eaton, 
and  will  be  about  the  size  of  the  original  picture. 
It  is  to  be  offered  in  connection  with  subscriptions 
to  The  Century  Magazine. 


COLLEGE    OF   PHYSICIANS    AND    SUR- 
GEONS, PROVINCE  OF  QUEBEC. 

The  Preliminary  examination  for  admission  to 
the  study  of  Medicine  takes  place  in  Quebec  at 
the  Laval  University  on  the  22nd  September.  The 
semi-annual  meeting  of  the  College  for  granting 
licenses  and  the  transaction  of  general  business 
takes  place  in  Quebec  on  the  28th  of  September. 
It  will  then  be  just  a  year  since  Mr.  Lamirande 
was  appointed  prosecuting  officer  for  the  College. 
During  that  time  he  has  not  been  idle.  A  large 
number  of  Medical  men  who  were  not  registered 
have  been  compelled  to  do.  Several  who  had 
never  taken  out  their  license,  although  entitled  to 
it,  have  been  brought  to  see  the  error  of  their  way. 
A  very  large  number  in  arrears  for  their  annua, 
contribution  have  been  taught  that  punctuality  in 
its  payment  is  the  cheapest  way  in  the  end.  In 
the  matter  of  prosecuting  charlatans,  at  least  good 
progress  has  been  made.  The  following  judgments 
have  been  rendered  in  favor  of  the  College. 

John  Resco,  IMontreal. 

Mrs.  Mcintosh,  midwife,  Montreal. 

Denis  Dragon,  Montreal. 

Joseph  Rondpre,  St.  Anne  la  Perade. 

Napoleon  Mercier,  Quebec. 

The  following  actions  are  now  pending  in  Court 

Theodore  D.  Whitcher,  Beebe  Plain. 

Gabriel  Courchene,  La  Baie,  Yamaska. 

Jerome  Fiset,  Quebec. 

Emilie  Fortin,  St.  Benoit. 

Richard  Birch,  Templeton. 

Joseph  Quintal,  Longueuil. 

J.  B.  Goulet,  Lambton. 


"  THE  BRIDAL  EVE." 

Mrs.  E.  D.  E.  N.  Southworth's  powerful  and 
highly  absorbing  novel,  "  The  Bridal  Eve,"  is 
shortly  to  be  issued  by  Messrs.  T.  B.  Peterson  & 
Brothers  of  Philadelphia,  Pa.,  in  excellent  style  at 
the  exceedingly  low  price  of  seventy-five  cents  a 
copy.  This  fascinating  story  deals  with  love, 
romance,  crime  and  woman's  devotion,  and  has 
plot  of  the  most  ingenious  and  effective  description. 
The  scene  is  laid  in  England,  and  the  characters 
mostly  move  in  high  social  circles.  The  cheapness 
of  the  work  should  give  it  an  immense  sale.  Every- 
body will  be  delighted  with  it. 


288 


THE    CANADA    MEDICAL    RECORD. 


WYETHS'    ELIXIR    OF    GENTIAN   WITH 
TINCTURE  OF  CHLORIDE  OF  IRON. 

In  this  preparation,  by  the  addition  of  a  small 
quantity  of  acidulated  Citrate  of  Potash,  the  pecu- 
liarly disagreeable  and  styptic  taste  of  the  Chloride 
of  Iron  is  avoided.  Physicians  will  find  this  pre- 
paration the  most  agreeable  and  effective  mode  of 
administering  this  pure  bitter  Tonic,  with  the  most 
prized  of  all  the  salts  of  Iron,  but  hitherto  often 
inadmissible  owing  to  difficulty  of  inducing  nervous 
and  fastidious  patients  to  take  it,  on  account  of 
styptic  taste,  effect  upon  the  teeth,  as  well  as  the 
occasional  diarrhcta  it  induces,  etc.,  etc.  This 
preparation  may  be  given  to  children  and  delicate 
females  with  great  benefit,  and  with  but  little  fear 
of  disagreeing  with  the  most  sensitive  stomachs. 


REVIEWS. 

The  Bacteria.  By  Dr.  Antoine  Macnin.  Trans- 
lated by  Dr.  G.  M.  Sternberg.  Little,  Brown  & 
Co.,  Boston. 

This  book  concludes  by  saying  :  (i)  "  Bacteria 
' '  are  cellular  organisms  of  vegetable  nature. 

"  (2)  Their  organism  is  more  complicated  than 
*•'  was  for  a  long  time  believed.  The  principal 
"  points  brought  to  light  are  :  their  structure,  the 
■"  presence  of  cilia,  the  nature  of  the  substance  con- 
"  tained  in  their  protoplasm,  colored  granules, 
"  grains  of  sulphur." 

We  doubt  if  more  than  a  small  minority  of  our 
professional  brethren  are  aware  of  above  facts. 
Should  this  surmise  be  correct,  perhaps  no  better 
raison  d'etre  could  be  for  this  volume. 

Independent  movement  does  not,  of  itself,  in- 
dicate animal  life,  as  such  movements  are  seen  in 
diatoms,  spores  of  algae  and  some  fungi.  The  pre- 
sence of  cilia,  which  are  found  in  nearly  all  bacteria, 
seem,  according  to  some  microscopists,  to  account 
for  their  movements.  Dr.  Magnin,  on  the  other  hand, 
agrees  with  Cohn  in  believing  it  to  depend  on  the 
presence  of  oxygen,  as,  when  this  gas  is  absent,  the 
bacteria  are  motionless.  No  doubt  now  exists  as 
to  the  true  nature  of  their  bodies.  Cohn  asserts 
that,  with  high  powers,  he  has  been  able  to  see  the 
cell  membrane.  The  action  of  chemicals  proves 
that  it  exists  and  is  composed  of  cellulose,  the  re- 
actions being  the  same  as  that  of  vegetable  cells. 
The  contents  consist  of  protoplasm  which  is  high- 
ly refractive.  Whether  the  gelatinous  substance  in 
which  some  forms  of  bacteria  are  included,  forming 
^ooglea,  is  a  secretion  from  the  protoplasm,or  is  pro- 


duced by  a  thickening  and  jellification  of  the  cell 
membrane,  is  not  satisfactorily  established. 

To  distinguish  bacteria  from  inorganic  substances, 
optical  and  chemical  signs  are  given.  These,  how- 
ever, are  frequently  fallacious.  Men  of  admitted 
scientific  attainments  and  renown  have  minutely 
described  as  species  of  bacteria  the  results  of  their 
method  of  procedure,  such  as  the  effects  of  chromic 
acid,  etc. ;  others  have  described  as  specific  forms 
what  have  been  proved  to  be  well-known  organisms 
present  in  many  putrefactive  processes.  The 
method  of  cultivation,  which  within  the  last  few 
months  has  been  followed  by  important  practical 
results  in  France  through  the  labors  of  Toussaint 
and  Pasteur,  is  by  far  the  best  means  of  distinguish- 
ing the  bacteria.  Koch  of  WoUenstein,  Greenfield 
and  Burdon-Sanderson  of  London  have  also 
done  much  good  work  in  this  field,  but  Pasteur's 
name  stands  pre-eminent.  The  presence  of  bacteria 
in  a  fluid  does  not  necessarily  signify  putrefaction- 
This  is  well  exemplified  in  the  case  of  a  microor- 
ganism discovered  by  Toussaint  in  what  is  inappro- 
priately termed  fowl-cholera,  with  respect  to  which 
Pasteur  has  particularly  directed  his  attention 
during  the  last  {t\s  months.  The  organism,  which 
is  most  destructive  as  a  disease,  occasions  no  putre- 
factive changes  in  chicken  broth,  in  which  it  may 
be  cultivated. 

Although  these  investigations  are  not  referred 
to  in  Dr.  Magnin's  book  for  the  very  good  reason 
that  they  were  undertaken  since  its  publication, 
the  author  does  justice  to  his  previous  labors. 

The  work  is  a  particularly  good  resume  of  what 
is  known  with  respect  to  bacteria.  Without  such 
a  book  as  this  it  would  be  a  difficult  matter  to 
acquire  correct  knowledge  of  their  true  nature. 
That  such  is  the  case  can  easily  be  imagined  when 
the  "  Bibliography  "  alone  in  Dr.  Magnin's  book- 
occupies  thirty-two  pages,  referring  to  about  600 
different  monographs  and  publications. 

We  cannot  leave  the  book  without  referring  to 
the  micro-photographs  which  have  been  made  by 
the  translater  under  the  auspices  of  the  National 
Board  of  Health  of  the  United  States. 

Although  all  the  plates  are  not  equally  well  ex- 
ecuted, the  work  reflects  credit  not  only  on  the 
artist  but  also  on  a  Board  of  Health  that  should 
hold  such  enlightened  views  as  encourage  such 
a  method  of  recording  scientific  investigations. 

G.  W. 


BIRTH. 


At  Emileville,  St.  Pie,  on  the  nth  June,  the  wife  of  Dr. 
E.  A.  Duclos  of  a  daughter. 


THE  CANADA  MEDICAL  RECORD. 


Vol.  IX. 


MONTREAL,  SEPTEMBER,  1881. 


No.  12 


O  OISTTEInTTS. 


ORIGINAL  COMMUNICATIONS. 

Vaccination  with  Calf  Lymph,  hf 
W.  E.  Bessey,  M.D 289 

PROGRESS  OF  MED  I  GAL  SCIENCE 
An  Opinion  as  to  Quinine  in  Pneu- 
monia, 296. — Benzoate  of  Soda 
in  Whooping  Cough,  296.  — 
Treatment  of  Leucorrhoea  in 
Children,  296 — For  Fresh  Cold 
in  the  Head,  296. — Management 
of  the  third  Stage  of  Labor, 
296,  —  Treatment    of  Diabetes 


Mellitus,  297. — Syphilis  in  Mar- 
ried   Life,     298. — Stigmata    of 
Maize,   300. — Rest     after    Deli- 
very,    301.  —  Management     of 
Abortions,  303  —  Amenorrhoea, 
303. — Treatment   of  Pneumonic 
Fever  by  the  employment  of  the 
Wet  Sheet,  303. — Treatment  of 
Chronic  Prostatic  Enlargement, 
304.  —  Therapeutical     Employ 
ment    of  Iodoform,  306. — Mor- 
phine in    Puerperal  Eclampsia, 
306. — Ergot  in  Neuralgia,    306. 


— Improvement  of  Sa3Te's  Treat- 
ment for  Spinal  Curvature,  306. 
— Sulphur  for  Pimples  on  the 
Face,  306. — Maternal  Impres- 
sions, 307. — Epistaxis  cured  by 
a  Blister,  307. — Cod  Liver  Oil 
in  Epilepsy,  307. — Beef  Sup- 
positories, 307. — Treatment  of 
Amenorrhoea 307 

EDITORIAL. 

To  our  Subscribers,  308. — Saccha- 
rated  Pepsin 308 


0m^mal  QammmmwhxM. 


VACCINATION  WITH  CALF  LYMPH. 

By   W.  E.  Bessey,  M.D.,  Public  Vaccinator  to    Board  of 
Health,  Montreal. 

Kead  before  the  Canada  Medical  Association  at  Halifax, 
N.S.,  August  4th,  1881. 

Mr.  President,  Gentlemen, — The  subject  of 
vaccination  with  lymph  dired  froin  the  animal  vs, 
one  which  at  present  is  occupying  so  much  of  the 
attention  of  the  Profession  every  where  that  no 
apology  is  necessary  for  its  introduction  on  an 
occasion  Uke  the  present. 

A  discussion  of  the  topic  of  animal  vaccination, 
if  fully  entered  into,  would  involve  a  rehearsal 
of  the  entire  history  of  vaccination  with  a  consider- 
ation of  the  many  unfortunate  results  which  have 
•occasionally  been  observed  to  follow  ordinary 
arm  to  arm  vaccination — this,  time  will  not  permit. 
The  troublesome  consequences  which  have  from 
time  to  time  been  observed  to  follow  the  use  of 
implore  lymph  are  the  disagreeable  facts  which  the 
Profession  have  always  had  to  contend  against^ 
.and  this,  coupled  with  the  frequency  with  which 
attacks  of  genuine  (variola)  small-pox^  sometimes 


fatal,  have  followed  spurious  vaccination,  has  led 
in  some  quarters  to  a  most  determined  opposition 
to  the  practice  of  vaccination. 

The  unfortunate  results  which  have  followed 
vaccination  miy,  in  all  fairness,  be  said  to  be  in- 
excusable, inismuch  as  with  due  attention,  and  a 
proper  knowle  Ige  of  the  subject,  such  casualties 
might  always  be  prevented. 

Such  accidents  are  usually  traceable  to  long 
humanized  virus  taken  from]  scrofulous  or  other- 
wise tainted  or  unhealthy  subjects,  or  it  may  be 
from  sources  qu'te  unknown  to  the  practitioner 
using  it,  and  directly  responsible  for  the  results. 

That  vaccine  is  very  sensibly,  but  gradually,  de- 
teriorated by  long  human  transmission  has  been 
well  established  by  Bosquet  and  others.  In  the 
illustrations  accompanying  this  paper  I  have  en- 
deavored to  give  an  illustration  of  a  perfect  vac- 
cination. The  resulting  cicatrix  from  vaccination 
with  bovine  lymph,  early  removes  of  the  human- 
ized and  long  humanized  almost  inert.  We  have 
learned  from  the  mistakes  of  the  past  that  two 
things  are  absolutely  necessary  to  guarantee  per- 
fect safety  in  the  daily  practice  of  vaccination  ; 
and  to  ensure  that  degree  of  prophylaxis  or 
immunity  from  a  future  attack  of  small-pox  which 
the  patient  has  a  right  to  expect. 


290 


Tin:   CANADA    MKDICAL   RECORD. 


First,  absolute  purity. 

In  this,  as  in  other  cases,  we  find  that  the  in- 
exorable law  of  i)ro])agation  holds  sway,  and  "  we 
reap  that  we  have  sown." 

If  our  lymph  has  contained ///5  mingled  with 
jvaccine  germs,  we  will  have  a  crop  of  septic  poison- 
ng,  taking  the  form,  it  may  be,  in  a  favorable  sub- 
ject of  edematous  inflammation  or  erysipelas,  fol- 
lowed by  abcesses. 

If  it  has  contained  the  taint  of  syphilis,  then 
following  the  decline  of  the  vaccine  vesicle  will 
appear  a  hardened  base  with  elevated  edges ;  or  in 
its  stead  perhaps  a  phagedenic  ulcer,  which  it  will 
require  all  the  skill  of  the  surgeon  to  treat. 

If  an  ichorous  liquid  has  been  included  in  the 
discharge  of  lymph  flowing  from  a  vaccine  vesicle, 
which  may  be  the  case  in  an  unhealthy  subject  in 
an  advanced  stage  of  the  disease,  then  such  lymph 
will  prove  most  virulent  in  its  action,  when  used 
upon  another  subject,  and  following  the  vaccine 
vesicle  (which  will  go  through  its  stage  of  develop- 
ment and    appear    all    right)    there    will  be  an 
acrimonious  discharge  and  a  slow  healing  ulcer, 
with  possibly  several  new  sores  occurring  where  it 
has  touched. 

Again,  some  forms  of  imperfect  vaccina  pus 
tules  are  described  by  old  writers  on  Vaccination 
under  the  head  of  Spurious  Vaccination.  Willan 
describes  Mr^,?,  and  Barns  (of  Glasgow,  \%26),one; 
and  as  security  against  small-pox  is  not  conferred 
by  spurious  vaccine  vesicle,  it  becomes  necessary 
to  study  carefully  not  only  the  characteristics  of 
the  genuine  disease  as  produced  with  pure  bovine 
virus  or  its  early  removes,  but  also  those  appear- 
ances which  characterize  spurious  vesicles. 

To  meet  these  dangers  we  have  been  obliged  to 
go  back  to  as  perfect  an  imitation  as  possible  of 
the  original  conditions  noted  by  Jenner  in  his 
observations  and  experiments. 

These  were  based  upon  the  observation  every 
where  corroborated— that  milkers  upon  whose 
hands  the  disease  vaccinia  had  been  casually  pro- 
duced by  contact  with  the  disease  as  it  appears 
spontaneously  upon  the  cow's  udders  were 
thoroughly  protected,  or  enjoyed  a  perfect  immu. 
nity  from  subject  attacks  of  small-pox  when 
exposed  thereto.  Neither  could  they  be  made  to 
contract  the  disease  by  inoculation. 

It  will  be  self-evident  that  the  above  conditions 
are  more  nearly  fulfilled  in  any  given  child's  case 
when   vaccinated    with    lymph    direct    from    the 


heifer,  than  when  lymph  of  long  human  transmis- 
sion has  been  used. 

The  question  arises,  does  the  virus  obtained  by 
this  inoculation  of  heifers  with  the  virus  of  origin- 
al cow-pox  induce  a  development  of  vaccinia  in 
greater  perfection  and  of  more  protective  efficacy, 
in  consequence,  than  that  derived  from  the  use  of 
virus  which  has  passed  through  a  long  series  of 
human  transmissions? 

I  maintain  that  it  does,  and  this  is  one  of  its 
principal  advantages.  P'or,  whatever  may  be  our 
opinion  of  the  degree  and  permanence  of  protec- 
tion afforded  by  long-humanized  vaccination,  it 
can  hardly  be  doubted  that  the  nearer  the  inten- 
tionally induced  disease  approaches  in  its  phen- 
omena to  that  accidentally  contracted  by  grooms 
and  milkers,  which  has  been  proved  beyond  cavil 
to  be  perfectly  and  permanently  protective,  then 
the  safer  must  we  be  in  the  assumption  for  artifi- 
cially induced  attacks  of  the  vacci?iia  disease 
direct  from  the  animal,  of  a  like  thorough  and 
permanent  protection. 

It  may  also  be  asserted  that  the  lymph  from 
the  heifer  when  applied  to  the  child  exhibits  perfect- 
ly all  the  phenomena  of  the  disease  described  as 
having  resulted  from  the  use  ofthe  earliest  removes 
in  Jenner's  time,  and  though  admitting  that  the 
virus  of  carefully  selected  human  subjects  one  or 
even  ten  removes  from  the  animal  may  be  equally 
protective,  and  less  liable  to  failure  in  the  use,  yet 
the  risks  from  possible  evils,  such  as  syphilitic, 
erysipelatous  or  septica^mic  contagion,  are  such 
as  to  make  the  choice  of  animal  lymph  almost  an 
imperative  duty  of  the  practitioner  of  to-day. 

It  may  safely  be  asserted  that  the  use  of  virus 
direct  from  the  animal  ensures  safety  from  scrofula >• 
syphilis,  cutaneous  diseases,  pus  inoculation  and 
more  especially  imi)erfect  vaccination  from  the  use 
of  deteriorated  lymph. 

Vaccine  virus,  being  indigenous  lo  the  heifer, 
does  not  degenerate  by  frequent  transmission 
through  the  animal,  but,  when  removed  to  a  foreign 
soil — the  human  subject — it  undergoes  modifica- 
tion, and  if  the  greatest  care  is  not  observed,  is  liable 
to  undergo  very  serious  degeneration,  for  it 
cannot  be  doubted  that  a  very  gradual  but  imper- 
ceinible  change  does  take  place  from  one  trans- 
mission to  another,  sometimes  more  perceptible  in  ' 
one  case  than  another. 

This  change  has  always  been  observed  to  be  in        || 
the   direction    of   a  shortening  of   the   period  of 
incubation   and  developement,  a  decrease  in  the 


THE   CANADA   MEDICAL   RECORD. 


291 


intensity  of  the  vaccinal  phenomena,  and  a  diminu- 
tion of  its  effect  upon  the  system. 

The  vaccinal  phenomena  seen  in  different  cases 
may  differ  materially,  because  of  the  different 
sources  from  whence  the  lymph  has  been  obtained, 
for  the  reason  that  no  two  stocks  of  vaccine  have 
manifested  precisely  the  same  characteristics  :  each 
is  distinct  in  appearance,  development  and  dura 
lion,  and  all  equally  protective. 

Some  of  the  early  lymph  used  in  Jenner's  time 
showed  a  tendency  to  undue  violent  irritation  and 
ulceration,  which  evinced  a  tendency  to  spread 
and  be  troublesome,  and  in  some  cases  was 
attended  with  erysipelas  ;  later  stocks  have  not 
manifested  these  characters.  The  Beaugency  stock 
■of  France  was  mild  in  character,  and,  wherever 
propagated,  its  use  has  given  every  satisfaction. 
The  Esnean  (Belgian)  in  the  hands  of  Dr.  Worl. 
mont,  has  attained  great  popularity  because  of  its 
characteristic  results.  Nothing  could  have  given 
greater  satisfaction  than  the  \'irus  obtained  by 
propagation  direct  from  heifer  to  heifer  of  our  own 
Canadian  Longue  Pointe  stocky  observed  near 
Montreal  on  Nov.  6th,  1877.  Its  use  has  been 
very  extensive  by  the  Board  of  Health  of  Mon- 
treal, and  has  been  entirely  free  from  any  unplea- 
sant complication,  as  the  following  statement  of 
the  Vaccination  Committee  will  attest,  and  which 
subsequent  experience  lias  confimied. 

The  undersigned  members  of  the  Vaccination  Committee 
of  the  Board  of  Health,  City  of  Montreal,  having  for  a 
length  of  time  had  under  their  personal  obsei'vation  the 
results  of  the  vaccine  lymph  supplied  to  this  Board  by  W. 
E.  Bessey,  M.D.,  have  pleasure  in  bearing  testimony  to  its 
purity  and  reliability.  Among  many  thousand  children 
where  it  has  been  and  is  now  being  used,  neither  undue 
irritation  nor  trouble  of  any  kind  has  occurred,  and  as  a 
fact  that  the  lymph  was  direct  from  the  heifer  became 
known,  '.he  prejudice  unhappily  existing  against  the  practice 
of  vaccination  in  certain  portions  of  the  community  has  been 
•overcome. 

(Signed), 

W.  H.  HiNGSTON,  M.D.,  Chairman. 

J.  W.  Mount,  M.D. 

F.  X.  Z.  Tasse,  M.D. 

A.  B.  Larocque,  M.D.,  Medical 

Health  Officer. 

A  new  source  of  lymph  has  been  recently  dis. 
covered  in  the  United  States,  called  the  Cohasset, 
which  is  being  propagated  by  Dr.  Martin  of 
Boston.  Of  its  characteristics  I  am  unable  to  speak. 

I  am  desirous  of  placing  on  record  a  protest 
against  a  statement  made  in  the  Boston  Transcript^ 
to   the  effec  tthat  Dr.  Martin  claimed   no    well- 


authenticated  case  of  spontaneous  cow-pox  has 
occurred  in  America  ?  Dr.  Martin  must  have  been 
aware  of  the  well-established  existence  of  an 
epidemic  of  cow-pox  among  the  herds  in  the  neigh- 
borhood of  Montreal  in  1877,  immediately  pre- 
ceded by  an  outbreak  of  horse-pock  attested  by 
Dr.  McEacherm,  V.S.,  Principal  Montreal  Veter- 
inary College,  and  the  high  character  and  standing 
of  Dr.  Kingston,  through  whose  patient  the  Lennie 
Longue  Pointe  stock  was  discovered,  must  be  a 
sufficient  answer  to  any  objections  that  might  be 
raised  against  it.  It  occurred  in  this  wise :  A 
patient  of  Dr.  Kingston's,  whose  husband  was  a 
farmer  at  Longue  Foinie,  called  upon  him  to  have 
her  child  vaccinated,  Nov.  5th,  1877,  because  she 
believed  their  cows  had  small-pox,  and  she  feared 
the  child  might  take  it,  and  enquired  whether  cows 
ever  had  small-pox?  (An  epidemic  of  small-pox 
had  previously  been  raging  in  the  city) .  On  being 
apprised  of  the  circumstance  by  Dr.  Kingston,  I 
visited  the  farm  next  mornings  in  company  with 
Dr.  Reed,  then  another  public  vaccinator,  and 
found  a  number  of  animals  in  different  stages  of 
the  disease.  I  procured  crusts  and  lymph,  and  on 
Nov.  7th  made  my  first  attempts  with  it  on  a 
number  (10)  of  children.  One  only  of  these  was 
successful,  namely  the  child  O'Mara. 

I  paid  a  second  visit  to  this  farm,  and  obtained 
some  lymph  from  a  heifer  in  the  best  possible  con- 
dition, and  with  this  I  succeeded  in  vaccinating 
other  children  and  some  heifers  at  Logan's  farm. 
Since  then  the  succession  has  been  kept  up  con- 
stantly from  animal  to  animal,  and  the  happy 
influence,  the  supply  of  vaccine  from  this  source 
has  had  in  eradicating  prejudice,  and  establishing 
confidence  in  the  minds  of  the  people  and  profes- 
sion of  the  city  of  Montreal,  has  more  than  satisfied 
me  for  the  very  great  trouble  and  expense  con- 
nected with  its  propagation,  which  the  necessity  of 
my  position  as  public  vaccinator,  in  the  face  of  the 
determined  opposition  of  a  misguided  public,  forced 
upon  me.  Let  this  suffice  as  to  the  source  of  our 
Canadian  lymph. 

The  objects  sought  to  be  attained  by  the 
practice  of  vaccination,  are,  as  I  understand 
it:  I  St.  To  secure  protection  against  future 
attacks  of  small-pox,  and,  2nd.  In  doing  so  to 
avoid  Avha  may  be  termed  ''accidents,"  in  the 
form  of  unpleasant  or  unfortunate  results,  which, 
it  must  be  admitted,  have  been  altogether  of  too 
frequent  occurrence.  The  first  of  these  objects  has 
not  been  secured  by  vaccination,  as  it  has  been  too 


202 


THE    CANADA    MEDICAL    KECORD. 


frequently  performed  in  the  past  without  care  or 
discrimination  as  to  the  lymph  used,  and  with 
perfect  indifference  us  to  the  result.  This  lack  of 
prophylactic  power  is  without  doubt  traceable  to 
the  use  of  degenerated  lymph,  although  some 
practitioners  of  my  acquaintance  point  to  their 
own  experience  and  that  of  the  Royal  Vaccine 
Establishment  of  England  as  arguments  against  this 
view.  But  the  frequent  recurrence  of  post-vaccinal 
small-pox  can  be  accounted  for  in  no  other  way 
than  by  the  assumption  of  a  previous  imperfect 
vaccination,  which  observation  in  small-pox  hospi- 
tals has  fully  established  as  true. 

One  of  the  reasons  why  old  practitioners  pre- 
ferred a  crust  for  vaccination  from  was  because 
crusts  of  a  typical  character  never  form  where  the 
vesicles  have  been  imperfect  either  in  type  or 
development,  and  hence  by  a  continual  survival 
and  reproduction  of  the  fittest  they  were  able  to  go 
on  for  years  without  much  apparent  degeneration 
in  the  lymph  in  use. 

Perfect  vaccinia  is  always  attended  with  pro- 
found constitutional  fever,  and  this  is  much  more 
marked  where  heifer  lymph  is  used  than  where 
exhausted  virus  of  long  human  transmission  has 
been  employed,  and  is  usually  coincident  with  the 
rise,  development  and  decline  of  the  areola  which 
begins  middle   of  8th  and  lasts  until    12th  day. 

Stress  requires  to  be  laid  upon  this  constitutional 
fever,  which  was  considered  of  the  greatest  import 
by  the  earlier  vaccinators,  who  deemed  a  vaccina- 
tion unattended  with  it  not  to  be  depended  upon 
as  protective  against  small-pox.  This  was  Jenner's 
explanation  yvhtn  J>osi-vaccinal  variola  excited  so 
much  comment  some  years  after  the  introduction 
of  vaccination,  laying  down  as  a  dictum  that  in 
all  such  cases  the  alleged  vaccination  had  been 
spurious,  and  that  the  unfallible  test  of  a  perfect 
vaccination — such  as  alone  was  proplyhactic 
against  small-pox,  consisted  in  the  occurrence  of 
this  accompanying  febrile  action  ;  that  without  it 
the  patient  must  not  be  considered  protected,  but 
should  be  revaccinated. 

In  my  own  judgment  a  better  test  of  a  perfect 
vaccination  is  the  production  of  characteristic 
vesicles,  passmg  through  all  their  several  stages 
of  development,  decline  and  fall  of  crust,  leaving 
behind  them  indelible  cicatrices  or  depressed  scars 
of  the  peculiar  and  well-defined  type. 

The  resulting  vaccine  scar  is  a  matter  of  great 
importance,  and  offers  to  the  observing  practitioner 
an  exct-!lent  guide  with  respect  to  the  perfection  of 


a  vaccination  owing  to  the  direct  relation  between 

the  two.      A  great  variety  of  vaccine  scars  are  ta 

be  met  with,  while  there  is  but  one  typical  of  a 

perfect  vaccination. 

Decanteleau,  a  French  writer,  in  a  monograph 

upon  "  the  cicatrices  of  vaccine,"  gives  illustrations 

of  sixty,  fifteen  of  which  are  typical  of  varieties 

always  to  be  seen.* 

*  I  have  endeavored  to  obtain  a  gooii  chromo-lithographic 
illustration  of  some  of  these,  with  perfect  resulting  vaccine 
vesicles,  after  use  of  bovine  lymph  taken  from  cases  in 
practice. 

These  variations  from  the  normal  type  may  be- 
accounted  for  in  the  following  manner  : 

They  may  result :  ist.  From  the  use  of  lymph 
enfeebled  by  a  long  series  of  human  transmissions. 
2nd.  Some  imperfect  condition  of  the  vaccine — 
however  pure — preventing  its  proper  development, 
or  an  insusceptibility  on  the  part  of  the  patient ;  or 
3rd.  Violence  applied  to  the  vesicle  by  which  it  is 
lacerated,  as  from  s«tatches,  adherent  clothing, 
etc. 

90  per  cent,  of  the  variations  are  due  to  the  first 
cause,  a  small  number  to  the  second,  and  fewer 
still  to  the  third.  Since  in  all  but  the  very  feeble 
good  vaccine  will  produce  a  pertect  vesicle  followed 
by  a  typical  scar,  even  rupture  of  the  vesicle, 
while  modifying,  fails  to  prevent  the  formation  of 
a  characteristic  cicatrix. 

The  phenomena  resulting  from  vaccination  with. 
virus  direct  from  the  animal  differ  materially  from 
those  presented  by  long-humanized  lymph,  and  from 
what  may  be  termed  spurious  vaccinations. 

Jenncr  described  the  fully  developed  disease  and 
areola  as  having  the  appearance  of  '•  a  pearl  upon 
a  rose  leaf,"  and  the  crust  resulting  as  of  a  shape 
exactly  the  same  as  that  of  the  vesicle,  circular  in 
form,  with  a  very  decided  umbilication  in  the 
centre.  The  color  of  the  crust  a  rich  dark  brown, 
sometimes  a  dark  mahogany  or  amber  color. 

The  Longue  Pointe  virus  gives  usually  a  group 
of  small  vesicles,  circular,  umbilicated  and  con- 
tiguous, but  not  confluent.  After  several  human 
removes  it  becomes  contiuent,  and  as  many  of 
these  vesicles  may  be  produced  as  the  operator  de- 
sires by  extending  his  crucial  scratches.  It  de- 
velops slowly — sometimes  very  tardily — until  the 
6th  day.  when  a  small  vesicle  begins  to  form,  which 
by  yth  day  is  quite  distinct,  and  by  the  Sth  is 
fully  developed  and  contains  a  quantity  of  clear 
water  lymph,  which  if  extracted  will  reproduce  it- 
self with  a  slight  quickening  or  shortening  of  time 
in  the  several  stages  of  the  phenomena. 


THE    CANADA    MEDICAL    RECORD. 


293 


On  the  afternoon  of  tlie  8th  day  the  areola  has 
begun  to  form,  which  is  very  decided  on  the  ninth. 
The  vesicle  now  has  the  look  of  a  bead  of  pearl 
imbedded  in  a  ground  work  of  a  rose  color,  ex- 
tending from  half  an  inch  to  one  or  two  inches 
and  tumid.  But  we  should  never  have  redness 
deepening  to  purple,  or  extensive  swelling — that  is 
indicative  of  edematous  inflammation,  the  result  of 
pus  poisoning  or  local  septicaemia  from  pus  crusts 
or  impure  lymph. 

The  fever  should  be  very  marked  from  the  9th 
to  the  1 2th  day,  by  which  time  the  lymph  has  be- 
come dry  and  opaque.  From  that  date  to  the  i8th 
the  scab  or  crust  is  in  process  of  formation^  and 
about  the  21st  day  may  be  removed  or  falls  off 
soon  after,  leaving  an  excavated  depression  or  pit, 
having  a  smooth  cefitral point  and  radiating  hands 
extending  to  the  circumference.  If  the  lymph  has 
been  humanized  a  number  of  foreolations  or  pin 
pointed  depressions  will  appear  among  the  radi- 
ating bands.  The  whole  should  be  terminated 
by  the  30th  day,  but,  if  violence  has  been  used,  and 
an  irritated  sore  or  vaccinal  ulcer  has  been  created, 
time  will  be  required  for  the  healing. 

And  here  I  would  like  to  enter  my  protest 
against  all  kinds  of  interference  with  vaccinal  sores? 
beyond  cleansing  with  warm  water  and  the  appli- 
cation of  a  little  salad  oil,  by  means  of  a  feather,  to 
the  surrounding  cuticle,  if  irritable.  Bandages, 
adherent  garments,  ointments,  powder,  and  all  other 
tamperings  of  the  ignorant  and  the  pretentious  are 
to  be  deprecated  and  condemned.  In  these 
phenomena  there  is  seldom  seen  a  single  vesicle, 
generally  a  group  of  them.  They  progress  in  de- 
velopment very  regularly  and  gradually,  seldom 
or  never  create  any  undue  irritation  or  ulceration, 
•and  are  attended  with  a  well-marked  and  decided 
constitutional  fever. 

I  have  frequently  applied  Boyce's  test  or  re- 
vaccination  as  a  test  of  the  constitutional  effects 
resulting  from  the  use  of  the  lymph  in  cases 
where  a  good  result  had  been  obtained,  and  always 
with  a  negative  result.  I  also  inoculated  six  differ- 
ent children  with  virus  obtained  from  small- 
pox cases,  but  without  producing  anything  more 
than  local  disturbance  and  a  slight  fever.  The 
action  of  this  stock  of  lymph  has  always  been  of  a 
benign  and  satisfactory  character,  and  it  has  proved 
to  us  in  Montreal  a  providential  blessing  by 
removing  prejudice  and  opposition  to  vaccination. 

A  very  frequent  species  of  spurious  vaccine  is 
evidenced  by  a  pustular  rather  than  a  vesicular 


eruption.  It  increases  rapidly,  instead  of  gradu- 
ally, thus  a  raised  centre  is  situated  on  a  hard  in- 
flamed base,  surrounded  with  diff'used  redness.  It 
contains  a  fluid  at  no  time  clear,  but  turbid  and 
opaque.  It  soon  bursts  and  discharges  an  abun- 
dant irritating  matter,  forming,  when  it  does,  flakcS 
of  a  dirty  white  crust.  If  a  scab  be  formed  or  the 
vesicle  has  had  the  general  aspect  of  a  vaccine 
vesicle,  and  has  progressed  regularly,  it  will  be 
found  on  the  ninth  day  to  contain  purulent  matter, 
and  will  probably  dry  up  and  fall  off  by  the  12th 
day,  leaving  a  soft  sloughy  sore  to  granulate.  This 
affords  no  protection  to  the  subject.  Another  type 
of  spurious  vaccination  shows  itself  in  the  form  of 
a  perfect  vaccine  vesicle  in  its  course  of  develop- 
ment; it  matures  early,  is  white  or  pearl  colored, 
with  a  slight  tinge  of  yellow,  perhaps  I  ought  to 
say  at  once  that  it  is  straw-colored— the  vesicles 
seem  too  full,  and  the  point  of  umbilication  is 
elevated,  as  if  ready  to  burst,  which  it  frequently 
does,  discharging  an  acrid  purulent  fluid,  which  is 
very  infectious,  and  new  pustules  are  created  where 
it  touches,  a  disagreeable  sort  of  secondary  vaccina- 
tion or  Boyce's  test.  It  leaves  a  ragged-looking 
spreading  ulcer,  hard  to  heal.  This  is  sometimes 
covered  with  a  friable  scab,  which  falls  every  two 
or  three  days,  to  be  renewed  again,  and  so  on  for 
weeks  or  months  together. 

A  piece  of  clothing  becoming  adhered  to  one  of 
these  sluggish,  soft,  or,  as  I  call  them,  scrofiilous, 
vaccine  sores  is  certain  to  cause  trouble,  as  with  its 
removal  the  surface  of  the  sore  is  opened  anew, 
aggravating  its  condition,  and  bringing  upon  the 
head  of  the  unlucky  practitioner  the  anathemas  of 
the  patient  or  friend. 

This  condition  of  things  may  occur  with  the 
best  virus  in  a  scrofulous  subject,  no  matter  how 
pure,  carefully  preserved  or  skilfully  used.  But  it 
more  especially  and  more  frequently  follows  where 
long  humanized  virus  has  been  used,  Jand  the 
greater  the  number  of  removes  from  the  original 
source,  the  greater  the  tendency  to  this  unpleasant 
complication. 

Dr.  Willan  described  three  typical  spurious 
vaccinal  results : 

I  St.  A  single  pearl-colored  vesicle,  less  than  the 
genuine.  The  top  flattened,  but  the  margins  not 
rounded  nor  prominent.  It  is  set  on  a  hard  base, 
slightly  elevated,  with  an  areola  of  a  dark  rose  color. 

2nd.  This  is  cellular,  like  the  genuine  vesicle, 
but  smaller,  and  with  a  sharp  angulated  edge,  areola 
pale  red  and  very  extensive. 


294 


THE   CANADA    MEDICAL    RECORD. 


3rd.  A  vesicle  without  an  areola. 

None  of  these  afTord  any  security  against  small- 
po.x. 

Three  causes  were  suggested  to  account  for  the 
failures  :  ist.  From  matter  having  been  taken  from 
a  spurious  vesicle,  or  from  a  genuine  vesicle  at 
too  late  a  period.  2nd.  From  a  patient  being 
seized  soon  after  vaccination  with  some  contagious 
fever,  as  measles,  scarlatina,  &c.  3rd.  From  the 
patient  having  been  affected  at  the  time  of  inocula- 
tion with  some  chronic  skin  disease,  as  tinea,  lepra* 
&c.  These  eruptions  always  disappear  after  vaccin- 
ation.    And. 

4th.  It   has    been    supposed    that    in    arm-to 

arm  vaccination  puncturing  the  vesicle  in   order 

to  take  lymph  from  it,  by  disturbing  the  process  of 

development,  may  destroy  its  prophylactic  influ- 
ence. 

It  must,  therefore,  be  manifest  that  some  test 
should  be  adopted  whereby  we  can  ascertain 
whether  the  system  be  protected. 

Two  have  been  proposed  :  First  Boyce's  test  or 
a  re-vaccination  on  the  tenth  or  twelfth  day  after 
first.  If  the  system  be  protected  no  regular  vesicle 
can  be  produced,  only  a  vaccinal  sore  will  result. 

Second^  variolation,  or  inoculation  with  small- 
pox virus.  If  the  system  is  protected  this  may 
produce  a  small  pustule,  wholly  unattended  with 
constitutional  fever;  sometimes  a  slight  febrile 
action  may  be  excited,  attended  with  an  efflores- 
cence of  the  skin,  which  rapidly  disappears,  but 
without  any  pustule.  If  performed  nine  days  after 
vaccination  it  will  not  be  a  fair  test,  its  action  then 
being  nil. 

Another  objection  to  the  use  of  humanized 
lymph  of  any  remove  is  its  liability  to  convey 
syphilis.  This  is  no  myth,  but  a  reality  against 
whch  we  must  guard. 

In  large  cities  and  more  densely  populated  rural 
towns,  it  is  impossible  to  be  certain  that  any  given 
child  is  free  from  the  taint  of  syphilis,  in  view  of 
the  frequency  with  which  young  men  become 
syphilized,  and  at  a  later  period  become  fathers  o 
families.  No  treatment  can  eradicate  the  tain 
from  the  system,  and  therefore  no  such  person  can 
propagate  a  perfectly  healthy  offspring. 

In  large  cities  and  more  densely  populated  rural 
towns  it  is  irnj)0ssible  to  be  certain  that  any  given 
child  is  free  from  any  taint  of  syphilis,  seeing  the 
frequency  with  which  young  men  (who  later  become 
fathers  of  families)  become  syphilized,  and,  after 
undergoing  a     course  of  treatment,  more  or  less 


effective,  marry,  reproduce  themselves,  and 
inevitably  impart  to  the  offspring  whatever  blood 
taints  were  lurking  in  the  parent  constitution. 

This,  by  means  of  vaccine  lymph,  may  be  spread 
to  large  numbers,  if  proper  precaution  be  not  taken 
to  avoid  it,  and  no  amount  of  care  can  guard 
against  such  a  danger  where  humanized  lymph  is 
made  use  of  for  public  or  extensive  vaccination. 

My  friendj  Dr.  Robillard  of  Montreal,  relates  aa 
experience  of  his  with  some  tubes  of  lymphs 
obtained  from  a  druggist  in  Liverpool  purporting  to 
be  from  the  Royal  Vaccine  Institution,  England,  by 
which  two  or  more  children  were  syphilized  and 
required  subsequent  constitutional  treatment  to 
restore  them  to  health  again. 

Mr.  Hutchison  publishes  illustrated  plates  of 
Vaccinal  Syphilis  occurring  in  eleven  out  of  four- 
teen Vaccinees,  vaccinated  from  a  child  carefully^ 
selected  at  one  of  the  stations  of  the  English 
National  Vaccine  Institute.  Ten  had  chancre  on 
lioth  arms,  one  on  a  single  arm.  and  three  escaped. 

I  was  once  called  upon  to  treat  a  case  of  syphi- 
litic lepra  on  a  child  which  a  senior  practitioner 
had  vaccinated  a  year  previous,  since  which  time 
the  child  had  never  been  well.  I  treated  it  con- 
stitutionally and  the  symptoms  entirely  disappeared. 

The  Lombardy  Gazette,  Feb.  2,  '78,  narrates  26 
cases.  The  Rivalta  calamity  will  also  be  fresh  in 
the  minds  of  professional  readers. 

We  are  all  liable  to  convey  some  blood  contami- 
nation or  septic  poison  of  more  or  less  import  by 
the  use  of  humanized  lymph,  no  matter  how  care- 
fully it  may  have  been  selected,  and  an  action  of 
damages  for  malpractice  would  be  liable  to  follow, 
much  to  our  detriment  at  the  same  time,  by  using 
a  sample  of  vaccine  from  which  perfect  protection 
cannot  be  secured  and  from  which  many  serious 
accidents  are  liable  to  follow. 

It  seems  to  one  alive  to  the  advantages  of 
vaccination  with  bovine  lymph,  almost  criminal 
culpability  to  use  humanized  lymph  for  the  purpose 
of  vaccination  when  animal  lymph — from  which  no 
bad  result  can  follow  and  perfect  protection  may 
be  guaranteed — can  be  obtained. 

The  advantages  to  be  derived  from  the  use  of 
heifer-transmitted  lymph  may  De  briefly  enumer- 
ated as  follows  : 

ist.  Animal  vaccme  guarantees  against  the 
possibility  of  transmitting  any  diseased  contami- 
nation. Cutaneous  disease,  syphilitic  or  septic  con- 
tamination are  quite  unknown  as  a  sequence. 

2nd.  It  enables  a  constant  supply  of  pure  lymph 


THE   CANADA   MEDICAL   RECORD. 


295 


to  be  kept  up,  on  which  to  draw  in  an  emergency 
To  this  end  it  is  desirable  that  the  Dominion 
or  Local  Government  should  subsidize  or  otherwise 
maintain  an  Animal  Vaccine  establishment,  so  that 
every  facility  may  be  afforded  for  its  propagation. 

3rd.  It  gives  the  greatest  possible  guarantee  of 
protection  by  enabling  the  practitioner  to  carry  out 
true  Jennerian  vaccination,  which  has  been  amply 
proven  by  the  recorded  experiments  of  Woodville 
and  others  to  be  permanently  protective. 

4th.  It  enables  vaccination  to  be  carried  on 
without  reference  to  those  already  vaccinated  or 
the  necessity  of  our  tapping  a  vesicle  to  obtain 
humanised  lymple,  thereby  rendering  it  less  pro. 
tective,  and  it  prevents  a  vaccine  famine. 

It  has  been  objected  to  vaccination  with  animal 
lymph  that 

I  St.  It  is  too  violent. 

This  I  have  found  to  be  reversed  in  the  case  of 
Longue  Pointe  virus,  the  action  of  which  has  always 
been  mild  and  pleasant.  I  have  found  always  that 
the  less  pure  the  lymph  has  been  that  was  used  in 
any  given  case,  the  greater  the  local  disturbance, 
and  not  long  since  I  was  asked  to  see  two  cases  in 
which  abscesses  had  followed  the  use  of  humanized 
lymph  giving  a  great  deal  of  trouble. 

2nd.  It  has  been  asserted  that  animal  vaccine 
might  communicate  diseases  from  the  animal. 

This  objection  cannot  hold  where  only  healthy 
animals  of  the  choicest  quality  are  used,  and  in  a 
<;ondition  fit  for  the  butcher. 

3rd.  That  it  is  difficult  to  take  unless  used  when 
quite  fresh. 

This  is  the  only  objection  worth  considering, 
which  may  be  met  and  overcome  by  trying  to 
understand  and  appreciate  the  fact  that  bovine 
albumen  is  much  less  soluble  than  the  human,  and 
therefore  special  care  is  necessary  to  liquify  the 
l>Tnph  on  the  ivory  point  by  dipping  in  cold  water 
previous  to  using,  and  rubbing  firmly  over  the 
scratches  to  remove  the  lymph  eflectually.  This 
quite  overcomes  the  difficulty. 

4th.  That  it  does  not  keep  long  active. 
If  collected  on  ivory  points  or  slips,  and  properly 
put  up  for  preservation,  it  keeps  active  as  well  and 
as  long  as  any  other  lymph. 

4th.  That  it  is  difficult  to  propagate. 
This  objection  disappears  in  the  hands  of  a 
competent  and  painstaking  physician.  There  is 
no  special  difficulty  in  vaccinating  animals  that 
cannot  be  readily  overcome  with  proper  appliances 
and  suitable  premises 


In  the  propagation  of  atiimal  virus  in  the  most 
efficient  state  for  human  vaccination,  it  should  be 
collected  at  a  certaifi  and  brief  period  during  the 
early  stage  of  the  vesicle,  while  that  taken  at  a 
much  later  stage  is  found  quite  efficient  for  the 
vaccination  of  other  animals. 

Animals  should  be  selected  of  the  best  possible 
quality,  and  should  be  vaccinated  directly  from 
each  other. 

It  cannot  be  denied  either  that  for  the  success- 
ful vaccination  of  animals  and  collection  of  virus 
in  the  best  condition  for  use,  a  high  degree  of 
intelligence,  patience,  experience  and  skill  are 
required.  It  will  not  do  to  assign  the  task  to  an  . 
ordinary  stable  man. 

6th.  It  has  been  objected  that  animal  virus  is 
expensive. 

This  objection  will  always  continue  owing  to  the 
trouble  and  expense  which  are  inseparable  with 
its  propagation,  but  if  the  Government  could  be 
induced  to  give  a  money  grant  sufficient  to  estabHsh 
and  maintain  a  National  Vaccine  Institute,  the 
expensiveness  of  it  might  be  no  longer  an  objection 
The  common  practice  of  vaccination  has  been 
very  carelessly  conducted  as  a  rule,  and  the  public 
have  had  no  guarantee  of  safety  from  impure  virus, 
for  the  following  among  other  reasons. 

I  St.  Because  of  the  absence  of  any  Government 
provision  for  the  maintenance  of  a  proper  Vaccine 
Institute  where  a  constant  supply  of  pu7-e  virus 
could  be  produced  for  gratuitous  or  partly  gra- 
tuitous distribution. 

2nd.  From  ignorance  and  carelessness  of  prac- 
titioners in  collecting  and  preserving  lymph  or 
crusts  for  future  uses. 

3rd.  Too  low  fees  for  vaccination,  considering  its 
vast  importance  and  the  trouble  and  responsibility 
M-hich  it  entails,  thereby  encouraging  indifference. 
4th.  Neglect  of  public  vaccination  by  municipal 
bodies,  and  low  salaries  given  public  vaccinators 
where  it  is  carried  on,  vesting  the  character  of 
service  rendered  entirely  upon  the  physician's  own 
conscientious  sense  of  duty. 

As  this  is  a  question  of  State  Medicine,  some- 
thing should  be  done  by  the  State  to  establish  a 
Vaccine  Institute.  It  would  be  very  gratifying  to 
find  the  example  of  the  Government  in  the  mother 
country  followed  by  the  Government  of  the 
Dominion  in  providing  animal  vaccine  at  the 
public  expense  for  gratuitous  distribution. 

I  trust  the  Committee  on  Sanitary  Legislation 
appointed  by  this  Association  may  use  its  influence 


2CG 


THE    CANADA    MEDICAL   RECORD. 


with  the  Dominion  Government  to  secure  an 
annual  grant  for  the  maintenance  of  a  National 
Vaccine  Establishment,  where  a  good  supply  of 
animals  can  always  be  kejjt  under  conditions 
favorable  to  the  projjagation  and  j)erpetuation  of 
the  stock  of  lymjjli. 

Such  an  establishment  is  an  imperative  necessity 
in  this  country,  in  the  interests  of  the  profession 
and  the  public. 

spFOOFC'^'yof  Jilcdical  Scimu. 

AN  OPINION  AS  TO  QUININE  IN  PNEU- 
MONIA. 

A  writer  in  the  St.  Louis  Clinical  Record  says  : 
"  I  think  a  good  many  pneumonic  patients  are 
killed  with  quinine.  If  there  is  any  indication  or 
reason  for  giving  it,  I  don't  know  what  it  is.  It 
disorders  the  nervous  system,  impairs  digestion. 
It  has  no  influence  in  preventing  hepatisation  or 
hastening  resolution.  I  know  a  man  in  my  coun- 
try who  has  complete  amaurosis  from  taking  qui- 
nine for  pnei.monia  last  winter.  His  doctor  gave 
him  half  a  bottle  in  twenty-four  hours  on  the  '  vaso- 
motor,' '  inhibitory,'  '  accelerating,'  '  depressing,' 
'  const:  icting,'  dilating,'  hypothetical  theory  of  the 
day.  But  the  fashion  now  is  quinine,  from  a  stone- 
bruise  to  a  broken  neck.  If  no  more  quinine 
should  be  used  than  is  really  beneficial  in  disease 
it  wouldn't  be  worth  a  dollar  a  bottle." — Pacific 
Med.  and  Surg.  Journal. 


BENZOATE    OF    SODA    IN    WHOOPINC- 
COUGH. 

D.  Tordeus,  of  Brussels,  writes  that  he  has 
prescribed  the  benzoate  of  soda  in  a  number  of 
cases  of  whooping-cough,  and  that  in  all  the 
cases  the  parents  reported  that  the  coughing  fits 
began  to  diminish  in  force  and  frequency  after  one 
or  two  days  of  treatment.  He  gives  four  grains  of 
the  salt  every  hour  to  a  child  of  two  or  three  years. 
The  drug  seems  not  alone  to  diminish  the  force 
and  frequency  of  the  jiaroyxsmj,  but  also  to  exert 
a  favorable  influence  on  the  mucous  membrane  of 
the  respiratory  tract,  and  to  prevent  the  develop- 
ment of  serious  pulmonary  complications.— /(^//r- 
nal  de  nied.^  etc.,  de  Bruxclles. 


TREATMENT    OF     LEUCORRHCEA    IN 
CHILDREN. 

Leucorrhcea     in    children,    says   ^I.     Bouchut 
{Practitioner ;  from  Le  Praticien),  is  caused  by 


vulvitis,  not  vaginitis  or  metritis.  He  therefore 
treats  this  condition  by  extreme  cleanliness,  re- 
peated bathing  with  bran-water  and  lead-water, 
lotions  of  corrosive  sublimate  (two  grains  to 
ten  ounces  of  water),  carbolic  acid  (two  grains 
to  the  ounce),  and  occasionally  solution  of  nitrate 
of  silver  (three  grains  to  the  ounce).  In  the  inter- 
vals of  applying  the  lotions  a  pledget  of  lint  satu- 
rated with  coal-tar  or  an  ointment  of  red  precipi- 
tate may  be  placed  between  the  labia.  Such  a 
pledget  kept  in  place  by  a  pad  protects  the  sur- 
rounding parts  as  well  as  the  labia  themselves 
from  the  irritating  secretion,  which  is  often  present 
in  considerable  quantities.  For  the  general  treat- 
ment M.  Bouchut  recommends  the  administration 
of  cod-liver  oil  and  quinine  to  strumous  patients, 
and  of  arsenic  to  those  with  eczematous  eruptions. 


FOR  FRESH  COLD  IN  THE  HEAD. 

Dr.  T.  F.  Houston  writes :  For  fresh  cold  in 
the  head,  accompanied  with  obstruction  in  the 
nasal  passages, 

I^  .  Carbolic  acid -   i 

Absolute  alcohol ..    I  ij 

Caustic  solution  of  ammonia    3  i 

Distilled  water I  iij 

M.  Make  a  cone  of  writing  paper ;  put  a 
small  piece  of  cotton  in  it ;  drop  on  the  cotton  ten 
drops  of  the  mixture,  and  inhale  until  all  is  eva- 
porated. Repeat  this  every  two  hours  unti 
relieved. — So.  Med.  Record. 


MANAGEMENT  OF  THE  THIRD   STAGE 
OF  LABOR. 

Dr.  Max  Runge,  in  a  communication  to  the 
Obstetrical  Society  of  Berlin,  criticizes  the  current 
teaching  regarding  the  management  of  the  third 
stage  of  labor.  He  takes  as  the  special  text  of  his 
animadversions  the  directions  given  by  P'ritsch, 
which  are  to  the  effect  that  immediately  after  the 
birth  of  the  child  the  uterus  is  to  be  seized  by  the 
hand  on  the  abdomen,  and  the  placenta  pressed 
out.  Dr.  Runge  states  that  for  a  long  time  he 
faithfully  carried  out  this  method  ;  and  so  did 
others  in  Prof.  Gusserow's  clinique.  The  objec- 
tion to  it  is,  that  the  squeezing  out  of  the  placenta 
is  begun  before  that  organ  has  become  completely 
separated  ;  consequently,  when  the  placenta  has 
been  exi)elled,  often  a  1  it  of  the  membranes  may 
yet  be  attached  to  the  i;t_>rus  and  be  left  behind 
after  the  placenta  has  been  taken  away,  ^^"hile 
this  teaching  was  carried  out  it  was  quite  a  com- 
mon thing  for  a  pair  of  forceps  to  be  needed  to 
remove  these  retained  pieces  of  membrane,  and 
secondary  post-i)artum  hemorrhage  became  ex- 
traordinarily  frequent.     He   refers  to   a    former 


THE   CANADA   MEDICAL    RECORD. 


297 


communication  of  his  own,  in  which,  treating  of 
post-partum  hemorrhage,  he  expressed  his  surprise 
that  within  a  short  time  he  had  many  cases  of  this 
compHcation.  Then  he  supposed  this  frequency 
was  fortuitous.  Now  he  knew  the  reason,  which 
was  his  undue  haste  in  pressing  out  the  placenta. 
Midwives  are  now  instructed,  after  the  birth  of  the 
child  (and  having,  of  course,  seen  that  the  uterus 
is  sufficiently  contracted  upon  the  placenta  to  pre- 
vent hemorrhage),  to  wash  and  dress  the  infant 
before  proceeding  to  press  out  the  placenta.  The 
separation  of  the  placenta  and  membranes,  Dr. 
Runge  holds,  is  not  complete  until,  upon  an 
average,  about  a  quarter  of  an  hour  after  the  birth 
of  the  child ;  and  therefore  about  this  length  of 
time  should  be  allowed  to  elapse  before  the  pla- 
centa is  pressed  out.  Since  instructions  based 
upon  this  principle  have  been  given  to  the  students 
and  midwives  of  the  Strasburg  Obstetric  Clinique 
post-partum  hemorrhage  has  become  of  very  infre- 
quent occurrence. — /our?ial  of  Psychological  Me- 
dicine. 


TREATMENT  OF   DIABETES   MELLITUS. 

Prof.  Flint,  in  a  recent   clinical  lecture  on   this 
subject,  said  : 

The  treatment  is  emphatically  dietetic.  There 
have  been  a  great  many  remedies  proposed  from 
time  to  time,  recommended  as  having  control  over 
this  disease.  Now  I  am  not  prepared  to  say  that 
there  are  no  remedies  which  do  exercise  more  or 
less  control  over  it.  But  we  should  commit  a  grave 
error,  and  act  very  much  at  the  expense  of  the 
prospects  of  our  patients,  if  w^e  gave  any  remedy 
which  rendered  them  less  careful  in  attending  to 
the  dietetic  treatment.  In  other  words,  the  diet- 
etic treatment  is  to  hold  the  first  place.  This 
treatment  consists  in  withholding  from  the  food 
almost  entirely  (for  entirely  we  cannot)  sugar  in 
any  form,  and  all  the  starchy  constituents  of  diet 
capable  of  being  transformed  into  sugar.  That  is 
the  principle.  Well,  if  we  merely  state  that  to 
patients,  and  tell  them  they  must  not  eat  sugar, 
they  must  not  eat  starch,  they  will  not  be  likely  to 
carry  it  out.  In  the  first  place,  it  is  not  likely 
they  will  know  enough  of  the  subject  to  be  able 
to  carry  it  out,  even  if  they  were  so  disposed  ;  and 
unless  we  go  further,  and  are  very  careful  as  re- 
gards details,  we  shall  find  that  the  elimination  of 
these  constituents  of  the  food  will  not  be  done  ; 
they  will  not  tolerate  it.  If  we  are  to  succeed  we 
should  give  appropriate  attention  to  the  prepara- 
tion of  the  food,  the  number  of  articles  which  the 
patient  should  be  allowed  to  take,  and  the  varia- 
tion of  the  food  from  day  to  day,  to  make  this  anti- 
diabetic diet  satisfactory  to  the  patients  ;  that  is, 
satisfy  their  appetites  and  the  purposes  of  nutri- 
tion. This  can  be  done,  and  if  it  is  done  the 
patient  carries  out  the  treatment,  because  it  is  no 
hardship  to  carry  it  out  ;  and  the  treatment  is  to 
be  carried  out  not  for  a  few  days,  or  a  few  v.-eeks. 


or  a  few  months,  but  for  an  indefinite  period — foi 
years,  and  perhaps  during  the  whole  of  life. 

How  is  this  second  object  to  be  effected  ?  We 
must  place  before  the  patient  a  list  of  all  articles 
of  food  which  are  to  be  avoided,  specifying  them  ; 
not  contenting  ourselves  with  the  statement  in 
general  terms,  but  specifying  on  the  one  hand  all 
the  articles  of  food  which  he  must  not  take,  and 
on  the  other  hand  all  the  articles  of  food,  animal 
and  vegetable,  and  so  on,  which  he  may  be  allowed 
to  take.  He  should  have  such  a  list  before  him, 
and  such  articles  should  be  selected  from  the 
allowable  ones  as  to  make  a  variety  from  day  to 
day,  and  so  prepared  by  the  artifices  of  cookery 
as  to  render  them  satisfactory.  It  can  be  done,  but 
it  requires  patience,  and  it  requires  care  on  the 
part  of  the  patient  or  somebody  else,  and  it  re- 
quires some  means.  A  very  poor  man,  who  has 
no  one  to  look  after  these  matters  for  him,  and 
who  has  not  sufficient  means  to  obtain  all  the 
articles  of  food  which  are  desirable,  w-ill  find  it 
very  difficult  to  conquer  this  disease  ;  and  in  cer- 
tain public  institutions — this  hospital,  for  in- 
stance— it  is  very  difficult  to  carry  out  the  proper 
dietetic  treatment.  It  requires  so  many  things  and 
so  much  attention  to  details  that  the  dietetic  treat- 
ment is  very  unsatisfactory  in  public  hospitals. 

The  article  of  food  which  will  cause  most 
trouble  is  bread,  and  diabetics  realize  the  force  of 
the  statement  that  bread  is  the  staff  of  life.  Fre- 
quently they  say  at  first  that  they  care  little  for 
bread,  and  can  get  along  without  it  with  no 
trouble  ;  but  they  do  not  find  it  so  after  a  while. 
They  find  that  there  is  a  craving  for  bread,  and 
they  feel  that  they  cannot  do  without  it.  So  there 
have  been  various  substitutes  for  it.  There  is 
what  is  called  the  diabetic  flour,  which  is  bran 
very  finely  ground  so  as  to  divest  it  of  all  rough  par- 
ticles ;  but  it  has  no  nutritive  quality  whatever.  It 
is  really  no  better  than  sawdust,  so  far  as  nutri- 
tive value  is  concerned,  and  the  patient  adheres 
to  it  only  a  short  time.  For  the  past  two  years 
the  patients  that  I  have  seen  have  been  in  the 
habit  of  using  a  bread  which  so  far  seems  to  be 
very  satisfactory,  but  it  is  not  entirely  divested  of 
starch.  It  is  what  is  called  gluten  bread,  pre- 
pared by  the  Health  Food  Company,  corner  of 
Tenth  Street  and  Fourth  Avenue,  of  this  city. 
Analysis  shows  that  it  is  not  entirely  divested  of 
starch,  but  it  is  so  prepared  that  it  is  not  deprived 
of  the  agreeable  qualities  of  ordinary  bread.  Last 
winter  I  brought  a  loaf  of  that  bread  before  the 
class  and  distributed  it.  I  like  it  to  eat  myself, 
finding  it  by  no  means  disagreeable  ;  and  patients 
take  this  bread  and  it  meets  their  w^ants,  thus  re- 
moving a  great  obstacle  to  the  successful  dietetic 
treatment  of  this  disease. 

I  do  not  deem  it  necessary  to  go  over  the  entire 
list  of  these  dietetic  articles.  You  will  find  them 
by  reference  to  different  works.  But  the  thing  to 
do  is  to  go  into  minute  details  with  the  patients. 
Explain  to  them  fully  just  what  is  to  be  done. 

\Vell  now,  after  they  enter  upon  this  course  of 


298 


THE    CANADA    MEDICAL    RECORD. 


treatment  in  a  very  considerable   proportion   of 
cases  the  sugar  diminishes  at  once,  and  sometimes 
it  speedily  disai)pears.     Of  course  we  should  ex- 
amine the  urine  from  time  to  time  to  determine  its 
condition  as  regards  the  presence  of  sugar  and  the 
amount  of  sugar.     'I'his  treatment  does   not  cause 
a  disappearance  of  the  sugar  in  all  cases.     I  have 
a  patient  under  observation  now  whom  I  saw  for 
the  first  time  about  three  weeks  ago — a  young, 
thin,  intelligent  man,  who,  I   have  reason  to  be- 
lieve, adopted  the  anti-diabetic  treatment  and  has 
carried  it  out  fully.     I  prescribed  no  medicine  at 
first,  and  that  has  been  my  custom,  in  order  to  see 
what  the  dietetic  treatment  will  do  of  itself.     In 
this  case  it  has  accomplished  very  little  so  far  ; 
and  this  case  I  am  led  to  fear  therefore  will  be  one 
in   which  we  cannot  expect  much  success  from 
treatment  of  any  kind.     If  the  dietetic  treatment 
does  not  succeed  we  have  no  other   resources  ; 
that  is,  no  medicinal  remedy  yet  known  will  suc- 
ceed.    It  may  have  a  certain  influence  over  the 
disease,  but  it  will  not  effect  a  cure.  Then  I  could 
mention  other  cases.     A  gentleman  whom  I  have 
seen  now  for  two  years,  who  until  lately  has  taken 
scarcely  any  remedies,  but  has  carried  out  the 
dietetic  treatment  very  faithfully,   presents  urine 
which  gives  no  evidence  of  sugar  whatev'er.     He 
retains  his  strength  mentally  and  physically ;  he  is 
a  man  of  great  activity,  being  engaged  in  business 
involving  large  responsibility,  able  to  go  on  with 
it,  and  finding  the  dietetic  treatment  jDCrfectly  satis- 
factory— finding  it  no  hardship. 

Now,  as  to  medicines,  as   I  have  said,  a  great 
number  have  been  proposed  from  time  to  time,  have 
been  tried  a  short  time,  and  then  have  passed  out 
of  use,  others  taking  their  j^lace.     This   patient  is 
not  under  my  own  care  here.     He  is  under  treat- 
ment with  the  sulphide  of  calcium,  a  fifth  of  a 
grain  three  times  a  day,  together  with  the  dietetic 
treatment,  so  far  as  it  can  be  carried  out.     With 
regard  to  this  sulphide  of  calcium,  one  patient — a 
medical  man  in  this  vicinity  who  suffered  from  this 
disease — consulted  me  about  three  years  ago,  at 
which  time  he  found  that  he  had  diabetes,  adopted 
the   dietetic  treatment,  relinquished  his  duties  in 
town,  which  were  exceedingly  laborious,  and  went 
into  the  country,  and  his  urine  after  a  time  showed 
no  evidence  of  sugar.  When  I  saw  him  last,  which 
was  a  (ew  months  ago,  I  had  never  seen  him  look 
better,   and  he  said  to  me  that  he  had  never  felt 
better  in  his  life.  And,  by  the  way,  as  an  evidence 
that  this  disease  may  have  existed  some  time   be- 
fore the  patient's  attention  has  been   directed  to 
any  disease,  this  has  been  said  to   me  over  and 
over  again  by  patients,  even  when    the  urine  still 
contained  sugar.     They  were  not  aware  that  they 
had   any  disease,  as  they  felt  nnich  better  than 
they  had  for  months,  perhaps  for  years    before. 
They  would  not  be  aware  that  they  had  any  dis- 
ease   were   it  not  for  a  chemical  examination  of 
the  urine.     If  they  could  put  that  out  of  view  they 
would  not  have  the   consciousness  of  having   any 
disease  at  all.     This  gentleman,   who  was  a  very 


able  practitioner,  was  led  to  use  the  remedy  that  I 
have  just  mentioned  from  finding  it  recommended, 
as  he  told  me,  in  some  medical  journal.  He  has  the 
impression  that  the  sulphide  of  calcium  had  con- 
siderable to  do  with  his  apparent  cure.  Well,  I 
am  free  to  say  that  when  I  talked  with  him  about 
it  my  own  belief  was  that  he  was  aj)parcntly  cured 
by  the  dietetic  treatment,  and  by  a  change  of 
habits  of  life,  the  avoidance  perhaps  of  some  ex- 
cesses. 

To  one  patient  who  came  to  see  me  I  stated 
these  facts  with  regard  to  that  remedy,  and  I  said, 
"If  you  feel  no  objection  I  will  prescribe  it  for 
you."    This  was  a  case  in  which  the  dietetic  treat- 
ment had  been  extremely  successful,  and  most  of 
the  time  there  was  very  little  if  any  sugar  in  the 
urine.     I  told  the  patient  that  the  remedy  in  ques- 
tion would  do  no  harm  ;  that  I  thought  I  could  say 
that.     He  said,  "  Well,  let  us  try  it."     I  put  him 
upon  the   remedy,  beginning  with    small   doses, 
and  increasing  them.     I  began  in  his  case  with  an 
eighth  of  a  grain,  but  I  think  we  might  begin  with 
a  quarter  of  a  grain  ;  in  other  cases  I  have  begun 
with  a  quarter  of  a  grain  three  times  a  day,  after 
a  fortnight  doubling  it,  going  up  to  two  grains,  and 
continuing  it  indefinitely.     Well,  this  patient  went 
on   in  that  way,  and  he  is  very  much  impressed 
with  the  idea  that  it  has  been  of  use  to  him.    Now 
we  must  make  some  degree  of  allowance  with  re- 
gard to  the  opinion  of  the  patient  as  to  the  effect 
of  the  remedy.     I  do  not  mean  to  say  that  the  re- 
medy has  not  been  of  value,  but  I  do  not  feel 
as  certain  as  the  patient  does  with  respect  to  its 
value.     I  am  also  prescribing  the  same  remedy  in 
three  or   four  other  cases,  but  the  period  during 
which  it  has  been  used  is   too  short,  I  think,  to 
enable  one  to  form  a  correct  judgment  with   re- 
gard to  it.     I  shall  certainly  continue  the   use  of 
the  remedy,  for  it  can  do  no  harm  ;  and,  moreover, 
it  is  a  gratifying  thing  to  the  patient  to  be  taking 
a  remedy  which  he  supposes  may  be  of  use.    The 
moral  effect  of  remedies,  as  people's  views  are  now, 
is  by  no  means  inconsiderable  ;  it  is  a  factor  which 
we   cannot  altogether  ignore  in  the   treatment  of 
disease. 

This  disease  I  believe  may  be  kept  in  abeyance 
indefinitely  by  appropriate  dietetic  treatment,  and 
yet  1  am  extremely  doubtful  whether  a  patient  can 
ever  properly  consider  that  there  is  a  permanent 
recovery. — American  Practitioner. 


SYPHILIS  IN  MARRIED  LIFE. 

By  M.  FouRNiER. 

Lecture  delivered  at  tlie  St.  Louis  Hospital  (Paris). 

Gentlemen, — How  often,  in  your  practice,  are 
you  consulted  by  individuals  who.  having  been 
unfortunate  enough  to  contract  syi)hilis,  desire  to 
know  if  they  are  completely  cured,  and  if  they 
may  marry  with  safety  ! 


THE   CANADA    MEDICAL    RECOID. 


299 


The  importance  of  the  reply  you  will  make  to 
such  a  question  cannot  be  over-rated.  If  you  in- 
terdict marriage  to  a  man  in  a  fit  condition  to 
marry,  your  medical  sentence  may  destroy  his 
happiness  and  his  subsequent  career.  If  you 
authorize  the  marriage  ofa  man  still  suffering  from 
syphilis,  you  expose  not  only  the  individual  him- 
self, but  also  his  young  wife,  to  whom  he  brings 
the  disease  as  a  wedding  present,  and  again  the 
entire  family  which  may  result  from  the  union. 

I  have  witnessed  too  often  these  sad  dramas  of 
family  life,  and  I  can  affirm  to  you  that  nothing 
can  be  more  execrable  than  the  situation  of  such 
a  man  before  a  wife  who  weeps,  but  forgives; 
before  her  family,  who  do  not  forgive ;  and  before 
a  nurse  infected  by  the  child,  who  recriminates, 
gives  rise  to  scandal,  and  divulges  the  secret.  We 
will,  then,  seek  to  resolve  this  terrible  problem 
regarding  syphilis  in  the  marriage  relations.  And, 
primarily,  an  important  question  presents  itself  for 
consideration. 

Does  s\-philis  constitute  an  absolute  obstacle  to 
marriage?  ''A  man  who  has  the  syphilis  should 
remain  a  bachelor ; "  this  is  what  you  will  very 
often  hear.  I  could  cite  two  verv-  honorable  prac- 
titioners of  my  acquaintance  who  have  renounced 
marriage  on  this  account.  One  of  the  two,  who 
enjoys  a  high  reputation,  has  never  allowed  him- 
self to  be  pursuaded  by  me,  and  always  replies  : 
■'  When  a  person  has  syphihs,  he  should  keep  it 
for  himself  alone." 

To  this  I  reply  :  when  one  has  the  syphilis  it 
should  be  cured,  and  then  marriage  and  a  family 
may  be  thought  of. 

tSyphihs  is  not  an  insurmountable  obstacle  to, 
nor  an  absolute  interdiction  of,  marriage ;  daily 
observation  shows  cases  where  such  marriages 
have  been  contracted  with  safety :  we  meet  every 
day  with  married  men  whom  we  have  seen  suffer- 
ing from  syphilitic  lesions,  and  who  have  trans- 
mitted absolutely  nothing  to  their  wives,  and  have 
children  as  healthy  and  flourishing  as  they  can 
desire. 

I  have  been  able  to  find  fifty-one  published 
cases  besides  those  I  have  observed  in  my  own 
practice.  These  fifty-one  syphiHtic  fathers  had 
ninety-two  children,  all  free  from  the  disease.  I 
recall  one  such  case  where  there  were  four  children 
and  another  where  five  children  were  bom.  I  have 
been  physician  of  both  families  for  many  years, 
and  have  never  observed  a  trace  of  syphilis  in  the 
children.  I  conclude,  then,  by  asserting,  with  a 
conviction  fortified  by  observation,  a  man  may 
enter  the  married  state  after  having  contracted 
syphilis  ;  but  he  should  marry  only  under  certain 
conditions. 

A  young  girl  espouses  a  man  presenting  syphi- 
litic lesions  ;  after  being  married  a  icw  months  a 
physician  is  called  to  the  young  wife,  who  presents 
strange  and  uncommon  symptoms  ;  syphilitic  emp- 
tions  are  found,  mucous  patches  about  the  mouth, 
grandular  enlargements,  falling  of  the  hair  (alope- 
cia), etc.     If  the   physician   seeks   for  the  origin 


of  these  lesions,  he  is  unable  to  find  any  trace  of 
initial  chancre,  or  of  a  bubo,  faithful  companion 
of  the  chancre  ;  secondary  les'ons  alone  are  found 
without  any  trace  of  primary  lesion  ;  on  the 
other  hand,  if  the  husband  is  questioned  in  secret, 
he  will  aftirm  and  protest  energetically,  that  he  has 
never  had  any  venereal  disease,  that  he  has  always 
carefully  examined  himself  after  intercourse,  etc. 

He  is  right ;  in  effect  his  wife  may  become 
syphilitic  through  contact  with  this  man  who 
exteriorly  appears  not  to  suffer  from  the  disease  ; 
this  apparently  paradoxical  fact  has  been  too  fre- 
quently observed  to  place  its  occurrence  for  one 
instant  in  doubt.  This  mvsterious  contagion  is 
explained  by  the  fact  that  the  woman  is  with  child. 
Always,  in  such  cases,  you  will  find  that  the  woman 
has  borne  a  child  or  had  a  miscarriage  a  short 
time  previously.  The  mother  has,  in  fact,  been  in- 
fected bv  the  child  and  not  bv  the  father.  Conta- 
gion  has  taken  place  through  the  placental  exchange 
going  on  between  mother  and  child  ;  a  fact  abso- 
lutely proven  to-day.  I  hold  it  as  a  constant 
fact  that  a  syphilitic  father  is  dangerous  for  his 
children. 

But  I  admit  that  the  possibility  of  transmission 
is  much  less  certain  than  has  been  generally  sup- 
posed when  the  father  alone  is  affected,  the 
mother  remaining  free  from  the  disease. 

Paternal  influence  may  be  rare  and  restricted, 
but  it  is  sometimes  exercised. 

Syphilitic  fathers  have  procreated  sv-philitic 
children,  the  mother  remaining  free  from  infection. 
Ricord,  Trousseau,  Diday,  Liegeois,  have  all 
given  incontestable  cases.  But  this  is  but  a  part 
of  the  question,  which  assumes  gravity  from  the 
following  considerations  :  The  death  of  the  foetus 
in  utero  is  very  frequent  under  the  conditions  of 
which  we  speak.  The  child  of  a  syphilitic  father 
dies  in  the  womb  of  its  mother  and  is  expelled  by 
miscarriage  or  by  premature  labor. 

A  young  wife  becoming  enceinte  has  one,  two, 
three'  miscarriages,  without  it  being  possible  to  find 
anv  other  cause  except  the  syphilis  of  the  father. 

And  what  proves  this  to  be  the  real  cause?  If 
the  father  places  himself  under  a  course  of  treat- 
ment, the  following  pregnancies  proceed  to  full 
term  and  the  children  are  born  alive,  without  the 
disease. 

I  have  observed  such  cases  very  many  times. 
I  will  cite  one  case  among  many  others  :  One 
day  I  met  a  fonner  companion.  His  wife,  though 
of  fine  constitution  and  very  strong,  had  miscar- 
ried four  times  in  succession.  I  then  recalled  to 
mind  that  my  friend  had  suffered,  long  before, 
from  svphilis,  and  had  not  followed  any  regular 
course  of  treatment.  I,  therefore,  advised  him  to 
place  himself  under  a  course  of  treatment  for  his 
syphilitic  affection,  which  I  did  not  consider 
cured. 

My  counsel  was  rigorously  followed,  and  fifteen 
months  later  I  learned  of  the  birth  of  a  fine  child, 
who  is  ten  years  of  age  to-day,  and  enjoys  excel- 


300 


THE    CANADA    MEDICAL    RECORD. 


lent  health.  Two  ulterior  pregnancies  in  the 
same  case  also  terminated  hai)j)ily. 

^Vhenevt•r  the  j)hysician  finds  himself  in  the 
presence  of  a  series  of  miscarriages,  occurring  in 
a  healthy  woman  of  good  constitution,  he  should 
commence  to  suspect  that  these  accidents  are  due 
solely  to  the  syphilis  of  the  father,  who  has  de- 
stroyed his  child  in  the  womb  of  its  mother. 

Another  important  point  is  :  a  syphilitic  father 
may  transmit  the  disease  to  his  wife,  and  then, 
the  father  and  mother  being  syphilitic,  what  will 
be  the  condition  of  the  children  ? 

Three  alternatives  present  themselves  : — 

1.  The  child  will  perish  in  utero,  and  that  is 
assuredly  the  best  for  the  child. 

2.  He  will  be  born  at  term,  but  infected  with 
the  disease. 

3.  He  will  survive  with  his  health  compromised 
and  exposed  to  all  the  alternatives  of  disease. 

a.  For  the  first  case— death  in  utero — expe- 
rience has  demonstrated  its  frequency ;  thousands 
of  cases  sufficiently  prove  its  occurrence  :  all  the 
observations  are  so  exactly  in  concord  that  they 
appear  stereotyped.  The  pernicious  influence 
continues  to  be  felt  even  in  ulterior  pregnancies  ; 
there  has  been  observed  series  of  four,  six,  and 
seven  successive  pregnancies  terminating  always 
the  same  way,  in  miscarriage.  I  have  seen,  at  the 
Lourcine  Hospital,  a  young  woman,  strong  and  of 
splendid  constitution,  who  married  in  her  nine- 
teenth year,  and  had  three  successful  pregnancies. 
Her  husband,  in  an  extra  conjugal  adventure,  con- 
tracted syphilis,  communicated  it  to  his  wife,  who 
became  enceinte  and  miscarried  in  the  fifth  month  ; 
a  second  pregnancy  terminated  in  premature 
labor,  the  child  being  dead  ;  a  third,  a  fourth,  a 
fifth  pregnancy  had  the  same  ending  ;  the  sixth 
terminated  in  miscarriage,  in  the  third  month  ;  the 
seventh  at  the  sixth  week,  in  the  same  way.  This 
case  is  extremely  interesting — seven  miscarriages 
succeeding  three  successful  pregnancies  and  super- 
vening after  transmission  of  the  disease. 

b.  In  another  series  of  cases  the  child  is  born 
living,  but  infected  with  the  disease,  and  is  conse- 
quently exposed  to  all  the  dangers  of  infantile 
syphilis,  from  which,  by  careful  nursing  and  atten- 
tion, a  few  infants  may  be  saved,  but  the  great 
majority  perish. 

c.  It  is  possible  that  the  child  escape  death  and 
the  disease  also,  but  the  influence  of  the  heredi- 
tary taint  will  show  itself  in  another  way  ;  by  the 
natural  debility  which  characterizes  the  most  of 
these  children,  who  are  weakly,  wrinkled,  like  old 
men,  and  of  very  poor  constitution ;  nothing 
attests  the  existence  of  syphilis,  but  they  are  so 
puny  that  they  cannot  survive  and  usually  succumb, 
wasting  away  gradually,  without  any  apparent 
disease,  no  particuk,r  lesions  being  found  at  the 
autopsy. 

Or,  again,  they  have  certain  morbid  predisposi- 
tions :  1st.  They  are  born  hydrocephalic,  or  fre- 
quently become  so.  2nd.  They  are  very  frequently 
subject  to  nervous  troubles,  to  epilepsy,  while  they 


are  very  young,  and  later  to  convulsions  ;  they  very 
often  die  in  simple  convulsions.  Finally,  they  are 
generally  lymphatic,  and  have  feeble  vital  resistance 
to  scrofula.  But  scrofula  is  not,  on  this  account, 
a  metamorphosis  of  syphilis,  as  has  been  erro- 
neously pretended;  it  is  a  fixed  morbid  entity,  just 
as  is  syphilis  ;  it  is,  however,  incontestable,  that 
venereal  disease  constitutes  a  predisposition  to 
scrofula,  inasmuch  as  it  is  a  debilitating,  asthenic 
malady,  acting  on  the  organism  in  the  same  dele- 
terious manner  as  insufficient  nourishment,  confin- 
ed, impure  air,  and  crowding  in  small,  humid 
tenements. 

Do  not  depart  thinking  I  have  exaggerated 
in  drawing  so  sombre  a  picture ;  I  have  but 
jjresented  to  you  what  I  have  but  too  often  seen, 
these  hidden  family  dramas- which  are  a  veritable 
social  misery.  I  will  cite  but  a  few  cases  taken  at 
random  ;  here  it  is  one  of  the  most  popular  actors 
in  one  of  the  great  theatres,  who,  having  contract- 
ed syphilis,  treated  it  with  supreme  indifference. 
Happily  he  did  not  infect  his  wife  and  had  a  heal- 
thy child,  but  he  was  attacked  himself  later  on  by 
a  syphilitic  ulceration,  which  took  on  a  phagedenic 
form.  I  was  unable  to  arrest  its  ravages,  and  it 
invaded  successfully  the  face,  nose,  upper  lip,  soft 
plate,  and  pharynx,  and  in  the  end  caused  the 
unhappy  being  to  become  an  object  of  horror  and 
disgust  to  all  about  him. 

In  another  case  an  artist,  a  painter,  contracted 
syphilis ;  the  disease  was  incompletely  treated,  and 
he  was  attacked  with  an  affection  of  the  eyes 
which  finally  caused  complete  loss  of  vision,  and 
the  unfortunate  was  obliged  to  apply  to  the  public 
Board  of  Charities  to  save  himself  from  starvation. 
I  could  not  finish  if  I  undertook  to  recount  all 
the  sad  social  calamities  I  have  witnessed.  What 
should  be  said  of  the  author  responsible  for  all 
these  evils  ?  He  is  more  ignorant  than  guilty,  and 
it  is  a  duty  we  owe  to  society  to  instruct  the  pub- 
lic concerning  these  dangers  they  ignore. — Med. 
and  Surg.  Reporter,  VhWz..,  Jan.  22. 


STICxMATA  OF  iMAIZE. 

Last  winter  and  again  this  spring  the  A'e7i's 
called  the  attention  of  its  readers  to  corn-silk, 
technically  stigmata  of  maize,  as  a  remedy  in 
nephritic  and  cystic  troubles,  etc.  The  medicinal 
properties  of  corn-silk  were  brought  to  the  notice 
of  the  profession  by  Dr.  Dufau,  a  French  Physi- 
cian, in  Ze  Courrier  Medical.  He  commends  the 
remedy  in  uric  and  phosphatic  gravel,  chronic 
cystitis,  mucous  and  muco-purulent  cystic  catarrh, 
and  in  cardiac  and  nephritic  dropsy.  *  Dufau  has 
given  it  without  injury  for  three  months  at  a  time. 
He  has  known  it  to  triple  and  even  quintuple  the 
quantity  of  urine  passed  in  twenty-four  hours.  He 
says  that  in  dicoction  it  is  unreliable  and  uncer- 
tain. He  gives  it  in  a  syrup  largely  diluted,  upon  an 
empty  stomach.  Stigmata  of  maize  is  said  to  have 
been  used  time  immemorial  by  the  Mexicans. 


THE   CANADA    MEDICAL   RECORD. 


301 


Dr.  Landrieux,  of  France,  has  published  two 
cases  showing  its  diuretic  properties.  The  first 
was  an  individual  with  ascites  from  cirrhosis.  Under 
the  influence  of  the  drug,  given  in  a  syrup,  the 
urine  arose  rapidly  from  five  hundred  grams 
to  twelve  and  fifteen  hundred  grams.  In  three 
weeks  all  ascites  disappeared.  The  other  case 
was  the  subject  of  heart  disease,  with  great  edema 
of  the  legs,  enoniious  ascites,  pulmonary  and  renal 
congestion,  and  a  considerable  diminution  of  urin- 
ary excretion.  The  stigmata  of  maize  increased 
the  quantity  of  urine  from  two  hundred  to  eight 
hundred  grams  in  twenty-four  hours.  The  edema 
and  the  ascites  disappeared  in  a  short  time.  Dr. 
Landrieux  terminates  his  article  thus  :  i.  Not  only 
the  different  preparations  of  the  stigmata  of  maize 
are  useful  as  a  modifying  agent  of  the  urine,  but 
these  same  preparations  can  be  equally  considered 
as  an  incontestible  diuretic  agent ;  2.  Diuresis  is 
rapidly  produced ;  3.  The  pulse  becomes  regular 
under  its  influence,  the  arterial  tension  increases, 
while  that  of  the  veins  diminishes  ;  4.  Complete 
tolerance  of  the  drug,  and  in  chronic  cases  the 
treatment  might  be  continued  during  a  month  or 
six  weeks  without  the  slightest  inconvenience. 

We  trust  that  some  of  our  friends  have  tried  this 
remedy,  and  will  write  us  the  results.  We  have 
used,  t  in  a  single  instance,  but  with  a  decided 
effect.  Two  double  handfals  of  corn-silk  were 
boiled  in  two  gallons  of  water  until  but  a  gallon 
remained.  A  tumblerful  of  this  was  given  thrice 
daily  to  a  patient  of  eighty,  the  subject  of  dropsy 
of  the  legs.  His  urine  was  scant,  but  a  thorough 
examination  failed  to  discover  in  the  heart  or  kid- 
ney or  liver  any  cause  for  the  dropsy.  While  tak- 
ing the  corn-silk  decoction,  which  relieved  his 
dropsy,  he  declared  that  he  had  never  made  so 
much  water  in  all  his  life. 

Professor  Scheffer,  of  this  city,  is  now  pre^iar- 
ing  an  extract  of  the  stigmata  of  maize.  Experi- 
ments must  yet  determine  the  time  for  gathering 
the  silk,  and  the  proper  dose  and  best  form  of  the 
remedy.  It  may  be  that  the  silk  should  be  gather- 
ed before  it  is  impregnated  by  the  pollen  from 
tassel. — Louisville  Med.    Times. 


REST  AFTER  DELIVERY. 

Dr.  H.  J.  Garrigues  read  a  paper  which  was  a 
revised  edition  of  his  former  paper  on  the  subject, 
read  Sept.  8,  1877,  and  pubnsaed  m  the  •'  Pro- 
ceedings of  the  Kings  County  Medical  Society." 
The  question  was,  "  How  long  should  a  woman 
remain  in  bed  after  confinement?  "  It  was  desir- 
able that  practice,  in  this  particular,  should  be  as 
uniform  as  possible,  and  the  author  believes  that 
the  views  entertained  should  not  be  so  divergent 
as  at  the  present  time. 

The  chief  representative  of  those  who  recom- 
mend that  the  time  should  be  shortened  as  much 
as  possible,  was  Dr.  Wm.  Goodell  of  Philadelphia. 
At  this  point  Dr.  Garrigues  referred  to   a  case  in 


which  the  woman  was  urged  by  her  medical 
attendant  to  rise  early,  and  she  rose  on  the  fourth 
day  after  delivery ;  and  on  the  fourteenth  day  she 
was  induced  to  ride  in  a  carriage,  but  it  was  nearly 
at  the  cost  of  her  life.  From  that  single  illustra- 
tion, however,  he  did  not  wish  to  draw  any  definite 
conclusions. 

At  the  time  Dr.  Goodell's  paper  was  read,  756 
cases  were  reported,  with  a  total  mortality  of  only 
six ;  and  the  chief  reasons  why  its  author  recom- 
mended early  rising  after  delivery  were  the  follow- 
ing :  I.  Labor^  if  it  was  a  physiological  process^ 
should  not  be  made  to  wear  the  livery  of  disease. 
2.  The  upright  position  excites  the  uterus  to  con- 
tract, and  thereby  lessens  the  amount  and  duration 
of  the  lochia.  3.  Uterine  diseases  are  not  known 
among  the  nations  whose  women  rise  early  after 
delivery ;  and  4.  Experience  has  shown  that  con 
valescence  is  far  more  prompt  and  sure  than  when 
the  woman  is  kept  in  bed  for  a  prolonged  period. 
To  these  points  Dr.  Garrigues  directed  the  attention 
of  the  Section.  He  maintained  that  although  partu- 
rition was  a  physiological  process,  it  was  one  in 
which  the  transition  from  the  normal  to  the  patho- 
logical condition  was  extremely  common  ;  and 
that  was  especially  true  of  women  of  modern 
times.  Again,  if  the  upright  position  favored  the 
discharge  of  lochia  and  diminished  its  amount 
and  lessened  its  duration,  it  must  also  be  borne 
in  mind  that  serious  displacements  were  liable 
to  be  produced  by  placing  the  woman  in  that 
position  before  the  changes  incident  to  the 
post-partum  state  had  gone  on  sufficiently  to 
enable  the  tissues  of  the  pelvis  to  resist  prope.iy 
superincumbent  weight  and  pressure  ;  and  there- 
fore by  other  means  should  the  influence  of  the 
lochia  be  modified.  While  it  might  be  true  that 
uterine  disease  did  not  apparently  exist  among  the 
women  of  nations  where  early  rising  after  delivery- 
was  commonly  practised,  there  were  two  factors  by 
which  such  a  conclusion  must  be  modified  when 
applied  to  modem  civilized  women;  first,  not 
much  was  known  of  uterine  disease  in  ancient 
nations,  and,  second,  modern  women  with  all  the 
enervating  influence  of  what  is  termed  civilization 
cannot  resist  disease  as  did  the  ancient  or  the 
modern  uncivilized  matrons. 

With  reference  to  the  good  results  obtained  by 
Dr.  Goodell,  he  thought  they  were  due  to  the 
general  excellent  care  given  to  his  patients,  rather 
than  to  early  rising  ;  and  besides  he  thought  it 
impossible  to  judge  of  final  results  by  those 
obtained  in  the  average  length  of  time  which  the 
woman  remained  in  the  retreat  after  delivery. 

Dr.  Garrigues  then  quoted  from  leading  author- 
ities in  three  chief  countries  in  Europe,  all  of 
Avhom  recommended  absolute  rest  in  the  horizontal 
position  for  one,  two,  and  even  three  or  four  weeks 
after  parturition.  In  New  York,  also,  most  obstetri- 
cians favored  the  long  period  of  retention  in  bed 
after  delivery. 

In  the  language  of  the  author  of  the  paper, 
'■'anatomy  and  physiology  teach  us  that  the  piier- 


302 


Tin:    CANADA    MEDICAL    RECORD. 


peral  litems  is  large,  heavy,  flal)l)y,  antcverlcd  and 
antcHected  ;  that  all  the  surrounding  parts  destined 
to  support  it  are  distended,  soft,  and  yielding,  that 
its  interior  j)resents  one  large  wound  bathed  in  a 
fluid  rich  in  disintegrated  tissue-elements  ;  that 
the  i)lacental  site  is  pervaded  by  large  venous 
sinuses,  filled  with  recently-formed  blood-clots ; 
that  at  least  the  vaginal  orifice  and  often  other 
parts  of  the  obstetric  canal  present  open  wounds  ; 
that  the  process  of  transformation,  absorption,  and 
regeneration  required  at  least  two  months  ;  and 
that  the  retrogression  is  most  active  during  the 
second  week." 

It  is  not  necessary  that  the  woman  should  lie 
ui)on  her  back  after  the  first  twenty-four  hours, 
but  her  position  might  be  changed  to  that  upon 
either  side.  The  liability  to  hemorrhage,  displace- 
ment of  thrombi,  causing  sudden  death,  and  the 
occurrence  of  septicaemia,  was  regarded  as  suffi- 
cient reason  for  insisting  upon  rest  in  the  horizon- 
tal position  for  several  days  at  least  after  delivery. 
The  vagina  should  be  kept  clean  with  disinfectant 
injections.  It  was  with  reference  to  rest  after  deli- 
very in  normal  childbirth  that  it  was  desirable  to 
reach  a  unanimity  of  opinion.  Upon  that  point 
Dr.  Garrigues  had  reached  the  conclusion,  from 
the  combined  teachings  of  experience  and  physio- 
logy, that  the  woman  should  be  kept  lying  quietly 
in  bed,  alternately  upon  the  back  and  side,  until 
the  uterus  has  contracted  sufficiently  to  be  behind 
the  symphysis,  and  for  two  months  she  should 
avoid  any  great  exertion. 

Dr.  Isaac  E.  Taylor  remarked  that  the  views 
held  by  Dr.  Goodell  were  substantially  those 
entertained  by  Hamilton  and  White,  and  pub- 
lished several  years  ago.  The  important  point, 
however,  was  with  reference  to  the  management 
of  the  woman  after  normal  natural  labor,  and  he 
did  not  a^'ree  with  Dr.  Goodell,  because  he 
believed  that  we  must  be  guided  by  the  nature  of 
the  case  under  observation  :  what  was  the  woman's 
physiological  condition  ?  what  was  the  condition 
of  the  uterus  as  regards  its  length,  weight  and  posi- 
tion ?  etc. 

Dr.  Taylor  then  referred  to  a  case  in  which  the 
uterus  returned  to  the  pelvic  cavity  within  five 
days  after  delivery,  and  the  woman  made  a  raj^id 
and  good  recovery  ;  but  not  every  case  progressed 
so  favoral)ly  as  that  one.  He  kept  the  woman  in 
bed  until  the  uterus  had  returned  to  the  jjelvic 
cavity,  whether  it  required  one  or  four  weeks.  So 
far  as  rest  after  deli/ery  was  concerned,  we  must 
judge  by  the  constitution  of  the  woman.  Rising 
within  two  or  three  days  and  sitting  on  a  vessel 
would,  doubtless,  facilitate  removal  of  clots  and 
also  the  lochia  ;  but  if  the  woman  suffered  formerly 
a  good  deal  from  the  discharge,  etc.,  he  kept  her 
in  bed  three  or  four  weeks.  There  could  be  no 
line  drawn  or  rule  laid  down  which  could  be  made 
ajjplicable  to  every  case. 

Dr.  S.  T.  Hubbard  remarked  that  he  had  found 
a  great  difference  among  women  with  reference  to 
the  time  after  delivery  at  which  they  could  get  up 


without  injury.  His  rule  had  been  to  keep  them 
in  the  recumbent  posture,  if  ])Ossible,  nine  or  ten 
days,  and  prevent  them  from  walking  for  two 
weeks.  He  thought  the  time  must  be  regulated 
by  the  attending  physician  without  reference  to 
any  rule. 

Dr.  Tusky  fully  agreed  with  Dr.  Garrigues,  and 
also  believed  that  an  important  factor  in  prevent- 
ing the  develojjment  of  i)uerperal  fever  was  main- 
taining the  recumbent  jjosture  after  delivery  for  a 
week  or  more.  He  referred  to  a  case  in  which  the 
woman,  feeling  perfectly  well  on  the  fifth  day  after 
a  normal  labor,  arose,  and  puerperal  fever  immedi- 
ately followed.  Some  women  might  get  up  on  the 
first  day  after  delivery  and  no  harm  follow  ;  and  so 
it  occasionally  occurred  that  a  person  fell  from  a 
third-story  window  and  received  no  serious  injury, 
but  he  regarded  such  as  exceptional  cases,  and 
thought  that  no  woman  should  rise  before  the 
eighth  or  ninth  day  after  a  normal  labor.  He  also 
approved  of  injections  of  the  cavity  of  the  body  of 
the  uterus  as  recommended  by  Hegar,  whenever 
the  external  os  was  patulous. 

Dr.  Caro  remarked  that  we  need  not  go  to 
Borne  to  study  Roman  women,  for  they  were  here, 
and  he  then  referred  to  his  experience  among 
Italian  women  in  the  city  of  New  York,  which  had 
been  that  early  getting  up  after  delivery  frequently 
destroyed  the  life  of  the  woman,  and  was  a  most 
prolific  source  of  all  kinds  of  pelvic  disease.  He 
never  allowed  a  woman  to  rise,  if  it  could  be  pre- 
vented, before  the  ninth  or  tenth  day.  He  regarded 
cleanliness  as  godliness,  but  it  was  a  virtue  which 
most  of  the  Italian  women  discarded  ;  and  doubt- 
less their  habits  in  that  respect  contributed  largely 
to  the  development  of  diseases  among  them. 

Dr.  Garrigues,  in  closing  the  discussion,  remark- 
ed that  he  took  it  for  granted  that  there  were 
injuries  more  or  less  severe  to  the  obstetric  canal 
in  every  case  of  labor.  The  injury  might  be  very 
slight,  but  it  was  sufficient  to  permit  the  absorp- 
tion of  septic  material ;  hence  the  care  that  should 
be  taken  to  keep  the  passages  properly  cleansed 
and  the  discharges  properly  disinfected. 

The  minimum  time  which  he  would  keep  the 
woman  in  bed  was  eight  days,  a  period  long  enough 
to  allow  granulations  to  form  for  the  repair  of  in- 
jury done  to  the  tissues  of  the  obstetric  canal. — 
JV.  V.  Medical  Record. 


]\IANAGEMENT  OF  ABORTIONS. 

Dr.  Parvin  (^The  Obstetric  Gazette,  July)  pre- 
sents his  manner  of  meeting  the  difficulties  of  these 
cases.  He  says  :  suppose  a  case  of  incomplete 
abortion  having  hemorrhage  which  by  its  persis- 
tence of  profuseness  brings  danger  to  the  patient, 
or  commencing  offensive  discharge  that  heralds  a 
l)Ossible  se]Jtica;mia,  and  then  interference  is  im- 
perative and  must  be  immediate.  Let  the  patient 
lie  on  her  back,  upon  a  hard  bed,  her  hips  brought 


THE    CANADA    MEDICAL   RECORD. 


303 


to  its  edge,  lower  limbs  strongly  flexed  ;  then  intro- 
duce Neiigebauer's  speculum,  and  bring  the  os 
fairly  in  view ;  now  catch  the  anterior  lip  with  a 
simple  tenaculum  or,  better,  with  Nott's  tenacular 
forceps,  and  then  if  there  be  any  flexion — and 
it  is  not  uncommon  in  cases  of  spontaneous 
abortion  to  obser\-e  this — use  gentle  traction 
to  strengthen  the  bent  canal ;  at  any  rate  fix  the 
uterus  by  the  instrument.*  Now  take  a  pair  of 
curved  polypus  forceps  of  suitable  size,  or,  better 
still,  Emmet's  curette  forceps,  and  gently  intro- 
duce the  closed  blades  into  the  uterine  cavity,  open 
them  slightly,  then  close  them  and  withdraw,  when 
the  fragments  of  membranes  can  be  removed,  and 
the  instrument  be  re-introduced.  Repeat  this  three 
or  four  times,  if  necessary,  until  all  membranes  or 
placental  fragments  are  extracted.  Then,  by  eansm 
of  an  applicator  wrapped  with  cotton  wool,  swab 
out  twice,  or  oftener,  the  uterus  with  Churchill's 
tincture  of  iodine — one  of  the  best  of  local  uterine 
haemostatics,  if  not  one  of  the  best  of  antiseptics. 
Finally,  let  the  patient  have  ten  or  fifteen  grains 
of  quinia,  and  it  will  be  very  rarely,  indeed,  that 
her  convalesence  is  not  prompt  and  perfect. 


AMENORRHCEA. 

In  cases  of  this  nature,  due  to  torpid  action  of 
the  ovaries,  Dr.  Goodell  orders  the  following  pre- 
scription : 

I^.  Ex.  aloes,  3  j.;  ferri  sulph.  exsic,  3  ij.,  assa- 
foet.   3  iv.  M.  et  in  pil.  No.  c,  divide. 

Sig. — One  pill  to  be  taken  after  each  meal.  This 
number  to  be  gradually  increased,  first  to  two,  and 
then  to  three  pills  after  each  meal. 

If  the  bowels  are  at  any  time  over-affected,  the 
patient  is  to  stop  and  begin  again  with  one  pill. 

Where  the  amenorrhoDa  is  due  to  arrested  devel- 
opment. Dr.  Goodell  has  derived  the  very  best 
results  from  the  constant  use  of  Blot's  pill,  as  re- 
commended by  Niemeyer : 

I^  .  Pulv.  ferri  sulph.,  potas.  carb.  purre,  aa  3  ij., 
mucil.  tragacanth,  q.  s.  M.  et  in  pil.  No.  xlviii, 
div. 

Sig. — To  be  given  daily,  in  increasing  doses, 
until  three  pills  are  taken  after  each  meal. 

This  gives  the  large  quantity  of  twenty-two  and 
a  half  grains  of  the  dried  sulphate  of  iron  per  diem. 

If  tliese  pills  give  rise  to  constipation,  Dr. 
Goodell  uses  this  formula  : 

5.  Pulv.  glycyrrh.  rad.,  pulv.  sennae,  aa  ss., 
sulphur  sublim.,  pulv.  feniculi,  aa  3ij.,  sacchar. 
purif.  §jss.  M. 

Sig. — One  teaspoonful  in  half  a  cupful  of  water 
at  bedtime. 

Where  the  suppression  is  due  to  change  of  habits 
and  loss  of  health,  tonics  are  employed.  When  the 


suppression  comes  on  suddenly,  from  cold  or  ex- 
posure while  in  the  midst  of  the  menses,  and  is 
accompanied  by  severe  lumbar  pains,  the  patient 
is  placed  in  a  mustard  hip-bath,  a  Dover's  powder 
is  administered,  she  is  put  to  bed  and  hot  drinks 
are  given  to  provoke  copious  diuresis  and  dia- 
phoresis.— AF.  V.  Record. 


*It  is  well  to  use  a  uterine  probe  in  order  to  ascertain  the 
course  of  the  [cervico-uterine  canal  and  the  depth  and  size 
of  the  uterine  cavity. 


THE  TREATMENT  OF  PNEUMONIC 
FEVER  (ACUTE  LOBAR  PNEUMONIA) 
BY  THE  EMPLOYMENT  OF  THE  WET- 
SHEET. 

Dr.  Austin  Flint,  in  a  recent  clinic  {Gat/lard's 
Medical  Journal,  March,  1881),  presented  three 
cases  of  pneumonic  fever,  treated  antipyretically  by 
means  of  the  wet-sheet,  no  other  active  measures 
of  treatment  having  been  employed.  The  favor- 
able course  of  the  disease  under  this  treatment,  in 
these  cases,  was  highly  gratifying.  Dr.  Flint  said, 
"  Inasmuch  as  these  cases  are  but  a  small  propor- 
tion of  those  which  have  been  treated  in  my  wards 
during  the  session,  you  may  ask  why  the  treatment 
has  been  thus  limited.  The  treatment  is,  as  yet, 
novel  in  this  country.  In  relating  the  first  two 
cases  at  a  meeting  of  a  medical  society  of  which 
I  am  member,  doubt  was  expressed  by  other 
members  as  regards  a  favorable  influence  produced 
by  the  treatment,  together  with  distrust  of  its  pro- 
priety and  safety.  I  was  not  without  apprehensions, 
in  the  first  place,  in  respect  of  the  treatment  iself, 
and,  in  the  second  place,  as  taking  the  place  of 
other  therapeutical  measures,  notwithstanding  the 
strong  testimony  of  some  German  writers  in  behalf 
of  the  efiicacy  of  cold  baths  in  this  disease.  These 
considerations  led  to  a  careful  selection  of  cases. 
The  cases  selected  were  those  in  which  the  disease 
was  in  an  early  stage,  the  patients  apparently 
robust,  the  pyrexia  considerable  or  high,  and  no 
complications  existing.  I  am  by  no  means  sure 
that  the  treatment  might  not  have  been  employed 
in  other  cases  with  advantage,  but  it  was  thought 
best  to  select  cases  in  which  there  was  the  least 
likelihood  of  harm  were  the  effect  not  satisfactory."^ 

The  plan  of  treatment  was  as  follows  :  The 
directions  were  to  employ  the  wet-sheet  whenever 
the  axillary  temperature  exceeded  103"  Fahr.  The 
patient  was  wrapped  in  a  sheet  saturated  with  water 
at  a  temperature  of  about  80°  Fahr.,  the  bed  being 
protected  by  an  India-rubber  covering.  Sprinkling 
with  water  of  about  the  same  temperature  was 
repeated  every  fifteen  or  twenty  minutes.  If  the 
patient  complained  of  chilhness,  he  was  covered 
with  a  light  woolen  blanket,  whieh  was  removed 
when  the  chilly  sensation  had  disappeared.  In 
none  of  the  cases  was  the  blanket  used  much  of 
the  time  when  the  patient  was  wrapped  in  the  wet- 
sheet.  The  patient  remained  in  the  sheet  until  the 
temperature  in  the  mouth  fell  to  102°  or  lower,  care 
being  taken  to  watch  the  pulse  and  other  symptoms. 
When  the  temperature  was  reduced,  the  wet-sheet 


304 


THE    CANADA    MEDICAL    RECORD. 


was  removed,  and  resumed  if  the  temperature  again 
exceeded  103°  Fahr. 

The  first  case  entered  the  hospital  on  the  third 
day  after  tlie  attack.     On  the  second  day  after  his 
entrance  the  wet-sheet  was  employed  thrice.     He 
remained  in  the  sheet  the  first  time,  two  hours  and 
forty-five  minutes  ;   the  second  time,  an  hour  and 
a  half,  and  the  third  time,  an  hour  and  ten  minutes. 
On  the  second  day  the  wet-sheet  was  employed 
once,  and  continued  for  one  hour.     On  the  third 
day  the  wet  sheet  was  not  employed,  the  tempera- 
ture not  rising   above   103"^.     On  the  fourth  day 
the  wet-sheet  was  employed  once,  and  continued 
for  an  hour.     There  was  com])lete  defervescence 
on  the   fifth  day,  and  no  return  of  the  fever  after- 
ward.    Dating  from  the  attack  to  the  cessation  of 
fever,    the    duration   of    the  disease   was    seven 
days.     The    patient   had   no  treatment   prior   to 
his   admission   into   the  hospital.     The  treatment 
in  the  hospital,  in  addition    to   the    employment 
of    the    wet-sheet,     consisted    of    carbonate    of 
ammonia  in  moderate  doses,   whiskey  given  very 
moderately,  and  a  little  morphia.     The  patient  was 
up  and  dressed  five  days  after  the   date  of  the 
defervescence.     There  were  no  sequels,    and  the 
patient  was  discharged  well. 

The  second  case  entered  hospital  seven  days 
after  the  date  of  the  attack.  She  had  no  medical 
treatment  prior  to  her  entrance.  The  wet-sheet 
was  employed  on  the  second  day  after  her  admis- 
sion, and  continued  for  six  hours.  Complete  defer- 
vescence took  place  on  the  third  day.  Recovery 
followed  without  any  drawbacks.  Both  lobes  of 
the  left  lung  were  involved  in  this  case.  The  inva- 
sion of  the  second  lobe,  probably,  was  about  the 
time  of  her  admission  into  hospital. 

The  third  case  entered  hospital  three  days  after 
he  was  obliged  to  give  up  work.  On  the  day  of 
his  entrance  the  wet-sheet  was  employed,  and  con- 
tinued for  ten  hours.  The  Avet-sheet  was  employed 
on  the  second  day  after  his  admission,  and  contin- 
ued for  five  hours.  Defervescence  took  place  on 
this  day.  I'he  duration  of  the  fever  was  five  days, 
dating  from  the  time  he  was  obliged  to  give  up  work 
and  seven  days  from  the  occurrence  of  chills  and 
pain  in  the  chest. 

Dr.  Flint  said  the  histories  of  these  cases  as  bear- 
mg  upon  the  treatment  employed  were  of  consider- 
able interest.  They  certainly  show  that  in  cases 
like  those  which  were  selected,  the  treatment  is  not 
hurtful.  More  than  this,  they  render  probable  the 
inference  that  the  disease  was  controlled  and 
brought  speedily  to  a  favorable  termination  by  the 
treatment.  7'hcy  also  go  to  show  that  the  disease 
is  essentially  a  fever,  and  that  treatment  is  to  be 
directed  to  it  as  such,  and  not  as  a  purely  local 
jnilmonary  affection.  It  remains  to  be  determined 
by  further  observations  how  often  and  to  what  ex- 
tent this  method  of  treatment  has  a  curative  efficacy. 
It  is  also  an  important  object  of  clinical  study  to 
ascertain  the  circumstances  which  render  the 
treatment  api)licable  to  cases  of  pneumonic  fever, 
and,  on  the  other  hand,  the  circumstances  which 


may  contra-indicate   its   employment  in  this  dis- 
ease. 

To  this  series  Dr.  Flint  adds  a  supplementary 
case  of  decided  interest  in  which  the  pneumonia 
began  in  a  well-pronounced  chill,  fever,  lieadache, 
pain  under  the  left  nipple,  cough,  and  a  feeling  of 
general  prostration.  lieing  without  a  home,  the 
patient  spent  the  time  from  Feb.  1 8th  to  the  morn- 
ing of  the  2ist  in  a  lumber  yard  without  food,  and 
with  no  shelter  but  a  pile  of  boards.  During  this 
time  there  was  a  snow-storm  of  considerable 
severity,  and  the  temperature  fell  as  low  as  io*> 
P'ahr.  On  admission  there  was  a  dusky  redness  of 
the  face,  and  the  expression  was  anxious  ;  pulse 
122,  respiration  52,  temperature  102.25°.  He 
complained  of  dyspnoea,  pain  in  left  side  and  cough. 
The  expectoration  was  semi-transparent,  adhesive, 
and  had  a  reddish  tint.  Increased  vocal  fremitus, 
dullness,  bronchial  breathing,  and  bronchophony 
over  the  left  lung. 

Treatment. — Whiskey,  3  ss,  Ammoniae  carb., 
gr.  V,  every  two  hours,  and  a  milk  diet.  Tempera- 
ture in  the  afternoon,  104.25°  F. 

22^!^.  Temperature,  a.m.,  99°  ;  p.  m.,  99.25°. 
Puls3  115  and  feeble.  Ordered  tr.  digitalis,  gtt.  x, 
every  three  hours. 

23^.  Patient  improved.  All  the  signs  of  solidi- 
fication are  yet  present,  and  the  crepitant  rale  is 
heard  behind.  Pulse  70  and  full.  Digitalis  dis- 
continued. Respiration  32.  Flush  had  disappeared 
from  the  face. 

24M.  Temperature,  a.m.,  98.25°;  p.m., 
98.25".  The  physical  signs  now  show  beginning 
resolution.  Dullness  is  less  marked,  bronchial 
respiration  has  given  place  to  broncho-vesicular, 
bronchophony  to  increased  vocal  resonance,  and 
the  subcrepitant  rale  is  frequently  heard. 

25/"//.  Much  better.  Temperature,  a.  m., 
97.50^.  Has  a  good  ai)petite,  takes  beef-tea  and 
milk. 

28//^  Patient  is  up  and  dressed. 

Two  inquiries  suggest  themselves  in  connection 
with  the  history  of  this  case.  One  is,  did  the 
disease  end  from  an  intrinsic  tendency  to  recover 
in  spite  of  the  circumstances  under  which  the 
patient  was  placed  for  the  first  two  days  of  his  ill- 
ness ?  It  is,  of  course,  absurd  to  suppose  that  the 
disease  was  arrested  by  the  whiskey  and  ammonia 
which  were  given  after  his  admission  into  the  hos- 
pital. The  second  inquiry  is,  did  the  exposure  in 
the  open  air  for  three  days  shorten  the  duration  of 
the  disease  by  means  of  an  antipyretic  effect  ? 
These  inquiries  are  submitted  by  Dr.  Flint  without 
discussion  for  the  reflection  of  the  reader. 


TREATMENT  OF  CHRONIC   PROSTATIC 
ENLARGEMENT. 

Mr.  Thos.  Smith,  surgeon  to  St.  Bartholomew's 
Hosjiital,  in  a  recent  lecture  jniblished  in  the  Lon- 
don Medical  Times  arid  Gazette,  gives  the  following 
advice  on  the  above  subject : — 


THE   CANADA   MEDICAL    RECORD. 


.^505 


Treatment. — Your  assistance  will  rarely  be 
sought  in  the  early  stages  of  this  disease ;  but 
should  you  be  consulted  by  an  elderly  patient 
suffering  from  undue  frequency  or  difficulty  in  mic- 
turition, it  will  always  be  prudent  to  make  a  digital 
examination  through  the  rectum,  to  ascertain  the 
condition  of  the  prostate.  The  examination  is 
best  made  with  the  patient  lying  down  on  his 
back.  Your  finger-nail  being  filled  with  soap,  and 
the  finger  well  oiled  or  greased,  it  should  be  intro- 
duced very  slowly,  so  as  not  to  excite  spasm  of 
the  sphincter. 

Should  you  judge  that  the  urinary  difficulty  is 
caused  by  prostatic  enlargement,  the  occasional 
passage  of  a  full-sized  instrument  will  often  relieve 
the  inconvenience,  and,  if  steadily  persevered  in 
at  regular  intervals,  will  generally  secure  the  patient 
against  all  the  more  serious  consequences  of  the 
disease. 

In  cases  where  the  difficulty  in  micturition  has 
gone  on  Rj^produce  an  inability  to  empty  the 
bladder  completely,  it  is  of  primary  importance 
that  at  least  once  in  the  twenty-four  hours  the  urine 
should  be  all  drawn  off;  but  in  carrying  out  this 
plan  it  is  necessary  to  exercise  caution,  lest  by 
suddenly  emptying  a  greatly  distended  bladder  you 
should  produce  a  complete  paralysis  of  the  organ, 
with  a  loss  of  the  power  of  voluntary  micturition, 
and  cystitis. 

As  a  general  rule,  if  there  be  not  more  than  one 
pint  of  retained  urine  in  the  bladder — that  is, 
urine  the  patient  is  unable  to  pass  for  himself,  it 
may  be  safely  drawn  off  at  once.  But  if  there  be 
more  than  this  of  residual  urine  (and  there  may  be 
several  pints),  you  should  draw  it  off  by  install- 
ments, taking  away  a  little  more  each  day,  until 
the  bladder  is  completly  emptied. 

This  complete  evacuation  of  the  bladder,  when 
once  accomplished,  should  be  repeated  each  day, 
by  means  of  an  instrument,  and  for  the  purpose 
an  india-rubber  catheter,  a  bulbous-ended  or  a 
Coude  catheter,  should,  if  possible,  be  used. 

By  these  means,  in  an  early  stage  of  the  disease, 
the  patient  will  generally  regain  the  power  of  nor- 
mal micturition,  or  at  all  events,  if  this  result  be 
not  attained,  he  will  be  secure  from  the  worst 
consequences  of  the  disease. 

The  treatment  may  be  carried  out  by  the  patient 
himxself  if  you  will  be  at  the  pains  to  teach  him 
how  to  pass  an  instrument — nowadays  a  compara- 
tively simple  process,  owing  to  the  great  improve- 
ments in  catheters  ;  for  you  should  know  that  since 
the  introduction  of  the  various  forms  of  soft 
catheters  now  in  use,  the  instrumental  treatment 
of  prostatic  enlargement  has  lost  more  than  half  its 
terrors  and  much  of  its  danger. 

This  large  silver  prostatic  catheter  which  I  now 
show  you — at  one  time  almost  the  only  instrument 
used  in  these  cases — is  truly  a  formidable  weapon 
with  its  long  shaft  and  wide-sweeping  curve.  It 
was  constructed  to  ride  over  the  prostate,  but  in 
the  hands  even  of  experienced  surgeons  it  frequent- 
ly failed  in  the  performance  of  its  normal  functions 


and  rode  under  the  gland,  or  through  its  substance. 
Used  with  a  strong  and  steady  hand  it  rarely  failed 
to  draw  off  water.  As  an  instance  of  its  powers 
in  this  respect,  I  may  mention  a  case  within  my 
knowledge  where  a  prostatic  catheter  in  the  hands 
of  an  energetic  surgeon  drew  off  some  gallons  of 
water,  which,  however,  a  post-mortem  examination 
disclosed  to  have  come  from  the  peritoneal  cavity 
I  will  suppose  now  that  you  are  called  upon  to 
treat  a  patient  with  retention  of  urine  dependent 
upon  enlarged  prostate.  The  difficulty  will  usually 
have  come  on  at  night  time ;  the  patient  will,  as  a 
rule,  be  advanced  in  years  ;  and  the  prostate  can 
be  felt  in  the  rectum  unduly  prominent.  In  such 
a  case  let  me  advise  you  first  to  try  a  flexible  red 
rubber  catheter,  of  full  size ;  it  will  often  find  its 
way  round  a  corner,  and  through  a  urethra  which 
would  be  impervious  to  a  more  rigid  instrument. 
This  failing,  you  should  try  and  pass  the  same 
catheter  with  a  stout  wire  stylet  reaching  two- 
thirds  of  the  way  down  the  instrument ;  this  gives 
you  more  power  to  push  the  catheter  onwards, 
and  leaves  the  end  flexible^  to  accommodate  itself 
to  the  distorted  urethra. 

Next  in  order  you  may  try  the  Coude  catheter, 
which  I  show  you :  then,  if  necessary,  the  bulbous 
French  instrument,  a  gum  elastic,  without  and  with 
the  stylet  j  and  lastly,  others  failing,  a  silver  instru- 
ment. 

Whatever  instrument  you  use,  let  it  be  a  full 
size ;  it  will  go  in  as  easily  as  a  smaller  one,  and  is 
less  likely  to  damage  your  patient.  Keep  the  point 
of  the  instrument  on  the  upper  wall  of  the  urethra  ; 
and,  above  all  things,  use  no  force. 

After  drawing  off  the  water  in  a  case  of  retention, 
the  patient  will,  for  a  time  at  least,  require  the 
regular  use  of  the  catheter  until  he  recover  his 
power  of  voluntary  micturition  ;  and  should  there 
have  been  great  difficulty  in  introducing  the  cathe- 
ter, I  should  advise  you  to  tie  it  in  for  the  first 
twenty-four  hours. 

In  the  subsequent  treatment  of  these  cases  of 
prostatic  retention,  in  addition  to  other  troubles 
you  will  often  have  to  contend  against  an  increas- 
ing frequency  in  micturition.  The  frequent  desire 
to  pass  water  must  be  resisted  as  much  as  possible 
by  the  patient,  or  it  will  grow  upon  him.  The  blad- 
der must  be  com.pletely  emptied,  and,  if  need  be, 
washed  out,  at  regular  intervals,  and  the  patient 
exhorted  not  only  to  resist  by  a  strong  effort  of  the 
will  the  solicitations  of  his  bladder,  but  to  avoid  all 
sights  and  association  that  are  likely  to  suggest  to 
him  the  necessity  of  micturition.  With  this  object 
in  view,  you  should  counsel  your  patient  to  keep 
his  catheter  and  chamber-utensil  out  of  sight ;  as 
soon  as  possible  to  leave  his  bed-room  during  the 
day ;  and  to  occupy  his  mind  by  any  pursuit 
which  may  draw  his  thoughts  away  from  his 
urinary  necessities. 


300 


THE   CANADA   MEDICAL   RECORD. 


THERAPEUTICAT.  EMPLOYMENT  OF 
IODOFORM. 

The  /ourtiai  de  Medicine  Bel^c  gives,  according 
to  the  Journal  de  pharmacie  ct  de  chimic,  a 
formula  which  i)emiits  the  employment  of  iodo- 
form without  inconvenience.  According  to  Dr. 
Lindeman  the  balsam  of  Peru  comj)letely  masks 
the  odor  of  iodoform  ;  two  parts  of  this  balsam 
neutralizes  perfectly  one  part  of  iodoform.  The 
best  vehicles  are  lard,  glycerine  and  above  all 
vaseline.  Here  is  a  formula  that  the  author 
recommends  : 

]J         Iodoform i  part. 

Balsam  Peru 3  parts. 

Vaseline 8  parts. 

He  also  often  prescribes  the  following  ; 

IJ    Iodoform i  part. 

Balsam 3  parts. 

Alcohol,  glycerine  or  collodion 12  parts. 

First  mix  exactly  the  iodoform  and  the  balsam 
Peru,  then  add  the  other  ingredients.— y^z^rwa/  de 
Medicine  et  de  Chirnrgie. 


MORPHINE    IN    PUERPERAL    ECLAMP- 
SIA. 

C.  C.  P.  Clark  says  he  has  never  seen  opium, 
properly  used,  fail  to  ward  off  eclampsia  when  it 
seemed  to  be  threatened ;  that  he  has  many  times 
seen  it  obviously  and  at  once  put  a  stop  to  the 
paroxysms  after  they  had  been  commenced ;  and 
that  he  has  never  known  a  patient  to  die  of  this 
disease  when  that  medicine  had  been  administered 
in  season,  in  sufficient  quantities,  and  in  the  pro- 
per manner. 

When  premonitory  symptoms  of  eclampsia 
appear,  continuous  or  paroxysmal  pain  in  the  head, 
alterations  and  figments  of  the  senses,  especially  of 
sight,  mental  dullness,  ataxy,  a  countenance  ex- 
pressive of  suffering  and  apprehension,  an  irreso- 
lute and  incapable  manner,  and  complaint  of  inde- 
finable distress,  he  orders  two  or  three  grains  of 
opium  per  diem  with  full  confidence  that  convul- 
sions will  be  warded  off  He  does  not  ignore 
eliminants,  but  does  not  trust  to  them  alone  or 
chiefly. 

When  the  convulsions  have  appeared,  he  says, 
the  patient  "  should  have  forthwith  injected  into 
her  arm  a  grain  and  a  half  of  morphine  ^_)'7«:W)?'//A" 
"  Should  the  paroxysm  return  any  time  after  two 
hours,  this  dose  should  be  repeated.  And  if  she 
be  in  labor,  she  should  have  another  dose  after 
eight  hours  any  way." 

He  asserts  that  a  comatose  or  half-comatose 
condition  is  no  contraindication  to  such  use  of 
moq)hine  ;  and  he  urges  that  this  course  be  pur- 
sued unhesitatingly  unless  the  patient  be  obvious- 
ly moribund  ;  and  has  the  greatest  confidence  that 
morphine  so  used  will  succeed  in  all  cases  where 
the  brain  has  not  already  sustained  irreparable 
injury  by  a  long  succession  of  paroxyms,  or  by  a 
few  of  great  violence. — Amer.  Jour,  of  Obstetrics. 


ERGOT  IN  NEURALGIA. 

Dr.  Marino,  of  Palermo,  says  that  local  injec- 
tions of  ergot  give  better  results  than  any  other 
treatment  in  tic  douloureux,  not  even  excepting 
(juinine.  Some  cases,  not  all,  of  sciatica  were 
relieved  in  the  same  way.  Other  forms  of  neuralgia 
should  receive  the  same  treatment.  The  injections 
usually  cause  pain,  but  abscesses  seldom  follow  if 
cold  water  compresses  are  applied  to  the  point  of 
puncture.  One  or  two  injections  suffice,  as  a  rule, 
but  they  may  have  to  be  continued  some  time. 
About  two  grains  of  ergot,  in  water  or  glycerine, 
is  the  proper  dose. — Londok  Medical  Recordi- 
st. Louis  Clinical  Record. 


IMPROVEMENT  OF  SAYRE'S  TREATMENT 
FOR  SPINAL  CURVATURE. 

Mr.  Richard  Dav}',  of  London,  believes  he  has 
an  improvement  on  Dr.  Sayre's  method  of  tripod 
suspension  in  applying  the  plaster  of  Paris  jacket 
in  spinal  caries.  He  places  the  patient  in  a  ham- 
mock, face  downward,  arms  hanging  through  slits 
in  the  canvas.  Extension  may  then  be  used  or 
not,  according  to  the  views  of  the  surgeon,  and  the 
plaster  of  Paris  or  other  dressing  leisurely  applied, 
including  the  canvass.  A  free  circulation  of  air 
is  allowed  access  to  the  body  and  the  dressing 
dries  rapidly,  the  patient  often  sleeping  during  the 
time  employed.  After  the  drying  is  complete  the 
spare  canvass  is  trimmed,  and  the  patient  literally 
takes  up  his  bed  and  walks.  After  reviewing  some 
of  the  other  methods  of  treating  spinal  caries 
according  to  Sayre's  plan,  that  is  of  providing  3lVl 
outside  support  of  the  body,  relieving  the  weak 
sjjinal  column,  Mr.  Davy  concludes  in  favor  of  his 
own  plan.  Aside  from  the  small  expense  and 
inconvenience  involved,  he  thinks  suspension  not 
always  safe  in  spinal,  and  especially  cervical, 
caries. — American  Practitioner. 


SULPHUR  FOR  PIMPLES  ON  THE  FACE. 

Dr.  Gage  Parsons  believes  that  Jlr.  Erasmus 
Wilson  was  the  first  to  propose  sulphur  lotion  in 
acne  punctata,  according  to  the  Practitioner.. 
The  usual  lotion  of  the  flowers  of  sulphur  with 
glycerine  and  water  is  undoubtedly  a  valuable 
remedy,  but  from  the  readiness  with  which  the  sul- 
])hur  separates  it  is  inelegant  and  inconvenient, 
while  it  is  not  quite  satisfactory  in  its  results. 
A  far  more  efficacious  mode  of  using  sulphur  is 
to  dust  the  face  with  pure  precipitated  sulphur 
every  night  with  an  ordinary  puff  used  for  toilet 
purposes.  Recently  two  severe  cases  of  acne  of 
two  years'  standing,  which  had  resisted  the  ordi- 
nary methods  of  treatment,  yielded  at  once  to  sul- 
l)luir  thus  apjilied.  If  the  sulphur  be  scented 
with  oil  of  lemon  or  roses  it  willform  an  elegant 
cosmetic. 


TUE    CANADA   MEDICAL    RECORD. 


307 


MATERNAL  IMPRESSIONS. 

The  following  occurred  in  the  practice  of  a 
Maryland  physician,  according  to  the  Dublin 
Medical  Journal :  "  A  lady,  during  pregnancy, 
carried  with  her  a  pocket  edition  of  Moore's  poe- 
tical words,  which  she  read  almost  constantly. 
Her  child,  at  three  years  of  age,  exhibited  a  most 
wonderful  gift  of  putting  sentences  into  rhyme;  in 
fact,  naturally  expressed  his  little  ideas  and  thoughts 
in  flowing  measure  ! "  Blame  not  the  bard — but  a 
case  like  this  shows  how  important  is  a  well-assorted 
library  to  a  gravid  uterus. — British  Med.  Journal. 


EPISTAXIS  CURED  BY  A  BLISTER. 

Dr.  Vemeuil  relates  the  case  of  a  man  whose 
epistaxis  occurred  every  third  day.  Sulphate  of 
quinia  was  given  without  avail ;  ergot  was  adminis- 
tered with  no  better  result ;  so  was  digitalis.  The 
patient  had  been  a  habitual  drinker.  The  liver 
was  thought  perhaps  to  be  "  cirrhosed,"  although 
no  enlargement  or  tenderness  was  found  in  this 
region.  A  large  fly-blister  was  applied  over  the 
liver,  since  which  time  the  epistaxis  has  not 
returned. 


COD  LIVER  OIL   IN  EPILEPSY. 

Dr.  Fairbairn,  of  Brooklyn,  N.  Y.,  writes  :  The 
digestive  disorder  and  annoying  and  disfiguring 
eruption  which  result  from  taking  the  bromides  in 
large  doses  for  a  length  of  time,  are  serious  dis- 
advantages connected  with  the  administration  of 
these  salts.  A  remedy  which  will  prevent  the  bad 
eftects  of  a  medicine,  and  at  the  same  time  will 
rather  aid  than  detract  from  its  good  effects,  is  cer- 
tainly a  valuable  one.  I  think  in  this  case  we  have 
such  a  remedy  in  cod  liver  oil. 

A  young  lady  suffering  from  epilepsy  has  been 
under  my  care  for  the  past  five  months,  who  has 
taken  bromide   of  potassium  in    large  doses   for 
nearly  a   year,    and  by  this   remedy  cod-liver   oil 
has   warded   off  the  above  troublesome   results. 
The  mode  of  taking  it   was'  this  :  Brom.  potas., 
S  ss.,  was  taken  thrice  daily  after  eating ;  this  was 
followed  one  hour  after  each  dose  by  ol.  morrhuae, 
3  ss.  When  first  attacked  by  the  malady  she  had 
eight  convulsions  in  twenty-four  hours.     She  began 
the  bromide  in  3  ss.  doses,  but  was  compelled  to 
stop  it  on  account  of  the  gastric  derangement.     A 
friend  recommended  the  cod  liver  oil.  She  resumed 
the  bromide,  adding  the  oil,  and  has  taken  it  with- 
out further  trouble  since.     The  eruption,  before 
profuse,     disappeared   under    this    management. 
The    disease   has   been  well  controlled,  only  four 
convulsions   having  occurred   in  the  past  seven 
months,     I    doubt   not  that  the  cod  liver  oil  has 
had  its  share  in  the  direct  benefit  done  to  the  ner- 
vous system,  besides  affording  a  protection  from 
the   irritating  salt   to   the  coats  of  the  stomach. 
In  summing  up  the  good  effects  of  the  oil  I  find : 
ist.  Absence  of  the  digestive  disorders;  2d.  Ab- 


sence of  the  acne  eruption;  3d.  That  the  anaemi 
usually  found  in  persons  taking  this  medicine  con 
tinually,  is  far  from  being  marked;  4th.  The 
body  is  better  nourished,  and  appetite  unimpaired. 
I  have  made  trial  of  this  treatment  in  others  cases, 
with  similar  good  results.  As  the  articles  that 
have  appeared  in  your  Journal  in  the  past  months 
on  the  bromides,  have  made  no  mention  of  this 
device,  I  have  been  led  to  write  the  above. — 
N.  V.  Medical  Record. 


BEEF  SUPPOSITORIES. 

Though  the  rectum  is,  strictly  speaking,  an  ex- 
cretory organ,    it  may  nevertheless,  by  virtue  of 
its  absorbing  power,  take  the  place  of  the  stomach 
and  small  intestine  in  the  ingestion  of  medicinal 
and   alimentary  agents.     Dupuytren  used  to  say 
that  owing  to  the  absence  of  digestion  the  agent 
passes  more  directly,  more  purely  and  more  surely 
to  its  destination  from  the  rectum  than  it  does  when 
taken  by  the  stomach.  Hence  the  speedy  efficacy  of 
chloral  in  mania  and  the  vomiting  of  pregnancy ;  of 
opium  and  ipecac  in  dysentery,  etc.     With  this 
fact  in  view  I  have  lately  used  Johnston's  or  Lie- 
big's  beef  extract  incorporated  with  cocoa  butter 
in   the   form   of  suppository   to    support   life   in 
chronic  gastric  disorders,  adynamic  diseases  and 
all  cases  where  the  administration  of  food  by  the 
ordinary  channel    was  impossible.     The   beef  is 
easily  combined  with  the  butter,  or  to  save  time, 
or  for  other  reasons,, the  hollow  suppositories  may 
be    used.     The    advantage   of  the    suppositories 
over  the    beef  injection    will  immediately   com- 
mend  'ms&M— Dr.  James   I.    Tucker,  in  Chicago 
Med.  and  Surg.  Journ. 

TREATMENT  OF  AMENORRHEA. 

William  R.  D.  Blackwood,  M.D.,  Physician  to 
St.  Mary's  Hospital,  writes,  in  the  Medical  Bulle- 
tin :  J-  J 
A  large  number  of  remedies  have  been  credited 
with  emmenagogue  properties,  many  of  thern 
being  inert,  and  some  of  them  simply  irritant  poi- 
sons whose  employment  has  frequently  resulted 
fatally,  especially  when  used  with  criminal  intent, 
as  abortifacients.  Strychnia  aff'ords  excellent  re- 
sults in  many  instances.  A  favorite  with  me  is 
the  following  : 

Strychnia  sulph gr- j ; 

Cinchonidia  sulph 3  j; 

Ferrum  per  hydrogen |  ^  ^  -  . 

Assafetida  pulv J 

Ext.  qussia q-s. 

M.  In  pil.  No.  60  div.  Sig.  One  four  times  daily. 
I  usually  add  at  bedtime  ten  drops  of  Squibb's 
fluid  ext.  ergot  in  water  ;  and  a  forcible  jet  of  cold 
water  along  the  spine  every  morning  on  rising  for 
a  few  iiiinutes,  with  brisk  friction  of  the  abdomen, 
succeeds  admirably  in  many  cases.  Exercise  in 
the  open  air,  equestrianism  particularly,  with  at- 
tention to  a  normal  action  of  the  skin,  kidneys, 
and  bowels  is  essentia!. 


308 


THE   CANADA   MEDICAL    KECORD. 


The  Canada  Medical  Record, 

£1  iHont!)li»  .UourititI  of  fHfliirinc  aiilJ  iJljarmac? 

EDITOR,  : 
FKANCIS  W.  CAMPBELL, M. A.,  M.D,,L.K.C.P.,  LOND 

ASSISiTA^T  KlUTOrtS: 

R.  A.  KENNEDY,  M.A.,  M.D. 

JAMES  PEKRIGO,  M.D.,  M.R.C.S.  Eng. 

BDITOR  OF  FHAKMACBITTICAL  DEPARTMXNT: 

ALEX.  H.  ZOLLMYER,  M.A.,  M.D- 

SUBSCRIPTION  TWO  DOLLABB  PIB  AKNCll  . 

All  communications  and  Exchanges  must  be  addreued  to 
the  Editor ,  Drawer  356, 1'oiitOJiee,  Montreal. 

MONTREAL.  SEPTEMBER,  1881. 


TO  OUR  SUBSCRIBERS. 

The  Canada  Medical  Record,  with  this 
number,  closes  the  ninth  year  of  its  existence. 
^Ve  have  much  to  be  thankful  for,  and  we  look 
back  with  feelings  of  great  satisfaction  to  the 
progress  which  the  Record  has  made  during  that 
period.  For  the  past  two  or  three  years  we  have, 
however,  felt  that  the  growing' claims  of  practice, 
as  well  as  duties  devolving  upon  us  in  other  spheres 
of  Medical  work,  has  prevented  our  giving  that 
constant  attention  to  the  Record  which  its 
interests  demanded.  The  result  has  been  that 
every  now  and  then  our  appearance  has  been 
delayed,  and  this  in  spite  of  every  effort  to  prevent 
it.  ^Ve  have,  we  believe,  succeeded  in  making 
arrangements  by  which  this  great  drawback  will 
in  future  be  avoided.  Dr.  Perrigo  has  withdrawn 
from  the  Editorial  chair,  much  to  our  regret,  and 
is  replaced  by  Dr.  Cameron,  who  is  already  known 
as  a  ready,  vigorous  and  logical  writer.  In  future 
the  Assistant  Editors  will  take  the  active  work  of 
the  Record  in  their  own  hands,  and  will  relieve 
the  Senior  Editor  of  the  major  part  of  it.  In  this 
way,  with  a  division  of  labor,  we  anticipate  being 
able  to  appear  regularly  within  a  day  or  two  of  a 
given  date.  Arrangements  have  been  made  for 
the  publication  of  a  number  of  communications, 
lectures,  &c.,  from  some  of  the  leading  Physicians 
and  Surgeons  of  Montreal.  We  are  also  pro- 
mised, from  one  well  qualified,  a  series  of  papers 
on  the  Early  Medical  History  and  Medical  Men 
of  Montreal,  while  the  Editors  proj)Ose  monthly 
to  give  the  history  of  the  Medical  Charities  of 
Montreal.     A  monthly  "  Hospital  Chat "  will  also 


form  a  feature  of  the  Record  for  the  future. 
The  Record  has  a  Dominion  reputation  for  the 
practical  character  of  its  selections.  This  depart- 
ment will  still  continue  under  the  control  of  the 
Senior  Editor.  The  Record  is  not  the  organ  of 
any  Medical  school,  clique,  or  party.  We  have 
conducted  it  for  nine  years  with  this  intention,  and 
we  challenge  any  one  to  prove  that  we  have  been 
unfaithful  to  the  programme  laid  down  by  us 
when  the  Record  was  first  issued.  We  ask  the 
co-operation  of  all — we  will  treat  every  one  alike 
— the  profession,  as  a  whole,  will  be  our  care. 

And  now  we  are  addressing  some  for  the  last 
time, — we  allude  to  quite  a  number,  who  have 
received  the  Record  for  periods  varj'ing  from 
nine  to  six  years  without  ever  paying  a  cent  of 
subscription :  We  have,  through  the  Record,  by 
letter,  and  by  post  card,  politely  asked  you  to  pay 
up ;  you  have  not  heeded  our  request,  and  as  we 
can  but  think  that  such  conduct  is  intentional, 
and  therefore  dishonest,  we  have  decided  to 
terminate  our  monthly  visits  to  you.  If  any  who 
read  this  desire  to  know  if  it  is  they  who  are 
meant,  we  refer  them  to  the  date  on  their  address 
label,  which  will  give  the  desired  information.  If 
we  wrong  any,  the  matter  can  be  easily  set  right 
by  the  amount  due  being  paid. 

We  ask  the  kind  aid  of  our  friends  to  extend 
our  circulation.  Our  Nova  Scotia  and  New 
Brunswick  subscribers  have  done  much  for  us  in 
that  way,  so  that  a  very  large  percentage  of  the 
Medical  men  in  both  these  Provinces  are  on  our 
list.    What  they  have  done,  others  can.  Will  you  ? 


SACCHARATED  PEPSIN. 

The  experience  of  physicians  has  been  so 
favorable  to  the  use  of  Pepsin  as  an  aid  to  impaired 
digestion  and  kindred  affections,  that  it  is  only 
necessary  to  say  the  Saccharated  Pepsin  Jno. 
Wyeth  &  Bro.  of  Philadelphia  manufacture  exhibits 
the  principle  most  fully,  and  will  give  therapeutic 
results  to  the  entire  satisfaction  of  the  physicians 
wishing  to  i)rescribe  this  remedy.  Each  tea-spoon- 
ful of  the  Liquor  Pepsins  prepared  by  the  same 
firm  represents  the  full  dose  of  Saccharated  Pepsin 
five  grains,  combined  with  Lactic  and  Muriatic 
Acids,  Glycerine  and  water. 


THE  CANADA 


Medical  Record 


"^S^Q-.y-    } MONTEEAL,  QCTOBEE,  1880.  {  ^.J^^L. 

TROMMER  EXTRACT  OF  MALT. 

From  the  LONDON  MEDICAL  RECORD,  3farch  15,  1879. 

Trommer'sMalt  Extract  is  a  preparation  which  has  baea  received  with  coasiderable  favor  both  in  Germany  and 
in  Amsrica,  and  is  now  being  introduced  into  this  country.  The  malt  extract  of  this  kind  of  an  unfermented  prepa- 
ration of  malt,  and  containing  carbo-hydrates,  milt-sugir  and  dextrine,  which  take  the  place  in  therapeutics  which 
has  hitherto  been  essentially  filled  by  cod-liver  oil,  while,  from  the  fact  that  these  carbo-hydrates  are  combined  with 
diastase,  with  phosphites,  and  with  the  bitter  principle  of  hop,  it  has  many  advantages  over  cod-liver  oil  in  respect  to 
its  power  of  aiding  digestion.  Thus  the  preparation  is  not  only  in  itself  nutritive,  bnt  also  tonic,  and  has  the  power 
of  increasing  the  gastric  secretion,  and  of  rendering  starch  digestible  through  the  medium  of  its  diastase,  which  con- 
verts it  into  glucose.  A  great  number  of  eminent  practitioners  abroad,  including,  indeed,  most  of  the  leading  teachers, 
speak  of  it  in  the  highest  terms,  and  independently  of  the  obvious  merit  of  its  composition,  there  is  in  its  favor  a  mass 
of  cliaical  evidences,  which  should  certainly  secure  for  it  an  extensive  trial  in  this  country. 


From  the  BRITISH  MEDICAL  JOURNAL,  April  19,  1879. 

This  extract  of  malt  has  obtained  a  very  large  c^debrity,  and  has  come  into  very  extensive  use  in  the  United 
States,  where,  indeed,  it  has  become  an  article  of  almast  daily  use  in  professional  practice.  Malt  extracts  of  the  kind, 
consisting  of  the  soluble  constituents  of  barley  malt,  not  fermented,  appear  to  have  considerable  value  in  maintaining 
and  strengthening  nutrition.  They  are  rich  in  malt  sugar,  dextrine  anl  diastase.  Floppe-Seyler  points  out  that,  while 
the  dextrine  possesses  the  property  of  increasing  the  activity  of  the  gastric  secretion,  and  the  diastase  assists  in  con- 
verting starch  into  glucose  and  dextrine^  the  malt  extract  includes  also  a  combination  of  malt  sugar,  alkalies  and 
phosphates,  which  together  make  it  a  nutrient  and  medicinal  agent  of  great  value.  There  is,  indeed,  an  accumulation 
of  considerable  clinical  evidence  that  malt  extract  is  capable  of  taking  the  place  of  cod-liver  oil,  to  a  large  extent,  in 
the  treatment  of  phthisis  aid  other  wasting  diseases.  In  Ziemsseu's  Oyclopaeiia,  vol.  xvi,  it  is  said  to  almost  entirely 
have  taken  the  place  of  cod-liver  oil  at  the  Basle  Hospital,  without  any  reason  having  been  found  as  yet  for  returning  to 
the  latter  remedy. 

.  From  the  LONDON  LANCET,  January  25,  1879. 

We  find  that  this  extract  converts  starch  into  glucose  and  dextrine  rapidly  and  in  large  quantity.  In  flavor  it  is 
excellent,  and  we  have,  therefore,  no  hesitation  in  praising  it  highly.  Malt  extract  seems  to  be  steadily  increasing  in 
favor  for  diseases  involving  impaired  nutrition;  but  its  preparation  requires  great  care,  as  it  is  easy  in  making  it  to 
destroy  its  activity  as  a  starch-converter,  and  so  render  it  nearly  useless.  The  malt  extract  is  supplied  in  various  forms  : 
for  example,  the  simple,  for  nutrient  purposes,  with  cod-liver  oil  (which  it  disguises  pleasantly),  with  the  hypo-phos- 
phite, and  with  iron. 

From  the  LONDON  CHEMIST  AND  DRUGGIST,  February  15,  1879. 

Trommer's  Extract  of  Malt  ia  one  of  the  best  of  the  various  preparations  of  a  similar  character.  It  is  of  the  con- 
sistence of  honey  or  treacle,  and  has  a  pleasant  flavor,  rendered  slightly  bitter  by  the  addition  of  hop.  Professor  Redwood 
finds  Trommer's  Extract  has  all  the  power  of  acting  on  amylaceous  bodies  which  diastase  possesses,  and  considers 
the  preparation  has  been  made  with  great  care  and  judgment. 


The  TROMMER  EXTRACT  OF  MALT  COMPANY  is  engaged  exclnsively  in  the  manu- 
facture of  Malt  Extract,  "  plain,"  and  in  such  combinations  as  have  been  suggested  and  approved 
by  some  of  the  most  eminent  members  of  the  Medical  profession  in  both  Europe  and  America. 
Notwithstanding  the  large  demand,  they  maintain,  by  unremitting  personal  attention  to  all  the 
details  of  manufacturing,  the  uniformity  and  excellent  quality  which  have  established  the  high 
reputation  attained  by  their  productions  on  both  sides  of  the  Atlantic. 


Sold  by  all  Druggists  throughout  the  Dominion  of  Canada. 
TROMMER  EXTRACT  OF  MAI.T  COMPANY,  Fremont,  Ohio,  U.S. 

W^HOLESALS     VGENTS  : 


LYMAN,  SONS  &  CO. 

mONTREAI,. 


LYMAN,  SONS  &  Co. 

TORONTO. 


THE  CANADA  MEDICAL  RECORD. 


To  the  Medical  Profession. 


LACTOPEPTINE. 


We  take  pleasure  in  calling  the  attention  of  the  Profession  to  Lactopeptine. 
After  a  long  series  of  careful  experiments,  we  are  able  to  produce  its  various 
components  in  an  absolutely  pure  state,  thus  removing  all  unpleasant  odor  and 
taste  (also  slightly  changing  the  color).  We  can  confidently  claim  that  its 
digestive  properties  are  largely  increased  thereby,  and  can  assert  without  hesi- 
tation that  it  is  as  perfect  a  digestive  as  can  be  produced. 

Lactopeptine  is  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.  It  contains  the 
five  active  agents  of  digestion,  viz :  Pepsin,  Pancreatine,  Diastase,  or  Veg. 
Ptyalin,  Lactic  and  Hydrochloric  Acids,  in  combination  with  Sugar  of  Milk. 


FOKmULA  OF  liACTOPEPTINE. 


Sugar  of  Milk 40  ounces.     Veg.  Ptyalin  or  Diasta.se 4  drachms 


Pepsin 8     " 

Pancreatine 6 


Lactic  Acid 5  fl.     " 

Hydrochloric  Acid.. 5  fl.     " 


IiACTOPEPTlKE  is  Eold  entirely  by  Physicians'  Prescriptions,  and  its  almost  universal  adop- 
tion by  physiciana  is  the  strongest  guarantee  we  can  give  that  its  therapeutic  value  has  been  most  thoroughly 
eetablished. 

Tbc  auder»>igned,  bavliig  tested  LACTOPEPTINE,  reconimeud  it  to  tlie  profession: 

'  ALFRED  L.  LOOMTS,  M.D., 

Profetior  of  Pathology  and  Practice  of  Medicine,  University  of  the  City  of  New  York. 

SAMUEL  R.  PERCY,  M.D., 

Profesior  Materia  Medica,  New  York  Medical  College. 

F.  LE  ROY  SATTERLEE,  iM.D.,  Ph.  D., 
Froftxior  of  Chem.,  Mat.  Med.,  and  Therap.,  in  N.  Y.  College  of  Dent. ;  ProJ.  of  Chem.  and  Hyg.  in  Am.  Vet.  Col.,  etc 

JAS.  AITKEN  MEIGS,  M.D.,  Philadelphia,  Pa., 
Prof,  of  the  Institutes  of  Med.  and  Med.   Juris.,  Jeff.  Medical  College;  Phy.  to  Penn.  Bos. 

W.  W.  DAWSON,  M.D.,  Cincinnati,  Ohio, 
Prof.  Pr in.  and  Prac.  Surg.  Med.  Col.  of  Ohio ;  Surg,  to  Good  Samaritan  Hospital. 

ALFRED  F.  A.  KING,  M.D.,  Washington,  D.  C, 
Prof,  of  Obstetrics,  University  of  Vermont. 

r  D.  W.  YANDELL,  M.D., 

\  Prof  of  the  Science  and  Art  of  Surg.,  and  Clinical  Surg.,  University  of  Louisville,  Ky. 

L.  P.  YANDELL,  M.D., 
Prof,  of  Clin.  Med.,  Diseases  of  Children,  and  Dermatology,  Univer.  o/  Louisville,  Ky. 

ROBT.  BATTEY,  M.D.,  Rome,  Ga., 
Bmeriius  Prof  of  Obstetrics,  Atlcnta  Med.  College,  Ez-Pres.  Med.  As.sociation  ofOa. 

CLAUDE  H.    MA3TIN,  M.D.,  LL.D.,  Mobile,  Ala. 

Prof.  H.  C.  BARTLETT,  Pb.  D.,  F.C.S.,  London,  England. 

The  New  York  PHARMACAL  ASSOCIATION, 

Nos.   10  &  12  COLLEGE  PLACE,  NEW  YORK. 


LOWDEN,  NEILL  &  CO.j  Toronto,  Ont, 

Wholesale  Agents. 


THE  CANADA  MEDICAL  RECORD. 


TROMMER  EXTRACT  OF  MALT. 


^*  In  Malted  Barley  we  have  an  unlimited  supply  of  diastatic  power." 

(W .  Roberts,  M.D.,  F.R.S.,  in  London  Practitioner.) 


Opinions  of  the  Medical  Press. 


*'  Haye    been    using    Trommer    Extract    with    excellent 
Tesults  ;  very  serviceable   ia   certain  forms   of    dyspepsia, 
•agrees  with  the  most  fastidious  stomach." — Canada  Lancet 
Toronto. 

"  This  Extract  converts  starch  into  glucose  and  dextrine 
rapidly  and  in  large  quantity.  Seems  to  be  steadily  in- 
■creasing  in  favor  for  diseases  involving  impaired  nutrition. 
— London  Lancet, 

"  There  are  many  conditions    in   infancy,   old  age  and 
•debility,  where  a  physician,  once  acquainted  with  the  value 
of  this  Extract,  would  be  at  a  loss  to   replace   it." — Medical 
and  Surgical  Reporter,  Philadelphia. 

"  During  convalescence  from  fevers,  in  cases  of  phthisis 
in  certain  forms  of  dyspepsia,  and  generally  in  all  cases  of 
malnutrition,  we  have  found  it  of  very  great  value." — Ohio 
Medical  Recorder. 


"  There  are  few  remedies  which  to 
m  priori  grounds  for  their  use.     The 


a  greater  extent  offer 
clinical  evidence,  too 
which  has  sanctioned  the  physiological  claims  of  Malt 
Extract,  is  abundant." — Louisville  Medical  JVews. 


"  Adapted  to  a  wide  range  of  cases  requiring  supple- 
mentary food  ;  acceptable  to  the  stomach  ;  aids  digestion  ; 
an  excellent  vehicle  for  other  medicines  ;  and  Avill  keep  in 
the  hottest  climate." — Medical  Journal,  Wilmington. 

"  The  Trommer  Company  has  hitherto  taken  the  lead  in 
the  introduction  of  the  Extract  of  Malt.  The  uniformity  and 
reliable  character  of  this  Extract  has  induced  an  enormous 
demand  and  sale,  so  that  we  presume  there  is  scarcely  a 
drug-house  on  the  continent  that  does  not  supply  it." — 
Obstetric  Gazette,  Cincinnati. 


"  It  is  employed  with  great  advantage  in  the  wasting 
diseases  of  children,  both  as  a  nutrient  and  to  improve  diges- 
tion."— Cincinnati  Medical  Times. 

"  One  of  the  best  of  the  various  preparations  of  a  similar 
character.  Prof.  Redwood  finds  Trommer's  Extract  has  all 
the  power  of  acting  on  amylaceous  bodies." — London  Chemist 
and  Druggist. 

"  The  preparations  of  Malt  manufactured  by  tne  Trommer 
Company  are  too  well  known  to  require  commendation. 
Malt  fills  a  place  in  the  treatment  of  disease  of  the  utmost 
utility." — Courier  0/ Medicine,  St.  Louis. 

"  Trommer  Extract  of  Malt  has  grown  so  rapidly  in  favor 
with  the  profession  that  there  are  few  practitioners  in  Canada 
who  do  not  regularly  prescribe  it."— Canada  Medical  Re- 
lord. 

"  The  Trommer  Company  was  the  first  to  bring  promi- 
nently before   the  American  profession  the  virtues  of  Mai- 
Extract.     As  a  Malt  Extract  we  have  no  hesitancy  in  saying 
hat  there   is   no  brand  in  the  market  its  equal  in  ever 
respect." — Medical  Advance,  Detroit. 

"  Eminent  practitioners,  including  most  of  the  leading 
eachers,  speak  of  it  in  the  highest  terms.  Independently  of 
the  obvious  merit  of  the  preparation  there  is  in  its  favor  a 
mass  of  clinical  evidence." — London  Medical  Record. 

"  There  is  no  scarcity  of  good  alimentary  articles,  but 
there  is  an  objection  to  most  of  them  that  they  will  not 
keep.  This  makes  our  estimate  of  Trommer's  Extract  of 
Malt  higher  each  season.  It  will  keep  in  the  hottest  cli- 
mate."— -V.  C.  Medical  Journal,  Wilmington. 


The  Troramer  Extract  Compaay  is  engaged  exclusively  in  the  manufacture  of  Malt 
Extract,  «  Plain,"  and  in  such  combinations  as  have  been  suggested  and  approved  by  some 
of  the  most  eminent  members  of  the  profession  in  Europe  and  America.  Notwithstanding 
the  large  demand  they  are  enabled,  by  unremitting  personal  attention  to  all  the  details  of 
the  manufacture,  to  maintain  the  excellent  quality  which  has  established  the  reputation  of 
their  preparations  on  both  sides  of  the  Atlantic.  v 


THE  CANADA  MEDICAL  RECORD. 


Maltine  in  Pulmonary  Phthisis. 


The  great  value  of  MALTINE  in  all  wasting  diseases,  and  especially  in  Pulmonary  affections,  is 
becoming  more  and  more  apparent  to  the  iviedicai  Piofession. 

Since  we  issued  our  pamphlet  on  Maltine  tne  year  ago,  w^e  have  received  nearly  one  thousand 
commendator/  letteis  from  the  MeiUcal  Piofesson  from  most  parts  of  the  -world,  a  large  portion  of 
which  speak  enthusiastically  of  it  in  Pulmonary  affections. 

Any  physician  who  w^ill  test  MALTINE,  Plain,  in  comparison  w^ith  Cod  Liver  Oil,  in  a  case  of 
Pulmonniy  Phthisis,  w^ili  find  that  it  w^ill  incre  <se  w^eiglit  and  build  up  the  system  far  more  rapidly. 
There  aie.  however,  many  cases  wheie  the  ccmpouiios  with  Hypophoaphites  Phosphates,  Peptones, 
Malto-Yerbiue,  and  Pepsin  and  Pancreatine  are  strongly  indicated. 


After  full  trial  of  thp  difTorent  Oils  and  Extract  of  Malt  preparations,  in  both  hospital  and  private  practice,  I  find  Maltine  most 
applicable  to  tli«  largest  number  of  patient*^,  and  superior  to  ai  y  remedy  of  its  clasi'.  Theoretically,  we  would  e.xpect  thi,s  preparation, 
wliirli  lias  become  jimctic/i/lv  officinnl.  to  bo  of  great  value  in  chronic  conditions  of  wa.ste  and  mal-nutrilion.  especially  ai?  exemplified 
ill  phthisis.  Being  rich  in  Diastase,  albuminoids  and  phosphates,  according  to.careful  analysis,  it  aids  in  digesting  farinaceous  food,  while 
in  itiiell  it  is  a  brain,  nerve  and  muscle  producer.  Wm.  Poktkr,  A.M.,  M.D.,  HI.  Louii,  Mo. 


123  Lundsdowne  Ilond,  Nottivg  Hilt,  fV.,  London,  October  I6//1,  1880. 
I  have  used  Maltink  with  Cod  Liver  Oil  with  the  happiest  results  in  a  case  of  tuberculosis  attended  with  tubercular  peiitonitis,  in 
which  the  temperature  of  the  patient  rose  to  105  1-5°  and  persistently  remained  above  100°  for  upwards  of  two  months.  The  only 
medicine  t&kcu  wa.s  Maltine  with  Cod  Liver  Oil,  and  an  occasional  dose  of  Carbonate  of  Bismuth,  to  check  diarrhoea.  She  gradually 
improved  and  made  a  peifect  recovery.  I  liud  Malti>k  with  Cod  Liver  Oil  is  more  readily  taken  and  more  easily  assimilated  than 
Cod  Liver  Oil  in  any  other  form.  Edmund  Nash,  M.D. 


Bridge  Home,  lieveshy,  Boston,  L'mcolnsliire. 
The  trial  of  your  MALTtNElmade  in  the  ca?e  of  a  lady  suffering  from  phthisis  pulmonalis  hiis  been  mo^t  satisfactory.    Her  left  lung 
had  been  in  the 'last  f  tage  of  disease  for  some  time,  and  lier  temperature  rang;ed  lor  many  months  between  101°  and  104°.    After  taking 
tlie  M^LTiNE  for  a  few  days  the  temperature  came  down  to  IOC-,  and  to-day  it  stands  below  99",  which  makes  me  feel  sanguine  that  the 
disease  is  checked.  Thomas  Hontek,  L.lt.C.l'. 


Kensington  Binpensary ,  London,  Nov.  1\th,  1879. 
We  are  using  your  Maltine  among  our  patients,  and  find  great  benefit  from  it,  especially  iu  ca-es  of  phthisis. 

1)11.  Cuippendale,  litsidtnt  Medical  Officer. 


The  Beeches,  A'orthwold,  July  '2Sth,  1S79. 
I  find  that  my  patients  can  readily  digest  your  Maltine  with  Cod  Liver  Oil  without  causing  any  unpleasant  after-teeling.    I  have 
full  coulideuce  in  the  virtue  it  posse.-ses  to  sustain  the  system  during  prolonged  ditseases  of  a  tubercular  or  atrophic  nature. 

EuEDKiucK  Joy,  L.li.C.i'.,  M.K.C.S. 


Pkok.  L.  p.  Yandell,  in  Loui.vitle  Medical  A<  ?/'.?,  Jan.  Zrd,  ISSO .— ilALi  ine  is  one  of  the  moct  valuable  remedies  e\er  introduced 
to  the  Medical  Professiun.  Wherever  a  constructive  is  indicated,  Maltine  will  be  found  e.xcL'lleut.  lu  puluiouary  phthisis  and  other 
hcrolulous  diseases,  ia  chronic  syphilis,  and  in  tlie  various  cachectic  conditions,  it  is  invaluable. 


Adrian,  .Mich.,  Feb.  Wh,  ISSO. 
I  have  used  your  Maltine  preparations  in  my  practice  for  the  past  year  and  consider  tliem  far  superior  to  the  Extract  of  Malt.    I 
have  used  your  Malto-Verbino  in  my  own  case  of  severe  bronchitis  that  has  troubled  nie  lor  the  past  five  years.    It  has  done  me  more 
good  than  anything  I  have  ever  tried.  J-  TiUPP,  M.D. 


Leighloii,  .Ita.,  Feb.  ISth,  I'^Si). 
1  am  more  pleased  with  your  Maltine  preparations  every  day  that  I  use  them.     I  don't  know  how  1  could  dispense  with  them  in 
Rome  cases  I  have  under  my  cure  at  this  time.     In  on'-  case  (specially,  the  Maltine  with  Cod  Liver  Oil  has  had  a  nuist  marked  eflect, 
agreeins  with  the  patient's  stomach,  wituout  the  least  trouble,  alter  other  preparations  of  Cod  Liver  Oil  had  bi-cn  tried  in  vain. 
*         "  J.  M.  IvUMPK,  M.D. 

AVjc  JHchmond.  fl'i.i.,  Aug.  lith,  I8S0. 
After  having  given  several  of  your  elegant  Maltine  preparations  thorough  trial  I  have  found  uone  of  them  to^  uisappoint  inc.    1 
corBiUer  it  invaluable,  and  as  indispensable  to  tlie  profession  as  opium  or  ijuiuiue.  E.  W.  Ei-lky,  M.D. 


In  order  to  test  the  comparative  merits  of  JIaltine  and  the  various  extracts  of  Malt  in  the  market.  I  purchased  from  dilTereut 
druggists  siiniiiles  of  .Maltine  and  of  the  most  fn  iiueiitly  prescribed  K.Mrac  s  of  Malt,  and  have  subjected  them  to  cliemicul  analysis. 

As  the  r.sult  of  these  exumiiiat ions,  I  liiui  that  Slm.tine  contains  IVciii  half  as  much  again  to  tliree  times  the  quantity  of  Phosphates, 
and  fnm  three  to  fourteen  times  as  much  Diabtase  aud  other  Albuminoids  as  any  of  tiie  Extracts  of  ilalt  examined. 

PuoK.  \V.\LTEu6.  Uainks,  M.D., 
Professor  0/ Chemistry  and  Toxtcology,  Bush  Medical  College,  Chicago. 


jD  compaiisou  with  tlie  alcoholic  -Malt  Extracts,  your  MALTl^E  is  about  ten  times  as  valuable,  as  a  flesh  former  ;  from  l.ve  to  ttn 
times  as  valuable,  as  a  heat  producer  ;  and  at  least  live  times  as  valuable,  as  a  staich  digesting  agent. 

I'KoFKesoK  Attfikld,  F.C.S., 
Prq/essor  0/ Practical  Chemistry  to  the  Pfiannaccultcal  Hociety  li/'  Great  Britain. 


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